Submit a Controlled Substance Sample for Testing

Drop off hours are from 9:30 am to 5:30 pm M-F excluding stat holidays.

Call or email for alternate drop off times: 250-929-2002 or [email protected]

Dealers License # 6-1507

Information

Client/Business Name: *

Contact Email: *

Phone Number: *

Health Canada Licence Number: *

License number is required for sample submission.

Address of Licensed Dealer: *

Submitted By: *

Date: *

Sample 1

Sample ID

Sample Matrix

(Ground mushroom, capsule, extract, tincture, pure substance, etc.)

Total Sample Weight (g)

(Total sample weight is the weight of the API plus excipient or carrier matrix.)

API Weight (g)

(Active Pharmaceutical Ingredient, ie. weight of ground mushroom, weight of mushroom extract or weight of pure substance.)

Special Instructions/Information:

Sample 2

Sample ID

Sample Matrix

(Ground mushroom, capsule, extract, tincture, pure substance, etc.)

Total Sample Weight (g)

(Total sample weight is the weight of the API plus excipient or carrier matrix.)

API Weight (g)

(Active Pharmaceutical Ingredient, ie. weight of ground mushroom, weight of mushroom extract or weight of pure substance.)

Special Instructions/Information:

Sample 3

Sample ID

Sample Matrix

(Ground mushroom, capsule, extract, tincture, pure substance, etc.)

Total Sample Weight (g)

(Total sample weight is the weight of the API plus excipient or carrier matrix.)

API Weight (g)

(Active Pharmaceutical Ingredient, ie. weight of ground mushroom, weight of mushroom extract or weight of pure substance.)

Special Instructions/Information:

Sample 4

Sample ID

Sample Matrix

(Ground mushroom, capsule, extract, tincture, pure substance, etc.)

Total Sample Weight (g)

(Total sample weight is the weight of the API plus excipient or carrier matrix.)

API Weight (g)

(Active Pharmaceutical Ingredient, ie. weight of ground mushroom, weight of mushroom extract or weight of pure substance.)

Special Instructions/Information:

Sample 5

Sample ID

Sample Matrix

(Ground mushroom, capsule, extract, tincture, pure substance, etc.)

Total Sample Weight (g)

(Total sample weight is the weight of the API plus excipient or carrier matrix.)

API Weight (g)

(Active Pharmaceutical Ingredient, ie. weight of ground mushroom, weight of mushroom extract or weight of pure substance.)

Special Instructions/Information:

Sample 6

Sample ID

Sample Matrix

(Ground mushroom, capsule, extract, tincture, pure substance, etc.)

Total Sample Weight (g)

(Total sample weight is the weight of the API plus excipient or carrier matrix.)

API Weight (g)

(Active Pharmaceutical Ingredient, ie. weight of ground mushroom, weight of mushroom extract or weight of pure substance.)

Special Instructions/Information:

Sample 7

Sample ID

Sample Matrix

(Ground mushroom, capsule, extract, tincture, pure substance, etc.)

Total Sample Weight (g)

(Total sample weight is the weight of the API plus excipient or carrier matrix.)

API Weight (g)

(Active Pharmaceutical Ingredient, ie. weight of ground mushroom, weight of mushroom extract or weight of pure substance.)

Special Instructions/Information:

Sample 8

Sample ID

Sample Matrix

(Ground mushroom, capsule, extract, tincture, pure substance, etc.)

Total Sample Weight (g)

(Total sample weight is the weight of the API plus excipient or carrier matrix.)

API Weight (g)

(Active Pharmaceutical Ingredient, ie. weight of ground mushroom, weight of mushroom extract or weight of pure substance.)

Special Instructions/Information:

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VANCOUVER ISLAND’S TESTING LAB – Serving all of Canada

VANCOUVER ISLAND’S TESTING LAB – Serving all of Canada

Submit a Controlled Substance Sample for Testing

Information

Sample 1

Sample 2

Sample 3

Sample 4

Sample 5

Sample 6

Sample 7

Sample 8

PURA ANALYTICAL LABS