LABORATORY SERVICES REQUEST FORM
FOOD CHEMISTRY SAMPLE SUBMISSION
ESR0805
vers 4.0 March 2020
SAMPLE 1 SAMPLE 2 SAMPLE 3 SAMPLE 4
SAMPLE ID
SAMPLE MATRIX
DESCRIPTION AND
FURTHER INFORMATION
SAMPLE INFORMATION
REQUIRED ON REPORT
Write TEST NAME below
& reporting units required
ANALYTICAL TESTS REQUIRED
www.esr.cri.nz
INSTITUTE OF ENVIRONMENTAL SCIENCE AND RESEARCH LIMITED
Christchurch Science Centre: 27 Creyke Road, Ilam, Christchurch 8041 | PO Box 29181, Christchurch 8540, New Zealand
T: +64 3 351 6019 E: chemistry@esr.cri.nz F: +64 3 351 0010
SAMPLE 5 SAMPLE 6 SAMPLE 7 SAMPLE 8
SAMPLE ID
SAMPLE MATRIX
DESCRIPTION AND
FURTHER INFORMATION
SAMPLE INFORMATION
REQUIRED ON REPORT
Write TEST NAME below
& reporting units required
ANALYTICAL TESTS REQUIRED
RESET FORM
BUSINESS NAME AND ADDRESS FOR REPORTING
FURTHER COMMENTS/INSTRUCTIONS
Extra report copy to:
Contact name:
Address:
Name
INVOICE TO (if different from reporting address)
Address:
Email: Phone:
Name:
Contact:
Purchase order number:
Email:
INSTRUCTIONS FOR USING FILLABLE FORMS: In Acrobat
Reader DC, please complete this form, then ‘SAVE AS PDF’ to
your hard drive. Email to chemistry@esr.cri.nz
Print out your form and send to ESR with your sample(s).
Samples sent to: Attention: Food Chemistry Laboratory, ESR, Christchurch Science Centre, 27 Creyke Road, Ilam, Christchurch 8041
SEND SAMPLES TO:
DATE SAMPLES SENT TO ESR
TURNAROUND TIME
Standard < 15 working days
Urgent 2–3 working days
(100% premium on price)
Fast < 8 working days (50% premuim on price)
If fast or urgent, please contact laboratory to check availability
Other
Using Acrobat Reader DC, SAVE AS pdf with a new name and email this request form to: chemistry@esr.cri.nz
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