Sample Sumbissions Form

Please enter details in the fields below:
Note: (*) denotes required fields.
Client Order Number:
 Client Project:
Client Name: (*)
Consignment Details:
Dispatched By: (*) From:
Consignment Note/Air Way Bill: No. Packages:
No. of Samples: Sample Weight:
 
Sample Types: and
Results To: Copy of Results To:
Name: (*) Name:
Address: (*) Address:
Fax Number: Fax Number:
Email: Email:
Invoice To:
Name: (*) Address: (*)
Turnaround: Hazardous Samples:
Routine Priority Hazardous Non Hazardous
Date Required: Describe Hazardous Sample:
Sample Analysis Requirements:

To send a detailed sample number and/or analysis information as an email attachment, click here to email GENALYSIS , otherwise enter the details into the fields below.


First Sample Number Last Sample Number Quantity Samples Elements (Detection Limits) Method of Analysis Instrumental Finish
 
Preparation Required/Special Instructions
Sample Disposal:
Hold for months, then dispose pulp bulk
Hold for months, then return pulp bulk
Other (please specify)
Submitted To:
Perth
Gate 6 16 Davison St.
Maddington
Western Australia
6109
PH: (618) 9251 8100
FAX: (618) 9251 8160
 Kalgoorlie
12 Keogh Way
Kalgoorlie
Western Australia
6430
PH: (618) 9021 6057
FAX: (618) 9021 3476
 Adelaide
11 Senna Road
Wingfield
South Australia
5013
PH: (618) 8162 9714
FAX: (618) 8349 7444
 Johannesburg
43 Malcolm Moodie Crescent
Jet Park, Gauteng
South Africa
1459
PH: +27 11 552 8149
FAX: +27 11 552 8248
Submitted By:
Name: (*)
Email: Date: