Request for Product Reclaim Evaluation
Product Information
Suspected Contaminant:_____________________________ Contaminant Dimentions:______________
Product Name:________________________________________________________________________
Product State:____________________________Package Type_________________________________
Height:_______________ Width:_______________ Length:_______________Weight:_______________
Package Content Count:_________________ Product Orientation_______________________________
Line Speed (FPM)_______________________ Product Spacing:________________________________
Product Samples Available: Yes / No Sample Quantity:____________________________________
Samples Contaminated: Yes / No Sample Return Required: Yes / No
Comments:___________________________________________________________________________
_____________________________________________________________________________________
Send samples to our testing lab 2330 NW Raleigh St. Portland OR 97210. Attention: John Cassa, GM
Company Information
Company:__________________________________ Contact:___________________________________
Address:_____________________________________________________________________________
City, State, Zip:___________________________________ Phone:______________________________
Email:___________________________________________ Fax: _______________________________
Print out this page and complete the requested information and fax to 503-248-0715