1. No category

PD&E QDP Sample Submission Form
Complete the yellow fields. E-mail this completed form, sample analytical, and project panel results to the assigned PD&E
Study Leader. Also deliver a signed hardcopy of the completed form with samples to the PD&E Study Leader.
Submission Form completed by:
Sample Submitter
Name:
Norm Adams
Department: 1AT
Phone:
4-2046
Date:
Norm Adaps
6/3 0/0 •
(mm/dd/yy)
PD&E Study Leader: Jenny Lewis
PD&E Study #:
668
Study Name:
SCoR II mg Validation
# Samples in this submission: 4
Signature below indicates you have obtained product integrity approval and your approval of the sample production data,
cigarette analytical data, and project panel subjective evaluations.
Project Leader Signature
Signature below indicates that the above information has been verified and is correct
Study Leader Signature
PD&E Use Only:
Date of Receipt:
(mm/dd/yy)
PD-QF-003-008
http://legacy.library.ucsf.edu/tid/kmu94g00/pdf
Page 1 of 5
'3030033956
PD&E QDP Sample Submission Form
Please allow data entry fields to expand as needed. For additional samples, complete a new PD&E Sample Submission Form.
Sample 1
Select only one category:
CGCode:
fitll
[~1 Competitor
• PM Market Product
Ollllo
I I Prototype
Rl Market Product Modification CG Code:
Complete Brand Name /
Marlboro'LighliM
A111 hien t M QiflllMll ( l a j B i M - S )
Detailed prototype description:
Please indicate the product's attributes:
If Other:
Brand Family:
PflarJbarb
Length:
QLS(80)
g K S (83/84)
Pack Type:
GSoll
EXJBox
Flavor:
Ex] Non-Menthol
Q Menthol
Filter:
H Non-Carbon
Q Carbon
Tip Color:
•
Cork
g j White
H N/A
B ° ther:
Circumference:
1X1 Regular
O Slim
0
H Other:
Country:
IE USA
Company:
g]PM
•
100
E3 120
§ j Other:
D Other:
H Other:
H Non-Filter
Super Slim
B Other:
DEI Other:
D M R
QB&W
QLorillard
•
Liggett
H Other:
POL Code (If applicable):
International Consumer Test Code (If applicable):
Q Overtipped
• No Print
Cigarette Identification:
Printed
Overtipped SW Code:
Non-Overtipped SW Code: 1 1 1 1 1 ? j
SW Sample ID:
Tar:
II.f
PM Delivery Targets:
Menthol:
Pack Code:
MIL: "TDENT'lCsee 02-0729)
Production Date:
1 1/6/02 (nun/ddAy)
Sample Origin:
• Retail
• Distributor
PM Factory/SW/Warehouse
Production Location:
Q MC
• Cabarrus
Semiworks
Ql Other
Required Approvals
Special PI Approval required?
M No O Yes PI #:
Restrictions:
Analytical approval required prior to testing? £><] No
Q Yes PTL Request #:
pb||il
PTL Submit Date: 1 1 1 1 1 1 (mm/dd/yy)
Screened by Project Panel?
O No [Xj Yes Comments:
Date Results Needed:
7/15/2003 (inm/dd/yy)
Comments:
Storage study: sample'1 is :0£.LKii78 ; : ; '(Clihicalili|liiiI
!!
IQENT"). The POL sample is 02^V:3R5
Sample Keywords:
(PD&E Use Only)
Brand ID:
1111
PD&E Sample ID:
ICASCigID:
PTLCode:
PD-QF-003-008
http://legacy.library.ucsf.edu/tid/kmu94g00/pdf
Page 2 of 5
'3030033957
PD&E QDP Sample Submission Form
Sample 2
Select only one category:
• PM Market Product
CGCode:
fitll
Hi Competitor
Rl Market Product Modification CG Code: O l l l l o
Prototype
Complete Brand Name /
Marlboro^OghlllK
Detailed prototype description: Month 6 (02AK1II J 6 |
Please indicate the product's attributes:
If Other:
Brand Family:
fflarlbarb
Q L S ( 8 0 ) g K S (83/84) • 100 E3 120 § j Other:
Length:
GSoll
EXJBox
Pack Type:
U3 Other:
H Other:
Flavor:
Ex] Non-Menthol
Q Menthol
Filter:
H Non-Carbon
O Carbon
H Non-Filter B Other:
ther:
Tip Color:
• Cork
g j White
H N/A
Circumference: 1X1 Regular Q Slim
0 Super Slim
H Other:
Country:
IE USA
DEI Other:
Company:
g ] P M ^QRJR Q B & W QLorillard • Liggett H Other:
m
B°
POL Code (If applicable):
International Consumer Test Code (If applicable):
Q Overtipped
• No Print
Cigarette Identification:
Printed
Overtipped SW Code:
Non-Overtipped SW Code: 1 1 1 1 1 ? j
SW Sample ID:
Tar:
II.f
Menthol:
PM Delivery Targets:
MIL:
"TDENT'lCsee
02-0729)
Pack Code:
1 1/6/02 (min/dd/yy)
Production Date:
• Retail
• Distributor
PM Factory/SW/Warehouse
Sample Origin:
Q MC
• Cabarrus
Semiworks
Ql Other
Production Location:
Required Approvals
M No O Yes PI #:
Special PI Approval required?
Restrictions:
Analytical approval required prior to testing? £><] No Q Yes PTL Request #:
D03085
PTL Submit Date: |/7Wa (mm/dd/yy)
Screened by Project Panel?
