ࡱ> _a^] hbjbj\\ .V6i6impp8Ok"&gg(jjj!!!!!!!$7$&p!jjjjj!!j!j!: ,L! 6#ĕ |!!0" R]']'L!]'L!0jjjjjjj!!4jjj"jjjj]'jjjjjjjjjpY :  51 INFORMATIONSHIPPING INSTITUTIONS INFORMATIONInstitution:51Institution:Investigator:Investigator:Department:Department:Laboratory Contact:Laboratory Contact:Phone:Phone:Fax:Fax:E.mail:E.mail:Veterinarian:Peter GasperVeterinarian:Phone:920-359-1182Phone:Fax:414-229-6729Fax:E.mail:gasperp@uwm.eduE.mailImport Coordinator:Jenny NemkeExport Coordinator:Phone:414-229-2905Phone:Fax:414-229-6729Fax:E.mail:nemke@uwm.eduE.mail: 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: I have supplied the following information to the ARC prior to animal arrival: [] A recent (last 3 months) health report of the colony [] A summary of health issues for the last 12 months for the whole facility [] A description of the health monitoring/serology programHusbandry InformationInformation about the shipping institutions facility: Room: [] Barrier [] Conventional Caging: [] Micro-isolator [] Open top [] Sterile [] Non-sterile Cage Change: [] Inside hood [] Without hoodWhen the animals arrive at 51 they will be housed in quarantine for the standard 6-week period. Will the animals be used while in quarantine? [] No [] Yes, Describe: Will the animals be bred while in quarantine? 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