OXYGEN

Home Care Medical LLC
Home Care Medical LLC

FULL PRESCRIBING INFORMATION: CONTENTS*

• Certificate of Analysis

FULL PRESCRIBING INFORMATION

Certificate of Analysis

CERTIFICATE OF ANALYSIS   UNIT NUMBER___________ SERIAL NUMBER___________ AMOUNT_________________INS, LBS, LITERS, CU FT.

USP TESTS

TEST      ID      ODOR      ASSAY

LIMITS   OK      NONE         99.2%

RESULT __           _____          _____

FOR CUSTOMERS USE TO DOCUMENT TESTS PERFORMED ON THIS VESSEL IF TESTING WAS NOT WITNESSED

TEST      ID      ODOR      ASSAY

LIMITS   OK      NONE         99.2%

RESULT __           _____          _____

CUSTOMER WITNESSED TESTS? _YES  ___NO

OXYGEN PURITY AND ID TESTED WITH A __________ ANALYZER MODEL NO_________   ABSENCE OF ODOR CONFIRMED BY THE OLIFACTORY METHOD _________  SUPPLIERS SIGNATURE_____________________ DATE____________  CUSTOMERS SIGNATURE_____________DATE____________   ENTER LOT NUMBER AND PLACE STICKER HERE________________ EXPIRATION DATE__________

MEDICAL GASES LIQUID OXYGEN U.S.P. DELIVERY TAG  FILLED BY: (PLEASE STAMP LOCATION ADDRESS OR PLACE LABEL BELOW)   THIS VESSEL CONTAINS OXYGEN U.S.P. (SEE REVERSE SIDE FOR TEST RESULTS)  OXYGEN PRODUCED BY THE AIR LIQUEFACTION METHOD