Requested analysis: <Bacterial endotoxin test> <29-OCT-2012> Date of samples sent: Analysis site: Biovian Oy, Tykistökatu 6 B, 4th floor / 4. krs, FIN-20520 Reference to Agreement: <01-JAN-2013> Add / Remove rows if needed: Sample code Date of Storage (°C, Acceptance (internal batch Sample type Sample volume Analysis method sample taken other) limit code) <Kinetic chromogenic <1234 water < < 0,005 EU/ml> method D of current <WFI> <01-JAN-2013> <+2 - +8 °C> <100 ml> European Pharmacopeia edition> Do not discard sample after CoA. Date and Signature: ______________________________________________________________ Please send analysis results to: <Name of company> <Firstname Lastname, QC Manager> <Street Address line 1> < Address line 2> < Address line 3> Tel <040-1234 567> E-mail: <customer@customer.com>
Requested analysis: <Bacterial endotoxin test> Date of samples sent: <29-OCT-2012> Analysis site: Biovian Oy, Tykistökatu 6 B, 4th floor / 4. krs, FIN-20520 Reference to Agreement: <01-JAN-2013> Add / Remove rows if needed: Sample code (internal batch code) Sample type Date of sample taken Storage (°C, other) Sample volume Acceptance limit Analysis method <1234 water <WFI> <01-JAN-2013> <+2 - +8 °C> <100 ml> < < 0,005 EU/ml> <Kinetic chromogenic method D of current European Pharmacopeia edition> Do not discard sample after CoA. Date and Signature: ______________________________________________________________ Please send analysis results to: <Name of company> <Firstname Lastname, QC Manager> <Street Address line 1> < Address line 2> < Address line 3> Tel <040-1234 567> E-mail: <customer@customer.com>
Sample_submission_form_starting_4.1.2016.docx