D2O Recovery Program

Date*

Title	Department


Company

First Name*	Last Name*


Email Address*

Street*


City*	State/Province*


Postal/Zip Code*	Country*

Phone*

Approximate quantity of D2O to be returned*

Quantity of containers to be returned: *Material that is packaged in multiple small containers must be consolidated prior to return shipment or a consolidation fee will be assessed*

CHEMICAL OR BIOLOGICAL PROCESS:

Please indicate here any chemical or biological processes the D₂O was used for:

CONTAMINANTS:

Contains alcohols:*

Yes

If Yes, ~amount:*

Contains salts:*

Yes

If Yes, ~ amount:

Contains HCI and /or HBr:*

Yes

Contains bacteria:*

Yes

If Yes, treated w/ 0.25% bleach – REQUIRED:*

Yes

Estimated total organics content:

% or ppm:*

pH: (can be filled in by CIL upon receipt after QC)

Other:

There is a 40% minimum enrichment requirement to take part in the D₂O Recovery Program (please contact us to discuss the review of lower enrichments). Be advised there is a 10 kg minimum; a 25 g sample (from each container) must be sent to CIL for testing prior to return of the entire batch. The return batch must include the contact name, organization, accounting contact person, and the purchase order or account number to be credited. Any returns in excess of 100 kg require written approval prior to shipment. Please do not return any material without prior approval from CIL. After receipt of this form, CIL will contact you for additional discussion.