AGLAE Association
Parc des Pyramides
427 rue des Bourreliers
59320 Hallennes lez Haubourdin - France
 +33 (0)3 20 16 91 40
contact@association-aglae.fr
www.association-aglae.fr
APPLICATION AND REGISTRATION FORM - AGLAE’S 2016 SCHEME
PLEASE COMPLETE THIS FORM BY COMPUTER
PRESENTATION OF YOUR LABORATORY
Name of your company:
Name of your laboratory:
Limited to 35 characters
Medical biology laboratory
Laboratory of an industry
Other, please specify:
Hospital
Food laboratory
Laboratory of the environment
Date the laboratory was created:
Number of employees carrying out the analyses:
Are you accredited:

ISO/IEC 17025?
Yes
If yes, for which scope?

ISO/IEC 15189?
Yes
No
In progress
No
In progress
Is your laboratory ‘officially approved’ by a third party (government approval, certification….)?
If yes, which one?
Yes
No
If you are neither accredited nor certified, how do you monitor (in a few words) the analytical performance of your
laboratory?
CONTACT DETAILS OF YOUR LABORATORY
Delivery address for the test materials:
ATTENTION: we do not wish deliveries in a P.O.box. This address should be the location of your laboratory.
Address:
Additional address:
Postal code - Town:
Country:
Tel:
@:
Limited to 35 characters per data field
If the invoice address is different, please specify it underneath:
Address:
Additional address:
P.O. box:
Postal code - Town:
Country:
Person in charge of "accounts payable":
Mr
Mrs
Miss
Name:
@:
tel:
European Union VAT number:
Necessary for laboratories within the European Union. Without it, the French VAT will apply.
Er-5-05-EN, Application and registration form
Issue No. 00, Revised on: 13/11/15 - PTS: 2016
Page 1 / 3
AGLAE Association
Parc des Pyramides
427 rue des Bourreliers
59320 Hallennes lez Haubourdin - France
 +33 (0)3 20 16 91 40
contact@association-aglae.fr
www.association-aglae.fr
OTHER INFORMATION
How did you hear about AGLAE?
Through web searches
Through events: workshop, show
Other, please specify:
Through third parties: ISO, EPTIS
By another laboratory
LIST OF PROGRAMMES REQUESTED
Find below the list of programmes conducted by AGLAE. These programmes are described on our website:
www.association-aglae.fr and in our catalogues available upon request.
Please tick the programmes you are interested in.
 A quote shall be sent upon receipt of this completed document.
The number of tests left and the transport fees will be taken into account.
Medical Biology
80 Cyto-bacteriology of urines
84 Coproculture
85 Blood culture
Base parameters and indicators in waters
Clean waters
1A Chemical analyses in clean waters
1Ab Chemical analyses in clean waters at low
concentration levels
1B Indicators in natural waters
1C Chlorophyll a and pheopigments index in natural
waters
1D Disinfection products in clean waters
1E Dissolved oxygen in clean waters
1G Dry residue in clean waters
50 Perchlorates and disinfection by-products in clean
waters
91 Odour and flavour in clean waters
Waste waters
2A Chemical analyses in waste waters
2B Indicators in waste waters
2C Indicators in waste waters at low concentration levels
Saline waters
6 Chemical analyses in saline waters
Carbogaseous waters
90 Chemical analysis in carbogaseous waters
Er-5-05-EN, Application and registration form
Issue No. 00, Revised on: 13/11/15 - PTS: 2016
Waters for medical use
83A Microbiology in waters similar to dialysis waters
83B Microbiology in waters similar to endoscope waters
86 Indicator germs in bacteriologically controlled waters
Microbiology in waters
11 Escherichia coli and intestinal enterococci by MPN
method
30 Microbiology in clean waters
31 Pseudomonas aeruginosa and pathogenic
staphylococci in clean waters
32 Legionella and Legionella pneumophila in clean waters
by culture
33 Legionella and Legionella pneumophila in waste
