Dynatec Labs|Biocompatibility test laboratory

Requesting Date

Company Requesting

Requestor

E-mail Only

Mail Only (Fee Applies)

Both (Fee Applies)

Telephone

Fax

Email

DSL Code(s) [Analysis Requesting]

Number Documented

Number Received

Method of Sterilization

Load Number

Catalog Number

Lot Number

Other

On Site Sampling Requesting

Yes No N/A

Sample Disposition:

Discard Return

Shipping Conditions:

Ambient On Ice Dry Ice

Sample Storage Condition:

Room (20 to 25°C) Refrigerator (2 to 8°C ) Freezer (-10 to -40°C)

Relinquished By:

Date:

Time:

Received By:

Date:

Time:

Test Request