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1 YOU MAY SUBMIT DATA BY: FAX: (706) 485-2123 FAX: (706) 485-2123 FAX: (706) 485-2123 FAX: (706) 485-2123 EMAIL : MAIL: Audit MicroControls C/O AUDITOR QC222 Technology Parkway, Eatonton, GA 31024 FACILITY:TECHNICIAN:ADDRESS: INSTRUMENT:CITY: STATE:ZIP:SERIAL NO:PHONE:FAX: PRODUCT NO: EMAIL :DATE OF RUN:Questions? Comments? Please call us: (866) 252-8348(866) 252-8348(866) 252-8348(866) 252-8348 Unit of measure:Unit of measure:LevelValue 1 Value 2 Value 3 LevelValue 1 Value 2 Value 3 AABBCCDDEEN otes:Notes:Unit of measure:Unit of measure:LevelValue 1 Value 2 Value 3 LevelValue 1 Value 2 Value 3 AABBCCDDEEN otes:Notes:Unit of measure:Unit of measure:LevelValue 1 Value 2 Value 3 LevelValue 1 Value 2 Value 3 AABBCCDDEEN otes:Notes:Analyte: Analyte: Analyte: Analyte: Analyte: Analyte: Unit of measure:Unit of measure:LevelValue 1 Value 2 Value 3 LevelValue 1 Value 2 Value 3 AABBCCDDEEN otes:Notes.

2 Unit of measure:Unit of measure:LevelValue 1 Value 2 Value 3 LevelValue 1 Value 2 Value 3 AABBCCDDEEN otes:Notes:Unit of measure:Unit of measure:LevelValue 1 Value 2 Value 3 LevelValue 1 Value 2 Value 3 AABBCCDDEEN otes:Notes:Unit of measure:Unit of measure:LevelValue 1 Value 2 Value 3 LevelValue 1 Value 2 Value 3 AABBCCDDEEN otes:Notes:Unit of measure:Unit of measure:LevelValue 1 Value 2 Value 3 LevelValue 1 Value 2 Value 3 AABBCCDDEEN otes:Notes:Analyte: Analyte: Analyte: Analyte: Analyte: Analyte: Analyte: Analyte: Analyte: Analyte.