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Customer: __________________________ Location: __________________________ Machine ID: __________________________ Product: __________________________ Sender: __________________________ Email: __________________________ Sump Size: __________ Date: __________ Testing Requested (check appropriate boxes) ❏ General (pH, concentration, bacteria, fungi, tramp oil) ❏ Salts (hardness, chlorides) ❏ Foam (foam test, Ca-Hardness) ❏ Corrosion (corrosion test, conductivity) ❏ Hycut (Mineral oil test) ❏ Competitive Analysis ❏ Other _________________________________________________ Water (check appropriate box) ❏ DI ❏ R.Osmosis ❏ City ❏ Other _________________________________ Issues (check appropriate boxes) ❏ Corrosion ❏ Dermatitis ❏ Foam ❏ Smell ❏ Staining ❏ Tooling life ❏ Other _____________________________________________________ Material (check appropriate box) ❏ Aluminum ❏ Steel ❏ Cast Iron ❏ Ti ❏ S. Steel ❏ Plastic ❏ Composite ❏ Magnesium ❏ Yellow Metals ❏ Other ____________________________ Customer: __________________________ Location: __________________________ Machine ID: __________________________ Product: __________________________ Sender: __________________________ Email: __________________________ Sump Size: __________ Date: __________ Testing Requested (check appropriate boxes) ❏ General (pH, concentration, bacteria, fungi, tramp oil) ❏ Salts (hardness, chlorides) ❏ Foam (foam test, Ca-Hardness) ❏ Corrosion (corrosion test, conductivity) ❏ Hycut (Mineral oil test) ❏ Competitive Analysis ❏ Other _________________________________________________ Water (check appropriate box) ❏ DI ❏ R.Osmosis ❏ City ❏ Other _________________________________ Issues (check appropriate boxes) ❏ Corrosion ❏ Dermatitis ❏ Foam ❏ Smell ❏ Staining ❏ Tooling life ❏ Other _____________________________________________________ Material (check appropriate box) ❏ Aluminum ❏ Steel ❏ Cast Iron ❏ Ti ❏ S. Steel ❏ Plastic ❏ Composite ❏ Magnesium ❏ Yellow Metals ❏ Other ____________________________ Customer: __________________________ Location: __________________________ Machine ID: __________________________ Product: __________________________ Sender: __________________________ Email: __________________________ Sump Size: __________ Date: __________ Testing Requested (check appropriate boxes) ❏ General (pH, concentration, bacteria, fungi, tramp oil) ❏ Salts (hardness, chlorides) ❏ Foam (foam test, Ca-Hardness) ❏ Corrosion (corrosion test, conductivity) ❏ Hycut (Mineral oil test) ❏ Competitive Analysis ❏ Other _________________________________________________ Water (check appropriate box) ❏ DI ❏ R.Osmosis ❏ City ❏ Other _________________________________ Issues (check appropriate boxes) ❏ Corrosion ❏ Dermatitis ❏ Foam ❏ Smell ❏ Staining ❏ Tooling life ❏ Other _____________________________________________________ Material (check appropriate box) ❏ Aluminum ❏ Steel ❏ Cast Iron ❏ Ti ❏ S. Steel ❏ Plastic ❏ Composite ❏ Magnesium ❏ Yellow Metals ❏ Other ____________________________ Customer: __________________________ Location: __________________________ Machine ID: __________________________ Product: __________________________ Sender: __________________________ Email: __________________________ Sump Size: __________ Date: __________ Testing Requested (check appropriate boxes) ❏ General (pH, concentration, bacteria, fungi, tramp oil) ❏ Salts (hardness, chlorides) ❏ Foam (foam test, Ca-Hardness) ❏ Corrosion (corrosion test, conductivity) ❏ Hycut (Mineral oil test) ❏ Competitive Analysis ❏ Other _________________________________________________ Water (check appropriate box) ❏ DI ❏ R.Osmosis ❏ City ❏ Other _________________________________ Issues (check appropriate boxes) ❏ Corrosion ❏ Dermatitis ❏ Foam ❏ Smell ❏ Staining ❏ Tooling life ❏ Other _____________________________________________________ Material (check appropriate box) ❏ Aluminum ❏ Steel ❏ Cast Iron ❏ Ti ❏ S. Steel ❏ Plastic ❏ Composite ❏ Magnesium ❏ Yellow Metals ❏ Other ____________________________
