Sample Information – Asbestos Analysis Name: * Order Number: Email: * Phone: * (###) ### #### Billing Address: * Address 1 Address 2 City State/Province Zip/Postal Code Country Address Sampled: * Address 1 Address 2 City State/Province Zip/Postal Code Country Sampled By: * Sampling Date: * MM DD YYYY Sample Locations and Material Description 1: Verum Group Reference 1: Sample Locations and Material Description 2: Verum Group Reference 2: Sample Locations and Material Description 3: Verum Group Reference 3: Sample Locations and Material Description 4: Verum Group Reference 4: Sample Locations and Material Description 5: Verum Group Reference 5: Sample Locations and Material Description 6: Verum Group Reference 6: Sample Locations and Material Description 7: Verum Group Reference 7: Sample Locations and Material Description 8: Verum Group Reference 8: Sample Locations and Material Description 9: Verum Group Reference 9: Sample Locations and Material Description 10: Verum Group Reference 10: Sampling guide: One material per sample wherever possible. Clear notes and descriptions where composite materials are present. - Textured plaster – chunky is better than powdered. Fibres are generally sparse and may not be evenly distributed so take a composite sample from a number of different places in the room. 3g minimum. - Vinyl – sample right to the floor boards including any adhesive or old vinyl and backing layers. - Fibrous cement board – break off a piece at least 1cm square. Be aware that different boards may have been used on the one construction so consider sampling more than one sheet. Received By: * Date Received: * MM DD YYYY Thank you!
