OFFICE USE ONLY
DR
640 Airpark Road, Suite D
Napa CA, 94558
Lab (707) 224-7903 ext. 306 or 307
Fax (707) 255-2019
FC
COMP
TSR
RSH
Have you submitted samples to us in the past?
Yes
IF YES, PLEASE FILL OUT ONLY THE (**) MARKED INFORMATION FIELDS
No
IF NO, PLEASE FILL OUT THIS FORM COMPLETELY
BEER ANALYSIS REQUEST FORM
PLEASE LABEL EACH SUBMITTED SAMPLE WITH YOUR BREWERY NAME, SAMPLE NAME, AND SUBMISSION DATE
PLEASE FILL OUT THE REQUIRED INFORMATION ON BOTH SIDES OF THIS FORM AND SEND OR BRING WITH YOUR SAMPLES
MINIMUM ANALYSIS CHARGE: $25.00 FOR TRANSACTIONS PAYING BY CASH, CHECK, OR CREDIT CARD. $50.00 FOR NET 30 DAY TERMS
** ACCOUNT NAME (Responsible Party)
** NAME (Person requesting analysis)
ADDRESS:
CITY
STATE
** DAYTIME PHONE
ZIP
** FAX
** EMAIL
CREDIT CARD #
EXP DATE
NAME ON CARD
SIGNATURE
** SEND RESULTS TO (If different from above)
** PLEASE SEND RESULTS BY
FAX
circle choice(s)
ARE THESE SAMPLES
INVOLVED IN A LEGAL DISPUTE
BETWEEN TWO PARTIES?
circle choice
COMMENTS

YES
PLEASE CHECK ALL THAT
APPLY
NO
E-MAIL


MAIL
I am not sure which test to run (please write a note or call
our lab staff to discuss the sample)
Do only the tests I select
Other
Please write the corresponding letter of the analysis you would like performed after the sample name in the table below.
Please refer to our webpage (http://www.gusmerenterprises.com) or current catalog for instructions on preparing, sending in your samples, and volume of sample required.
LETTER(S) OF REQUESTED
ANALYSES
** SAMPLE NAME
LETTER(S) OF REQUESTED
ANALYSES
** SAMPLE NAME
1.
6.
2.
7.
3.
8.
4.
9.
5.
10.
ANALYSIS FOR COMMERCIAL BREWERS
For unlisted services, call us at (707) 224-7903
Panels
Test Code
Basic Beer Chemistry
Finished Beer
Export
Filterability 1 Grade
Filterability 2 Grades
Membrane Clogging Index
Mineral & Metal
Stability (Chill Haze)
BBC
FBP
EXP
FIL-1
FIL-2
MCI
HM
SP
Individual Test
A
B
CAL
CH
C
O
T
Alcohol
Bittering Units
Calories
Chill Haze (Rapid)
Color (SRM, EBC)
Free & Total SO2
Total Titratable Acidity (as Lactic)
CA
CU
FE
PB
MG
NA
ZN
Calcium
Copper
Iron
Lead
Magnesium
Sodium
Zinc
ME
MB
MY
MM
MD
MR
MQ
MP
MC
YCV
Minerals & Metals
Included Analysis
Alcohol, Extracts, pH, Color, Bittering Units
Alcohol, Extracts, pH, Color, Bittering Units, CO2, Air, Yeast, Mold , Bacteria
Please contact Lab for more information (707) 224-7903
Pre & Post NTU readings 1 Filter Grade, recommendation
Pre & Post NTU readings 2 Filter Grade, recommendation
Index value to determine if beer is ready for sterile filtration
Calcium, Copper, Iron, Sodium
Tannin, Protein Content, Recommendation
Sample
Size
Price
Each
2 (12 oz.)
2 (12 oz.)
TBD
$45.00
$60.00
TBD
$60.00
1 gal.
1 gal.
$100.00
3 (12 oz.) $40.00
50 mL
$50.00
2 (12 oz.) $35.00
50 mL
50 mL
$20.00
$35.00
$25.00
$35.00
$20.00
$25.00
$20.00
50
50
50
50
50
50
50
mL
mL
mL
mL
mL
mL
mL
$20.00
$20.00
$20.00
$20.00
$20.00
$20.00
$20.00
Microscopic Exam
50 mL
Bacteria
Yeast & Mold
50 mL
50 mL
Yeast, Mold & Bacteria
Dekkera/Brettanomyces
50 mL
50 mL
Wine Spoilage (Brettanomyces/Pediococcus/Acetobacter)
Bacteria Filter Membrane
50 mL
375 mL
Yeast & Mold Filter Membrane
Yeast, Mold & Bacteria Filter Membrane
Yeast Count Viability
375 mL
375 mL
100 mL
$25.00
$15.00
$20.00
$25.00
$15.00
$20.00
$25.00
$25.00
$40.00
$35.00
50 mL
50 mL
2 (12 oz.)
50 mL
50 mL
Microbiology Test
Exam
Direct Plating
Filter Plating
Yeast Count Viability