Mass Spectrometry Sample Submission Form
(Radioactive Samples Will Not Be Accepted Without Prior Approval of Kathy Stone)
| Name: | Date: |
| Department: | P.I.: |
| Yale Cancer Center Member? (Circle one): YES NO | Telephone: |
| Institution: | FAX: |
| Shipping Address:
(City, State, Zip): |
Billing Address (Required):
(City, State, Zip): |
| Email: | Charge No: (If HHMI enter HHMI and HHMI cost center number, otherwise enter Yale charge number, purchase order number or PHS record of call.) |
Description of Samples |
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| 'Sample #mple Sample | 11 |
2 |
3 |
4 |
| 'Sample Name Sa | ' | ' | ' |
' |
| Biological Source (if appropriate) | ' | ' | ' | ' |
| Estimated Total Amount (µg) | ' | ' | ' | ' |
| Estimated Total Amount (picomole) | ' | ' | ' | ' |
| Total Volume (µl) | ' | ' | ' | ' |
| Monomer Mass (Da) | ' | ' | ' | ' |
| Form (PVDF, solution or dry) | ' | ' | ' | ' |
| Radioactive? | ' | ' | ' |
' |
| Isotope/cpm | ' | ' | ' | ' |
| Biohazard? (If yes, explain below) | '' | ' | ' | ' |
Requested Services (check all services requested on each sample) |
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| MALDI-MS | ' | '' | ' | ' |
| ESMS | ' | ' | '' | ' |
Complete the Following Two Entries for Exact Mass Determinations on 150-1,000 Da Compounds |
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| Expected Monoisotopic MW | ' | ' | ' | ' |
| Molecular Formula | ' | ' | ' | ' |
To indicate whether the sample should be recorded in positive or negative ion mode, please
indicate the proposed structure or compound type for each sample:
If samples are submitted in solution please give the solvent/buffer - use a separate form
if different samples are in different solvents.
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If samples are submitted dry please give the method of precipitation or the volume/composition of the buffer/solvent that was dried:
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