Test Request Form: ID 45137 Name & Contact

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TEST REQUEST FORM

Walton Science Research Lab Lab Ref. No (Lab use only )


R&I, Refrigerator, WHIPLC
(Applicant must complete all serials of this form and any incomplete form will not be accepted.) 14826
Test Requested By :
ID 45137 Name & Contact Md. Jasim, LED Bulb & Light, Quality Management (QM), QC, 1678861904, ledb&l.qc-
[email protected]

Sample Details: (Using samples from multiple cost centers in a single Test Request Form is strictly prohibited.)
1 Safety Wire(Po-4029844)

2
Mail copy
3

Testing Parameter: (if any test name is red color then contact with lab for costing details)
Product Type Test Name Method Condition (if any) Data For Sample Sl
Sl No
1 Metal Tensile ASTM E8 10 All

Signature with ID of the HOD/ Section Incharge as per cost center* Sample Received By (Lab use only)
Product Fan
Cost Center No 82 Signature with ID: Date: 17-01-24
Urgent (minimum 1 working day)
Quality Management (QM)-QC-IQC - 082
BDT 958 Time: 03:44pm
Regular
BDT 871
* Please select product & the cost center from the dropdown list in yellow mark area 17-Jan-24 2:59 PM
Sample details

Lab Reference No Sample Received By 1. Safety Wire(Po-4029844)


(Lab use only) (Signature with ID, Date & Time) 2.
3.
14826 4.
Tentative Report 5.
date 6.
Location : 5 th Floor (Lift-3), Main Building, WHIPLC, Contact : 01678-861144, [email protected] 17-Jan-24 2:59 PM

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