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									                                                                                      For IsoTrace Use Only        Page 1 of
IsoTrace Laboratory
Accelerator Mass Spectrometry Facility
at the University of Toronto

Iodine-129 Sample Submission Form
                                                                                      Date Received (D/M/Y)        Location

                                                                                      TOI Numbers Assigned

                             General Instruction                                          Return this form with samples to
Please type or print. If space is insufficient, append additional pages of the    Isotrace Laboratory / I-129 Analytical Service
Sample List Form, or of any format including the same information. Please         University of Toronto
also append any existing sample data sheets. Use one form for one type of         60 St. George Street
sample material only. For futher information,                                     Toronto, Ontario
Phone:(416) 978-2258                                           Fax: (416)         Canada
978-4711                                                                          M5S 1A7
Samples submitted by:                                                 Append address if submitting for the first time.

Purchase order or contract number:                                    Project name:

Sample material (iodide, rock, clay, sand, sediment, water, filter paper, etc.):
Give detailed description of the sample material if any.

Give natural I-127 concentration if available, or estimate.

Should I-127 concentration be measured?

Can all sample material be used?                                      Should any unused material be returned?
If not, specify quantity.                                             Additional charge for returned sample material - 15$ per

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:                                                               Latitude:

Area, Country, etc.:                                            Longitude:                                   (Or specify for each sample
in the attached table)

Significance of these particular samples (reasons for analysis):

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