CHAIN OF CUSTODY -
Analysis Request
Request for R&D or QA/QC Testing of Raw
Material, Intermediate and Finished Products
Date Shipped: __________ P.O. No.________________________
Raw Material[
], Intermediate [
], Finished Prod.
[ ]
From:_____________________________________Address:_____________________________________
______________________________________________________________________________________
Telephone / Fax /
E-Mail:______________/_____________/__________________Contact:_______________
Sample
Description:______________________________________________________________________
Lot
Nos.:_______________________________________________________________________________
Sampled By:________________________Date
Sampled:__________ Total No. of Containers Sampled:____
Container Nos.
____________________________________________________ Composite
Yes [ ]
No [ ]
Requested By:
________________________________Date:________ Turn Around:
Critical [
] Rush [
]
|
Test |
Method |
Reqstd √ |
Comments |
|
HPLC [ ] LC/MS[ ] GC [
] GC/MS [ ]
Assay |
|
|
|
|
Product Fingerprint by
LC/MS
|
|||
|
Pesticide Multi-residue
Screen |
|||
|
Heavy Metals
Method II USP or ICP |
|
|
|
|
Microbiological Profile |
USP |
|
|
| Tests: USP[ ] AOAC[ ] FCC[ ] FDA[ ]; EU [ ]; WHO [ ]; OECD [ ] | |||
|
Test All Label Components |
|
|
|
|
Other: |
|
|
|
Guidelines: FDA[ ] EPA [ ] OECD [ ] WHO [ ] Other:
Comments:_____________________________________________________________________________
Sample received at ADPEN by: __________________________
Date:_____________
Condition/Observations: ___________________________________________________
Completed Chain of Custody must accompany samples.
Please include product or raw material specs.