Page 1310 - Catalog filters BALDWIN for tractors

Auto Parts / FIELD REPORT FORM

DISTRIBUTOR EQUIPMENT OWNER
Company Name __________________________ Company Name __________________________
Address ________________________________ Address__________________________________
City ____________________________________ City ____________________________________
State __________________________________ ZIP ____________________________________
Contact Contact
Person ________________________________ Person __________________________________
Phone __________________________________ Phone __________________________________
Filter Number __________________ Installation Date __________ Removal Date ______________
Repair Shop ____________________________ Cost of Repairs $ __________________________
(ATTACH ITEMIZED REPAIR BILL)
Street __________________________________ Contact __________________________________
City ____________________________________ Phone __________________________________
State __________________ ZIP ____________ FAX: ____________________________________
EQUIPMENT Model ________________ Year ________ Serial No. ____________________
Type of
Equipment ______________________________ Make __________________________________
Damaged Part Total Miles or
Engine, Pump, Etc. ________________________ Hours on Unit ____________________________
AIR FILTER Has the system recently been worked on? __________________________________
Has the filter Miles/Hours Oil Sump
been washed? ________________ on Oil __________________ Capacity __________________
Pressure/Restriction Gauge reading at removal ________________________(psi/inches of H2O/Mercury)
Usual Filter Change Interval __________________________________________________ (Miles/Hours)

COOLANT How often is the system tested? ________________________________________
Type of Cooling System Type of
Antifreeze Used ________________ Capacity ________________ SCA Used __________________
Cooling System Last Cleaned ________________________________________________ (Miles/Hours)
OIL/HYDRAULIC Has the system recently been worked on? __________________________________
Type of Oil Sump Miles/Hours
Oil __________________________ Capacity ________________ on Oil ____________________
Usual Oil Change Interval ____________________________________________________ (Miles/Hours)
FUEL Has the system recently been worked on?__________________________________
Type of Miles/Hours Fuel System
Fuel ________________________ on Filter ________________ Pressure __________________
PLEASE USE A SEPARATE PAGE TO DESCRIBE WHAT HAPPENED!
Signature of Signature of
Distributor ______________________________ Owner __________________________________
Please send this Report, any Repair Bills, Explanation, Oil/Coolant Samples and Filters to:
ATTN: SERVICE ENGINEERING
BALDWIN FILTERS
4400 E Hwy 30
Form 387 Kearney, NE 68847

1308 / Auto Parts

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