Document Title:

Viral Clearance Sample Submission Form

Eurofins Document Reference:
Revision: 5 Historical Reference: Form 6869
1-P-QM-FOR-9009045
Effective date: Jul 4, 2017 Status: Effective

Submitting Intermediate Product (Biologic) GMP Commercial (Lots Intended or On Market)

Company/Client Acct. No. Other (Explain) GMP Non-Commercial
On Behalf Of: Non-GMP
Reporting Contact(s): REQUIRED TO CHOOSE ONE REQUIRED TO CHOOSE ONE

Quote #
PO #
Eurofins Contact:
Dispose of Sample- Yes Hazardous- BSL2- Blood Pathogen-
No Provide FedEx/UPS______________ Controlled Substance, Class-__________

 for interference testing

sample storage
Virus conditions
( all that apply) ( Required cond.) Sample Description

Frozen (-70C)
Frozen (-20C)
Room Temp

Refrigerated
Pseudorabies Virus

Porcine Parvovirus
Name of process step (As you would like Referenced on the CoA)

MVM (MMV)
(as listed in the quote or the protocol)

Reovirus
XMuLV

Comments: Signature/Date:
_____________________________________________________

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 Document Title:
Viral Clearance Sample Submission Form
Eurofins Document Reference:
Revision: 5 Historical Reference: Form 6869
1-P-QM-FOR-9009045
Effective date: Jul 4, 2017 Status: Effective

Guidance Document for Viral Clearance Request Form

To avoid delays in testing, the following information is required to be indicated on the form, if any of the following information is missing testing will
not be initiated until all information can be supplied:
 PO and/or Quote number. If you do not have either, please enter NA.
 If large quantities of samples will be submitted, a secondary page with sample and testing information must be attached to the original form.
 Laboratory location that will be completing testing.
 Signature and date (Can be hand written or electronically signed). Indicates approval with all applicable terms and conditions needed to initiate testing.
One sample submission form is to be used per quote and material.
 Please provide separate containers for Interference and Spiking Steps and identify which steps they go to.
 An MSDS must be provided for all materials, if one is not on file samples will be placed on hold.
 Email a copy of the completed form to your ELLI contact prior to submission and send a hard copy with the samples.
 If you are a new client contact, you must provide an address, phone number, and email address.

Disclaimers:
 If the storage condition is not identified, a condition similar to how the sample was received will be assigned.
 Sample discard, if no contact information is provided the samples will be discarded appropriately at no charge after the Certificate of Analysis is generated.
(15 days for water testing and 30 days for all other testing.) Note: If sample return is requested a FedEX or UPS account number must be supplied.
 List the sample description and storage conditions as you would like it to appear on the final report. Sample descriptions should match what is written on
the container.
 If the measurement of uncertainty is required as per the ISO 17025 standard, then indicate in the comments section.

Address for shipment:

Lancaster, PA (USA): 2430 New Holland Pike, Suite C100, Lancaster, PA 17605

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