Sultan Qaboos University
Central Analytical and Applied Research Unit
(ISO 9001-2008 Certified)
SAMPLE SUBMISSION FORM INTERNAL
Genetic Analyzer
Doc. No.
Issue Date
Revision No
Revision date
Doc. Page No
:
:
:
:
:
CAARU/F/003
01.05.2014
01
28.09.2015
1/1
General Information
Name
Supervisor
E Mail
College
Department
Phone/Extn/GSM
O
O
Funding Source
ABI Big Dye V3.1
Sample
Information
Department Budget
O Student Project
Others/Grants(Please Specify the ):__________________________________
Full Service
PCR, PCR Purification & Gel Electrophoresis
DNA Extraction Only
Sequence Reaction and Sequence Purification
Run Plate Only
(Note:- Primers Should be provided)
Source of Genomic DNA:
O Plasmid O PCR Product O Others:_______________________________
Storage Temperature :
O RT O 4ºC O -20ºC O -80ºC
Biohazard Samples :
O Yes
O No
Sample ID
Sample Description
Quantity
Remarks
S.No.
1
2
3
4
5
6
Brief Description of Experiment: (You may attach any additional information/details on separate sheet)
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………
Note
-
-
All Coloured samples are unaccepted
We DO NOT accept any samples with potential biohazard
Label and print clearly (Unclear information will cause delay in processing)
Submit all samples in a plastic bag with clear identification information
Number of
Samples
Head/Advisor Signature
Test Request No.: CAARU/
Sample Received By:
Sample Condition :
Job Allotted To :
Delivery Performance Rating:
Appointment Schedule (Date/Time): DD/MM/YEAR
O 9 AM
O 1 PM
Date
For CAARU use
Sample Received
Analysis Completed
Expected Report Delivery
Actual Report Delivery
Report No:
DD:MM:YEAR
Date
Note: Sample will not be analyzed if the form is not completely filled
The collected Samples are subjected to disposal 30 days from the date of reporting
Central Analytical And Applied Research Unit, Sultan Qaboos University
Post Box:50, Al Khoudh, Muscat 123, Sultanate Of Oman
Email: [email protected], Tel : +968-24146801, Fax: +968-24146810
http://www.squ.edu.om/science/Units/CAARU
DD:MM:YEAR
DD:MM:YEAR
DD:MM:YEAR
Download

Submission From Internal – Genetic Analyzer