/ P.O. Box 200 lab code:
NL-3200 AE Spijkenisse
the Netherlands
ing. R.J.Starink
Tel.: +31 181 69 45 41
Fax: +31 181 69 45 43
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INTERLABORATORY STUDY iis17P08

Per-&Polyfluorinated Compounds in polymer, total

Proficiency test period: August 9 – September 15, 2017

Report form A for late reported test results

What do you normally report in day-to-day circumstances for PFOA and PFOS?

For PFOA we report *):

O Linear only

O Branched only

O Sum of Branched and Linear

For PFOS we report *):

O Linear only

O Branched only

O Sum of Branched and Linear

*) Please select the right option.

Further, it would be great to receive the amounts of linear, branched or the sum of isomers which are normally not reported (if available) also. Please use the tables below to fill in the amounts of PFOA and/or PFOS determined.

Sample #17610 : Pink PVC Squares

Unit / Actual test method used *) / Unrounded result
*) / Rounded result cfr. used standard *)
Linear PFOA / mg/kg
Branched PFOA / mg/kg
Total PFOA / mg/kg
Linear PFOS / mg/kg
Branched PFOS / mg/kg
Total PFOS / mg/kg

*) Please see letter of instructions (www.kpmd.co.uk/sgs-iis-cts/).

Sample #17611 : Green PVC Squares

Unit / Actual test method used *) / Unrounded result
*) / Rounded result cfr. used standard *)
Linear PFOA / mg/kg
Branched PFOA / mg/kg
Total PFOA / mg/kg
Linear PFOS / mg/kg
Branched PFOS / mg/kg
Total PFOS / mg/kg

*) Please see letter of instructions (www.kpmd.co.uk/sgs-iis-cts/).

Report form B for late reported test results

Is your laboratory accredited in accordance with ISO/IEC17025 to determine these components? No / Yes (Please circle the right option)

Was the sample grinded or cut prior to analysis or used as received? 1) / Grinded / Cut / Used as received / Other, please specify:
What was the final estimated particle size before analysis?
Which technique was used to extract/release the analyte(s)? 1) / ASE / Soxhlet / Stirrer / Mechanical Shaking / Thermal Desorption / Ultrasonic / Other, please specify:
Which solvent was used to extract/release the analyte?
What was the extraction time (minutes) and temperature (°C)?
Any remark?

1)  Please circle the correct option

Name of laboratory: Date of sample receipt:

Country: City:

Name of contact person: Date of report: