Sample Submittal Form

Internal Use Only

Company Name:
Submitted by:

Date Received:

Courier/Waybill:

Workorder No:

Telephone:

Client Code:

# Containers:

Quote:

Date Shipped:

Template:

PO Number:

Standard Project:

Commodity:

Proyecto Stgo Metals P-430

Ore

Slidos

Special Instructions:
Sample Type:

Rock

Pulp

Soil

Sediment

Percussion
Drill Core

Trace

Other Lixiviacin

Results to
Name:

Sample Return
Pulps

Invoice

Email:

Address:
City:

Country:

Certificate

Return after analysis

Return after analysis

Data File

Return after 90 days

Return after 45 days

Discard

Discard

Paid Storage

Paid Storage

QC Certificate

State:

Zip:

Webtrieve Only

Webtrieve Only

Copy to
Name:

Certificate

Email:

Rejects

Failure to indicate pulp & reject instructions will result in

disposal without notice

Return Address:

Data File

Webtrieve Only

Copy to
Name:

Certificate

Email:

Attention:

Data File

Authorized By:
Name:
Signature:

Samples ID's

Sample Preparation
Required
(Prep Code)

(Elements or Method Code)

Premium Service

TAC
T

TH
CON E LAB
TO
F
AVA IRM
ILA
BIL
IT Y

Finish No.

Check here for

Rush

Analytical

CO N

Start No.

Quantity

(Please Print)

Total Samples

Print

Reset Form