Integrated Analytical Solutions, Inc.
R&D Division
IAS Tracking No.:
Bioanalytical Submission Form
For IAS Only
Submit samples to: 1456 Fourth Street, Unit C, Berkeley, CA 94710
This work is for research purposes. It is not intended to comply with the GLP regulations or the SOPs of the IAS GxP Division and does not involve oversight by
the IAS Quality Assurance Unit. Form must be completed prior to initiation of testing. Please attach additional information as necessary.
Client Information
Company name
and address:
Contact person,
phone and email:
Billing Information
IAS Quote No:
Client PO # or AP Contact:
Submission Information
Date shipped:
Shipper name and address (if not from client):
SAMPLES WILL BE HELD FOR UP TO 3 MONTHS AFTER ANALYSIS AND DISPOSED OF UNLESS OTHERWISE INDICATED.
Please check here if samples are to be returned. 
Sample and Service Information
Study No.:
Test Article/Compound(s)
Submission: Please indicate amount of compound if provided (or NA, if previously provided) and if compound is in solution, the concentration and solvent (e.g. 5 mg/mL in DMSO). Powders
are preferred; please check solvents that can be used with the powder. Please fill in compound information as completely as possible.
Storage: Powders will be stored at room temperature and solutions will be stored at -20oC unless specified otherwise.
Please check one:
Compound Name
Quantify Parent Only
Monoisotopic
(Exact) Mass
Quantify Parent and Metabolites/Multiple Compounds
Salt Form
(as applicable)
Formula
Weight
Submission (see above for instructions)
Chemical Formula
Amt (wt or vol)
Structure provided below
Structure provided below
Structure provided below
Structure provided below
Structure provided below
Structure provided below
NA
NA
NA
NA
NA
NA
Conc. & Solvent
NA
NA
NA
NA
NA
NA
Dissolution Solv.
DMSO
MeOH
other:
DMSO
MeOH
other:
DMSO
MeOH
other:
DMSO
MeOH
other:
DMSO
MeOH
other:
DMSO
MeOH
other:
ACN
H2O
ACN
H2O
ACN
H2O
ACN
H2O
ACN
H2O
ACN
H2O
Assay Guidelines
I.V. Samples up to 30 minutes will be diluted 1/5 to reduce vehicle interference unless this box is checked. 
Volume: 25 µl must be recoverable from each sample otherwise the sample may not be analyzed and a charge may still be applied.
Organization: Samples not organized according to the description below or the attached documentation may have a sorting fee applied.
Repeat Analysis: A sample with a measured concentration >30% above the highest calibration standard (ULOQ) will be diluted and re-analyzed, and this repeat analysis will be charged as
an additional sample.
Storage: Samples will be stored at -20oC unless specified otherwise.
Compound(s) to
Quantify:
Calibration Range:
(Check One)
Species:
Dose &
Route:
Matrix:
Tot. No. Samples Analysis Info: (samples to analyze of submittedSubmitted:
IDs, time pts, conc. …etc., other instructions)
15-50,000 ng/mL (default)
3-10,000 ng/mL
Other:
15-50,000 ng/mL (default)
3-10,000 ng/mL
Other:
Integrated Analytical Solutions, Inc.
P: (510) 649-9016 F: (510) 649-9017
533558043
CONFIDENTIAL
e-mail: services@ianalytical.net
website: www.ianalytical.net
Page 1 of 2
Integrated Analytical Solutions, Inc.
R&D Division
IAS Tracking No.:
Bioanalytical Submission Form
For IAS Only
Submit samples to: 1456 Fourth Street, Unit C, Berkeley, CA 94710
This work is for research purposes. It is not intended to comply with the GLP regulations or the SOPs of the IAS GxP Division and does not involve oversight by
the IAS Quality Assurance Unit. Form must be completed prior to initiation of testing. Please attach additional information as necessary.
Sample and Service Information
15-50,000 ng/mL (default)
3-10,000 ng/mL
Other:
15-50,000 ng/mL (default)
3-10,000 ng/mL
Other:
15-50,000 ng/mL (default)
3-10,000 ng/mL
Other:
15-50,000 ng/mL (default)
3-10,000 ng/mL
Other:
15-50,000 ng/mL (default)
3-10,000 ng/mL
Other:
15-50,000 ng/mL (default)
3-10,000 ng/mL
Other:
Additional Service Requests or Notes
Dosing Formulation Analysis
Please check if dosing formulation analysis is requested, and provide the sample ID, concentration, and vehicle for each sample (e.g. Grp1 CmpdA, 2mg/mL in
20%DMSO+80%PEG).
Total number of dosing formulations submitted:
Sample ID, concentration, and vehicle (for each):
Additional notes: Please provide additional information, specific storage instructions, chemical structures, tissue weights and plate maps here, as applicable.
For IAS Only: Log-in Date
Initials
Condition
Location
Log-in Date
Initials
Condition
Location
Log-out Date
Initials
Returned
Disposed
Integrated Analytical Solutions, Inc.
P: (510) 649-9016 F: (510) 649-9017
533558043
CONFIDENTIAL
e-mail: services@ianalytical.net
website: www.ianalytical.net
Page 2 of 2