ACSES - Analysis

University of Alberta
A C S E S

Analysis Request Form

Company: Department:

Person requesting analyses Title:

Shipping address *NO P.O. BOXES* :

Telephone number: Facsimile number:

Electronic mail address:

Invoicing address:

Your purchase order number:
Results will not be released until
purchase order number is received

Turnaround requested:

Normal
(Results generally within 14
days of sample receipt)

72 hour
50% Surcharge
(minimum verbal report within
three business days of sample receipt)

24 hour
100% Surcharge
(minimum verbal report within
one business day of sample receipt)

Describe the problem:

Analyses required (if known):

Sample description:

Discard sample(s) after analyses?:

Yes

Return sample(s) after analyses:

Yes*
*$10.00 CAD for Canadian shipments
will be added to invoice

Report format:

Hard Copy

Facsimile

Electronic Mail

Floppy Disk *
*$2.00 CAD will be added to invoice

Compact Disk by Courier *
*$10.00 CAD will be added to invoice

Sample submission guidelines:

1. Samples and area(s) of analysis should be clearly marked and labeled

2. Samples should be clean (i.e. free of finger prints, dirt, debris), and wrapped separately

3. A surcharge of $25.00 CAD will be levied when obvious dangerous/hazardous goods arrive in our facility without the appropriate Dangerous Goods Declaration and MSDS

Your name: Date:

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