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MA Use Only Invoice No.: Sample Submission Form Login/Date Storage Location CUSTOMER CONTACT INFORMATION Company Name Street Address City State, Zip code SAMPLES INFORMATION Number of Line Samples
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USP/NF Test(s) Requested Sample Results (quantity, quantity, % %) Contact Information Contact Name First Last Initial Subject / Group Phone Number Mobile Email Contact Type Telephone/Home/Cell E-mail Address City State, Zip Code Country Phone/Cell ID Please use the “Submit Sample Request Form” to submit your sample. Your request for a USP/NF sample may be returned to you via email for possible correction or correction of sample data. If corrected, the sample will no longer be required to be submitted to WGS. Your request for USP/NF sample may be returned as an original or photocopy. The original will be sent to the address indicated on the request form. If the sample is to be returned as an original, it is recommended that a photocopy of the WGS label be supplied along with the completed sample request form. The samples will be analyzed using the appropriate method or methods specified in the following table (which may include a variety of additional testing, such as analysis by X-Ray, neutron, X-Ray diffraction, or TEM). To obtain an estimate of the actual number of samples required for a USP/NF analysis, please contact the National Standards Institute (NIST) for assistance in determining the appropriate sample quantity for the analysis in which the requested sample will be made available. Sample Quantity NIST/WGS Method 1 Sample Method 1 NIST/WGS Method 2 Sample Method 2 NIST/WGS Method 3 Sample Method 3 If you would like additional information about the analytical process, please contact your National Standards Institute. Return To Contents What is the difference between an SM or NPS sample and an SP sample? Sample Type Sampling Date SM Sample (SM Type 1) Sample (SM Type 2) Date (Month) NPS Sample (NPS Type 1) Sample (NPS Type 2) Date (Month) (WGS type(s)) Sample (WGS Type(s) of Substantial Material) Date (Month) Note: NPS samples may be returned to the user for correction or correction of sample data.

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