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PACIFIC CALIBRATION SERVICES

1. Calibration Survey Form

Please answer the questions below in regards to your recent calibration.

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* 1. Customer Name (optional)

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* 2. Was performed in a timely manner?

Yes

No

N/A

Other (please specify)

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* 3. Instruments returned in good condition?

Yes

No

N/A

Other (please specify)

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* 4. Overall Satisfaction?

Very Satisfied

Satisfied

Not Satisfied (please specify)

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* 5. Comments or Suggestions?