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Date test performed <br />Lot # 21q 0 <br />=�� <br />Test performed by <br />Expiration date Z 2o 12, <br />Staple SPORDI Test Envelope in space below after completing test: <br />(Make sure that flaps are securely closed so that test strips will not fall out) <br />00 114OP4 <br />/Y <br />114 �..- . <br />VS <br />Directions for Laboratory Specimen Processing Dept: <br />Do not order test in RUBICON System. Send this form with the SPORDI Envelope <br />attached directly to the Microbiology Dept at HCCL <br />Set up Date:. Time: B y: <br />Directions for Microbiology CLS: <br />When test is complete, fill out the Sterility Test Report section on the envelope. <br />Remember to sign and date the form, reattach a copy then send original test envelope to: <br />Dept. >I e <br />k" <br />SJMC Environmental Services Dept, <br />Attention: Gloria Shepherd at X 6472 immediately if there is a test failure. <br />9. 06A,74 11 ?)-.1 �'e� 4, -k <br />t4T& -7 <br />