Fine Grinding Corporation

FINE GRINDING CORPORATION 241 East Elm Street Conshohocken, PA 19428 T: 610-828-7250; F: 610-828-2584 PROCESS INFO/SAMPLE REQUEST FORM

Company Name:

Contact Name: Contact Phone #: Fax #: E-mail: Date: Customer P. O.:

Product Name: Is product hazardous? Yes / No Is an EPA registration number required? Yes / No Is the product friable? (can be broken by impact) Yes / No SDS has been sent to [email protected] Yes / No SDS MUST BE SUBMITTED PRIOR TO SENDING SAMPLES/MATERIAL AND MUST ACCOMPANY ALL SAMPLES/SHIPMENTS. Intended Use: FDA Regulated Yes / No Ingredient: Confirm Industrial use only: Yes / No

Process Requirements: Average Particle Size:______(mesh/micron) Maximum Particle Size:______(mesh/micron)

Are fines an issue? Yes / No Must lot integrity be maintained? Yes / No Total Quantity of Product: Finish Packaging: Type of Container: ______Size: ______Liner required? Yes / No If so, how many?

Labeling Information:

Shipping Instructions:

Special Instructions:

Value of Product: (required for insurance purposes) Disposition of Extra Product: Shipments are to be sent pre-paid, NO COLLECT SHIPMENTS WILL BE ACCEPTED BY FGC.

D:\Docs\2017-12-07\01f8e4c330ba7cd2e7f2a04a996efc70.doc updated 2/6/17