NMR Job Order - 2014

NATIONAL CHEMISTRY
INSTRUMENTATION CENTER
NATIONAL CHEMISTRY
INSTRUMENTATION CENTER
Department of Chemistry
Department of Chemistry
School of Science and Engineering
School of Science and Engineering
Rm C104 G /F Schm itt Hall, Katipunan A ve, Loyola H eights, 1108, Q uezon City, Philippines • Tel. N o. (632) 4266001 loc 5629 • Fax N o. (632) 426-1323
w ebsite: ww w .adm u.edu.ph/ls/sose/ncic • em ail: ncic.sose@ ateneo.edu
Rm C104 G /F Schm itt Hall, Katipunan A ve, Loyola H eights, 1108, Q uezon City, Philippines • Tel. N o. (632) 4266001 loc 5629 • Fax N o. (632) 426-1323
w ebsite: ww w .adm u.edu.ph/ls/sose/ncic • em ail: ncic.sose@ ateneo.edu
____________________________________
NMR Job Order Number
Client / Contact Name: __________________________________________________________________________________
Email / Mobile No: ______________________________________________________________________________________
Research Adviser/Supervisor: ____________________________________________________________________________
Email / Mobile No: ______________________________________________________________________________________
Institution: ____________________________________________________________________________________________
NUCLEAR MAGNETIC RESONANCE ANALYSIS CLAIM FORM
Minimum Sample Height (5mm Tube)
NUCLEAR MAGNETIC RESONANCE ANALYSIS REQUEST
____________________________________
NMR Job Order Number
Sample Code
(List in order of priority and LIMIT TO 8 CHARS)
NMR
Solvent
Sample Information
NMR Experiments
Project: _______________________________________________________________________________________________
Sample Code
Sample Information
Amount
(List in order of priority)
(mg)
(To be filled up by NCIC)
NMR
Solvent
NMR
Experiments
Operator
Run Time
IMPORTANT NOTES AND POLICY AGREEMENT
1.
1.1. Sample/s has been checked for suitability to be analyzed by NMR with regards to sample purity, stability, solubility and
sample size with minimal sample preparation required.
1.2. Sample/s has been checked for solubility in the indicated solvent and gives a stable solution free of ALL solid particles.
1.3. All relevant properties, precautions, hazards and special instruction has been conveyed to NCIC staff.
1.4. The client should inform NCIC if special sample handling is required. NCIC will not be responsible for degradation of
samples or improper sample handling due to lack of information from the client.
ENCIRCLE ALL THAT APPLY :
Sample Prep: Client / NCIC
Data Processing:
NMR Tube: NCIC / Client Provided / Purchased
FID Soft C opy / FT Soft C opy (peak labels / integrals /
m ultip licity / j-coupling / calculated spectra) / FT H ard Copy
Solvent: Client / NCIC
/
CO A
2.
Sample Recovery: sample / sample container / NMR tube
3.
Sample Run: Client / NCIC
Run Queue: Rush / Regular
Processing: Client / NCIC
Payment : Fully Paid / Balance: ____________________
4.
SPECIAL H ANDLING / INSTRUCTIONS / NOTES : _________________________________________________________________
5.
________________________________________________________________________________________________________
Upon submission and receipt of samples by NCIC staff, the client hereby agrees to the NCIC terms and conditions outlined in the claim form.
Name / Signature of Client
Supervisor
NCIC Staff
Date
FO R IN TERN AL U SE:
Current Status
Operator
Remarks
Date
Sample Prep
Sample Run
Sample Data
Processing
SOA Number
Billing
Release
Any deviations from the following requirements need special arrangements to be made beforehand between the
Research Adviser / Supervisor and NCIC staff before sample is accepted for NMR analysis:
6.
7.
8.
The NCIC assures the client of strict confidentiality of NMR data and that the client has complete ownership of the
NMR data.
The client should acknowledge the National Chemistry Instrumentation Center (NCIC) and the use of JEOL LA 400-FT
NMR in any publication where the NMR data is reported.
The client should retrieve their samples after completion of analysis. NCIC will discard samples not claimed one (1)
month after the analysis unless special instructions are indicated.
NMR results will be released only upon full payment of charges unless there has been prior arrangement with NCIC
staff.
The NCIC does not guarantee permanent storage of NMR data. The client may request for a copy of their data.
Present this claim form duly signed for claiming of results.
Upon submission and receipt of samples by NCIC staff, the client hereby agrees to the aforementioned NCIC terms
and conditions
Name / Signature of Client
Supervisor
NCIC Staff
Date

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