通标标准技术服务有限公司 广州市经济技术开发区科学城科珠路198号2楼 邮编：510663

SGS-CSTC Standards Technical Service Co., Ltd. 2/F, 198 Ke zhu Road, Science Park, Guangzhou Economic & Technology Development Zone, Guangzhou, CHINA 510663

TEL: +86(0)20 8215 5643/5640/5644/5610

FAX: +86(0)20 8207 5169

Applicant (申请单位): (显示在报告抬头) (中英文)

香港亚星国际集团有限公司 （HK YAX INT’L GROUP LTD）

Buyer: (买 家 )

Address: (地址，中英文)

广州海珠区广州大道南448号财智大厦1509 1509#choice plaza south guangzhou main road,Guangzhou,china

Post code: (邮 编 )

510310

Contact Person(联系人):

谢亮根

Email(电子邮件):

yxspw@stoneshotfix.com

Tel (电话)：

020-89014402

Fax(传真):

020-84283539-605

Mob(手机)：

13538778019

Payer (付款单位) 中英文:

谢亮根

Department (部门):

Address (地址，中英文):

广州海珠区广州大道南448号财智大厦1509 1509#choice plaza south guangzhou main road,Guangzhou,china

Post Code (邮编):

510310

Contact Person(联系人):

谢亮根

Email(电子邮件):

yxspw@stoneshotfix.com

Tel (电话)：

020-89014402

Fax(传真):

020-84283539-605

Mob(手机)：

13538778019

Report Delivered to: □Applicant □Payer Invoice Delivered to: □Applicant □Payer □By Fax □By Email (报告原件寄至) (上述申请方) (上述付款方) (发票寄至) (上述申请方) 上述付款方) (传真) (邮件)

Sample Description (样品描述) 中英文 :

Color( 颜色英文):

Jet hematite

Style No.(款号):

Order No.(订单号):

Manufactor (生产厂商英文):

Composition(成份英文):

Exported to(出口目的国):

End Uses(最终用途英文):

No. of Sample( 样品数):

5g

Test Required: please tick(ü) as appropriate.(请在所需测试项目前打ü，或在空白栏中填写所需测试的项目)

□ Alkylphenol (Aps)烷基酚 (NP+OP)

□ N-nitrosamines N-亚硝酸

□ Alkylphenol Ethoxylates(APEO)烷基酚乙基氧化物

□ Navy Blue蓝色染料

□ AZO Dye Analysis 偶氮染料分析

□ Nickel Release 镍释放量

□ Allergenous Disperse Dyes 致敏性分散染料

□ OPP邻苯基酚

□ BHT 二叔丁基羟基甲苯

□ Organotin Compounds有机锡化合物

□ Biocide Finish生物灭杀剂

□ Ozone Depleting Substance (CFCs)氟氯碳化物

□ Carcinogen Dyes 致癌染料

□ PAHs 多环芳烃

□ Chlorinated Aromatics Organic Carriers 氯化有机载体

□ Pesticide Content 农药含量

□ Chlorinated Phenols氯化苯酚

□ pH Value (pH值)

( ) PCP ( ) TeCP ( )TCP

□ Polyvinyl Chloride聚氯乙烯

□ Chromium VI 六价铬

□ PVC Plasticizers (Phthalates) 增塑剂 (邻苯二甲酸盐)

□ Dioxins & Furans 二噁英及氧(杂)茂

□ Sensory Verification of Smell 气味量度

□ Extractable Metal Content 重金属含量

□ Solvents 溶剂

□ Flame Retardants 阻燃剂

□ Total Cadmium Content 镉

( ) PBB 多溴联苯 ( ) PBDE五溴联苯醚

□ ROHS

( ) PBB,TEPA,TRIS,PBDE,OBDE 纺织品环保常规5项

Total Lead Content铅含量

( )Others Item 其他项目 :

Lead in surface paint/coating 涂层含铅量

□ Formaldehyde Content (甲醛含量)

CPSIA HR 4040

□ Volatile Organic Compounds (VOCs)挥发性有机代合物

Others 其它 :

Standards/Methods used (采用标准/方法): □ ISO □ AATCC □ EN □ DIN □ JIS □ GB □USEPA □Others (please specify) :____________________________________

Service Required(服务种类): □ Regular (5 working days) □ Express (3 working days) □ Double Express (2 working days) □ Emergency (1 working day) (常规5-7个工作日) (加急, 3工作日, 加40%附加费) (特快, 2工作日，加100% 附加费) (紧急, 1工作日, 加150% 附加费)

□Comment (评语) □Chinese Report (中文报告/额外收费) □Self-pick up正本报告是否自取: □ Yes是 □ No否 注意:每份申请表对应一份报告,每份报告最低收费是200 RMB.

Return remaining sample (是否要退还剩余样品): □Yes是 □No否 所有样品的保留时间为30天

We apply for the above tests and agree to SGS general conditions of services (available on request).我们申请以上测试并同意SGS通用服务条款（备索） Authorized Signature and company Chop (申请人签名及盖章): _______________ Date (日期): ________________________

Received and Checked by Laboratory (实验室查收): Date日期:

Member of the SGS SA (Société Générale de Surveillance)