RGA 27261

Product Notice
Date: August 17, 2022
Contact Number: 734-384-7898
Contact Name(s): Tenneco / DRiV Warranty
Products
Part Numbers: VS50608R, HS26241PT, HS26239PT, HS26239PT1, HS26370PT, HS26370PT1, LKQ5770, 2603179
Product Descriptions: Valve Cover Gasket Set, Head Gasket Set, Full Gasket Set
Packaging Label Date Codes Affected: From 211101 to 220228
Reason / Process For Return
Our records indicate that we shipped you one or more of the products listed above that does/do not conform to our
standards. Please scrap inventory of the part number(s) with the affected packaging label date codes shown above.
1. Please visually inspect sets within the date codes shown above and scrap affected sets using the affidavit form
included.
Pictures of the location of the date codes can be found below.
2. Email a copy of the completed affidavit to [email protected], referencing RGA 27261 in the subject line.
3. Credit will be issued to your account upon receipt of affidavit form.
If you have any questions, please call 734-384-7898 and speak with a Warranty CSR.
Visual Aid
Date Code Location Example
The Date Code is located on the
bottom right-hand corner of the
package.
From 211101 to 220228
Part image example
Unaffected
gaskets will
have these
bumps.
Affected gaskets
will not have
bumps.
AFFIDAVIT OF DESTRUCTION
TRC/RGA #
Customer Ref #:
Customer Name :
Customer Acct #:
DC Location and # :
We, the undersigned, certify that we personally witnessed and/or supervised the destruction of the attached
list(s) of
_____________________________
BRAND NAME
We further agree that DRiV will not be responsible for any future requests for credit on these specific sku’s at
this location.
Product has been:
 Destroyed in field (if under 60 units)
 Shipped to: ________________________________________________________________ for
destruction (if over 60 units) (include all contact information, including phone number)
Provide a final inventory list of the product destroyed – part number and quantity.
Destruction took place on _____/______ / 2022
At ______________________________________________________________________________
The individuals signing on behalf of the Customer and DRiV below represents that the information in this form
is accurate under penalty of perjury. Both the Customer and the individual signing on behalf of the Customer
will be liable for any damages incurred by DRiV, directly or indirectly, as a result of any inaccuracy supplied in
this form.
Signatures required: must be signed by DRiV personnel and customer
________________________________________ ________________________________________
DRiV Signature
Customer Signature
________________________________________ ________________________________________
DRiV Printed Name/Title
Customer Printed Name/Title
________________________________________ ________________________________________
Date
Date