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