Petaluma Site Sample Submission - Infinity Laboratories

Company/Organization*
Phone Number*
Fax Number
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Name*
First Last

Storage Conditions
- Room Temperature
- 2 to 8°C
- ≤-20°C
Handling Requirements
- Not Hazardous
- Bio-Hazard
- Chemical Hazard
- Other
Include SDS/MSDS with samples if hazardous – a fee will apply for disposal of hazardous items.
If other, please specify
Sample Disposition
- Return
- Discard
All samples will be discarded after completion of test, unless otherwise indicated below
Carrier
Account
Special Instructions
Please use this section only for instructions related to special sample preparation, testing instructions, etc.
Purchase Order Number

Please include a copy of your PO with this form
Quote Number

Please include a copy of your Quote with this form
Authorized by*
Date*
MM slash DD slash YYYY

Petaluma Site
Sample Submission