Sample Intake

Due Date(Optional)

Sample Type Binder Emulsion Paint Additive Aggregate Sealants / Membranes Designs

Lab Select Cold Process Mix Centre - Regina Eastern Research Centre Saint-Hyacinthe GECAN - Acheson McAsphalt Research Centre - Toronto Other

Plant Number Select 451 - Acheson 453 - Ashcroft 250 - Bécancour 121 - Brampton 435 - Calgary 450 - Clairmont 339 - Dartmouth 326 - Dieppe 340 - Eastern Passage 439 - Edmonton 120 - Hamilton 436 - Langley 438 - Macklin 222 - Montreal 114 - North Bay 118 - Oshawa 116 - Ottawa 325 - Perth Andover 115 - Port Stanley 434 - Regina 251 - Saint Hyacinthe 338 - Saint John 452 - Shepard 113 - Thunder Bay 224 - Valleyfield 433 - Winnipeg

Sample Grade

Sample Source

Batch Number

Lot Number

Description(Optional)

Tests Requested(Optional)

Notes(Optional)