<p> MASS SPEC SAMPLE SUBMISSION FORM Call UMESH (850) 644-1697 Please Fill out Completely AND SIGN AT THE BOTTOM</p><p>Name: _ Date: Phone: email: Professor: Sample Name: </p><p>Resolution: Low High </p><p>Inlet Method (if EI/CI): Direct Inlet (Standard). If in solution: Solvent & Conc. (mg/mL) GC Inlet If GC, please attach GC trace and conditions and give Sample concentration and solvent: </p><p>Ionization Method: (Please circle one) EI CI+ ESI+ Soluble in MeOH/ACN/H2O ? CI- ESI- Soluble in MeOH/ACN/H2O ? FAB+ FAB-</p><p>Molecular Formula (if known) & Structural formula:</p><p>Estimated Molecular Weight: (If GC, List in order of elution)</p><p>Mass Range to Scan:</p><p>Sample: Origin: </p><p>Likely Impurities: </p><p>Last Purification Technique: </p><p>% Purity: Special Instructions (handling, storage, etc.): I certify that this sample is submitted for research purposes only. </p><p>Signature: Date: </p>