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: caaru@squ.edu.om, Tel : +968-24146801, Fax: +968-24146810 http://www.squ.edu.om/science/Units/CAARU DD:MM:YEAR DD:MM:YEAR DD:MM:YEAR