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    Contact Information

    Name

    Title

    Email

    Company Name

    Shipping Address

    City

    Country

    State

    Zip

    Billing Address

    City

    Country

    State

    Zip

    Phone Number

    Fax Number

    Customer PO

    * Sales Order Confirmation will be provided after PO or Credit Card information is received.

    Section 1 of 4

    Sample Tracking Information

    Sample Name

    Customer RMA Number (if applicable)

    * The Customer RMA Number is supplied by the Customer to Canty and used to track OUTGOING samples back to the customer facility after testing is complete.

    Section 2 of 4

    Customer:
    Place the sample materials in suitable containers for shipment to Canty and call Canty for a sample tracking number.
    Customer must ship in an appropriate DOT container and is responsible for local and Federal regulations, compliance and
    disclosures. For materials that cannot be shipped rental equipment can be supplied and is recommended in these cases. Use
    as many containers as necessary for proper analysis of particles. Include sample preparation instructions if appropriate

    Section 3 of 4

    (1) Is the sample material hazardous?
    YesNo

    (2)What precautions should be taken?

    (3) What is the average size of the particle?

    (4) Range of particle size?

    (5) Do the particles have consistent characteristics (shape, size, color, etc.) ?

    (6) Are the particles abrasive or do the particles cling to each other and the container?

    (7) What type of repeatability do you presently have?

    (8) Please enclose a typical data set or readout for each of the samples you have sent us. It is imperative that the actual data for the samples submitted is provided to us. If you have graphs, please email them (lab@jmcanty.com)

    Section 4 of 4

    (9) Desired output from the CANTY system?

    (a) Particle Size Distribution
    YesNo

    (b) Area (where applicable)
    YesNo

    (c) Width (where applicable)
    YesNo

    (d) Length
    YesNo

    (e) Aspect Ratio (where applicable)
    YesNo

    (f) Mean Size
    YesNo

    (g) Opacity
    YesNo

    (h) Turbidity
    YesNo

    (i) Color Analysis
    YesNo

    Please provide information on the colors you need identified and what you require for each color. (Particle size distribution, Difference in color from standard, etc.)

    (j) Black Speck Detection
    YesNo

    Please provide information on what constitutes an "undesirable" characteristic in your sample and how much/how concentrated this characteristic needs to be in order to trigger a detection in your present analysis technique. It is essential that you provide us with a sample that has recognizable "clean" portions as well as an identified example of the undesirable characteristic. Send two separate samples if necessary.

    (k) Other - Please Explain:

    (10) What is the goal of your product analysis? What level of inspection do you need? Is a random sampling that provides reflective data about the product sufficient?

    (11) What type of reproducibility do you require?

    (12) How are particles currently being moved through process? (open conveyor, closed pipe air transport, liquid suspension, etc.) ?

    (13) Are you interested in...
    OnlineLabBoth

    (14) How often do you need the data updated (seconds, minutes, hours) ?

    (15) What type of output do you require (Graph, QC Data Archive, System Control Parameter, etc.) ?

    (16) What type of flow rate do you desire at the inspection point (lbs/time, liters/time, pieces/time, etc.) ?

    (17) Are there any portions of the sample that are relatively unimportant and could be ignored to increase the effectiveness in analyzing characteristics critical to your process as well as rate of analysis (eg. Fines may be present, but insignificant to analysis) ?

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