ID Number:
Name:
BC Username:
BC Department:
Advisor:
E-mail: @bc.edu
Sample Name:
Project:
Notebook Number:
Notebook Page:
Ionization Technique:
Ionization Mode:
Required Mass Accuracy:
Proposed Molecular Weight:  g/mol
Proposed Molecular Formula:
Concentration:   Or
Amount Submitted:  
Solvent:
Soluble In:
Stability Issue:
Toxicity Issue:
Storage:
Sample Return:
For all samples, list all other components (e.g. salts, buffers) and their concentrations:
Important: If the sample contains NR4+ (e.g. NBu4+),PPh4,PPh3,P(O)Ph3, DMSO or TFA, please indicate:
Important: Avoid particulate matter in the sample: filter if necessary.)
Comments:
   Proposed Structure or Reaction Scheme:
 
 
Office Use Only:
 
Accuracy: [ ] High Res [ ] Low Res