RETURN MATERIAL AUTHORIZATION # 

•	ITEM RETURNED MUST HAVE THIS FORM COMPLETED

•	ATTACH MSDS TO THIS FORM; 
MSDS is required for all liquids except pure water. (OSHA “Right to Know” law-29CFR 1910.1200)

Name of last liquid pumped: ________________________________________________

MSDS Provided:    YES            NO      SERIAL # 

•	ENCLOSE FORMS IN AN ENVELOPE, SECURELY ATTACHED TO THE OUTSIDE OF SHIPPING CONTAINER IN AN EASILY-VISIBLE LOCATION

I certify that the enclosed item(s) have been properly decontaminated and the appropriate MSDS is enclosed.  I understand and agree that Car-May may bill my Company $500 as a decontamination fee if contaminants are discovered.

Company:  ____________________________
	
Customer Name:	_______________________		 Date: 	-____________________

Authorized Signature: _____________________________

Phone #: _______________________________________	Fax #: _________________________ 

E-mail address: _____________________________________________

Return Item, Freight Prepaid to: Car-May LLC
				  2322 W. 25th Street Rd.
				  Greeley, CO, USA 80634

				  RMA # 

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