Please fill this out, print it, and send it with samples to:
ANTER LABORATORIES, INC.
E-mail: testing@anter.com 		1700 UNIVERSAL ROAD PITTSBURGH, PA 15235-3998 USA
Phone (412) 795-6410      Fax: (412) 795-8225
TESTING INSTRUCTIONS

SAMPLES SUBMITTED WITHOUT THIS FORM BEING FULLY COMPLETED WILL NOT BE TESTED.
In compliance with State and Federal "Right to Know" and Safety Laws, it is mandatory that personnel who will be in contact with the submitted test specimens, be made aware of all properties or behaviors that will require precautions to avoid danger to themselves or to property. Please fill out a separate sheet for each material type, if more than one type is being tested. (Material types are considered being different if compositional variation exists.) Concealment of known hazards, or making false statements may be a violation of applicable laws.
 
A. SAMPLE AND MATERIAL CHARACTERISTICS:
1. Sample Designation(s) as they appear on the individual bag/container     samples.
a.) b.) c.) d.) e.)
f.) g.) h.) i.) j.)
k.) l.) m.) n.) o.)
seperate list attached which is made part of this form by reference.
        Title of List:
Purchase orders, additional instructions, packing lists, and sample containers must have fully reconcilable identification with the above.
2. Generic or Trade Name of Material (seperate sheet required for each composition):
Manufacturer's MSDS form     attached     not available.
It is certified that no melting (except where it is specifically part of the test to be performed), softening to slump, decompostion, release of noxious, poisonous, or flammable vapors/gases, evaporation of material which may condensate elsewhere will occur, as long as the material (sample) is heated below °C.
If known: melting point °C, boiling point °C,
softening point °C, flash point °C, ignition temperature in still air °C.

B. HAZARDS AND PRECAUTIONS:
Sample(s) of the material lot are hazardous to:
touch, inhale (as dust when cut, grind etc.), inhale (vapor), ingest, come in contact with water,
other: .
The sample material, when heated to a temperature below the stated safe test temperature, may, by release of any substance, or by contact, attack or otherwise interact (corrode, locally melt, discolor, etc.) with:
alumina, fused silica, graphite, aluminum, stainless steel,
some of which may comprise the portion of the instrument with which the sample comes into contact.

Note: reactive samples may be refused or require extra cost protective encapsulation.

Additional instructions related to hazards, storage, etc:        on seperate attached sheet.
 
C. TEST TO BE PERFORMED:
Thermal Expansion, from oC to oC, (must be below above stated safe heating limit).
  heating only heating and cooling replicate test times
  in air nitrogen argon vacuum (10-2 torr range)
  special atmosphere/precautions:
  special temperature cycle attached
Thermal Conductivity, from oC to oC, (must be below above stated safe heating limit).
  oC, oC, oC, oC, oC, oC,
  special atmosphere/precautions:
  special temperature cycle attached
Thermal Diffusivity, from oC to oC, (must be below above stated safe heating limit).
  oC, oC, oC, oC, oC, oC,
  in air nitrogen argon vacuum (10-2 torr range)
  special atmosphere/precautions:
  special temperature cycle attached
Specific Heat Capacity, from oC to oC, (must be below above stated safe heating limit).
  oC, oC, oC, oC, oC, oC,
  in air nitrogen argon vacuum (10-2 torr range)
  special atmosphere/precautions:
  special temperature cycle attached
D. DISPOSITION:
Samples will be retained for 30 days after the completion of testing, thereafter return samples, discard samples,
discard excess of lot. All shipping expenses for return of material to Customer or disposal expenses for hazardous substances are chargeable to Customer.

I certify that the descriptions given above faithfully describe the samples and the materials submitted for testing. It is agreed that in case a sample contaminates the testing equipment or parts thereof, applicable repair or replacement costs will be accepted. This testing program is contracted with the understanding that Anter Laboratories, Inc.'s liability hereunder is limited to $100.00 in case of loss or mishandling for each sample or uncut material lot, and at maximum to the amount paid for each test as to the quality, reliability, or usefullness of the data generated for whatever purpose, with no liability for direct or consequential damages, loss of profit, legal or other expenses whatsoever. Each sample/test being an independent item, and disputes arising from one shall not automatically include others. Disputes, if any, are to be resolved by arbitration after Anter Laboratories, Inc. has been afforded sufficient time and opportunity to rectify claimed discrepancy(s). It is acknowledged that portions of this work may be subcontracted.

Authorized signer:
Name (Print): ___________________________________ Signature: _________________________
Company: ___________________________________________________ Date: _________________________
Address: __________________________________________________________________________________________
Phone No: ___________________________________________________ Fax No: ___________________________
E-mail: ______________________________________________________ Purchase Order No: __________________
Please verify all information before mailing your form(s) for each sample.

Last modified 01/06/2004