University of Wisconsin Medical Radiation Research Center Radiation Calibration Laboratory (ADCL) 1111 Highland Avenue, WIMR Rm B1002 Madison, WI 53705-2275 Phone: (608) 262-6320 REQUEST FOR INSTRUMENT CALIBRATION Step 1 of 2 50% Reporting and Shipping AddressDate MM slash DD slash YYYY PO Number(Required) [Valid Entries are: Your PO Number, Pending, Credit Card, or Invoice]Physicist(Required) Institution(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos 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RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) Return Shipping Instructions: Your instruments will be returned to you via FedEx Std Overnite unless otherwise requested. Please indicate the amount of insurance coverage desired. If you wish to use an alternate mode of transportation, please fill in the appropriate information below. The cost of shipping, handling and insurance will be prepaid and added to your invoice. International Customers: If you are shipping from outside the USA, please call in advance to discuss international shipping requirements. All return shipments to international destinations require the use of your shipping account. The UWRCL will not prepay customs and duty charges.Alternate Shipping MethodFedEx Std Overnite (delivered by afternoon next day) [default service]FedEx Priority (delivered by 10:30 AM next day)FedEx Economy (2nd day)UPS Red (delivered by 10:30 AM next day)UPS Blue (2nd day air)UPS Select (3rd day air)UPS GroundOtherIf "Other" is chosen, please enter the desired service To use your own Shipping Account, enter your Account Number here Insure Package[USD] Terms of Service: The University of Wisconsin is not liable for any damage or loss of the instruments unless said damage or loss is due to negligence on the part of the laboratory personnel. Note: You must accept the Terms of Service in order to fill out the rest of the form.Accept the Terms of Service(Required) I agree to the Terms of ServiceInstrument Submitted for CalibrationTo enter Electrometer and/or Survey Meter scales, manually type in the Scale Name(s) in the Scale Name text box(es) [One per box]Calibration TypeChoose...Therapy Ion ChamberWell-ChamberElectrometerDiagnostic Ion Chamber/SystemkVp MeterSurvey MeterModel No. Serial No. Calibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpScale Name Scale Name Scale Name Scale Name Scale Name Scale Name Scale Name Scale Name Unless the first box below is checked, I authorize the UWADCL to perform minor electrometer repairs or battery replacement, which may cost up to $500 Please contact us before performing any electrometer repairs or battery replacement Remove and do not replace electrometer battery if it is faulty and not required for operation Add a second instrument? Yes No Calibration TypeChoose...Therapy Ion ChamberWell-ChamberElectrometerDiagnostic Ion Chamber/SystemkVp MeterSurvey MeterModel No. Serial No. Calibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRScale Name Scale Name Scale Name Scale Name Unless the first box below is checked, I authorize the UWADCL to perform minor electrometer repairs or battery replacement, which may cost up to $500 Please contact us before performing any electrometer repairs or battery replacement Remove and do not replace electrometer battery if it is faulty and not required for operation Calibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpScale Name Scale Name Scale Name Scale Name Add a third instrument? Yes No Calibration TypeChoose...Therapy Ion ChamberWell-ChamberElectrometerDiagnostic Ion Chamber/SystemkVp MeterSurvey MeterModel No. Serial No. Calibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRScale Name Scale Name Scale Name Scale Name Unless the first box below is checked, I authorize the UWADCL to perform minor electrometer repairs or battery replacement, which may cost up to $500 Please contact us before performing any electrometer repairs or battery replacement Remove and do not replace electrometer battery if it is faulty and not required for operation Calibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpScale Name Scale Name Scale Name Scale Name Add a fourth instrument? Yes No Calibration TypeChoose...Therapy Ion ChamberWell-ChamberElectrometerDiagnostic Ion Chamber/SystemkVp MeterSurvey MeterModel No. Serial No. Calibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRScale Name Scale Name Scale Name Scale Name Unless the first box below is checked, I authorize the UWADCL to perform minor electrometer repairs or battery replacement, which may cost up to $500 Please contact us before performing any electrometer repairs or battery replacement Remove and do not replace electrometer battery if it is faulty and not required for operation Calibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpScale Name Scale Name Scale Name Scale Name Add a fifth instrument? Yes No Calibration TypeChoose...Therapy Ion ChamberWell-ChamberElectrometerDiagnostic Ion Chamber/SystemkVp MeterSurvey MeterModel No. Serial No. Calibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-Co-60 Water (TG-51)Co-60 Air Kerma (TG-21)Cs-137UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW120-MUW150-MUW200-MUW250-MCalibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-HDR Ir-192 (all types)Best Medical Ir-192 (Seed in Ribbon)Cs-137 Tube Source (all types)BARD STM1251Best Medical 2301IsoAid IAI-125A AdvantageTheragenics AgX100Best Medical 2335CivaTech Oncology CS-10CivaTech Oncology CivaDotIsoAid IAPd-103A AdvantageTheragenics Model 200IsoRay Medical CS-1 (Revision 2)Novoste 3.5 French (all lengths)Calibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRCalibration Point-UW30-LUW40-LUW50-LUW80-LUW100-LUW20-MUW30-MUW40-MUW50-MUW60-MUW80-MUW100-MUW150-MUW200-MUW250-MUW23-MOUW25-MOUW28-MOUW30-MOUW35-MOUW28-MRUW32-MRScale Name Scale Name Scale Name Scale Name Unless the first box below is checked, I authorize the UWADCL to perform minor electrometer repairs or battery replacement, which may cost up to $500 Please contact us before performing any electrometer repairs or battery replacement Remove and do not replace electrometer battery if it is faulty and not required for operation Calibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpCalibration Point-Radiographic kVpMammographic kVpScale Name Scale Name Scale Name Scale Name CommentsPrint the completed form and include with shipment.EmailThis field is for validation purposes and should be left unchanged. 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