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NACT506.2M As Received Sample Analysis Request Form
st
Effective from 1 July 2014 - Payment is required before report is issued
Admin to fill in details
Pricing Guide- Please select service required
Prices are subject to change without
notice
•Prices are for homogenous samples
only (no soils or dusts)
•Prices and turnaround for 10+
samples to be agreed with Laboratory
Manager
IF MAILING: Turnaround starts from
date samples are received
Business Clients
Cost (includes GST)
 5 business days turnaround
 2 business days turnaround
 Next business day turnaround
 Same business day turnaround
(please check with lab)
$132.00
$44.00
$154.00
$66.00
$176.00
$88.00
1st sample
Each additional sample
1st sample
Each additional sample
1st sample
Each additional sample
$220.00 1st sample
$132.00 Each additional sample
Purchase Order Number:
(Please also attach sheet)
Payment Details:
Our Fee: $
Agreed To By Client:
incl GST
NAA Approved By:
Total No. of Samples: _______
Report due:
/
/ 20
 Exact Cash Credit card:  Visa  MasterCard TAX INVOICE REQUIRE 
Payment Method:
Card Holders Name:
Card Expiry Date:
Card Number :
Business ABN:
CCV Number:
Payment Processed Date:
(Required for tax invoice)
Contact information: Please attach your business card then complete those fields not provided on your card
Date:
/
/20
Client/Business Name:
Report Attention to:
Postal Address :
Client to fill in details
Post Code:
Email Address for report:
Phone / Mobile/ Fax:
 Email Mail  Fax &  Phone Call
Send Report by:
Sample Details:
 As Above or please specify below
Street/Site Address:
Post Code:
Specific Sample Location:
(eg. Bathroom Floor)
1.
5.
2.
6.
3.
7.
4.
8.
Laboratory Use Only:
Day, Date Received:
Client No:
Analyst
Name
Initial
Job No:
Approved Signatory
Date
Name
Initial
Date
BSA Box:
Phone Msg
Result to Client
Name
Initial
Date
 Email Mail
 Fax
Prepared
SEE OVERPAGE FOR RECOMMENDATIONS FOR SAMPLE COLLECTION
CONTROLLED DOCUMENT
Issue No. 7M
Issue Date: July 2014
Authorised By: Jessica Brunner
Page 1 of 2
I:\Quality Management System\Business Quality Manual\Business Management Quality System\Forms\Word versions\NACT506.2M As Received Sample Analysis
Request Form V7.doc
NACT506.2M As Received Sample Analysis Request Form
When taking samples, we recommend:

Wearing a P2 dust mask and disposable gloves; these can usually be purchased from hardware stores;

Sampling at edges where material may already be loose, to minimise disturbance;

Dampening down the material with fine mist water spray to minimise fibre release;

Collecting a 2 inch square quantity only. (Samples smaller than this may not be sufficient for our analysts to make a
determination; samples larger than this pose shipping, handling and storage problems and cost.)

Collecting each sample into a separate, labelled clip-lock clear plastic bag for accurate identification;

Placing all samples into a second group clip-lock clear plastic bag;

Delivering samples to our laboratory/ sending via courier to avoid potentially dangerous goods in the mail.

Including the filled out request form with the samples, and

Addressing the package attention to ‘Laboratory’, so the package is not opened outside of laboratory conditions.
PLEASE NOTE: Samples received that do not conform with the above conditions will not be accepted or analysed.
Examples of unacceptable practices are bare samples, samples in shopping bags, samples in envelopes, large samples in
builders’ plastic or asbestos waste bags.
Laboratory Address:
Level 1 / 677
High Street
Kew East Vic 3102
If you’ve any queries, please feel to free to call our Laboratory Manager on (03) 9896 8761
.
CONTROLLED DOCUMENT
Issue No. 7M
Issue Date: July 2014
Authorised By: Jessica Brunner
Page 2 of 2
I:\Quality Management System\Business Quality Manual\Business Management Quality System\Forms\Word versions\NACT506.2M As Received Sample Analysis
Request Form V7.doc