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Hand specimen sampling and viewing request form

Required fields are marked with an asterisk ( * ).

First name: *

Surname: *

Company name and address: *
Your business or place of work

Email address: *

Contact number: *

Viewing date: *

Name of supervisor (students only):

Supervisor email (students only):

Five working days notification are normally required prior to viewing and/or sampling

Clients will be informed of any risks involved with the requested samples prior to the date required. MRT reserves the right to deny any request of samples with potential risks. Indicate All Potential Hazards, eg: Radiation, Asbestos, Heavy Metals, Skin irritants if known on form.

Use of MRT pXRF is by arrangement only contact MRT-Laboratories@stategrowth.tas.gov.au prior to viewing days.

Registration No.
(e.g. G404799)		Type of Sample required
(e.g. TS, powder, etc.)		Hazards
(Y/N)		Testing purpose
(e.g. Petrology, ICPMS etc.)		Destination
(e.g. Lab or University)

If you wish to view/sample more than 10 hand specimens download this table, complete details and attach it to the form below.

Upload excel table of > 10 hand specimens if required:

By submitting this form I agree to:
1. Supply a digital copy of all results and reports obtained from the sample(s) and;
2. Return all samples (pulps, crushes or offcuts) to MRT at my own expense.

Verification

Personal information protection statement
You are providing personal information to Mineral Resources Tasmania, who will manage that information in accordance with the Personal Information Protection Act 2004. The personal information collected here will be used by Mineral Resources Tasmania for the purpose of addressing your specific request, and related purposes under the Mineral Resources Development Act 1995 and associated laws, including for national identity. Mineral Resources Tasmania may also use the information for related purposes, or disclose it to third parties in circumstances allowed for by law. You have the right to access your personal information by request to Mineral Resources Tasmania and you may be charged a fee for this service.