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Romer Labs Inc.
1301 Stylemaster Drive
Union, MO 63084-1156, USA
Tel: +1 636 583 8600
Fax: +1 636 583 2340
Email: [email protected]
Sample Submission Form – Mycotoxins
CONTACT INFORMATION
Company Name:
Site Address:
Invoicing Address:
(if different from site address)
Contact Name(s):
Accounts Payable Contact:
Email:
Tel/Fax:
Tel/Fax:
PO#
Toxin/Combination Analyses
indicate technology:
HPLC/TLC
Single Toxin Analysis - check 1 of the following toxins:
Aflatoxin B1/B2/G1/G2
Cyclopiazonic Acid
Diacetoxyscripenol (DAS)
HT2 Toxin
Nivalenol
Sterigmatocystin
Aflatoxin M1
Deoxynivalenol (DON) (Vomitoxin)
Fumonisin B1/B2/B3
Moniliformin
Ochratoxin A
T2 Toxin
LC-MS/MS
Citrinin
AcetylDON
Fusarenon-X
Neosolaniol
Patulin
Zearalenone
Mycotoxin Screen (Aflatoxin, DON, Fumonisin, Zearalenone, Ochratoxin A, Citrinin, Trichothecenes A & B)
Three Toxin Screen - check any 3 of the following toxins
Aflatoxin
DON
Zearalenone
Ochratoxin A
T2 Toxin
Four Toxin Screen -
check any 4 of the following toxins:
DON
Fumonisin
Zearalenone
Ochratoxin A
T2 Toxin
Five Toxin Screen -
check any 5 of the following toxins:
DON
Fumonisin
Zearalenone
Ochratoxin A
T2 Toxin
Aflatoxin
Aflatoxin
Trichothecenes Screen
(Type A & Type B)
Type A Trichothecenes
(T2 Toxin, HT2 Toxin, DAS, Neosolaniol)
Type B Trichothecenes
(DON, AcetylDON, Fusarenon-X, Nivalenol)
Toxin Analyses by ELISA
Aflatoxin Deoxynivalenol (DON) (Vomitoxin)
Fumonisin
US Lab Submission Form, v.4.0 April 2013
Fumonisin
T2 Toxin
Ochratoxin A
Zearalenone
Sample ID
Commodity
DateSignature
Turn Around Times*
same day
1 day
3 day
5 day
same day
1 day
3 day
5 day
same day
1 day
3 day
5 day
same day
1 day
3 day
5 day
same day
1 day
3 day
5 day
same day
1 day
3 day
5 day
*ELISA Testing only available with standard 5 day
Romer Labs Inc.
1301 Stylemaster Drive
Union, MO 63084-1156, USA
Tel: +1 636 583 8600
Fax: +1 636 583 2340
Email: [email protected]
Sample Submission Form – Additional Tests
CONTACT INFORMATION
Company Name:
Site Address:
Invoicing Address:
(if different from site address)
Contact Name(s):
Accounts Payable Contact:
Email:
Tel/Fax:
Tel/Fax:
PO#
Other Single Item Analyses
Melamine
Ergot Alkaloides
LC-MS/MS Melamine
Grain Grade
L
C-MS/MS Melamine & Related Compounds
Mold Yeast Count (Ammeline, Ammelide, & Cyanuric Acid)
Mold Yeast Count & Identification
Water Activity
Protein
Mold Yeast Count
Urease Activity
Drug Residues ELISA
Chloramphenicol
Nitrofurans (AMOZ)
Nitrofurans (AOZ)
GMO Analyses
CHC Pesticides & PCB Screen
Dioxins (CEF)
Organo-Phosphate Pesticide Screen Only (OP)
indicate technology:
Bt-Cry1F, Herculex Bt-Cry34Ab1, Herculex® Rootworm
Bt-Cry9C, StarLink®
PAT, Liberty Link®
Bt-Cry1Ab, YieldGard®
Bt-Cry1Ab & Bt-Cry3Bb1, YieldGard® Plus
Bt-Cry3Bb1, YieldGard® Rootworm
®
Sample ID
US Lab Submission Form, v.4.0 April 2013
Pesticides/PCBS & Other Residues
PCR quantitative
LFD (Lateral Flow Device)
CP4 EPSPS, RoundupReady
Bt-Cry1Ac, BollGard® I
Bt-Cry2Ac, BollGard® II
PMI, Positech®
Vip3A, VipTera®, VipCot®
EPSPS (GA12), Roundup Ready®
®
Commodity
DateSignature
* Please email or call for more specific turn around time information for your requested analyses.
Turn Around Times
1 – 2* weeks dependent upon analyses requested
1 – 2* weeks dependent upon analyses requested
1 – 2* weeks dependent upon analyses requested
1 – 2* weeks dependent upon analyses requested
1 – 2* weeks dependent upon analyses requested
1 – 2* weeks dependent upon analyses requested
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