O No [Xj Yes Comments:
Date Results Needed:
7/15/2003 (mni/dd/yy)
Comments:
Storage study: sample'1 is :0£.LKii78 ;:; '(Clihicalili|liiiI
!!
IQENT"). The POL sample is 02^V:3R5
(PD&E Use Only)
Sample Keywords:
Brand ID:
ill
PD&E Sample ID:
ICAS CigID:
PTLCode:
PD-QF-003-008
http://legacy.library.ucsf.edu/tid/kmu94g00/pdf
Page 3 of 5
'3030033958
PD&E QDP Sample Submission Form
Sample 3
Select only one category:
• PM Market Product
• Market Product Modification
Complete Brand Name /
Detailed prototype description:
Pit Competitor
H Prototype
CG Code:
CG Code:
Please indicate the product's attributes:
Brand Family:
Experimental
Length:
Q L S ( 8 0 ) g K S (83/84)
• Son
[XlBox
Pack Type:
Flavor:
•
Non-Menthol
Filter:
•
Non-Carbon
Tip Color:
•
Cork
Circumference:
M Regular
Country:
IB USA
Company:
[ 2 PM
POL Code (If applicable):
Cigarette Identification:
SW Sample ID:
PM Delivery Targets:
Pack Code:
Production Date:
Sample Origin:
Production Location:
Required Approvals
•
If Other:
•
100
•
120
•
Carbon
Other:
H Other:
Menthol
M White
• Slim
§ j Other:
Q Non-Filter
•
N/A
B Other: | r i i f fmm( yarn)/1 lmm(
BMi7C)^6mm
• Other:
•
Super Slim
B Other:
H Other:
QRJR
•
B&W
•
Lorillard
0 Liggett
•
pill
Other:
International Consumer Test Code (If applicable):
• Overtipped
H Printed
| 3 No Print
Overtipped SW Code:
Non-Overtipped SW Code:
Tar:
11.-0
Menthol:
K2:(s»02-e500)
I W 3702 (imii/dd/vv)
• Retail
• Distributor • PM Factory/SW/Warehouse
• MC
Q Cabarrus
g j Semiworks
• Other
Yes
Special PI Approval required?
•
No
HNo
Analytical approval required prior to testing?
PI#:
20021740
Restrictions: 10Q people/3 paeksper day/1 year
El; Yes PTL Request #:
D03J86
PTL Submit Date: 4/7/03 (min/dd/yy)
Comments:
Yes
Screened
by
Project
Panel?
I~l
No
Date Results Needed:
7/1:5/2003 (mm/dd/yy)
Comments:
Sample submitted to ARISTA LAB on ApritfJJ2QQ3
Sample Keywords:
SCoRf Reduced Risk
Brand ID:
till
PD&E Sample ID:
ICAS CigID:
PTL Code:
PD-QF-003-008
http://legacy.library.ucsf.edu/tid/kmu94g00/pdf
l|l|l§|f
(PD&E Use Only)
Page 4 of 5
'3030033959
PD&E QDP Sample Submission Form
Sample 4
Select only one category:
• PM Market Product
• Market Product Modification
Complete Brand Name /
Detailed prototype description:
Pit Competitor
H Prototype
CG Code:
CG Code:
Please indicate the product's attributes:
Brand Family:
Experimental
Length:
Q L S ( 8 0 ) g K S (83/84)
• Son
[XlBox
Pack Type:
Flavor:
•
Non-Menthol
Filter:
•
Non-Carbon
Tip Color:
•
Cork
Circumference:
M Regular
Country:
IB USA
Company:
[ 2 PM
POL Code (If applicable):
Cigarette Identification:
SW Sample ID:
PM Delivery Targets:
Pack Code:
Production Date:
Sample Origin:
Production Location:
Required Approvals
•
If Other:
•
100
•
120
•
Carbon
Other:
H Other:
Menthol
M White
• Slim
§ j Other:
Q Non-Filter
•
N/A
B Other: | r i i f fmm( yarn)/1 lmm(
BMi7C)^6mm
• Other:
•
Super Slim
B Other:
H Other:
QRJR
•
B&W
•
Lorillard
0 Liggett
•
pill
Other:
International Consumer Test Code (If applicable):
• Overtipped
H Printed
| 3 No Print
Overtipped SW Code:
Non-Overtipped SW Code:
Tar:
11.-0
Menthol:
K2:(s»02-e500)
I W 3702 (imii/dd/vv)
• Retail
• Distributor • PM Factory/SW/Warehouse
• MC
Q Cabarrus
g j Semiworks
• Other
Yes
Special PI Approval required?
•
No
HNo
Analytical approval required prior to testing?
PI#:
20021740
Restrictions: 10Q people/3 paeksper day/1 year
El; Yes PTL Request #:
D03J86
PTL Submit Date: 4/7/03 (min/dd/yy)
Comments:
Yes
Screened
by
Project
Panel?
I~l
No
Date Results Needed:
7/1:5/2003 (mm/dd/yy)
Comments:
Sample submitted to ARISTA LAB on ApritfJJ2QQ3
Sample Keywords:
SCoRf Reduced Risk
Brand ID:
till
PD&E Sample ID:
ICAS CigID:
PTL Code:
PD-QF-003-008
http://legacy.library.ucsf.edu/tid/kmu94g00/pdf
l|l|l§|f
(PD&E Use Only)
Page 5 of 5
'3030033960