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DEPARTMENT OF THE ARMY
US ARMY COMMAND
SOMEWHERE, USA 55515
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OFFICE SYMBOL
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MEMORANDUM FOR COMMANDER, United States Army Public Health Command
(MCHB-TS-TTE), 5158 BLACKHAWK ROAD, ABERDEEN PROVING GROUND, MD
21010-5403
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SUBJECT: Request for Toxicity Clearance for [subject chemical or product]
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1. Request a toxicity evaluation to be performed and a Toxicity Clearance be
issued for [subject chemical or product], a new product being considered
for use in [state application]. The new product will replace [chemical
name] in this particular application.
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2. Enclosed is the technical information on the product provided by the
manufacturer. The manufacturer is XYZ, Inc., Street address, City, State. The
manufacturer POC is [name] at [phone number]. The POC in this office is [name]
at Commercial [phone number] and DSN [phone number].
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