SAMPLE SHIPMENT FORM

Recipient:Sender:Shipment Information:

[Recipient Person][Sender Person][Quotation Number]

KYMOS Pharma Services, S.L.[Company][Study Number] *

Parc Tecnològic del Vallès. C/ Paletes, 7[Address][Study Director] *

08290 Cerdanyola del Vallès.[Number of Items] Data Logger

Barcelona. Spain[Date]

* Non mandatory fields

Content:

Samples and Materials (reagents, standards, columns or others) / Batch / Expected Quantity / Delivered Quantity / Storage Conditions / Handling Conditions / Safety Data Sheet
Temperature / No Light
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug
No RequirementsRoom Temperature (<25ºC)Climatic ChamberRefrigerator (2 to 8ºC)Frezeer (-20ºC)Ultrafrezeer (-80ºC) / No RequirementsBiologic hazardRadioactive hazardHigh potent drug

Comments(please, justify differences in quantitie, if any) Additional Information:Signature:

Reception schedule:Monday toThursday 8:30 to 16:00 and Friday 8:30 to 14:00.
Phone: +34 935 481 848
Disclaimer: A detailed checking of the shipment content will be done within the following 15 days from the reception date.

Formulario: D003-m02e02 (fecha de vigencia: 15/09/2015)