ࡱ> Y[X] bjbj\\ .N6i6im..8 )!&  (555\!^!^!^!^!^!^!$$&p!!55!55\!\!: ,(!5`TOÕ H!!0! R)')'(!)'(! !!L!)'.Y :  51 INFORMATIONRECEIVING INSTITUTIONS INFORMATIONInstitution:51Institution:Investigator:Investigator:Department:Department:Laboratory Contact:Laboratory Contact:Phone:Phone:Fax:Fax:E.mail:E.mail:Veterinarian:Peter Gasper Veterinarian:Phone:920-359-1182Phone:Fax:414-229-6729Fax:E.mail:gasperp@uwm.eduE.mailExport Coordinator:Jenny NemkeImport Coordinator:Phone:414-229-2905Phone:Fax:414-229-6729Fax:E.mail:nemke@uwm.eduE.mail:Exporting Animal Information Species:Inoculated and/or exposed to:Number Shipping:Infectious agents? [] Yes [] No#M / #F:Recombinant DNA? [] Yes [] No Background Strain:Carcinogens? [] Yes [] NoGenotype:Toxic chemicals? [] Yes [] NoAge/DOB:Previous surgery/experimental procedures? [] Yes [] NoFacility:Room Number(s)Immune status of the animals (select only one): [] Normal [] Deficient [] UndeterminedIf the animal(s) has been inoculated and/or exposed to infectious agents, recombinant DNA, carcinogens, toxic chemicals, and/or radionucleotides, please identify: If the animal(s) has had surgery or other experimental procedures performed on them, please describe: Type of genetic modification: [] Tg [] KO [] KI [] N/A [] Other:  Special Housing or Husbandry Needs: Information about the 51 facility: Room: [] Barrier [] Conventional Caging: [] Micro-isolator [] Open top [] Sterile [] Non-sterile Cage Change: [] Inside hood [] Without hood     51 Animal Resource Center Animal Shipping Form - Exporting Page  PAGE 1 of  NUMPAGES 2 456CFGTUVdestu      # + , 3 4 5 : F G L M N V ] f m n o hg56OJQJh6bOJQJh6b56OJQJh6b5OJQJh6bCJOJQJh6b5CJOJQJM56CGTUoiii$Ifkd$$Ifl0L&  07'4 lap  $$Ifa$L]LUVdestMGGGG$Ifkd$$Ifl\Lpl&$  }  07'4 laptuMGGGG$Ifkd~$$Ifl\Lpl&$  }  07'4 lapMGGGG$IfkdV$$Ifl\Lpl&$  }  07'4 lapMGGGG$Ifkd.$$Ifl\Lpl&$  }  07'4 lapMGGGG$Ifkd$$Ifl\Lpl&$  }  07'4 lapMD>D>$If $$Ifa$kd$$Ifl\Lpl&$  }  07'4 lap   MG>GG $$Ifa$$Ifkd$$Ifl\L&8k 07'4 lap   , 3 4 MG>GG $$Ifa$$Ifkd$$Ifl\LT&   07'4 lap4 5 : G L M MG>GG $$Ifa$$Ifkd$$Ifl\LT&   07'4 lapM N V f m n MD;D5$If $$Ifa$ $$Ifa$kdv$$Ifl\LT&  07'4 lapn o MG>GG $$Ifa$$IfkdN $$Ifl\L&8k 07'4 lap MG>GG $$Ifa$$Ifkd4 $$Ifl\Lpl&$  }   07'4 lap MG>GG $$Ifa$$Ifkd( $$Ifl\Lpl&$  }   07'4 lap    # $ B C T U    M N W X ]   J K X Y Z ] "p㶶㯯 h6b5\h6b5OJQJ\h6bCJOJQJh6b5CJOJQJh6b56CJOJQJh6bOJQJh6b56OJQJh6b5OJQJE MG>GG $$Ifa$$Ifkd $$Ifl\Lpl&$  }  07'4 lap  MD $$Ifa$kd $$Ifl\L&8k 07'4 lap  # $ B $If $$Ifa$qkd $$Ifl4L&7'  07'4 laf4p B C T U ]WWW$Ifkd$$Ifl4FLp&$   07'    4 laf4p ]TIC$If  !$If $$Ifa$kdd$$Ifl4FLp&$   07'    4 laf4p ]TNN$If $$Ifa$kd4$$Ifl4FLp&$   07'    4 laf4p    M ]TNN$If $$Ifa$kd$$Ifl4FLp&$   07'    4 laf4pM N W X ]TNNN$If $$Ifa$kd$$Ifl4FLp&$   07'    4 laf4p ]TNN$If $$Ifa$kd$$Ifl4FLp&$  ` 07'    4 laf4p ]TNN$If $$Ifa$kd$$Ifl4FLp&$   07'    4 laf4p J ]T $$Ifa$kd$$Ifl4FLp&$    07'    4 laf4pJ K X Y 8^kd $$IflL&7'07'4 la $$Ifa$^kd$$IflL&7'07'4 laY Z 8666^kd$$IflL&7'07'4 la $$Ifa$^kd$$IflL&7'07'4 la "p $a$$a$p     h6bmHnHu h6bCJh6b5CJ\h6bjh6bU h6b5\%,1h/ =!"