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LECO European LSCA Centre
GC-TOFMS Sample Submission Form
This form must be completed fully with your LECO Sales Specialist. The information is fundamental
and essential for the optimal organization of your sample measurements.
Please don´t use abbreviations for chemical names to avoid mistakes.
After reviewing the completed SSF our Application Chemists, will contact you to schedule sample
shipping and dates for analysis.
If you have any question, please contact us: LSCA +49(0)2166-687-104 or -107
SepSci@leco.de
www.leco-etc.com
Sales Specialist Name:
Date:
Company submitting samples:
Contact person:
Address:
City:
Postal code:
Country:
Telephone number:
FAX Number:
E-Mail address:
Number of samples
What sample volumes were shipped?
Sample matrix:
Application field:
Which system do you wish to assess?
Pegasus HT
Pegasus 4D
TruTOF HT
Pegasus HRT
GCxGC (Please specify the Detector type. µECD or FID
Are safety data sheets sent with the samples?
Yes
Do you currently measure these samples by GC or GC-MS?
Please specify here
GC-FID/ µECD/NCD/SCD
No
Yes
No
GC-MS
Notice: If it´s possible please attach a chromatogram.
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Parameter
GC Parameters:
Injector:
Liner (Type, Company):
Isothermal Temperature:
Temperature Programming:
Initial Temperature
Initial Hold Time
Temperature Ramp Rate
Final Temperature
Final Hold Time
Type of Injection Port Liner:
Injection Mode:
Split
(
:1 split ratio)
Splitless (
min purge time;
On Column
Retention Gap Phase Type
Length
Inner Diameter
Film Thickness
Injection Volume L
Sample Solvent -
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o
C
o
C
min
o
C/min
o
C
min
mL/min purge flow)
m
mm
microns
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Column
Length
m
Inner Diameter
mm
Phase
Film Thickness
microns
Carrier Gas
o
Column Flow
mL/min (measured at
C)
Electronic Pressure Control (EPC)
Constant Flow
(
mL/min)
Constant Pressure (
psi)
Pulsed Splitless
Pressure
psi
Pulsed Pressure
psi
Pulse Time
min
Purge Time
min
Purge Flow
mL/min
Pulsed Split
(
:1 split ratio)
Pressure
psi
Pulsed Pressure
psi
Pulse Time
min
Column Oven Temperature Program:
Ramp 1
Ramp 2
Ramp 3
o
o
o
Initial Temperature
C
C
C
Initial Hold Time
min
min
min
o
o
o
Ramp Rate
C/min
C/min
C/min
o
o
o
Final Temperature
C
C
C
Final Hold Time
min
min
min
Mass spectrometer Programme:
Mass spectrometer Type:
Single Stage Quadrupole
Multi Stage Quadrupole
Magnetic Sector
Ion Trap
Manufacturer
Model
Mass Range
u to
u
Acquisition Time
min
Solvent Delay
min
Scan Rate
seconds/scan
Detector Programme:
Detector Type:
FID
ECD
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Manufacturer
Model
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Sample information (Please provide a Minimum of 500 µl of each Sample)
Specifically, which analytes are expected in the samples? Please don´t use generic chemical class
terminology.
Name
CAS No.
MW
Expected Concentration
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
Notice: Please add further pages when the space here is insufficient. Additionally,
please attach the spectra of the analytes of interest where possible.
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Sample Storage:
Stored by room Temperature
Yes
No
Stored in the refrigerator?
Yes
No
Stored in the Freezer?
Yes
No
How long are the samples stable?
Date of sample preparation?
Please enter details here if other storage requirements are necessary.
Contained in the sample(s):
Dioxin
Hazardous levels of priority pollutants
Hazardous levels of other types of compounds
Concentrations of drugs requiring DEA licensing
Yes
Yes
Yes
Yes
Sample Preparation:
Derivatization necessary?
Yes
Which Derivatization agents are required?
When should great care be taken during sample preparation?
When should samples be derivatised?
How long are samples stable in the derivatised form?
No
No
No
No
No
Aim of analysis
Quantitative Analyses
Qualitative Analyses
Yes
Yes
No
No
What kind of information should be contained in the report?
1.
2.
3.
4.
5.
6.
Which properties should be tested with this system?
1.
2.
3.
4.
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Please identify here what current and future analytical problems are faced. Furthermore, the
impact these challenges present in your laboratory and to your business.
Define the detection (LOD) and qualification limit (LOQ) needs for your analysis
May LECO use this data for creating future application notes, snapshots or marketing material?
Would you like to use the data for publications in collaboration with LECO?
Outline your goals and expectations from this sample analysis. Include here your required time
frame for completion and any deadlines that must be adhered to.
Please note we will contact you for planning the next steps.
_____________________________________________
Customer Signature
Form No. 203-505-293
8/08 REV7
___________________
Date
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