waters by culture
35 Legionella and Legionella pneumophila in clean waters
by PCR
36 Legionella and Legionella pneumophila in
waste waters by PCR
37 Salmonella in clean waters
Chemistry in solid matrices
9 Chemical analyses and metals in sediments
10 Organic micropollutants in sediments
40 Chemical analyses and metals in recoverable sewage
sludges
41 Organic micropollutants in recoverable sewage
sludges
43 Chemical analyses and metals in contaminated sites
and soils
44 Organic micropollutants in contaminated sites and
soils
51 Chemical analyses and metals in waste (leaching)
Page 2 / 3
AGLAE Association
Parc des Pyramides
427 rue des Bourreliers
59320 Hallennes lez Haubourdin - France
 +33 (0)3 20 16 91 40
contact@association-aglae.fr
www.association-aglae.fr
Metals in waters
3A Metals in clean waters
3B Metals in waste waters
3C Metals in flat natural mineral waters (bottled)
Organic pollutants in clean waters or in natural
waters
4C Volatile organohalogens and benzene derivatives in
clean waters
4Cb Volatile organohalogens and benzene derivatives in
clean waters at low concentration levels
20A Other Priority substances - Chlorophenols in
natural waters
21A Other Priority substances - Alkylphenols in natural
waters
22A Other Priority substances - Chloroanilines in natural
waters
23A Other Priority substances - Organotin compounds
in natural waters
24A Other Priority substances - Brominated Diphenyl
Ethers in natural waters
25A Other Priority substances - Biphenyl in natural
waters
26A Other Priority substances - Phthalates in natural
waters
27A Other Priority substances - C10-C13 chloroalkanes
(SCCPs) in natural waters
28A Other Priority substances - Chloroacetic acid in
natural waters
29A Other Priority substances - Epichlorohydrin in
natural waters
52 AOX in clean waters and in waste waters
54 Toxins of cyanobacteria in natural waters
55 Glyphosate, AMPA and Aminotriazole in clean
waters
57 Pharmaceuticals in natural waters
58 Bisphenol A in natural waters
59 Perfluorinated compounds in natural waters
64 PAHs and PCBs in clean waters
65 Pesticides and degradation residues in natural
waters
66 THMs in swimming pool waters
67 Acrylamide in natural waters
Indexes in waters
5A Global indexes in natural waters
5B Global indexes in waste waters
5C Total hydrocarbons index in natural waters and in
waste waters
Organic pollutants in waste waters
4E Volatile organohalogens and benzene derivatives in
waste waters
4Eb Volatile organohalogens and benzene derivatives in
waste water at low concentration levels
20B Other Priority substances - Chlorophenols in waste
waters
21B Other Priority substances - Alkylphenols in waste
waters
22B Other Priority substances - Chloroanilines in waste
waters
23B Other Priority substances - Organotin compounds
in waste waters
24B Other priority substances - Brominated Diphenyl
Ethers in waste waters
25B Other Priority substances - Biphenyl in waste
waters
26B Other Priority Substances - Phthalates in waste
waters
27B Other priority substances - C10-C13 chloroalkanes
(SCCPs) in waste waters
28B Other Priority Substances - Chloroacetic acid in
waste waters
29B Other Priority substances - Epichlorohydrin in
waste waters
52 AOX in clean waters and in waste waters
71 PAHs and PCBs in waste waters
72 Pesticides and degradation residues in waste waters
Biology and ecotoxicology
12 Hydrobiology
13 Ecotoxicology
16 Biological Diatom Index
34 Protozoans in clean waters
COMPLETION
Completed on the (date)
By (name)
in (town)
as (job position)
Please return it completed by email to: contact@association-aglae.fr
Note: information given in this document shall not be disclosed.
Er-5-05-EN, Application and registration form
Issue No. 00, Revised on: 13/11/15 - PTS: 2016
Page 3 / 3