Registration RNE.AL.DL.25.03 – Three exposures

Nome del laboratorio / Laboratory name *

Persona di riferimento / Contact person *

Nome

Cognome

Email *

Email CC *

Telefono / Telephone *

Indirizzo / Address (street, city, country) *

Dati di fatturazione / For invoice issue:

Ragione sociale / Company name *

Indirizzo di fatturazione completo / Full company address

Telefono amministrazione / Company telephone

PEC *

Only for Italian laboratories (otherwise enter 000)

Codice fiscale

P. IVA / VAT number *

Codice SDI *

Only for Italian laboratories (otherwise enter 000)

Emissione buono ordine da vostra struttura / Order issuance *

SET I

Name of the device *

Device name used in laboratory, e.g. PoliMI-CR39

Type of device (CR-39, LR 115, electretes...) *

If electretes, configuration

Detector and holder manufacturer *

Analysis System *

Range of measurement (in kBq h m-3) *

ISO 17025 accreditation? *

If yes, insert the accreditation range of measurement (in kBq h m-3)

Name of the device (SET II)

Device name used in laboratory, e.g. PoliMI-CR39

Type of device (CR-39, LR 115, electretes...) (SET II)

If electretes, configuration (SET II)

Detector and holder manufacturer (SET II)

Analysis System (SET II)

Range of measurement (in kBq h m-3) (SET II)

ISO 17025 accreditation? (SET II)

If yes, insert the accreditation range of measurement (in kBq h m-3) (SET II)

Note aggiuntive / Additional notes

Message