17546 Bee Line Highway, Jupiter, Florida USA Phone: (561) 625-0133 Fax: (561) 625-0717 www.btools.com
Sample Analysis Request Form
For the quickest and most complete analysis of your sample(s), please fill out this request
form.
Client Information
Date:
Purchase Order Number:
Contact Name:
Company:
Department:
Address:
City:
State / Province:
Zip / Postal Code:
Country: USA
Phone:
Fax:
e-mail:
Confidentiality Agreement Required:
Sample Information
Sample Name:
Sample Number:
Merk Index:NA
PDB Code:
C.A.S:
IR Spectrum:
Sample Structure
Sample Analysis Request Form
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17546 Bee Line Highway, Jupiter, Florida USA Phone: (561) 625-0133 Fax: (561) 625-0717 www.btools.com
Type of Analysis Required
VCD
Temp Study
pH Study
VCD with Absolute
Configuration
Temp Study
pH Study
Protein FT-IR
Temp Study
pH Study
Protein FT-IR and
Secondary Structure
Determination
Temp Study
pH Study
Optical Rotation
Temp Study
UV spectroscopy
Feasibility Study
If there is a type of analysis that you would like to have preformed that you do not see
above, please enter a detailed request below so we can determine if we can provide such
analysis.
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17546 Bee Line Highway, Jupiter, Florida USA Phone: (561) 625-0133 Fax: (561) 625-0717 www.btools.com
Sample Analysis Request Form
Sample Physical Properties / Hazards
Health:1
Reactivity:0Flammability:1 Special:
MSDS Attached M.P. / B.P:
Solvent
Polar
pH:
Mol Formula:
Empirical Formula:
Concentration:
Volume:
Mol Wt.
Amount:
Non-polar Buffer / Solvent:
Ionic Strength:
Solvent Physical Properties / Hazards
Health:
Reactivity:
Flammability:
MSDS Attached M.P. / B.P:
Mol Formula:
Special:
Mol Wt.
Empirical Formula:
Special Sample Precautions
Shipping Temp:RT
Storage Temp:RT
Light Sensitive
Air Sensitive
Temp Sensitive
Hydroscopic
Electrostatic
Sample Instructions:
Please include any additional information not covered in this form for the proper
handling, storing or analysis of your sample(s) :
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17546 Bee Line Highway, Jupiter, Florida USA Phone: (561) 625-0133 Fax: (561) 625-0717 www.btools.com
NFPA Rating Summary
Health (Blue)
4
Danger
3
2
1
0
Warning
Warning
Caution
May be fatal on short exposure, specialized protective
equipment required
Corrosive or toxic. Avoid skin contact or inhalation
May be harmful if inhaled or absorbed
May be irritating
No unusual hazard
Flammability (Red)
4
3
2
1
0
Danger
Warning
Caution
Flammable gas or extreamly flammable liquid
Flammable liquid and flash point below 100oF
Combustible liquid flash point of 100oF
Combustible if heated
Not combustible
Reactivity (Yellow)
4
3
Danger
2
1
0
Warning
Caution
Stable
Danger
Explosive material at room temperature
May be explosive if shocked, heated under confinement or
mixed with water
Unstable or may react violently if mixed with water
May react if heated or mixed with water but not violently
Not reactive when mixed with water
Special Reactivity Key (White)
Water Reactivity
Oxidizing Agent
W
Oxy
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