Sample Submission form

PG-09 All. 3

Include the following form and MSDS in the package with the samples
Failure to comply with these instructions will result in a delay of sample analysis

Alfatestlab quotation ID
Enter your contact information for report delivery and post analysis support:

Name/Surname Company

Email Phone number

Shipping temperature Ambient 2-8°C -20°C -80°C

Conservation temperature Ambient 2-8°C -20°C Other

Sample name Chemical nature Analysis required

chemical name (if Available) please enter the code on quotation

For more samples please fill in 2 or more submission forms

Additional information (specifications, method, scope of study, sample characteristics, analysis suggestions, etc.)

Report language Italian English

Report delivery Standard 10 days Priority 2-4 days (+40% on quote)*
Report type Standard Custom* [Extra fee] .......................
* To be agreed in advance with Alfatestlab

Alfatestlab Registration section [to be filled by Alfatestlab personel only]

Sample compliance Compliant Conditionally accepted Rejected Other

ID Request: Date: Sign:

Notes:

Via Firenze, 30/A info@alfatestlab.com www.alfatestlab.com

20063 Cernusco sul Naviglio (MI) Italy +39 02 6129 4602 +39 02 8496 1204