Compound Submission Form
| Submitter Name: | Submitter Compound ID: | ||||
| Compound Name: | |||||
| Structure: | |||||
| Molecular Wt: | Molecular Formula: | ||||
| Stability: | Soluble in DMSO? | yes | no | warm | |
| Hygroscopic/Deliquescent? | If "no": | v.sol | mod.sol. | insol. | warm |
| Appearance: | WATER | ||||
| ETHANOL | |||||
| Sample Wt.(mg): | OTHER______________ | ||||
| Special Safety/Handling/Storage Requirements: |
Proprietary and Confidential – For Official Use Only
NOTE This sample Compound Submission Form is provided for your convenience and can be used to accompany the samples that you plan to submit to the TAACF for tuberculosis screening. If your organization has comparable data sheets, those may be used instead. Data submission in any electronic format is preferred. Regardless of the type of form used, certain key information must be provided for each submitted compound: submitter identification number, structural formula, molecular weight, molecular formula, sample appearance, solubility data in DMSO or, if insoluble in DMSO, another solvent (preferably water or ethanol), and any special safety/handling/storage requirements. |