Lab Req. – BV Url Bureau Veritas Minerals Analysis Request Form Date SUBMITTED BY Bureau Veritas Laboratory Address Select Lab * Select Lab CA -VANCOUVER – 9050 Shaughnessy St. V6P 6E5 CA – WHITEHORSE – 77 Colins Lane Lot 53, Y1A 0A8 Project Name * Email * Quote Number Phone Number Shipment ID PO# ANALYSIS REQUIREMENTSSample Type Sample Type1 Sample Type2 Sample Type3 Sample Type4 Sample Type5 Sample Type6 Sample Type7 Sample Type8 Quantity Quantity1 Quantity2 Quantity3 Quantity4 Quantity5 Quantity6 Quantity7 Quantity8 Sample Sequence Sample Seq1 Sample Seq2 Sample Seq3 Sample Seq4 Sample Seq5 Sample Seq6 Sample Seq7 Sample Seq8 Prep Code prpcode1 prpcode2 prpcode3 prpcode4 prpcode5 prpcode6 prpcode7 prpcode8 Analytical Package package1 package2 package3 package4 package5 package6 package7 package8 SAMPLE STORAGE & DISPOSAL (Below section MUST be filled in BEFORE any prep or analysis will begin)REJECTS (Rock and core) Rejects Return immediately after analysis Return after 60 days at cost Paid disposal after 60 days Paid storage after 60 days Pick up RJSV (Soil, till, sediment, vegetation) PULPS (All samples) Pulp Return immediately after analysis Return after 90 days at cost Paid disposal after 90 days Paid storage after 90 days Pick up RUSH SERVICE Rush Request (Contact lab for pricing and availability PRIOR to submission) Special Instructions ADDITIONAL COPIESName Name Name Name Name Company Company Company Company Company Email Email Email Email Email
