THIONVILLE LABORATORIES, LLC

5440 Pepsi Street
New Orleans, LA 70123
(504) 733-9603
E-mail – operations@thionvillenola.com

SAMPLES SUBMITTED TO THIONVILLE

ANALYSIS REQUEST FORM

FOR ACCT OF *

ADDRESS

NO. OF SAMPLES (filled in automatically from the rows below if left blank)

SAMPLE IDENTIFICATION	COMMODITY	ANALYSIS REQUESTED	SPECIFIC METHOD

+ add more sample rows · download fillable PDF version

REPORTING & BILLING

Report (CoA) to *

Invoice to

PO # (if required)

Requested turnaround time

Invoicing information

ADDITIONAL INFORMATION:

CoA & invoice sent by E-mail after completion of testing; payment of invoice due within 30 days.
$20 Lab Sample EPA Disposal Fee added to all invoices. $85 lab minimum fee for any analytical work performed.
Payment by check or wire transfer only within 30 days. No credit cards.

Please include product analysis specifications. If not available, please note that below.

Product specifications

Other notes

SUBMITTED BY

Sample submitted by *

Date

Contact phone number *

E-mail *

*PLEASE NOTE THAT IF THIS REQUEST FORM DOES NOT ACCOMPANY THE SAMPLES, IT COULD RESULT IN DELAY OF TESTING AND REPORTING OF RESULTS IN A TIMELY MANNER.

You'll get a printable copy to include with your samples.

Rev.1-7-26/kc