Sample Accountability Record Form FDA 421 PSC Graphics

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Specifications	Sample Accountability Record Form FDA 421 PSC Graphics
Business section

SAMPLE ACCOUNTABILITY RECORD 10. SAMPLE DELIVERY 12. C. 2. NAME OF PRODUCT D. 4. NAME AND ADDRESS OF RESPONSIBLE FIRM 3. SAMP

Specifications	Sample Accountability Record Form FDA 421 PSC Graphics
Suggested Link Details/Purchase
Content	SAMPLE ACCOUNTABILITY RECORD 10. SAMPLE DELIVERY 12. C. 2. NAME OF PRODUCT D. 4. NAME AND ADDRESS OF RESPONSIBLE FIRM 3. SAMPLE NO. CRX/DEA SPL SPLIT SAMPLE A. PERSONALLY FROM 6A. BY WHOM RECEIVED6B. DIST/DIV7. DATE RECORDS REC’D 5. DATE SAMPLE RECEIVED PP A. B. DESCRIPTION OF SHIPMENT 9. Continue on reverse; also record on reverse details for which space is lacking above SHIPPING CONTAINERS C. SHIPPED FROM D. B/L NO. A. B. VIA SAMPLE PACKAGES B. DATE SEAL INSCRIPTION C. CONDITION COPY IN FULL TYPE SIZE, TYPE, ETC. CONDITION CONDITION NUMBER 1. STORAGE LOCATION BUSAIRFREIGHT 11. SAMPLE RETURNED NUMBER AMOUNTFROMTODATETOAMOUNTFROM A. DATE SDN 8. METHOD OF SHIPMENT B. DATE DESTROYEDC. DESTRUCTION METHODD. AMOUNT DESTROYEDE. BY WHOMF. REASON SAMPLE DISPOSITION FORM FDA 421 (7/03)(2 PART) PSC Graphics (301) 443-1090EF
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