Contact: Email: shead@scripps.edu or philo@scripps.edu Phone: (858)784-9941 or 2263, ask for John, Jessica, Steve or Phil. TSRI Next Generation Sequencing Facility – Sample Submission Form Send samples to: OR Attn: John Shimashita 3215 Merryfield Row. MEM-250 San Diego, CA 92121 Drop at: nd 250 MEM. (2 floor) http://www.scripps.edu/california/research/ngs/MEMmap.pdf Sample submission date:______________ Researcher Name: P.I. name: Email contact: Phone no.: (TSRI customers only) Admin. Email: Scripps Acct.#: Add (non-TSRI customers) Institution/Company name: P.O. number: Sample Type: DNA: __ gDNA __ Plasmid __ Cosmid/Fosmid __ cDNA __ BAC __PCR product __ Other (explain):_____________________________________________________________ RNA: __ total RNA __ polyA RNA __Other (explain):________________________________ Sample Buffer: ____________ Have Samples Been Purified? _____ YES _____NO Method used: ___________________________________________ Sequencing Type: HiSeq2000 __Single Read: __1X100 MiSeq __2 X75 __Paired-End: __2X100 __2X300 __Other (explain):_________________________________________________________________________________________________ Type of sample you are working with (species)?: _______________________________________________ Sample Information: Please fill out the following table with appropriate information: Sample Archive Disclaimer: If you would like to archive your sample(s) and/or prepped library(s), please pick them up from the facility. We do not retain samples after 6 months from run completion. Sample Name Sample 1 Sample 2 Sample 3 Sample 4 Sample 5 Sample 6 Sample 7 Sample 8 Sample 9 Sample 10 Sample 11 Sample 12 Sample 13 Sample 14 Sample 15 Sample 16 Sample 17 Sample 18 Sample 19 Sample 20 Sample 21 Sample 22 Sample 23 Sample 24 Sample concentration Volume Comments