Guidelines

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GUIDELINES FOR MICRO/CHEM ARF

LABORATORY NUMBER DATE


CUSTOMER TEL NO
ADDRESS BOX
TYPE OF SAMPLE
PURPOSE OF ANALYSIS
SAMPLE CODE SAMPLE DESCRIPTIONQUANTITYCONTAINER METHOD COST TOTAL

SMEWW or
USFDA/BA
M
MODE OF PAYMENT
AMOUNT OR NO DATE
SUBMITTED BY
RECEIVED BY DATE DUE

GUIDELINES FOR MICRO/CHEM BILLING STATEMENT

NAME DATE
ADDRESS BILL NO. DOST-XI-M/C-mm-000
SERVICES RENDERED REFERENCE QUANTITY AMOUNT
Microbiological Analysis MIC-yyyy-mm-0000-000
Certfication Fee MIC-CER-yyyy-mm-000
Pure Culture MIC-CUL-yyyy-mm-000
Chemical Lab Fee CHEyyyy-mm-0000-000
TOTAL
PREPARED BY NOTED BY RECEIVED BY
mm-000

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