Specializing in Quality, Safety and Nutritional Content Analyses
Address packages(s) to:
1375 Van Dyke Avenue, San Francisco, CA 94124 USA
Phone: (415) 822-1100 / Fax: (415) 822-6615
ATTN: Lab Sample for Analysis
Please complete this form, excluding shaded areas, and enclose it with your sample. Enter full contact info below or attach your
business card. Keep a copy for your records.
Anresco File #:
City, State, Zip:
SAMPLE DESCRIPTION AND ANALYSIS REQUIRED
On the left side below, please provide a description of your sample(s). On the corresponding line to the right, list analysis(es) to be performed. Note any special instructions at the bottom of this form.
Include brand/label, size/weight, storage condition, packaging
SERVICE TYPE (check the applicable box)
Routine turnaround (ranges from 10-15 days) is the default.
If sample is received before 10:30 am, Day 1 of the turnaround
All rush services must be preapproved. Rates may not apply to all analysis. Please contact your representative.
will start the same day. Otherwise, Day 1 will begin the following
5 Day TAT (50% surcharge)
3 Day TAT (100% surcharge)
2 Day TAT (200% surcharge)
Next Day (300% surcharge)
Check here if you want your sample to be returned to you (if any is remaining and at your expense) or if you wish to pick up (no charge). Otherwise, please be advised that all samples will be disposed of at a
minimum of 30 days after reporting results; perishable samples will be retained for a minimum of 5 working days.
Check here if sample is hazardous material. Hazardous material samples will be accepted for analysis under the condition that if any is remaining, it may be returned to customer. A return fee and/or
disposal charge will be added to the analysis fee (minimum charge $50.00).
Date Approved: 05/13/16
Approved by: NgaLy Frank
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