MSL/CHiBi
Proteomics Core Facility
Mass Spectrometry Hub
Sample Submission Form
Page 1 of 2 / Room 344/436
2125 East Mall (NCEBuilding)
Weekdays 9 AM-5 PM
Please ensure you have an open JV
or an active PO for processing
Questions:
Office: 604-822-8311 (Leonard Foster)
Lab: 604-827-5209 (Jason Rogalski)
Fax: 604-827-2603

Mass Spec File number
MS2K / Date received:
Date completed:
User Name (Last, First): / PI Name (Last, First):
Department
Address / Telephone
Fax
Email
Open Order JV #: J
Description of Samples
Total number of samples submitted:
Sample No. / 1 / 2 / 3 / 4 / 5 / 6 / 7
Sample Name
Genus & Species
Sample Type / ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
/ ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
/ ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
/ ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
/ ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
/ ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
/ ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
Purpose of analysis / MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
/ MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
/ MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
/ MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
/ MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
/ MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
/ MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
Form of submission / Gel BandLiquidDriedOther:
/ Gel BandLiquidDriedOther:
/ Gel BandLiquidDriedOther:
/ Gel BandLiquidDriedOther:
/ Gel BandLiquidDriedOther:
/ Gel BandLiquidDriedOther:
/ Gel BandLiquidDriedOther:
Molecular Weight (Da)
Total Volume (µl)
Estimated TOTAL Amount in submitted sample / Amount:
µg pmol / Amount:
µg pmol / Amount:
µg pmol / Amount:
µg pmol / Amount:
µg pmol / Amount:
µg pmol / Amount:
µg pmol
Best storage conditions / 4C-20C / 4C-20C / 4C-20C / 4C-20C / 4C-20C / 4C-20C / 4C-20C
Buffers or Solvent composition: list ALLbuffers AND concentration of organic solvents, salts, detergents, etc…

Mass Spectrometry Hub Sample Submission Form Page 2 of 2

Sample No. / 8 / 9 / 10 / 11 / 12 / 13 / 14
Sample Name
Genus & Species
Sample Type / ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
/ ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
/ ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
/ ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
/ ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
/ ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
/ ProteinPeptideSmall MoleculePolymerOligoTrptic DigestOther, pls explain:
Purpose of analysis / MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
/ MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
/ MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
/ MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
/ MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
/ MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
/ MWtIDQuantitationProfilingQC/DegradationPost-Trans Mod.De-Novo Seq.Other:Profiling of
Form of submission / Gel BandLiquidDriedOther:
/ Gel BandLiquidDriedOther:
/ Gel BandLiquidDriedOther:
/ Gel BandLiquidDriedOther:
/ Gel BandLiquidDriedOther:
/ Gel BandLiquidDriedOther:
/ Gel BandLiquidDriedOther:
Molecular Weight (Da)
Total Volume (µl)
Estimated TOTAL Amount in submitted sample / Amount:
µg pmol / Amount:
µg pmol / Amount:
µg pmol / Amount:
µg pmol / Amount:
µg pmol / Amount:
µg pmol / Amount:
µg pmol
Best storage conditions / 4C-20C / 4C-20C / 4C-20C / 4C-20C / 4C-20C / 4C-20C / 4C-20C
Buffers or Solvent composition: list ALLbuffers AND concentration of organic solvents, salts, detergents, etc…
Additional Comments for Mass Spectrometry sample handling and analysis

Version Jan 15, 2016