Fax: (865) 241-4644; Phone: (865) 574-5014; E-Mail: [email protected] Hours: Monday - Friday 8:00am - 4:30pm (Eastern Time) Date* MM slash DD slash YYYY I. Equipment InformationManufacturer:*Model Number:*Description:*Range:*Unique Instrument Identification No: (if applicable)II. Calibration SpecificationsNeed Date: MM slash DD slash YYYY Manufacturer Standard Calibration Manufacturer Standard Calibration Special Case Special Case Calibration PointsTolerances or Mfr. SpecificationsSpecify Special Calibration Instructions or Requirements (Such as gas, optimization, etc.):Requested Calibration Interval:NOTE: By leaving this field blank, you are authorizing the ORNL Metrology Laboratory to select a calibration interval based on manufacturer's recommendation calibration interval, experience with similar instruments or values from other sources (industry or government databases, other respected calibration labs, etc.). The calibration interval will be used to determine the calibration due date based on the date of the calibration by ORNL Metrology plus the calibration interval and will be used by ORNL Metrology Lab to issue calibration due reminders. Type of Calibration: NVLAP Accredited (Includes ISO 17025 and NIST Traceable) ISO 17025 (Includes NIST Traceable) NIST Traceable Have any of the devices requested to be calibrated been potentially contaminated by chemical, biological, radiological or other hazardous materials? Yes No If you checked "Yes" please describe below:III. Customer InformationCompany:*NOTE: Each instrument must be labeled showing company ownership.Mailing Address:* Street Address City State / Province / Region ZIP / Postal Code Shipping Address: Street Address City State / Province / Region ZIP / Postal Code Fax:Email:* By submission of this form, you are indicating that you are not aware of a commercial calibration laboratory which is capable of performing the requested calibration in accordance with your specific technical requirements for this calibration.* Confirm NameThis field is for validation purposes and should be left unchanged.