(Date & Time): 02/02/2007 / By: William Bernt
Currier: DHL FedEx UPS USPS Walk-In Other: / Sample Storage: Lab Freezer Refrigerator Other:
Samples/PO Received
(Date & Time):02/02/2007 / By: William Bernt
Samples Returned
(Date & Time): / By:
MSDS INCLUDED:
YES / NO / Hazardous Samples: YES / NO / Return Samples:
YES / NO / Return Cooler:
YES / NO
DUE DATE: 02/09/2007 / PCL PROJECT #:3623
For PCL Office Use Only
Particle Sample Submission Form
Characterization Laboratories, Inc.
PLEASE SIGN FORM AND INCLUDE YOUR PURCHASE ORDER OR PROCARD NUMBER WITH SAMPLES
COMPANY: / Complete Genomics, Inc.Invoice Contact: / Contact: / Dr. Norman Burns
Address: / Address: / 750 North Pastoria Ave.
City, State, ZIP: / City, State, ZIP: / Sunnyvale, CA, 94085
E-mail: / E-mail:
Phone: / Phone: / (408) 431-6007
Fax: / Fax:
Quote#: / Signature:
(if applicable) / REQUIRED
PO/Credit Card#: / Industry Type:
Card Exp. Date: / Sample Type:
Card Signature:
Special Invoice Instructions
Is this a cGMP Project? / YES / NO / Is this a Litigation Case? / YES / NO
SAMPLE TYPE / SAMPLE ID# / # of
SAMPLES / ANALYSIS REQUESTED / CLASSIFICATION:
Normal
Hazardous*
(MSDS Required)
STORAGE:
Ambient
Refrigerator
Freezer
Light Sensitive
PLEASE INCLUDE MSDS WITH SAMPLES WHEN POSSIBLE
Special Sample or Data Reporting Instructions:
SAMPLE PRIORITY STATUS / Standard (e-mail data within 5 business days) / Rush not available for all analyses
Please call to inquire
Hardcopies of data will be FedEx Priority Overnight
100% Rush / 100% Surcharge
(e-mail data within 3 business days)
cGLP / 100% Surcharge
(e-mail data within 10 business days)
Return Samples? / YES* NO / Additional $35 min. fee (FedEx Ground)
*MSDS Required for Hazardous samples–additional shipping charges may apply
By submitting samples to PCL you (the client) agree to the terms of payment for services provided, including additional charges and legal fees for late payment or non-payment. In no event shall PCL be liable to the client for any indirect, special or consequential damages or lost profits arising out of or related to services performed or to be performed by PCL as described herein. PCL’s liability to the client hereunder, if any, shall in not exceed the total amount paid to PCL. The agreement between PCL and the client shall be deemed to have been performed in its entirety in the State of California and shall be interpreted in accordance with the laws of the State of California.