Review Form

Data Review and Confirmation

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Company/Organization:
NAPT ILC/PT ID:
Contact Name/Title:
Address:
City: State/Province: Zip/Postal Code:
Phone: Fax: Email:
ILC/PT Participation Date:
Data Review Date:
Data Reviewed By (please list all):

Setpoints Requiring Review

(Revised value fields are to be filled out as applicable)

Setpoints#
Orginal Measured Value
Revised measured Value
Orginal Uncertainity Value
Revised Uncertainity Value
* Explanation for Revised Setpoint

*Required for acceptance of any revised data submitted to NAPT.

Select Applicable Option:

I confirm that the data listed above and previously submitted to NAPT for the specified ILC/PT and date of participatioon has been reviewed by the individual(s) named. The orginal data submitted to NAPT was correct and at this point does not require revision or re-submittal.This confirmation also serves as a request for this ILC/PT to be issued upon the receipt by NAPT of this completed form.

-OR-

I confirm that the data listed above and previously submitted to NAPT for the specified ILC/PT and date of participation has been reviewed by the individual(s) named. The orginal data submitted to NAPT was incorrect and the correct values and an explanation for the incorrectly submitted data have been entered onto this form and re-submitted to NAPT within the required 5 business days.This confirmation of review and data re-submittal also serves as a request for the revised data to undergo a technical review and preliminary Report issued.

Name(Submitted by): Today's Date:

Comments:

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