SAMPLE SUBMISSION FORM
advertisement
Sample Submission Form Chain of Custody Include the following in the package with the samples: 1. A completely filled out Sample Submission Form. A Client provided sample package list can used as replacement to this form if we already have a contract or billing information. 2. Sample Information such as porosity and well information. 3. Quote for services if applicable. (Failure to comply with these instructions will result in a delay of sample analysis) Customer Contact Information Customer Name: Company Name: Address: City, State, Zip Code: Phone Number: Email Address(s) for Results: Ship To Bill To Payment Information (Hard Copy of PO or credit card information is required prior to releasing results) Purchase Order # or Credit Card #: Contact person for purchase orders or Name on credit card: Expiration Date: Security Code: Type of Card: Provide E-mail for CC holder or PO contact for Invoicing: Type of Service Surcharge Price Normal (typically 14 working days) List Price Priority (4-7 working days) List + 50% Would you like your samples returned to you? Yes No Shipping Account Number If no shipping account is provided and the samples are to be returned, a $50 shipping and handling fee will be added to the invoice for each project. Sample Information and Analysis Conditions Sample Description (e.g. cuttings, core samples, shale) Do you need the samples cleaned (soxhlet or Dean Stark extraction)? Yes No Do you require any sample crushing before analysis? Yes No Would you like us to contact you before starting the analysis? All samples will be analyzed using our Standard Operating Procedure (SOP). If you have a special analysis condition that you would like us to follow please identify that here Yes No Customer Sample ID’s (List individually) Starting Depth End Depth Sample Analysis Information Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD PoroTechnology Attn: Ben Harrell ♦ 201 Kingwood Medical Drive Suite B300 ♦ Kingwood, TX ♦ 77339 ben@porotechnology.com ♦ www.porotechnology.com ♦ phone 832-412-9520 ♦ fax 832-412-9523 Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Sample Submission Form Chain of Custody Results will be sent electronically in excel format to all email addresses listed above. Customer Sample ID’s (List individually) Depth End Depth Sample Analysis Information Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage XRD Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Drainage and Imbibition Gas Adsorption Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD Bulk Density Micropore PSD PoroTechnology Attn: Ben Harrell ♦ 201 Kingwood Medical Drive Suite B300 ♦ Kingwood, TX ♦ 77339 ben@porotechnology.com ♦ www.porotechnology.com ♦ phone 832-412-9520 ♦ fax 832-412-9523 Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM Other SEM
