Samples Received
(Date & Time):
Currier: DHL FedEx UPS
Samples/PO Received
(Date & Time):
Samples Returned
(Date & Time):
MSDS INCLUDED:
YES / NO
USPS Walk-In
Other:
Sample Storage:
Other:
By:
Freezer
Lab
Refrigerator
By:
By:
Hazardous Samples:
YES / NO
DUE DATE:
Return Samples:
YES / NO
Return Cooler:
YES / NO
PCL PROJECT #:
For PCL Office Use Only
Sample Submission Form
Particle
Characterization Laboratories, Inc.
PLEASE SIGN FORM AND INCLUDE YOUR PURCHASE ORDER OR PROCARD NUMBER WITH SAMPLES
COMPANY:
Invoice Contact:
Shipping Instructions
Address:
Please ship samples to:
Particle Characterization Laboratories, Inc.
845 Olive Avenue
Novato, CA 94945
Phone (415) 893-1113; Fax (415) 893-893-0132
City, State, ZIP:
E-mail:
Phone:
Important: Please ship via. FedEx, UPS, DHL, California Overnight, or
other carrier that allows for electronic tracking of the package. Please email us the tracking number at [email protected].
Fax:
Quote#:
(if applicable)
PO/Credit Card#:
Signature:
Card Exp. Date:
Card Signature:
Required
Special Invoice Instructions
Sample Processing Information
SAMPLE
PRIORITY
STATUS
Return
Samples?
Standard
(e-mail data within 5 business days)
Rush not available for all analyses
Please call to inquire
100% Rush / 100% Surcharge
(e-mail data within 3 business days)
cGLP / 100% Surcharge
(e-mail data within 10 business days)
YES*
NO
Hardcopies of data will be FedEx Priority Overnight
Additional $35 min. fee (FedEx Ground)
*MSDS Required for Hazardous samples–additional shipping charges may apply
Sample Information
SAMPLE TYPE
SAMPLE ID#
# of
SAMPLES
ANALYSIS REQUESTED
CLASSIFICATION:
Normal
Hazardous*
(MSDS Required)
STORAGE:
Ambient
Refrigerator
Freezer
Light Sensitive
PLEASE INCLUDE MSDS WITH SAMPLES WHEN POSSIBLE
By submitting samples to PCL you (the client) agree to the terms of payment for services provided, including additional charges and legal fees for late payment or nonpayment. In no event shall PCL be liable to the client for any indirect, special or consequential damages or lost profits arising out of or related to services performed or to
be performed by PCL as described herein. PCL’s liability to the client hereunder, if any, shall in not exceed the total amount paid to PCL. The agreement between PCL
and the client shall be deemed to have been performed in its entirety in the State of California and shall be interpreted in accordance with the laws of the State of California.