IH/Environmental Media Order Form

Phone and fax orders may be placed during business hours 8:00am - 5:00pm PST. Mail orders to SGS Forensic Laboratories, Attn: Customer Service:

Delivery shipped within 2 business days.

FOR INTERNAL USE Northern CA 3777 Depot Road, Suite 409 Hayward, CA 94545 Tel: 510/887-8828 Fax: 510/887-4218

Southern CA 20535 South Belshaw Ave. Carson, CA 90746Tel: 310/763-2374 Fax: 310/763-4450

Shipped By: Date Shipped:

FedEx/UPS Tracking No.:

Customer Account No.: Date: Name: Phone: Fax: Company: Email: Address: City: State: Zip: Bill My Account: YES / NO PO Number:

BILLING INFORMATION

SHIPPING INFORMATION (if different than above)

Name: Phone: Fax: Company: Email: Address: City: State: Zip: Order Picked Up: YES / NO Signature: Date Signed:

PRODUCT UNIT PRICE QTY TOTAL Each Pack

PCM Cassettes (25mm, 0.8 µm MCE) $ 1.00 $ 50.00/50 TEM Cassettes (25mm, 0.45 µm MCE) $ 1.50 $ 75.00/50 Metals Cassettes (37mm, 0.8 µm MCE) $ 2.00 $ 100.00/50 Metals Cassettes (37mm, 0.8 µm PVC) $ 3.00 $ 150.00/50 Metals/Dust Cassettes (37mm, 0.8 µm MWMCE) $ 7.00 $ 350.00/50 Dust Only Cassettes (37mm, 0.45 µm MWPVC) $ 7.00 $ 350.00/50 Metals Water Bottles (250mL HDPE) $ 3.50 $ 84.00/24 Centrifuge Tubes $ 0.30 $ 15.00/50 Ghost Wipes $ 0.25 $ 5.00/20 Wipe Template (1 sq ft) $ 40.00 SEM Stub w/ Carbon Tab (12.7mm) $ 10.00

Other (please write or type below)

SUBTOTAL Sales tax applies to equipment rental, media sales, and flat rate shipping costs. TAX (9.75% in CA) Next Business Day - @ 8:00 AM - $60.00 @ 10:00 AM - $45.00 @ 3:30 PM - $30.00 2-3 Business Days - $15.00 7-10 Business Days - $10.00 For Sat Delivery, please call us. SHIPPING Use FedEx / UPS Account No.: _

TOTAL PAYMENT INFORMATION Credit Card Type: Visa MC AMEX Discover Cardholder's Name: Credit Card No.: Expiration Date: Security Code:

Phone and fax orders may be placed during business hours 8:00am - 5:00pm PST. Mail orders to SGS Forensic Laboratories, Attn: Customer Service:

Delivery shipped within 2 business days.

FOR INTERNAL USE Northern CA 3777 Depot Road, Suite 409 Hayward, CA 94545 Tel: 510/887-8828 Fax: 510/887-4218

Southern CA 20535 South Belshaw Ave. Carson, CA 90746 Tel: 310/763-2374 Fax: 310/763-4450

Shipped By: Date Shipped:

FedEx/UPS Tracking No.:

Microbiology Media Order Form

Customer Account No.: Date: Name: Phone: Fax: Company: Email: Address: City: State: Zip: Bill My Account: YES / NO PO Number:

BILLING INFORMATION

SHIPPING INFORMATION (if different than above)

Name: Phone: Fax: Company: Email: Address: City: State: Zip: Order Picked Up: YES / NO Signature: Date Signed:

PRODUCT UNIT PRICE QTY TOTAL Each Pack of 10

Malt Extract Agar (MEA) Plates $ 2.00 $ 15.00 Tryptic Soy Agar (TSA) Plates $ 2.00 $ 15.00 Allergenco-D Cassettes $ 5.00 37mm Polycarbonate Filters N/C Tape Lift Kits (2 Slides) $ 6.00 Tape Lift Kits (5 Slides) $ 10.00 Dustream™ Kits for Allergen (OK for most vacuum cleaners) $ 20.00 Additional Dustream™ Kit Filters for Allergen $ 3.00 Water Bottles with Sodium Thiosulfate (120mL) $ 1.50 Water Bottles with Sodium Thiosulfate (290mL) $ 2.00

Other (please write or type below)

SUBTOTAL Sales tax applies to equipment rental, media sales, and flat rate shipping costs. TAX (9.75% in CA) Next Business Day - @ 8:00 AM - $60.00 @ 10:00 AM - $45.00 @ 3:30 PM - $30.00 2-3 Business Days - $15.00 7-10 Business Days - $10.00 For Sat Delivery, please call us. SHIPPING Use FedEx / UPS Account No.: _

TOTAL PAYMENT INFORMATION Credit Card Type: Visa MC AMEX Discover Cardholder's Name: Credit Card No.: Expiration Date: Security Code:

Equipment Rental Form

Phone and fax orders may be placed during business hours 8:00am - 5:00pm PST. Mail orders to SGS Forensic Laboratories, Attn: Customer Service:

Delivery shipped within 2 business days. All equipment shipped from Hayward, CA.

FOR INTERNAL USE Northern CA 3777 Depot Road, Suite 409 Hayward, CA 94545 Tel: 510/887-8828 Fax: 510/887-4218

Southern CA 20535 South Belshaw Ave. Carson, CA 90746Tel: 310/763-2374 Fax: 310/763-4450

Shipped By: Date Shipped:

FedEx/UPS Tracking No.:

Customer Account No.: Date: Name: Phone: Fax: Company: Email: Address: City: State: Zip: Bill My Account: YES / NO PO Number:

BILLING INFORMATION

SHIPPING INFORMATION (if different than above)

Name: Phone: Fax: Company: Email: Address: City: State: Zip: Order Picked Up: YES / NO Signature: Date Signed:

PRODUCT UNIT PRICE QTY TOTAL Daily

IH/ENVIRONMENTAL Rotometer Rental $ 10.00 Pump Rental w/ Rotometer (Low Flow) $ 25.00 Pump Rental w/ Rotometer, Stand (High Flow) $ 25.00 TO-17 Air Sampling Kit Rental $ 50.00

MICROBIOLOGY Andersen Sampler Rental $ 50.00 Zefon Bio-Pump Rental $ 25.00

OTHER (please write or type below)

SUBTOTAL Sales tax applies to equipment rental, media sales, and flat rate shipping costs. TAX (9.75% in CA) For all delivery days and times, please call us for details. Shipping charges are dependent upon weight and destination. SHIPPING Use FedEx / UPS Account No.: _

TOTAL PAYMENT INFORMATION Credit Card Type: Visa MC AMEX Discover Cardholder's Name: Credit Card No.: Expiration Date: Security Code: