Please type or print in BLOCK LETTERS and send both pages with

Please type or print in BLOCK LETTERS and send both pages with

TEST REQUEST FORM
HEAVY METALS
Submitting Company:
Address
Report Recipient :
Phone:
Purchase Order No.:
State
Zip
Fax :
E-mail :
Report cc :
Phone:
Fax :
E-mail :
City
Invoice will state the above report recipient. Please advise if different:
Invoice Recipient :
Phone:
Fax :
E-mail :
SAMPLE INFORMATION:
Sample Description:
# of Samples Submitted:
Manufacturer / Vendor:
SKU #:
Children’s
Children’s
Product
Product
Country of Origin:
Style #:
Country of Distribution:
SERVICE REQUIRED (Check One):
Regular (7 - 10 business days)
Same Business Day from receipt of sample - *175% surcharge
Adult
Adult
Product
Product
Next 2 Business Days from receipt of sample - 75% surcharge
Next 3 Business Days from receipt of sample - 40% surcharge
Next 4 Business Days from receipt of sample - 35% surcharge
Next Business Day from receipt of sample - *100% surcharge
Next 5 Business Days from receipt of sample - 25% surcharge
**Samples including completed paperwork for regular and rush service must be in receipt of BV by 11:00am and by 10:00am for same day rush.
TESTING REQUESTED - Note: There is a minimum report fee of $200:
QUOTATION REQUIRED BEFORE TESTING Please note that quotation fees may apply for this service. Testing is initiated upon receipt of
signed quotation with complete information and samples.
RETEST – Test failing sections of previous report # ______________________________(required for retest)
Call to discuss applicable tests
Test item regardless of applicability to checked regulation
16 CFR 1303 Lead Content (scrapable surface coatings)
( Composite Colors
Individual Colors)
Lead in Substrate Limit:____
Client Lead in Surface Coating- Specify Limit:_____
ASTM F963 Heavy Metals Content
EN71 Pt. 3 Heavy Metals Content (Toy items going to Europe)
CCPSA Heavy Metals Content
TPCH (Heavy Metals content in packaging)
21 CFR 175 - 177 (H) FSSE
Please specify material type (Polyethylene, Homopolymer Polypropylene,
Copolymer, Melamine, Polycarbonate, Paper ,Rubber)
OR if there are multiple material types
Request and return FDA Food Safety Testing Form 01381
California Prop. 65 Jewelry
Material composition documentation needed for each component.
For Cal Prop Jewelry please specify age grade:___________________
Canada Lead in Children Metallic Jewelry (Total and Soluble Lead)
Illinois Lead Content
.
INTERIOR TESTING OF FOOD WARE
FDA Extractable Lead & Cadmium
(6 identical items needed – Ceramic Only)
CA Health & Safety Code 25249.5 (Prop. 65 lead/cadmium)
(6 identical items needed – Ceramic or Colored Glass)
Greater than or equal to 2,000 identical items distributed in California
(additional 6 identical items needed)
EXTERIOR TESTING OF FOOD WARE
CA Prop 65 Raw Materials for Decorated Tableware (Decals or Paints)
NIOSH wipe test (1 sample needed)
SGCD Extractable Lead & Cadmium (Lip &Rim)
(6 identical items needed – Ceramic or Glass)
CA Prop 65 Testing on Rim – ASTM C927
(6 identical items needed – Ceramic or Glass)
US CPSIA 2008 LEAD
CPSIA Total lead content in Children's Metal Jewelry
- Material composition documentation needed for each component
CPSIA Total lead content in substrates*
Composite up to 3 colors?
Yes
No
CPSIA Total lead content in surface coating*
Composite up to 3 colors?
Yes
No
*Requires FHSA Use and Abuse testing to determine accessibility.
Other Tests/Instructions:
Date
Authorized Signature
A typed or electronic signature is an execution of this TRF and the Conditions of Testing. A hard copy requires a hand-written signature.
Please include both pages of the completed test request form with each carton of samples and forward to:
Bureau Veritas Consumer Products Services, Inc.; 100 Northpointe Parkway, Buffalo, New York 14228-1884
Tel: (716) 505-3300 Fax: (716) 505-3301 cps.bureauveritas.com
CPSD-AN-TRFS-BF-HEAVY METALS TRF-V15
04/23/2015
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CPSD-AN-TRFS-BF-HEAVY METALS TRF-V15
04/23/2015
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