USP <1116> Kit Subscription First Name * Last Name * Company Name * Phone # * Email * Address City / Town State / Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP / Postal Code Ship to Address Media Type Single Media, Dual Incubation, Trypticase Soy Agar (TSA) Dual Media, Single Incubation, Trypticase Soy Agar (TSA) and Malt Extract Agar (MEA) Dual Media, Single Incubation, Trypticase Soy Agar (TSA) and Sabouraud dextrose agar (SDA) Frequency One time Weekly Monthly Quarterly Other Analysis Surface Sample Quantity (With Controls) Air Sample Quantity (With Controls) TSS air samplers use 90mm plates. If you have an SAS sampler, you may require either a 55mm or 90mm plate type. Gowning Qualification Quantity (With Controls) Gowning Qualification tests are assumed to be one-time orders separate from air and surface frequency. Plate Type Contact/55mm Air/Settling/90mm Report Type Lab Report Only Lab Results Summary Report (tabulated results along with executive summary) Viable Air Sampler / Spinner Rental Special Instructions Leave this field blank
