Sample Submission
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Please fill out the form below each time you submit a sample for mass spectrometry analysis. You can also download it as a pdf file or excel file.
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| First time submitters, please talk to a MS staff member before filling out this form. | |||
| Submitter Information | Attach Sample Here | ||
| Name _____________________________________ | (1 - 2 mL vials or microfuge tubes are preferred), | ||
| Phone____________ E-mail___________________ | or Indicate Location (next to inbox, in refrigerator, etc.) | ||
| Res. Director/Dept.__________________________ | Sample Label_______________________________ | ||
| Chem. Dept. Recharge # _____________________ | |||
| Sample Information | |||
| Target Elemental Formula / Monoisotopic Mass | Chemical Structure (attach separate page if necessary). | ||
| __________________________________________ | |||
| Solubility of Target Molecule(s)_________________ | |||
| ___________________________________________ | |||
| Sample State: (1) Solid____ (2) Neat Liquid____ | |||
| (3) Dissolved in ______________ Conc.___________ | |||
| Special Handling / Analysis Considerations | |||
| (thermal stability, chemical incompatiblities, purity, | |||
| likely impurities, degree of solubility, etc.) | |||
| __________________________________________ | |||
| __________________________________________ | |||
| Suggested Ionization Method, if known. | Please Note | ||
| ESI____ MALDI____ GC/MS(EI/CI)____ APCI____ | (1) When in doubt, discuss any questions / issues with the | ||
| MS Lab staff prior to sample submission. | |||
| Required Mass Resolution | (2) Salts and detergents will interfere with all MS techniques. | ||
| Low (± 0.3 Da) ____ | (3) Solvent volatility is important in MS analysis. | ||
| High (< 5 ppm) ____ (MW < 1000, attach low | |||
| resolution spectrum, otherwise it will be run first) | |||
| Analysis Report (Staff Use Only) | |||
| Date Submitted_____________ | Date Analyzed______________ | ||
| Sample Preparation / Analysis Comments ___________________________________________________________ | |||
| Found ________________________________________________________________________________________ | |||
| _____________________________________________________________________________________________ | |||
| _____________________________________________________________________________________________ | |||
| _____________________________________________________________________________________________ | |||