Please type or print in BLOCK LETTERS and send - DOC - DOC

							                                                              TEST REQUEST FORM
                                                                HEAVY METALS
 THIS TEST REQUEST IS SUBJECT TO THE CONDITIONS OF TESTING SET FORTH ON PAGE 2 HEAREOF
 Please type or print in BLOCK LETTERS and send both pages with samples to be tested unstapled.
Your Company Name:                                                                     Purchase Order No.:
Address                                              City                            State                 Zip
Contact Person :
Phone:                                 Fax :                               E-mail :
Report and invoice will state the above company name and contact person. Please advise if different:
Report to:    Company                                                  Contact Person:                                                  Tel #:
     cc:      Address                                                                            Email:
Invoice to:   Company                                                  Contact Person:                                                  Tel #:
              Address                                                                            Email:
 Sample Description:                                                                                                # of Samples Submitted:
 Manufacturer :
 SKU / UPC:                                                                            Country of Origin:
 Item / Style #:
SERVICE REQUIRED:            (Check One)             If this is a retest, please state previous report #:
      Regular (7 business days)          Next 5 Day (25% surcharge)             Next 3 Day (40% surcharge)          Next 2 Day (50% surcharge)
      Next Business Day* (100% surcharge)        Express (100% surcharge for extended time tests)          Same Business Day* (175% surcharge)
* - Sample receipt by 10:30am required.
   Call to discuss applicable tests           Test in accordance with Quotation #         dated                           Quotation requested prior to initiation
TESTS STANDARDS:                (Check Applicable Box(es))                                             INTERIOR TESTING OF FOOD WARE
     16 CFR 1303 Lead Content (Painted items only, scrapable surface coatings)          FDA Extractable Lead & Cadmium
     ( Composite Colors            Individual Colors)                                   (6 identical items needed – Ceramic Only)
     EPA-SW-3051 & 3050B (Lead in substrates)                                                 Long Report for Customs             Short Report
         Composite like materials        Individual tests (no composites)
         XRF                                                                            CA Health & Safety Code 25249.5 (Prop. 65 lead/cadmium)
     ASTM F963 Heavy Metals Content (Painted toy items going to US)                     (6 identical items needed – Ceramic or Colored Glass)
     EN71 Pt. 3 Heavy Metals Content (Toy items going to Europe)                        Greater than or equal to 2,000 identical items
     CHPA Heavy Metals Content (Painted toy items going to Canada)                       distributed in California;(additional 6 identical items needed)
     CONEG (Packaging Material Regulation)
     CPSC Children’s Metal Jewelry                                                                      EXTERIOR TESTING OF FOOD WARE
     ( Total lead only          Total lead and acid extraction)                         CA Prop 65 Raw Materials for Decorated Tableware (Decals or Paints)
     21 CFR 176.170 Solvent Extractives Paper                                           California Extractable Lead and Cadmium by Total Immersion
     21 CFR 175 - 177 Solvent Extractives (general, simple) (HM)                        (6 identical items needed – Ceramic or Glass externally decorated)
Please specify plastic type (Polyethylene, Polypropylene, Copolymer, Melamine,          SGCD Extractable Lead & Cadmium (Lip &Rim)
Polycarbonate)                                                                          (6 identical items needed – Ceramic or Glass)
    EPA-SW-3050B & EPA –SW-3051 for California Prop. 65 Jewelry – Material              California Prop 65 Testing on Rim – ASTM C927
    composition documentation needed for each component.                                (6 identical items needed – Ceramic or Glass)
     Canada Lead in Children Metallic Jewelry (Total Lead and Soluble)                  NIOSH 9100 Wipe Test Modified
     Other (Please Specify)                                                                                  US CPSIA 2008 LEAD
                                                                                        CPSIA Total lead content in substrate
                                                                                        Composite up to 3 colors?      Yes
                                                                                        Limit:      600 ppm (effective 2/10/09)
                                                                                                    300 ppm (effective 8/14/09)
                                                                                        CPSIA Total lead content in surface coating (no compositing)
                                                                                        Limit 90 ppm (effective 8/14/09)




   Date                                                  Authorized Signature


                                      Please include a 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
                                                                                                                           Lab use only:
                                                                                                                           Sample No. __________




  Last updated 6-24-09                                                   Page 1 of 2