OXYGEN Dailymed
Generic: oxygen is used for the treatment of Carbon Monoxide Poisoning Hypoxia, Brain Cluster Headache Decompression Sickness Embolism, Air Gangrene Lung Diseases, Obstructive Pneumonia Pulmonary Edema Pulmonary Fibrosis Respiratory Insufficiency Retinopathy of Prematurity Wound Infection
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Oxygen Usp Coa
AIR LIQUIDEÂ OXYGEN U.S.P. Â Â Â Â Â Â Â Form Number: 2A-ALL-QUA-0005-F
                                                           Revision:        0
                                                           Effective Date: 03/29/06
                                                           Page:              1/1
CERTIFICATE OF ANALYSIS
Air Liquide large Industries U.S. L.P. – Houston, TX 77056
PRODUCED BY AIR LIQUEFACTION
1.Location      Street Address1                                 2. Carrier ________________
Street Address 2
City, State Zip
3. Lot Number ______________________Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 4. Trailer No _____________
PRE-FILL REPORTÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â FILL REPORT
5.Residual Assay       6. Odor                                  7. Trailer loaded with appropriate product per appropriate
  (>99.5% O2)                Detected                               loading procedure by:
  _______ %               Yes   No                             Signature _________________________
  ________                  ________                            Date _____________________________
   Initial                          Initial
ANALYSIS REPORT
Test required            Method of Analysis                         Specifications                     Results
OXYGEN ASSAY      PARAMAGNETIC      ___                99.5% O2 Minimum              9. ____%
                                   8.Analyzer Tag Number       Â
ODOR                        Organoleptic (Nasal)                          None                                      10. ______
USP applies only when used in a medical application or by medical customers properly registered with the FDA. Note: Oxygen that is produced by the air liquefaction process is exempt from the requirement of the impurity test for Carbon Dioxide and Carbon Monoxide.
11. Analyzed By        ________________________           Date ____________
12. Witnessed By      ________________________           Date ____________
    (only required for HRC customers)
13. Does this lot require additional testing? ___ NO           ___ YES – attach page 2
14. SQCU Review/Release _______________________Â Â Â Â Date ____________
MANDATORY FORM
User must assure that this revision of the form is current prior to use. Completed forms become permanent records subject to the record retention policy.
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