André. E. Lalonde
AMS Laboratory
For A.E. Lalonde AMS Laboratory Use Only
Date Received (D/M/Y)
Iodine-129 Sample
Submission Form
UOH Numbers Assigned
Ship Samples to:
General Instructions
Please type or print and append any existing sample data sheets. Use one
form for each type of sample material only. For further information
contact Monika Wilk at:
Phone: (613) 562-5800 ext.6183
E-mail: mwilk@uottawa.ca
Radiohalide Laboratory, University of Ottawa
25 Templeton Street, rm 444
Ottawa, Ontario
Canada
K1N 6N5
Samples submitted by (name, address & contact info):
Name:
Address:
Phone:
Email:
Purchase order or contract number:
Project name:
Provide detailed description of the sample material (iodide, rock, clay, sand, sediment, water, filter paper, etc.):
Provide I-127 concentration if available, or estimate:
Should I-127 concentration be measured? (Yes or no)
Can all sample material be used?
Should any unused material be returned?
If not, specify quantity:
Please note there is an additional charge for returned sample
material of $15 per shipment
What unit should be used for reporting I-129 results? (I-129/I-127 ratio, I-129/gram, or I-129/litre):
Estimate the range of I-129 results in the required unit, give basis for the estimation:
Describe any possible sources of I-129 contamination in the sampling environment:
Date of sample collection:
Site name:
Area, Country, etc.:
Latitude:
Longitude:
Elevation:
(Or specify for each sample in the attached table)
UOH Number
(assigned by
A.E. Lalonde
AMS Lab)
Submitter's
Sample Identification Code
Sample Size
I-127
Weight (gram)
Concentration
or Volume
(if available)
(litre)
Geographic Location
Latitude/longitude/Elevation
UOH Number
(assigned by
A.E. Lalonde
AMS Lab)
Submitter's
Sample Identification Code
Sample Size
I-127
Weight (gram)
Concentration
or Volume
(if available)
(litre)
Geographic Location
Latitude/longitude/Elevation