| Contact Name: | Position: |
| Company: | |
| Address: | |
| City: | State/Zip: |
| Phone: | Fax: |
| E-mail: | Website: |
Samples should be returned to: Representative [ ] Customer [ ]
Required Date:
What is the objective for the sample cleaning:
Better Cleaning [ ] More throughput [ ] Eliminate Solvents [ ] Cost Savings [ ] Other [ ]
Please explain the objective in detail:
Material:
Size(s) of parts:
Batch size:
Contaminant(s):
Throughput:
What process is immediately before cleaning:
What process is immediately after cleaning:
What is the current cleaning method:
What is the current cleanliness level:
What is the current method of cleanliness testing:
Desired Variables:
What is the desired throughput:
What is the desired cleanliness level
What is the desired method of cleanliness testing:
| Submitted by: | Date: |