1.

Report To

Name, address, phone number, and fax number of the person who should receive "Report of Analysis".

2.

Invoice To

Name, address and phone number of the person or department to whom the invoice should be sent.

3.

Sample Description

Complete sample description (including quantity) and identification numbers as they should appear on your final "Report of Analysis".  Please include a description of the of the sample container or packaging.

4.

P.O. Number

A  P.O. Number is required for all testing.  Many clients issue standing P.O.'s for routine testing.

5.

Test Required

Specify all tests to be performed.

6.

Procedure Reference

Include procedure references.  Send written procedures unless Northview or compendial procedures are to be used.

7.

Expected Levels

List specifications for product attributes to be tested.  (This will alert us to notify you quickly of unanticipated results.)

8.

Safety & Storage

Special storage and safety information  NOTE: Hazardous samples must be accompanied by an MSDS or other adequate safety information.

9.

GLP Request

Some studies intended for submission to EPA and FDA must be performed in accordance with GLP regulations.  There is an additional charge for GLP treatment.  Please indicate if GLP treatment is required.

10.

Special Instructions

Information on preparation, handling or testing of samples, report format, report or invoice copies etc.

11.

Need Results Date

If you need your test results by a certain date, indicate the date on your Request for Analysis. If we cannot meet your target date and/or if a rush surcharge is applicable, we will call you.

12.

Disposition of Samples

Indicate whether samples should be returned or discarded.  We reserve the right to return any samples.  NOTE:  Unless you request otherwise, all non-hazardous, non-GLP samples are discarded within 30 days after a report is issued.

13.

Signature/Date:

Please sign and date the Request For Analysis form.