Free Dental Unit Water Testing Kit Introductory Special with subscribing to Sterilization Assurance Service Sterilization Assurance Service & Water Testing ORDER FORM date ______________ Dr., Mr., Mrs., Ms. Name (Last)_________________________________ (First) _____________________ (M.I.)___________ Address _______________________________________________________ City ______________________________________ State ______________ Zip _________________ CustomerID # (for current customer only) ____________________________ Phone ( ) ________________________________ Fax ( ) ________________________________________ Name of office_____________________________________________________ E-mail ________________________________ Sterilizer Type / Number: (supplies for each sterilizer must be kept separate for identification purposes). Steam _______ Chemical Vapor _______ Dry Heat _______ EO Gas _________ Basic 1) One test strip and one control strip in each test; 2) Return envelopes; 3) Monthly report; 4) Failure notification via phone. Price Quantity Amount • Introductory Special: A free water testing kit for new customer $69 / 12 spore tests (addn’l unit $65) _______ $__________ $159 / 52 spore tests (addn’l unit $149) _______ $__________ Optional: 1) Certificate of Participation $12/ea _______ $__________ 2) Prepaid return envelopes $ 18 / 52 _______ $__________ Intensive 1) Two test strips and one control strip in each test; 2) Prepaid return envelopes; 3) Certificate of Participation; 4) Report on each test; 5) Binder for report keeping; 6) Failure notification via phone. Price Quantity Amount • Introductory Special: A free water testing kit for new customer $98 / 12 spore tests (addn’l unit $95) _______ $__________ $278 / 52 spore tests (addn’l unit $258) _______ $__________ Dental Unit Water Testing • In-Office Testing Kits (test by yourself) 1) Millipore HPC Sampler; 2) Whirl-Pak Bag containing chlorine neutralizer (sodium thiosulfate); 3) Instructions. Price/Water Test Kits Quantity Amount $ 48/4 water test kits ________ $ _________ $ 79/8 water test kits ________ $ _________ • Delivery – Testing (Full dilutions indicate exact Heterotrophic bacteria counts) Deliver to: SAS Lab, 24876 Taylor Street, Loma Linda, CA 92350 Call for local map and directions Time: Wednesday or Thursday (8:00 – 12:00) Costs: $14.00 each testing (minimum of 3 samples for $42.00) Written Report: 10 days later Water Quality Certificate: Included, if testing results meet the ADA’s goal (< 200 CFU / ml) • Flush the waterlines for 2 minutes before taking samples. • Keep water samples on ice during delivery. • If sterile containers are needed, please complete the Order Form, fax or mail it to us. We will provide containers. Send me _____________ sterile water containers for DUW testing. Price each testing Quantity Amounts $14.00/each test ________ ________ Check enclosed $______________ payable to the SAS-LLU. Order date _______________________ Charge: Total $__________ r Visa r MC Number on card ____________________________________________ Name on card _____________________________________________________ Exp. date ________________________ Mail to: Sterilization Assurance Service, Loma Linda University School of Dentistry, 24876 Taylor St., Loma Linda, Ca 92350 Telephone: (909) 558-8794, (909) 558-0656; Fax: (909) 558-0307; E-mail: SAS@sd.llu.edu back to contents University | Medical_Center | LLU&MC_home | Search | Employment | News_&_events | Academics | Our_mission | Admissions | Registration | Research | Alumni | Student_resources All contents copyright © 2001 Loma Linda University. All rights reserved. Revised February 14, 2001 Send comments and questions to webmaster@univ.llu.edu  URL: http://www.llu.edu