(PRC‐JUST) Jordan University of Science and Technology (JUST) Pharmaceutical Research Center (PRC) 1.Client Details: Name: Research No. Address: Contact: Phone: Fax: E-mail: Company: Additional Info. : 2.Analysis request details. No. of samples: Samples Hazardous (If yes, MSDS must be supplied) Yes No Recommended Sample Storage: Room Temp. 4˚C -20˚C other_____ The samples should Return to the client. Yes No (samples will stored Only 3 months) # Sample Identification: (eg. Lot Number, Date) PRC-JUST Sample Code Sample Description and/or required analysis 1 2 3 4 5 Notes________________________________________________________________________ _______________________________________________________________________. Client Name & Signature: PRC-JUST Director & signature: