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Request for Analysis Form
FPA rwquest form for fertilizer analysis
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: FPA-LSD-F01
REPUBLIC OF THE PHILIPPINES
OFFICE OF THE PRESIDENT
FERTILIZER AND PESTICIDE AUTHORITY
FPA Bldg., BAI Compound, Visayas Ave., Diliman, Quezon City P.O. Box 2582
Tel. Nos. 920-8173*920-8573*922-3368*441-1601
E-mail add: fpa_77@yahoo.com Website: http://fpa.da.gov.ph
REQUEST FOR ANALYSIS FORM
CLIENT INFORMATION
Kindly provide complete information and please write legibly.
Client/Company
Address
Contact No.
E-mail Address
Purpose of Analysis
Turnaround Time
Mode of Receipt
☐ New Registration
☐ Regular
☐
Walk-in
☐
FPA Method
☐ Renewal
☐ Rush
☐
Courier
☐
Client’s Method
☐
Others, pls. specify:
☐ Re-analysis
☐ Monitoring
Method Type
Laboratory Analysis Fee
Total Amount (PhP):
O.R. No.:
__________________
☐ Others (pls. specify):
___________________
Date:
SAMPLE INFORMATION
Item
No.
Sample Code
(FRD)
Laboratory Code
(LSD)
Sample
Name/Type
Comments/
Remarks
Physical Description
1
2
3
4
5
Note: Please use additional sheet for additional samples.
Relinquished
by:(Client/Representative only)
Date:
Received by:(FRD only)
Time:
Relinquished by:(FRD only)
Date:
Time:
Received in Lab:(LSD only)
Time:
Effective Date: 16 May 2018
Revision: 02
Date:
Date:
Time:
Page 1 of 2
Please tick the box of desired analysis.
Individual Tests
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MACRONUTRIENTS
Total Nitrogen (Nitrate-Containing) (P 1,550.00)
Total Nitrogen (Nitrate-Free) (P 1,250.00)
Ammoniacal Nitrogen (P 1,100.00)
Nitrate Nitrogen (P 910.00)
Total Phosphorus (P 1,220.00)
Available Phosphorus (P 400.00)
Total Potassium (P 910.00)
Calcium (P 1,010.00)
Magnesium (P 1,610.00)
Sulfur (P 400.00)
OTHER TESTS
Biuret (P 330.00)
Organic Matter (P 350.00)
Moisture Content (P 240.00)
pH (P 320.00)
Specific Gravity (P 550.00)
Aluminum (P 1,390.00)
Free Acidity (P 530.00)
Free Phosphoric Acid (P 760.00)
GC Analysis, pls. specify active ingredient
(P 3,360.00):
____________________________________________
HPLC Analysis, pls. specify active ingredient
(P 3,130.00):
____________________________________________
Impurities Determination (GC-MS) (P 4,550.00)
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MICRONUTRIENTS
Boron (P 1,570.00)
Cobalt (P 1,370.00)
Copper(P 1,370.00)
Iron (P 1,330.00)
Manganese (P 1,370.00)
Molybdenum (P 1,540.00)
Sodium (P 1,380.00)
Zinc (P 1,330.00)
Chloride (P 730.00)
HEAVY METALS (for special cases only)
Arsenic (P 1,540.00)
Cadmium (P 1,420.00)
Lead (P 1,470.00)
Mercury (P 1,540.00)
PLANT GROWTH REGULATORS
Amino Ethyl Hexanoate (P 3,430.00)
Brassinolide (P 4,660.00)
Gibberellic Acid (P 2,960.00)
Indole-3-Butyric Acid (P 3,660.00)
1-Naphthaleneacetic Acid (P 3,880.00)
Nitrophenol and Nitroguaiacol (P 5,010.00)
Paclobutrazol (P 3,340.00)
Triacontanol (P 3,470.00)
MICROBIAL TESTS
Escherichia coli (E. coli) (P 1,050.00)
Total Coliform (P 900.00)
Uncertainty of measurementto be included in the laboratory test report?☐Yes☐No
TERMS AND CONDITIONS:
Sample Receipt: All samples received in the laboratory
shall be delivered prepaid except for samples from
monitoring activities. All samples submitted for analysis
shall be accompanied with a request for analysis form.
Client’s Method: If the client requests to use their own
method for the analysis, the Laboratory Services Division
(LSD) shall be informed prior to the acceptance of the
sample.The client shall provide LSD a copy of the
method; however, the acceptance of sample is still
subject to the availability of equipment and laboratory
chemicals.
Fees: The schedule of laboratory fees and charges is
based on the released FPA Administrative Order No. 01 s.
2011, Administrative Order No. 19 s. 2012 and
Administrative Order No. 01 s. 2015.
Turnaround time: Standard turnaround time for release of
laboratory test reports is within twenty one (21) working
days and five (5) working days for regular samples and
rush samples, respectively. Five (5) days will be added to
the turnaround time for every additional five (5) samples
for a single transaction per client. For sample with more
than five (5) test parameters, additional five (5) days will
be added to the turnaround time.
Rush Service: Fast-track analysis shall incur a 100%
surcharge.
Delivery of Service: LSD guarantees that all work shall be
done in accordance with the generally-accepted
methods and practices.
Measurement Uncertainty: The measurement uncertainty
range is reported in the laboratory test report upon
request of FRD or the client.
Confidentiality: All laboratory data and test reports shall
remain confidential between FPA and the client. No
information shall be released to others without written
consent from the client and approval from FPA.
Return of Sample: All fertilizer samples shall be returned to
the client upon release of the laboratory test report.
Sample not retrieved after a month the test report was
released will be disposed by FPA.
I agree with the stipulated terms and conditions above:
_____________________________
Signature over Printed Name
Page 2 of 2
_________________
Date
Page 3 of 2
SAMPLE INFORMATION
Item
No.
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Sample Code
(FRD)
Laboratory Code
(LSD)
Sample
Name/Type
Physical Description
Comments/
Remarks
