Issue No.

: 001
Technical Procedure
Issue Date: 1/02/2022
ISO 17025:2017 Revision No.: 000
TP-7.01-01 Revision Date: --
Copy No. ( ) Review of requests, tenders
Page
and contracts
Appendix 1
A request of sample analysis
Date: / /
Sample Name: ....................................................................................................
Sample B.N#: ………………………………………….
Quantity: …………………………………………………
Man. Date: ……………………. Exp. Date: ………………………

Required Tests:
Date/Time of
SN Required Test Notes
Result

*Supplier certificate of analysis (raw materials)? Yes No

*Sample accepted? Yes No
*Anomalies and deviation of sample from specs (in case of sample rejection)
....................................................................................................................................
*Is there any other requirements? Yes No
....................................................................................................................................

Lab Manager:
Signature:
…………………………...
F 7.01-01/01