Part Name Laser Part Number 000012

Safety and/or
Govement Regulation YES x No Engineering Drawing Change Level ________
Additional Engineering Changes ___________________________________________________
Shown on Drawing No. _____ 2 Purchase Order No. ________ 751
Cheking Aid No. __________ 2 Engineering Chage Level ____________________

SUPPLIER MANUFACTURING INFORMATION SUBMISSION INFORMATION

MICRO-EPSILON 130 mm x 12mm x 40 mm
Supplier Name & Supplier Code Dimensional Materials/Functional

Misión de Huamantla 18 - B Customer Name/Division

Street Address Buyer/Buyer Code
Cuautitlan Izcalli Edo de Mexico 54710
City State Zip Application industrial

NOTE: Does this part contain any restricted or reportable substances. Yes
Are plastic parts identified with appropriate ISO marking codes. x Yes

REASON FOR SUBMISSION

Initial Submission Change to Optional Construction or Material
Engineering Change (s) Sub-Supplier or Material Source Change
x Tooling Transfer, Replacement, Refurbishment, or additional x Change in Part Processing
Correction of Discrepancy Parts Produced at Additional Location
Tooling Inactive > than 1 year Other - please specify

REQUESTED SUBMISSION LEVEL (Check one)

Level 1 - Warrant only (and for designated appearance items, an Appearance Approval Report) submitted to customer.
Level 2 - Warrant with product samples and limited supporting data submitted to customer.
Level 3 - Warrant with product samples and complete supporting data submitted to customer.
x Level 4 - Warrant and other requirements as defined by customer.
Level 5 - Warrant with product samples and complete supporting data reviewed at supplier's manufacturing location.

SUBMISSION RESULTS
The results for dimensional measurements material and functional tests x appearance criteria
These results meet all drawing and specification requirements: x Yes No (if "NO" - Explanation R
Mold/ Cavity / Production Process proceso de produccion

DECLARATION
Ihere by affirm that the samples represented by this warrant are repressentative of our parts, have been made to the applicabl
Production Part Approval Process Manual 3rd Edition Requirements. I further warrant these samples where
produced at the production rate of___3___/ 8 hours. I have noted any deviations from this declaration below.

Explanation/Comments:
Print Name laser Title base 1
Supplier Authorized Signature

FOR CUSTOMER USE ONLY (IF APPLICABLE)

Part Warrant Disposition: x Approved Rejected Part Functional Approval:

Customer Name Antonio Huerta Lopez Customer Signature

g Change Level ________2 Dated______ 8/1/2018
Dated_________________
Weight (kg) 0.015
_____________ Dated ____________________

Plastico, aluminio, lente cilindro

Materials/Functional Appearance

Guia Laser
75732

x No
No
No

onal Construction or Material

r Material Source Change

at Additional Location

Report) submitted to customer.

plier's manufacturing location.

ts x appearance criteria statistical process package

(if "NO" - Explanation Required)

s, have been made to the applicable

 samples where
declaration below.

Phone No. FAX No. 365489

Date

BLE)
art Functional Approval: x Approved
Waived

Date 7/12/2018