Collection Kit Labels

1
Sample IdentificationThis information will be used to identify your samples for the Laboratory.
Please Select
Please Select
1
2
3
4
5
6
How Many Samples are you testing, 6 Max.
Address where samples will be collected
City
Postal Code
Please Select
Please Select
Alberta
British Columbia
Labrador
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Charge to Account
2
Do you want us to send you a Sample Collection Kit?No Charge for Canadian addresses.
Send me the Free KitI have my own Supplies
3
Can we use this Address to send the Kit to?{sampleIdentification[1]} {sampleIdentification[5]}
Yes, use this addressNo, different Address
4
Mailing Address to send the Asbestos Sample Collection Kit* This field is required.
Address
Postal Code
City
Please Select
Please Select
Alberta
British Columbia
Labrador
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Country
5
Sample # 1* This field is required.Please indicate location and type of material being collected.
Please Select
Please Select
Attic
Basement
Bathroom
Bedroom
Ceiling
Garage
Garden
Kitchen
Mechanical Room
Other
Roof
Sewer
Shed
Walls
Yard
Location of Sample
Please Select
Please Select
Boiler Insulation
Ceiling Insulation
Cement
Door Jam
Drywall
Duct Insulation
Glue
Other
Sealant
Shingles
Soil
Tiles
Wall Insulation
Wall Sheeting
Window Sill
Material
Collected By
6
Sample # 2* This field is required.Please indicate location and type of material being collected.
Please Select
Please Select
Attic
Basement
Bathroom
Bedroom
Ceiling
Garage
Garden
Kitchen
Mechanical Room
Other
Roof
Sewer
Shed
Walls
Yard
Location of Sample
Please Select
Please Select
Boiler Insulation
Ceiling Insulation
Cement
Door Jam
Drywall
Duct Insulation
Glue
Other
Sealant
Shingles
Soil
Tiles
Wall Insulation
Wall Sheeting
Window Sill
Material
Collected By
7
Sample # 3* This field is required.Please indicate location and type of material being collected.
Please Select
Please Select
Attic
Basement
Bathroom
Bedroom
Ceiling
Garage
Garden
Kitchen
Mechanical Room
Other
Roof
Sewer
Shed
Walls
Yard
Location of Sample
Please Select
Please Select
Boiler Insulation
Ceiling Insulation
Cement
Door Jam
Drywall
Duct Insulation
Glue
Other
Sealant
Shingles
Soil
Tiles
Wall Insulation
Wall Sheeting
Window Sill
Material
Collected By
8
Sample # 4* This field is required.Please indicate location and type of material being collected.
Please Select
Please Select
Attic
Basement
Bathroom
Bedroom
Ceiling
Garage
Garden
Kitchen
Mechanical Room
Other
Roof
Sewer
Shed
Walls
Yard
Location of Sample
Please Select
Please Select
Boiler Insulation
Ceiling Insulation
Cement
Door Jam
Drywall
Duct Insulation
Glue
Other
Sealant
Shingles
Soil
Tiles
Wall Insulation
Wall Sheeting
Window Sill
Material
Collected By
9
Sample # 5* This field is required.Please indicate location and type of material being collected.
Please Select
Please Select
Attic
Basement
Bathroom
Bedroom
Ceiling
Garage
Garden
Kitchen
Mechanical Room
Other
Roof
Sewer
Shed
Walls
Yard
Location of Sample
Please Select
Please Select
Boiler Insulation
Ceiling Insulation
Cement
Door Jam
Drywall
Duct Insulation
Glue
Other
Sealant
Shingles
Soil
Tiles
Wall Insulation
Wall Sheeting
Window Sill
Material
Collected By
10
Sample # 6* This field is required.Please indicate location and type of material being collected.
Please Select
Please Select
Attic
Basement
Bathroom
Bedroom
Ceiling
Garage
Garden
Kitchen
Mechanical Room
Other
Roof
Sewer
Shed
Walls
Yard
Location of Sample
Please Select
Please Select
Boiler Insulation
Ceiling Insulation
Cement
Door Jam
Drywall
Duct Insulation
Glue
Other
Sealant
Shingles
Soil
Tiles
Wall Insulation
Wall Sheeting
Window Sill
Material
Collected By
11
Contact Name* This field is required.Who can we contact if we have questions?
First Name
Last Name
12
Contact Phone Number* This field is required.
Please enter a valid phone number.
13
Email Sample Labels To:* This field is required.
Your email will be used to send you information on your sample(s).
14
Use this option if the labels need to be sent to someone else to collect the sample(s)Use this field if the email is different from the contact email.
example@example.com
15
EZbestos.ca
16
Drop off or arrange pick up of your sample

After you have collected your samples, you will need to arrange to have them dropped off at collection site or arrange to have them picked up.

When the lab results are ready, we will send you an email with a secure link to review your results online through your Ezbestos Profile. Your profile will also provide you with recommendations from the experts on next steps you should consider. Results are always confidential.

Learn more: How to collect samples
17
Samples Included.
18
Collection Address
19
City \Town
20
PC
21
Bill to Account
Should be Empty: