KLT Sample Submission Form - Kroff

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KLT Kroff Lab Sample Submission Form

Please complete and submit this form prior to sending samples to the lab.

Shipping address:
Kroff Lab Services, Inc
2301 Duss Ave
Building 1A, Suite 34
Ambridge, PA 15003

Lab Phone: 412-224-6000
Lab Email: [email protected]

Your Name:(Required)

Email:

Phone:

Submission Date:

formID:

Account Name:(Required)

Kroff Rep Name

Parent Company

Customer Type

Existing Customer

Prospect

Account City & State:

Kroff Company:

Number of Samples:

Requested Turnaround Time or Date:

Shipment Carrier:

Tracking Number (if known):

Analysis Billing:

Deduct

Bill to Customer

Reason for Sample Submission:

Sample list

Sample Name or Location:	Sample Date	Sample Type	System Type:	Treated? (Y/N):	Treatment Description:	Analysis Options	Actions

There are no samples.

Your Name:

Email:

Phone:

Submission Date:

Account Name:

Existing Customer

Prospect

Estimated Annual Account Revenue:

Account City & State:

Kroff Company:

Number of Samples:

Requested Turnaround Time or Date:

Shipment Carrier:

Tracking Number (if known):

Analysis Billing:

Deduct

Bill to Customer

Reason for Sample Submission:

Sample Name	Sample Date	System Type	Treated?	Treatment Description	Standard Water Analysis	Deposit Analysis	Microbio Testing	Product Analysis	Treatment Testing	Additional Testing and/or Comments and/or Hazards

Additional Comments about Project:

³ Please note any of the following hazards and contact KLT prior to shipping:

May contain cyanide
May contain chlorine/oxidizers
Off-gassing
Biogrowth
Non-aqueous liquid
Acidic Sample (pH < 3)
Basic Sample (pH > 12)
Any other hazards

Additional Comments about Project:

Attached files:

Drop files here or

Accepted file types: jpg, gif, png, pdf, docx, xlsx, doc, xls, ppt, pptx, jpeg, Max. file size: 50 MB.

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