WATERLAB (PTY) LTD

CLIENT INFORMATION

DATE
CONTACT PERSON
POSTAL ADDRESS / COMPANY
ORDER NUMBER
VAT REG NUMBER
TELEPHONE NUMBER
FAX NUMBER
CELLPHONE NUMBER
E-MAIL
PLEASE SELECT METHOD/S BY WHICH REPORT AND INVOICE SHOULD BE SEND:
E-MAIL / FAX / MAIL / COLLECT BY HAND
REPORT:
INVOICE:
CHEMICAL ANALYSES REQUIRED:
PLEASE SUPPLY ANALYTICAL REQUIREMENTS OR INDICATE ON ATTACHED LIST
Number of samples:
Sample Type/description (ex.: potable, sewage, environmental)
Sample volume sufficient: / Y / N / Details:
Numbered correctly: / Y / N / Details:
Samples received by: / Signature:
Processed and logged by: / Signature:
Additional Comments:

PAYMENT POLICY

COD CLIENTS: WHEN ANALYSES ARE COMPLETED, THE CLIENT WILL BE NOTIFIED THEREOF. RESULTS WILL BE RELEASED ONLY WHEN THE ACCOUNT IS SETTLED IN FULL.

ORDER NUMBER: PLEASE SUPPLY DOCUMENTATION SHOWING A COMPANY ORDER NUMBER (NOT REQUEST/DELIVERY NUMBER) WITH DELIVERY OF SAMPLE/S.

ELECTRONIC PAYMENTS:Payments can be made into the following account:

Bank: Standard Bank

Account Number: 010789693

Code & Branch: 010045 (Pretoria)

Any requests with regard to payments and invoices can be made with Me. Leonie Hurd at 012-349-1044/1066 (Accounts Dept.) or by email at

CLIENT SIGNATURE / Please note that our turnaround time is 7 to 10 working days. Alternative deadlines must be arranged in writing, in advance with management.

This document is printed on both sides: P.T.O

Mark required analyses

Chemical Parameters / Quant Metals ICP-OES / Quant Metals by ICP-MS*
pH / Sodium / Na / Silver* / Ag / Nickel* / Ni
Electrical Conductivity / Potassium / K / Aluminium* / Al / Osmium* / Os
Total Dissolved Solids* / Calcium / Ca / Arsenic* / As / Phosphorus* / P
Suspended Solids* / Magnesium / Mg / Gold* / Au / Lead* / Pb
Colour* / Aluminium / Al / Boron* / B / Palladium* / Pd
Taste & Odour* / Antimony* / Sb / Barium* / Ba / Praseodymium* / Pr
Turbidity / Arsenic* / As / Beryllium* / Be / Platinum* / Pt
Total Alkalinity / Barium* / Ba / Calcium* / Ca / Rubidium* / Rb
[1]Carbonate Alkalinity*/Carbonate* / Beryllium* / Be / Cadmium* / Cd / Rhenium* / Re
[1]Bicarbonate Alkalinity*/Bicarbonate* / Bismuth* / Bi / Cerium* / Ce / Ruthenium* / Ru
[1]Hydroxide Alkalinity*/Hydroxide* / Boron* / B / Cobalt* / Co / Antimony* / Sb
Ammonia-N / Cadmium / Cd / Chromium* / Cr / Scandium* / Sc
Nitrate-N / Chromium / Cr / Caesium* / Cs / Selenium* / Sr
Nitrite-N / Cobalt / Co / Copper* / Cu / Silicon* / Si
Total Phosphate-P* / Copper / Cu / Dysprosium* / Dy / Samarium* / Sm
Ortho-Phosphate-P / Iron / Fe / Erbium* / Er / Tin* / Sn
Chloride / Lead / Pb / Europium* / Eu / Strontium* / Sr
Sulphate / Lithium* / Li / Iron* / Fe / Tantalum* / Ta
Fluoride / Manganese / Mn / Galium* / Ga / Terbium* / Tb
Bromide* / Molybdenum* / Mo / Gadolinium* / Gd / Tellurium* / Te
Total Coliform Bacteria* / Nickel / Ni / Germanium* / Ge / Thorium* / Th
Faecal Coliform Bacteria* / Phosphorus* / P / Hafnium* / Hf / Titanium* / Ti
E. coli* / Selenium* / Se / Mercury* / Hg / Thallium* / Tl
Heterotrophic Plate Count* / Silicon* / Si / Holmium* / Ho / Thulium* / Tm
[s]Legionella / Silver* / Ag / Iridium* / Ir / Uranium* / U
Dissolved Organic Carbon / Sulphur* / S / Potassium* / K / Vanadium* / V
Total Organic Carbon / Strontium* / Sr / Lanthanum* / La / Tungsten* / W
COD / Thallium* / Tl / Lithium* / Li / Yttrium* / Y
BOD* / Tin* / Sn / Lutetium* / Lu / Ytterbium* / Yb
Oxygen Absorbed* / Titanium* / Ti / Magnesium* / Mg / Zinc* / Zn
[1]Sludge Volume Index* / Tungsten* / W / Manganese* / Mn / Zirconium* / Zr
Solids – Settleable* / Uranium* / U / Molybdenum* / Mo
Solids – Volatile* / Vanadium* / V / Sodium* / Na
Sugar* / Zinc / Zn / Niobium* / Nb / ICP – MS Scan*
[s]Surfactants* / Zirconium* / Zr / Neodynium* / Nd
Volatile Fatty Acids*
TPH & BTEX / Metals not by ICP
[s]VOC / Hexavalent Chromium*
[s]PAH
Tri-Halomethanes
Phenol* / Other:
Oil & Grease*
Cyanide – Free*
Cyanide – Total*
Chlorophyll-a*
[s]Algae Identification/count

[s]Analyses conducted by sub-contracting laboratories

[1]Additional analyses required for calculations.

* = Not SANAS AccreditedTests marked “Not SANAS Accredited” in this document are not included in the SANAS Schedule of Accreditation for this Laboratory.

Revision No: 07 / Effective Date : November 2016 / WLAB/4.4.1a/ClientInfo/Form / Page 1 of 2