Mill Identification
Sales Representative
Producer Identification
Standard Analysis Package
Hardness, Calcium, Magnesium, Sodium
Alkalinity
Chlorides
Total dissolved solids
Iron
Sulfates
pH
Additional Analysis
Nitrates (NO3)
Nitrites (NO2)
Zinc, Copper, Manganese
Phenols
Conductivity
Phosphates (PO4)
Potassium
Total Sulfides (specific bottle for sulfides)
Other: ____________________________________
PROHYDRO PROHYDRO S
Comments
Sampling Date
Check this Box for New Customer:
Temperature Upon Receipt of the Sample: _________
Individual and/o r Additional analysis
Total Coliforms
Fecal Coliforms
Streptococcus
E. coli
HPC
Enterococcus
Yeast / Mold
Atypical Colony
Pseudomonas (choose one)
aeruginosa
Comments
Water
Representative Email Address & Phone Number
Chemical Analysis Bacteriological Analysis
*This form must be associated with only one sample*Information on this report are confidential
ITF3.2DE02-04-2019
SELKO Programs
Acidification Titration Curve: 500 mL Required
AQC Swine
Nitrates / Total Coliforms:
Sample must be kept between 2 °C and 8 °C
Package Water LCQ: Canadian Quality Milk Program Total Coliforms, E. coli, EnterococcusPackage Water 1: Total Coliforms, Fecal Coliforms, Fecal StreptococcusPackage Water 2: Total Coliforms, Fecal Coliforms, E. coliPackage Water 3: Total Coliforms, Fecal Coliforms, Fecal Streptococcus, E. coliPackage Water 4: Total Coliforms, Fecal Coliforms, Fecal Streptococcus, HPCPackage Water 5: Total Coliforms, Fecal Coliforms, Fecal Streptococcus, E. coli, HPC Package Water 6: Total Coliforms, E. coli
Package Water 7: Total Coliforms, Fecal Coliforms, Atypical colonies, Pseudomonas spp
(specific bottle for AQC)
(specific bottle for micro)
general (spp)
°C