PLM Asbestos Test Form

Sample Submission Form

PLM Asbestos Test
First and last name or Company Name *
Company or Personal Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Contact Person(s) *
Separate multiple entries with a comma
Contact E-mail *
Results are sent only to the person(s) listed in this field. Separate multiple entries with a comma.
Invoicing E-mail
example@example.com
Contact Phone Number *

Area Code Phone Number

Project Name/Address *
Please write this information on the sample bag(s) so we can match your samples to your CoC.
Project Number
P.O. Number

If submitting built up roofing (BUR) please use the "BUR TAT and Price" drop down menu for that sample.

Turn around times (TAT) will begin upon delivery of the samples to the lab.We will send you an updated version of this form with the time and date that the samples were recieved at the lab and a job number.

Payment required before results can be released. Check or credit card is accepted. We will call you for payment.
PLM TAT and Price
Price is per sample and includes the first three layers. A $5 surcharge will be assessed for each layer after the initial three.
PLM BUR TAT and Price
Price is per sample and includes the first five layers. A $5 surcharge will be assessed for each layer after the initial five.
Sample Information. Please click the "+" icon for each sample submitted beyond the first. *
Relinquished By *
Type First and Last Name
Samples Recieved By
Office Use Only
Job Number
Office Use Only. Please reference this number when calling about this job
Should be Empty:

Sample Submission Form