Sample evaluation form


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SAMPLE EVALUATION FORM
Submit Sample to: Agmet LLC. 5533 Dunham Rd. Maple Heights, OH. 44137 PH: 216-663-5200
Date Sent: ________________ No. of Samples: ______________

Generator:  ______________________________________________

Address: _______________________________________________

_______________________________________________

_______________________________________________

Generator Contact: __________________________ E-mail: _________________________

Phone: ______________________________ Fax: _______________________________

Broker: ______________________________________ Contact: _______________________

Phone: _______________________________ E-mail: ______________________________
Material Profile Attached: Yes / No

Material: ___________________________________________________________________

___________________________________________________________________

Describe Generation Process: ____________________________________________________

Date to Lab: ____________ Test Requested by: _____________ Lab Used: ___________

Date Completed: ___________ Salesperson: __________________

Analyze for: __________________________________________________________________

______________________________________________________________________________

Analytical Results: ______________________________________________________________

______________________________________________________________________________

Comments: __________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Technical Recommendation: _____________________________________________________

______________________________________________________________________________

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