Rev 0.1 - 02/06/14
FC-04-04-00-01a
Chemical Analysis
Request Form: Water
Client information
T0349
This form may be completed on your PC, or printed and completed by hand
Client Name
Address
Tel no
Town
Email
Zip Code
Order no
Special Requests
Sample labeled
Date
Sample sealed
Signature
Requests
Lab #
Click inside the relevant blocks to select the tests you require
Sample ID
Analysis
1
2
3
4
5
Type of Water
6
7
8
Test Description: Type of Test
1: Chemical Analysis
pH, EC, Ca, Mg, K, Fe*, Cl, SO4, CO3*, HCO3*, B*, NO3-N, Cu, Zn, Mn, P*, NH4-N, Na, F, TDS*
*2: Heavy Metals
Cd, Cr, Hg, As, Pb
3: Drinking Water
EC, pH, TDS*, Turbidity*, NH4-N, Ca, Cl, F, Mg, NO3-N, K, Na, SO4, Zn, Al*, Sb*, As*, Cd*, Cr*, CN*, Co*, Fe, Pb*, Mn, Hg*, Ni*, Se*,
V*, Cu
4: Irrigation Water
pH, EC, Na, K, Ca, Mg, Fe, Cl, SO4, CO3*, HCO3*, B, NAV*, Langelier*
5: Effluent Water Package 1:
NO3-N, NO2-N*, SS*, NH4-N, pH, EC, COD
6: Effluent Water Package 2
pH, EC, K, Ca, Na, NAV (SAR)*, SS*
7: Effluent Water Package 3
Effluent Water Package 2 + COD
8: Global Gap
Chemical Analysis, *Heavy Metals, TMA, Coliforms, E. Coli
28 Hoofweg | Wellington | 7655 | PO Box 813, Wellington, 7654
*Not SANAS accredited
www.wynlandlab.co.za | [email protected] | Tel: (+27) 21 873 3514 | Fax: (+27) 21 873 3515