High Purity Gas and Volatiles Testing

Atlantic Analytical Laboratory, Inc. — Sample Submission Form

Instructions: Please complete as directed, then click on “Submit” at the bottom of the form. A hardcopy of your completed form will be printed on your selected printer. You must sign this copy and enclose it with the actual sample(s) to be submitted. (You may wish to photocopy this form for your records prior to dispatch). An e-mail will be automatically generated and sent to Atlantic Analytical containing the information on this form to alert us in advance that you are preparing to send us a sample, and secure your place in our sampling tracking system.

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Project Information: (all fields required)

*Project Discussed With:

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*Date Discussed:

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Pricing & Service Requested:

Verbal Quote Obtained:

Written Quote Obtained:

Quotation Needed:

Standard Turn-Around (T/A):

Same Day T/A:

24 hr T/A:

2-3 Day T/A:

Purchase Order No.:

General Information: (fields marked with an "*" are required)

*Number of Samples Submitted for Analysis:

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Sample Identification, Information, Background, Description, etc:

*Sample Date.:

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Hazards & Precautions: (i.e. Toxic Chemicals, Flammability, Reactivity, Biohazards, etc.):

Sample Information:

Analytical Tests Requested/Special Instructions: (Analytes of interest, test methods, specifications, detection thresholds, etc.):

Sample Disposition (please select):

Return:

Discard:

Your Carrier ID/Account No.:

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Return Service (please select):

Priority Overnight:

Standard Ground:

Other:

Report Results To: (all fields required)

Company:

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Address:

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Personal Information: (all fields required)

Phone:

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Fax:

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Email:

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Contact Name/Title:

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Reporting Method:

Mail Results:

Fax Results:

E-mail Results:

Call Contact:

Atlantic Analytical Laboratory, LLC
Mailing address: P.O. Box 220 · Whitehouse, NJ 08888 USA
Shipping address: 291 Rt 22 East · Salem Industrial Park – Building # 4 · Whitehouse, NJ 08888 USA
Phone +1.908.534.5600 · Fax +1.908.534.2017 · www.AtlanticAnalytical.com · www.ImpurityProfiling.com

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