SAMPLE ANALYSIS REQUEST FORM (SARF) - BASIC Please type into this form, save and e-mail back to [email protected] Company Name* Company address Company account no. Account to* (Company / Dept.) Department Your request number Order number* (if required) Direct contact number Requested by* Submitted on (yyyy/mm/dd)* Report e-mail address* Total no. samples submitted* Report e-mail address* Total no. of pages All fields marked with *, are mandatory and MUST be completed. Samples cannot be analysed if any of this information is omitted. Please note that all samples indicated on one SARF will be reflected on one Certificate of Analysis (COA) Product Description* Please note that the information indicated on this form, is what will appear on the Micro report. Therefore, please ensure that all the relevant details to be reflected on the Micro report is supplied and indicated on this form. Special request / Other sample information Test Date (yyyy/mm/dd)* Test Category Analysis Required (click in box to select) Total Microbial Activity (TMA) Salmonella Staphylococcus aureus Salmonella - VIDAS SLM Method Escherichia coli Vibrio Coliforms Enterobacteriaceae Clostridium perfringens Listeria spp (ISO 11290-1) present/absent Pseudomonas species Listeria monocytogenes (ISO 11290 -1 ) present/absent Bacillus cereus Listeria monocytogenes enumeration (ISO 11290 - 2) Lactobacillus spp Listeria monocytogenes: AFNOR method (present/absent) Yeast & Mould Listeria spp & Listeria mono (present/absent) - VIDAS LDUO Method Lactic acid bacteria (including aerobic & anaerobic bacteria) Campylobacter (present/absent) - VIDAS CAM Method Other Test Please note that the information indicated on this form, is what will appear on the Micro report. Therefore, please ensure that all the relevant details to be reflected on the Micro report is supplied and indicated on this form. Confidential 2013/07/01 Page 1 SAMPLE ANALYSIS REQUEST FORM (SARF) - BASIC Please type into this form, save and e-mail back to [email protected] All fields marked with *, are mandatory and MUST be completed. Samples cannot be analysed if any of this information is omitted. Please note that all samples indicated on one SARF will be reflected on one Certificate of Analysis (COA) Product Description* Please note that the information indicated on this form, is what will appear on the Micro report. Therefore, please ensure that all the relevant details to be reflected on the Micro report is supplied and indicated on this form. Special request / Other sample information Test Date (yyyy/mm/dd)* Test Category Analysis Required (click in box to select) Total Microbial Activity (TMA) Salmonella Staphylococcus aureus Salmonella - VIDAS SLM Method Escherichia coli Vibrio Coliforms Enterobacteriaceae Clostridium perfringens Listeria spp (ISO 11290-1) present/absent Pseudomonas species Listeria monocytogenes (ISO 11290 -1 ) present/absent Bacillus cereus Listeria monocytogenes enumeration (ISO 11290 - 2) Lactobacillus spp Listeria monocytogenes: AFNOR method (present/absent) Yeast & Mould Listeria spp & Listeria mono (present/absent) - VIDAS LDUO Method Lactic acid bacteria (including aerobic & anaerobic bacteria) Campylobacter (present/absent) - VIDAS CAM Method Other Test Product Description* Please note that the information indicated on this form, is what will appear on the Micro report. Therefore, please ensure that all the relevant details to be reflected on the Micro report is supplied and indicated on this form. Special request / Other sample information Test Date (yyyy/mm/dd)* Test Category Analysis Required (click in box to select) Total Microbial Activity (TMA) Salmonella Staphylococcus aureus Salmonella - VIDAS SLM Method Escherichia coli Vibrio Coliforms Enterobacteriaceae Clostridium perfringens Listeria spp (ISO 11290-1) present/absent Pseudomonas species Listeria monocytogenes (ISO 11290 -1 ) present/absent Bacillus cereus Listeria monocytogenes enumeration (ISO 11290 - 2) Lactobacillus spp Listeria monocytogenes: AFNOR method (present/absent) Yeast & Mould Listeria spp & Listeria mono (present/absent) - VIDAS LDUO Method Lactic acid bacteria (including aerobic & anaerobic bacteria) Campylobacter (present/absent) - VIDAS CAM Method Other Test Please note that the information indicated on this form, is what will appear on the Micro report. Therefore, please ensure that all the relevant details to be reflected on the Micro report is supplied and indicated on this form. Confidential 2013/07/01 Page 2 SAMPLE ANALYSIS REQUEST FORM (SARF) - BASIC Please type into this form, save and e-mail back to [email protected] All fields marked with *, are mandatory and MUST be completed. Samples cannot be analysed if any of this information is omitted. Please note that all samples indicated on one SARF will be reflected on one Certificate of Analysis (COA) Product Description* Please note that the information indicated on this form, is what will appear on the Micro report. Therefore, please ensure that all the relevant details to be reflected on the Micro report is supplied and indicated on this form. Special request / Other sample information Test Date (yyyy/mm/dd)* Test Category Analysis Required (click in box to select) Total Microbial Activity (TMA) Salmonella Staphylococcus aureus Salmonella - VIDAS SLM Method Escherichia coli Vibrio Coliforms Enterobacteriaceae Clostridium perfringens Listeria spp (ISO 11290-1) present/absent Pseudomonas species Listeria monocytogenes (ISO 11290 -1 ) present/absent Bacillus cereus Listeria monocytogenes enumeration (ISO 11290 - 2) Lactobacillus spp Listeria monocytogenes: AFNOR method (present/absent) Yeast & Mould Listeria spp & Listeria mono (present/absent) - VIDAS LDUO Method Lactic acid bacteria (including aerobic & anaerobic bacteria) Campylobacter (present/absent) - VIDAS CAM Method Other Test Product Description* Please note that the information indicated on this form, is what will appear on the Micro report. Therefore, please ensure that all the relevant details to be reflected on the Micro report is supplied and indicated on this form. Special request / Other sample information Test Date (yyyy/mm/dd)* Test Category Analysis Required (click in box to select) Total Microbial Activity (TMA) Salmonella Staphylococcus aureus Salmonella - VIDAS SLM Method Escherichia coli Vibrio Coliforms Enterobacteriaceae Clostridium perfringens Listeria spp (ISO 11290-1) present/absent Pseudomonas species Listeria monocytogenes (ISO 11290 -1 ) present/absent Bacillus cereus Listeria monocytogenes enumeration (ISO 11290 - 2) Lactobacillus spp Listeria monocytogenes: AFNOR method (present/absent) Yeast & Mould Listeria spp & Listeria mono (present/absent) - VIDAS LDUO Method Lactic acid bacteria (including aerobic & anaerobic bacteria) Campylobacter (present/absent) - VIDAS CAM Method Other Test Please note that the information indicated on this form, is what will appear on the Micro report. Therefore, please ensure that all the relevant details to be reflected on the Micro report is supplied and indicated on this form. Confidential 2013/07/01 Page 3