Contact@Nordwestlabs.

com

Sample Submission Form

Shipment Info:

Carrier: Tracking Number: # of package: # of samples:

Proforma # Project name / number:

Waybill Instructions
Please fill the waybill form using the below instructions:
Please declare the materials as Geological Samples for Research and do not mention soil. Value for
Customs: Nominal Fee (CDN$5.00)

Sample Drop off address:

Nordwest Geochemical Consulting, Suite # 165
2-558 Upper Gage Avenue
Hamilton, ON L8V 4J6, Canada
EMail: Contact@NordwestLabs.com
Tel: +1 (365)-228-3949

Client Info:

Company: Laboratorio Metalurgico Chapi SAC Submitted by: Maria Pecho Ancasi

Attn: Email: info@laboratoriometalurgico.com

Adress: Calle Las Magnolias Mz ¨J¨, Lt- 16-Urb. Papa Leon XIII, Lima- Cañete- Chilca – Perú
Payment Info:
Payment will be done through wire transfer; instructions for payment will be provided.

Payment will be done by credit card; credit card information form will be sent.

Authorized by:

Invoice Info:

This project has been authorized by: based on quote #

with purchase order number .

Invoice to be sent to the attention of .

Signature:
 Contact@Nordwestlabs.com

Sample Submission Form

Instruction for isotopic test/geochronology:

Rock type:

Suspected geological era: Minerals to be separated:

Required test:

Sample Name # of fractions Sample Instructions

M1- SULF9 2 Concentrated - Tail P80 ≈ 165microns

M2-SULF9 2 Concentrated - Tail P80 ≈ 165microns
M3-SULF9 2 Concentrated - Tail P80 ≈ 165microns
M4-SULF8 2 Concentrated - Tail P80 ≈ 165microns
M5-SULF10 2 Concentrated - Tail P80 ≈ 165microns
M6-SULF10 2 Concentrated - Tail P80 ≈ 165microns
M7-SULF10 2 Concentrated - Tail P80 ≈ 165microns
BLENDING1 2 Concentrated - Tail P80 ≈ 165microns
BLENDING2 2 Concentrated - Tail P80 ≈ 165microns
Concentrated - Tail
M2 2 Concentrated - Tail P80 ≈ 165microns
M3 2 Concentrated - Tail P80 ≈ 165microns
Concentrated - Tail
M5 2 Concentrated - Tail P80 ≈ 165microns
M6 2 Concentrated - Tail P80 ≈ 165microns
 M8 2 Concentrated - Tail P80 ≈ 165microns
M9 2 Concentrated - Tail P80 ≈ 165microns
M10 2 Concentrated - Tail P80 ≈ 165microns
M11 2 Concentrated - Tail P80 ≈ 165microns
M12 2 Concentrated - Tail P80 ≈ 165microns
M13 2 Concentrated - Tail P80 ≈ 165microns
M14 2 Concentrated - Tail P80 ≈ 165microns
M15 2 Concentrated - Tail P80 ≈ 165microns
M16 2 Concentrated - Tail P80 ≈ 165microns
M17 2 Concentrated - Tail P80 ≈ 165microns
M18 2 Concentrated - Tail P80 ≈ 165microns
M19 2 Concentrated - Tail P80 ≈ 165microns

Instruction for Mineralogy/Geochrmistry

Project name: 2230LM- MARCOBRE Sample type:

Required test: QEMSCAN – PMA

Minerals of interest to be focused on: