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Sample Submission Form
Sample Submission Form
Sample Submission Form
2019-12-15T14:35:52-06:00
Requester Name
First
Last
Department
Project Title
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Email
Phone
Sample Types
High Performance Liquid Chromatography (HPLC) Sample
Ion Chromatography (IC) Sample
CHNS Sample
Inductively Coupled Plasma Optical Emission Spectrometer (ICP-OES) Sample
Gas Chromatography - Mass Spectrometry (GC/MS) Sample
Accelerated Solvent Extractor (ASE) Sample
Total Organic Carbon (TOC) Sample
Sample Information HPLC
Sample Description:
No
Sample #
Quantity(ml)
Type of Column
Type of Analysis: Quantitative/ Qualitative
Solvent A & concentration
Solvent B & concentration
Flow Rate
Detector: DAD/FLD
Chromatographic Conditions HPLC
Injection Volume
Detection Wavelength (s)
Chromatographic Mode
Isocratic
Gradient
Temperature
Remarks
Sample Handling Requirements
Note: Please contact the facility before submission of any time sensitive or unstable compounds.
Freezer
-20C
-80C
Refrigerator
Magnetic
Light Sensitive
Room Temperature
Air Sensitive
Volatile
Toxic/Carcinogenic
Other Special Storage Conditions
Samples to be returned after analysis
Yes
No
If No, please enclose disposal procedure in attachment.
Sample Information IC
Sample Description:
ANION & CARBOHYDRATE ANALYSIS
Minimum Quantity of Sample Required: 10 ml filtered liquids with 0.45µm filter.
Type(s) of Anion(s) to be analyzed
Bromide, Br
Chloride, Cl
Fluoride, F
Nitrate, NO3-
Nitrite, NO2-
Phosphate, PO43-
Sulfate, SO42-
Type(s) of Carbohydrate(s) to be analyzed
Inositol
Sorbitol
Arabitol
Fructose
Sucrose
Glucose
Lactose
Xylose
Sample Handling Requirements
Note: Please contact the facility before submission of any time sensitive or unstable compounds.
Freezer
-20C
-80C
Refrigerator
Magnetic
Light Sensitive
Room Temperature
Air Sensitive
Volatile
Toxic/Carcinogenic
Other Special Storage Conditions
Samples to be returned after analysis
Yes
No
If No, please enclose disposal procedure in attachment.
Chromatographic Conditions IC
Column
Temperature
Remarks
Sample Information CHNS
Sample Description:
Sample ID
State of sample e.g. Liquid
Quantity of Sample (mg, ml)
Number of components
Analyze for (C, H, N, S)
CHNS ANALYSIS- Minimum quantity of sample required is 1 g Note: Dry/remove solvent thoroughly before submission. Results are highly affected by presence of solvent & water content.
Sample Handling Requirements
Note: Please contact the facility before submission of any time sensitive or unstable compounds.
Freezer
-20C
-80C
Refrigerator
Magnetic
Light Sensitive
Room Temperature
Air Sensitive
Volatile
Toxic/Carcinogenic
Other Special Storage Conditions
Sample to be reutrned after analysis
Yes
No
If No, please enclose disposal procedure in attachment.
Sample Information ICP
Sample Description:
METAL ANALYSIS ON ICP
Minimum Quantity of sample required: 5ml filtered with 0.45µm Note: Standards used in calibration are certified standards prepared in acid/water matrix only.
No.
Sample ID
Type of sample
Quantity of samples
Element to be analyzed
Expected Values (ppm, ppb, %)
Determined Values (ppm. ppb, %)
Digestion
H20
HNO3
HCl
HF
H2SO4
AQ
hot plate
microwave
10ml
25ml
clear solution
ppt observed & filtered
View Mode
Axial
Radial
Note: Both options may be chosen as well.
Sample Handling Requirements
Note: Please contact the facility before submission of any time sensitive or unstable compounds.
Freezer
-20C
-80C
Refrigerator
Magnetic
Light Sensitive
Room Temperature
Air Sensitive
Volatile
Toxic/Carcinogenic
Other Special Storage Conditions
Sample to be returned after analysis
Yes
No
If No, please enclose disposal procedure in attachment.
Sample Information GCMS
Sample Description:
Specify Impurities
Concentration
No.
Sample ID
Molecular Weight
Type of Sample
Volatile
Solvent
Melting Point
Boiling Point
Pressure mm Hg
Type of Analysis Requested
Unknown Scan (by GC-MS only)
Unknown Scan (by GC-MS) and Quantitation (% or ppm) - GC-MS
Unknown Scan (by GC-MS) and Quantitation (% or ppm) - GC-FID
Quantitation (% or ppm) - GC-MS
Quantitation (% or ppm) - GC-FID
General Residual Solvents
USP
List Solvents
If Quantitation, indicate expected range
Column Type
Current Analytical method Available
Yes
No
If Yes, then
Inlet Temperature
Oven Temperature
Auxiliary Temperature
Splitless
Split Ratio
Head Pressure(psi)
Carrier Gas Flow Rate
Sample Handling Requirements
Note: Please contact the facility before submission of any time sensitive or unstable compounds.
Freezer
-20C
-80C
Refrigerator
Magnetic
Light Sensitive
Room Temperature
Air Sensitive
Volatile
Toxic/Carcinogenic
Other Special Storage Conditions
Sample to be returned after analysis
Yes
No
If No, please enclose disposal procedure in attachment.
Sample Information ASE
Sample Description:
No.
Sample ID
Sample weight (5g-100g)
Type of Sample (Solid, Semi-Solid, Gel)
Cell Size (22ml, 66ml, 100ml)
Type of Solvent for Extraction
Sample Run Temperature (oC)
Run time
Sample Handling Requirements
Note: Please contact the facility before submission of any time sensitive or unstable compounds.
Freezer
-20C
-80C
Refrigerator
Magnetic
Light Sensitive
Room Temperature
Air Sensitive
Volatile
Toxic/Carcinogenic
Other Special Storage Conditions
Sample to be returned after analysis
Yes
No
If No, please enclose disposal procedure in attachment.
Sample Information TOC
Sample Description:
No.
Sample ID
Sample Volume (ml)
Type of Analysis (TC, TOC, IC, TN)
Sample Handling Requirements
Note: Please contact the facility before submission of any time sensitive or unstable compounds.
Freezer
-20C
-80C
Refrigerator
Magnetic
Light Sensitive
Room Temperature
Air Sensitive
Volatile
Toxic/Carcinogenic
Other Special Storage Conditions
Sample to be returned after analysis
Yes
No
If No, please enclose disposal procedure in attachment.
Lab Use:
Log Number
Number of Samples
Date Received
Received By