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0 <br />St Joseph®s Medical Center Environmental Services Dept <br />Date test performed_,,,_,,_, <br />Lot # 21q () <br />Test performed by <br />Expiration date <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 />6o P1 .6-6 <br />5 <br />4V <br />0 U <br />-6t&uc 0 <br />kw Ta4ov <br />DiJ%w for Labo-raffory Specimen Processing Dept: <br />Do not order test in RUBICON System. Send this form with the SPORDI Envelopt <br />attached directly to the Microbiology Dept at HCCL <br />Set up Date: J! I Time:. 2 t 13 By: <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:AoeO of <br />Dept. k-,, e C, <br />SJMC Environmental Services Dept. rej-t <br />Attention: Gloria Shephera at X 6472 immediately if there is a test failure. <br />fila �kl eil <br />'7 <br />Z <br />