Melbourne Markets Residue Test Request

Wholesaler*

Contact Person*

Email Address*

Pick-up Date*

SAMPLE 1

Grower Name*

Address*

Product Type

Variety

Tests required
 C3 C4 C5 C6 CAD M1 M2 M3 M4 W1

Reference Nos

Comments

SAMPLE 2

Grower Name

Address

Product Type

Variety

Tests required
 C3 C4 C5 C6 CAD M1 M2 M3 M4 W1

Reference Nos

Comments

SAMPLE 3

Grower Name

Address

Product Type

Variety

Tests required
 C3 C4 C5 C6 CAD M1 M2 M3 M4 W1

Reference Nos

Comments

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