GSS Project No: / Client Contact:
Date Sent: / Client Organization:
Date Rec’d: / Shipping: FedEx UPS US Post Other:
Total No.of Samples: / Number of each: MinSep:DZ:CZ:ZFT:AFT:DAFT:Other*:
Material return instructions: Separates only Separates plus ALL residual material (additional charge)

Service code definitions:

MinSep = Mineral Separation DZ = Detrital ZrnUPb Age

AFT = Apatite Fission Track and UPb analysisCZ = Crystallization ZrnUPb Age

DAFT= Detrital AFTZFT = Zircon Fission Track

*Other = (U-Th)/He – Ap or Zrn, Electron probe microanalysis (EPMA), CL imaging – specify for each sample

Sample Identification InformationPlease add the full sample numbers and requested services.

GSS # / Client Sample # / Service Requested / GSS # / Client Sample # / Service Requested
01 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 11 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
02 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 12 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
03 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 13 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
04 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 14 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
05 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 15 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
06 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 16 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
07 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 17 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
08 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 18 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
09 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 19 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
10 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 20 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:

GSS Sample Registration Formcontinued (p. 2), for large projects

GSS Project No: / Client Contact:

Sample Identification InformationPlease add the full sample numbers and requested services.

GSS # / Client Sample # / Service Requested / GSS # / Client Sample # / Service Requested
21 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 34 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
22 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 35 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
23 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 36 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
24 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 37 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
25 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 38 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
26 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 39 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
27 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 40 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
28 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 41 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
29 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 42 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
30 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 43 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
31 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 44 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
32 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 45 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
33 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 46 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:

GSS Sample Registration Form continued (p. 3), for large projects

GSS Project No: / Client Contact:

Sample Identification InformationPlease add the full sample numbers and requested services.

GSS # / Client Sample # / Service Requested / GSS # / Client Sample # / Service Requested
47 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 59 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
48 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 60 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
49 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 61 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
50 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 62 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
51 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 63 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
52 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 64 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
53 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 65 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
54 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 66 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
55 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 67 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
56 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 68 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
57 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 69 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:
58 / Min Sep DZ
AFT CZ
DAFT ZFT
Other: / 70 / Min Sep DZ
AFT CZ
DAFT ZFT
Other:

Sample Registration Form© GeoSep Services