Form FDACS-03224 "Metrology Calibration Request" - Florida

Form FDACS-03224 is a Florida Department of Agriculture and Consumer Services form also known as the "Metrology Calibration Request". The latest edition of the form was released in February 1, 2017 and is available for digital filing.

Download an up-to-date fillable Form FDACS-03224 in PDF-format down below or look it up on the Florida Department of Agriculture and Consumer Services Forms website.

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Download Form FDACS-03224 "Metrology Calibration Request" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Consumer Services, Bureau of Standards
METROLOGY CALIBRATION REQUEST
Section 531.415, Florida Statutes
ADAM H. PUTNAM
Rule 5J-22.005, Florida Administrative Code
COMMISSIONER
Florida Metrology Laboratory
3125 Conner Blvd Lab 2, Tallahassee, FL 32399
Phone: (850) 921-1580 Fax: (850) 921-1593
For calibration services send completed request form with items submitted.
No client of the Florida Metrology Laboratory may claim product certification, approval, or endorsement
by NVLAP, NIST, or any agency of the U.S. Government. See 15 C.F.R. § 285.3 and NIST Handbook
150-2016 for additional information.
Shipping Information
Billing Information (if different)
Company Name
Address
City, State & ZIP
Phone
Email
Tech. Contact/Title
Purchase Order #
Phone
Artifact Owner (if different from above)
Shipping Method and Instructions
Company Name
Address
City, State & ZIP
Phone
Official Use Only
Date Received:
/
/
Comments:
Customer
Repeat
New
Review needed?
yes
no
Time required
Review
Standards
Laboratory does not have appropriate standards or
Mass Working
SOP:
8
methods to meet customer requirements
Mass Primary
4
5
Volume
SOP:
19
21
Date Completed
/
/
14
Tolerance applied
Laboratory Pick up by:
NIST 105-
ASTM E617
OIML R111
Date
/
/
Fees Relayed to Customer:
Technical Manager Signature
FDACS-03224 Rev. 02/17
Page 1 of 2
Florida Department of Agriculture and Consumer Services
Division of Consumer Services, Bureau of Standards
METROLOGY CALIBRATION REQUEST
Section 531.415, Florida Statutes
ADAM H. PUTNAM
Rule 5J-22.005, Florida Administrative Code
COMMISSIONER
Florida Metrology Laboratory
3125 Conner Blvd Lab 2, Tallahassee, FL 32399
Phone: (850) 921-1580 Fax: (850) 921-1593
For calibration services send completed request form with items submitted.
No client of the Florida Metrology Laboratory may claim product certification, approval, or endorsement
by NVLAP, NIST, or any agency of the U.S. Government. See 15 C.F.R. § 285.3 and NIST Handbook
150-2016 for additional information.
Shipping Information
Billing Information (if different)
Company Name
Address
City, State & ZIP
Phone
Email
Tech. Contact/Title
Purchase Order #
Phone
Artifact Owner (if different from above)
Shipping Method and Instructions
Company Name
Address
City, State & ZIP
Phone
Official Use Only
Date Received:
/
/
Comments:
Customer
Repeat
New
Review needed?
yes
no
Time required
Review
Standards
Laboratory does not have appropriate standards or
Mass Working
SOP:
8
methods to meet customer requirements
Mass Primary
4
5
Volume
SOP:
19
21
Date Completed
/
/
14
Tolerance applied
Laboratory Pick up by:
NIST 105-
ASTM E617
OIML R111
Date
/
/
Fees Relayed to Customer:
Technical Manager Signature
FDACS-03224 Rev. 02/17
Page 1 of 2
Please provide the following information for EACH individual item submitted:
Test Kits:
Loose Weights:
Test Measures and Provers:
Serial number
List EACH weight by Serial Number OR
List EACH artifact by Serial number
Number of pieces
Nominal value and unique identifier
Nominal value
Material
Material
Material
Manufacturer
Manufacturer
Manufacturer
Tolerance class
Tolerance class
Density (if known)
Density (if known)
ALSO LIST EACH WEIGHT by Nominal value AND
unique identifier (in the Serial Number Column)
LIMS ID
Serial Number
Information
Lab use only
OR Nominal & Unique ID
I certify that the information entered into this form is true and correct to the best of my knowledge.
Customer Name(print)
Date
Customer Signature
*
Page 2 can be submitted multiple times if additional lines are needed.
FDACS-03224 Rev. 02/17
Page 2 of 2
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