#$% $$If!vh#v#v:V l  07'554ap $$If!vh#v$ #v #v} #v :V l 07'5$ 5 5} 5 4ap$$If!vh#v$ #v #v} #v :V l 07'5$ 5 5} 5 4ap$$If!vh#v$ #v #v} #v :V l 07'5$ 5 5} 5 4ap$$If!vh#v$ #v #v} #v :V l 07'5$ 5 5} 5 4ap$$If!vh#v$ #v #v} #v :V l 07'5$ 5 5} 5 4ap$$If!vh#v$ #v #v} #v :V l 07'5$ 5 5} 5 4ap$$If!vh#v8#vk#v#v:V l 07'585k55/ 4ap$$If!vh#v#v #v#v :V l 07'55 55 / / 4ap$$If!vh#v#v #v#v :V l 07'55 55 / 4ap$$If!vh#v#v #v#v :V l 07'55 55 4ap$$If!vh#v8#vk#v#v:V l 07'585k55/ 4ap$$If!vh#v$ #v #v} #v :V l 07'5$ 5 5} 5 / / 4ap$$If!vh#v$ #v #v} #v :V l 07'5$ 5 5} 5 / 4ap$$If!vh#v$ #v #v} #v :V l 07'5$ 5 5} 5 4ap$$If!vh#v8#vk#v#v:V l 07'585k55/ 4ap$$If!vh#v7':V l4  07'57'/ / 4af4p $$If!vh#v$ #v #v:V l4 07'5$ 5 5/ 4af4p$$If!vh#v$ #v #v:V l4 07'5$ 5 54af4p$$If!vh#v$ #v #v:V l4 07'5$ 5 5/ 4af4p$$If!vh#v$ #v #v:V l4 07'5$ 5 5/ 4af4p$$If!vh#v$ #v #v:V l4 07'5$ 5 5/ 4af4p$$If!vh#v$ #v #v:V l4 07'+5$ 5 5/ / 4af4p$$If!vh#v$ #v #v:V l4 07'+5$ 5 5/ 4af4p$$If!vh#v$ #v #v:V l4 07'+5$ 5 5/ / 4af4pw$$If!vh#v7':V l07'57'4a$$If!vh#v7':V l07'57'/ 4a$$If!vh#v7':V l07'57'/ 4a$$If!vh#v7':V l07'57'/ 4ax666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH66666666666666666666666666666666666666666666666666666666666666666p62&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH @@  Heading 1$$@&a$5\FF  Heading 2$$@&a$ 56\]DA D Default Paragraph FontVi@V 0 Table Normal :V 44 la (k ( 0No List <@< Header  !CJaJ4 @4 Footer  !PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V (BO)MBT.$@0H!A>풠Uc-zD[&!rX=}zC0` ި%.]Ssd--7 +fOZեrŵVœ\lji2ZGwm-3˵j7\ Uk5FҨ-:xRkcr3Ϣ+9kji9OP Et-j|#p;E=Ɖ5Z2sgF=8 K}*7c<`*HJTcB<{Jc]\ Ҡk=ti"MGfIw&9ql> $>HmPd{(6%z:"'/f7w0qBcF6f Iöi1(\}B5ҹ~Bcr6I;}mY/lIz1!) ac 1fm ƪN^I77yrJ'd$s<{uC>== Ƌ(uX=WA NC2>GK<(C,ݖm: &-8j^N܀ݑ$4:/x vTu>*ٞn{M.Ǿ0v4<1>&ⶏVn.B>1CḑOk!#;Ҍ}$pQ˙y')fY?u \$/1d8*ZI$G#d\,{uk<$:lWV j^ZơSc*+ESa1똀 k3Ģxzjv3,jZU3@jWu;z \v5i?{8&==ϘNX1?  O4׹ӧCvHa01 %xz24ĥ=m X\(7Xjg !Ӆqd? cG7.`~w*?, 2 nN*"Fz_&n &\ F:l[+%f 0N IIlllo p&Ut 4 M n  B M J Y   !"#$%NUW\gio!8@0(  B S  ?NTVefl~NTVeflDHw{LP333333333333333+::FFV] +::FFV]?+\.@#;碍h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhu u ^u `OJQJo(hHhEE^E`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hH@#;?+                  g6b@ ]]]]@Unknown G.[x Times New Roman5Symbol3. .[x Arial9GaramondC. Aptos Display3. Aptos;Wingdings?= .Cx Courier NewA$BCambria Math"qhGGgs  !20KQ@P  $Pg2!xxCE UWM INFORMATIONnemkeMounika Yaradla  Oh+'0 $ D P \ ht|51 INFORMATIONnemke Normal.dotmMounika Yaradla2Microsoft Office Word@G@:8 -@Õ@Õ ՜.+,0 hp  UW-Milwaukee  51 INFORMATION Title  !"#$%&')*+,-./012356789:;<=>?@ABCDEFGIJKLMNOQRSTUVWZRoot Entry FPÕ\Data (1Table4='WordDocument.NSummaryInformation(HDocumentSummaryInformation8PCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q