Sample Submittal Data Form
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SECTION 1: CLIENT INFORMATION (+Indicates Required Field)

+Company
+Station
+Unit #
 
+Contact
Position
+Address 1
 
Address 2
+City
+State
  
+Zip Code
  
+Phone #
 
+Email
 

SECTION 2: BILLING INFORMATION (If different from above) AND SHIPPING DETAIL

Address 1
Address 2
City
State
Zip Code
Phone #
Email
P.O. #
(if applicable)    
Shipping Method
Shipping Tracking #

SECTION 3: REQUESTED LAB SERVICES (+Indicates Required Field)

   

+ Hold down the Control (Ctrl) key to make multiple selections

To learn more about these services, review our Lab Service Package Descriptions.
(Requires Adobe Acrobat Reader!)
   
 
If Other was selected, please clarify:
 
+ Service Priority
 (Add an additional 100% to total invoice for Rush Service)
  NOTE: RUSH Service is dependant on acceptance of project and availability at the time of submittal.
+ Sample is a


SECTION 4: BOILER OPERATIONAL DATA (+Indicates Required Field)

Boiler Manufacturer
  
Boiler Size (MW)
  
Boiler Vintage (i.e. 1982)
 
Boiler Type (i.e. Fossil)
  
Fuel Type (i.e. PRB Coal)
   
SH Outlet Pressure (psig)
 
Temp (F)
 
RH Outlet Pressure (psig)
Temp (F)
Last Chemical Cleaning
Month
Year
  
Solvents Used for Chemical Cleaning

           (Only select the number of tubes/samples to have the above services performed)
To continue to Section 5, please select the number of Tubes/Samples you need to provide details for: