The Campbell Microanalytical Laboratory

Department of Chemistry

University of Otago

Union Place

P.O. Box 56

Dunedin

New Zealand

Tel: (64)-3-479-7886
Fax: (64)-3-479-7906
Email: microlab@chemistry.otago.ac.nz

ANALYSIS REQUEST
(to accompany sample for analysis)

Sample No: ..............................................................................................

Report to: .................................................................................................

.................................................................................................................

.................................................................................................................

.................................................................................................................

Analyses desired: ......................................................................................

M.P. (°C) ...................... B.P. (°C) .................. @ .................... mmHg

Hygroscopic? Volatile? Sublimes? Explosive?

Other elements present: .............................................................................

Type of compound: ...................................................................................

N present as: ............................................................................................

Composition: C ....................................................... H ....................................................... N ....................................................... Cl, Br, I, F.......................................... S ........................................................

Structure, if known:

Drying instructions, etc. (temp., pressure): .................................................

.................................................................................................................

Date: ................................... Signed: ....................................................