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 ____________________________
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