APPLICATION FOR LABORATORY ACCREDITATION IN THE AFPC

Date of request ____________

Laboratory __________________________

Address _____________________________

City, State, Zip _______________________________________________

Phone Number ________________________

Fax Number __________________________

E-mail _____________________________

Contact Person _____________________

Analytical Parameter/s being requested for accreditation

List Parameter/s _________________________________________________________

Quality Assurance Manual submitted with Application ______Yes ______No

Submit Check sample results for past 12 months with comparison in table form

________Yes ______No

Check Sample Programs with Laboratory Identification

AFPC Fertilizer No. ________ AFPC Rock No. ________ MAGRUDER No. _________

COMMITTEE ONLY

Reviewed by: ________________________________________________________

Comments: __________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

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