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) _____________________ (MI)___________
Address _______________________________________________________
City ______________________________________
State ______________ Zip ________________
Customer ID # (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) Binder for keeping report; 5)
Failure notification via phone
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 keeping report; 6) Failure notification via phone
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 Waterline 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
$ 39/4 water test kits ________ $ _________
$ 65/8 water test kits ________ $ _________
________________________________________________________________________
Delivery – Testing (Full dilutions indicate exact Heterotrophic
bacteria counts) Ship DUWL samples via Express Mail overnight, or deliver
samples to SAS laboratory.
Deliver to: SAS Lab, 24876 Taylor Street, Loma Linda, CA 92350
Call for local map and directions
Time: Monday–Thursday (8:00–12:00)
Costs: $14.00 each test (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, and fax or mail it to us. We will provide containers.
Send me _____________ sterile water containers for DUW testing.
Price each test
$14.00/each test ________ ________
__ Check enclosed $______________ payable to the SAS–LLU. Order date
_______________________
Charge: Total $__________ __Visa __MC
Number on card____________________________________________
Name on card_____________________________________________________
Expiration 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
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