Page 128 - Catalog filters BALDWIN for trucks

Auto Parts / FIELD REPORT FORM

DISTRIBUTOR EQUIPMENT OWNER
Company Name ______________________________ Company Name _________________________________
Address ____________________________________ Address________________________________________
City ________________________________________ City ___________________________________________
State ________________ ZIP___________________ State _________________ ZIP ___________________
Contact Contact
Person ______________________________________ Person ________________________________________
Phone _______________________________________ Phone ________________________________________

Filter Installation Removal
Number ________________________ Date ________________________ Date _______________________
Repair Shop Cost of
Name _______________________________________ 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
Owner _______________________________________ Distributor ______________________________________
Please send this Report, any Repair Bills, Explanation, Oil/Coolant Samples and Filters to:

ATTN: SERVICE ENGINEERING
BALDWIN FILTERS
4400 E Hwy 30
Kearney, NE 68847

126 / Auto Parts

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