Custom Air Reference Materials Quote Form

Please submit a new form for each custom air reference materials you wish to request.

Name: (First, M.I., Last) Company/Location: Phone number: FAX number: Position or Title: E-mail address:

Compound: CAS# Conc. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.   Compound (cont'd): CAS# Conc.: 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

Concentration: ppm   ppb

Balance Gas: helium nitrogen air other (specify):

Cylinder Size: 14 liters 48 liters 104/110 liters   110 liters Pi Marked for EU countries other (specify):

Please enter any additional compounds, comments or instructions. Thank you.

Definitions compound: Component(s) which will make up the reference mix (example: dimethyl sulfide, formaldehyde, etc.) CAS#: Chemical abstract services registry number. concentration: ppm (parts per million) or ppb (parts per billion)

You can also fax a request to (814) 353-1309