NMMTB form

MESB Sample Processing page,

National Marine Mammal Tissue Bank Form
Field ID:

Other I D Number:

Common Name:

Genus species:

Stranding Type:

Condition:

Single

Incidental Take ......

Mass

Live Capture.....

UME

Subsistence

Fisheries

Other (specify):

Rescue

Other (specify):

Add'l. Remarks:

0Alive 0 Fresh Dead 0 Euthanized
I f euthanized, with what and how much:
Was animal in rehabilitation?

Animal Location:

State:

0 yes

0 No

Ifyes:

County:

4Where:

From:
To:

City/Island/Community:

OceanjBaylSea:
Locality Details:
Latitude:

Longitude:

N

Time of death (Zulu) .........

W

Place of Death:

0 C 0F

Internal body temp. of animal:
If transportedbefore tissue removal:

-

Vehicle Type:

Rigor?

0 yes 0 NO

Length of Transport:

Ambient weather condition:
Remarks:
-

Place of tissue removal:

Time of tissue removal (Zulu) ....

If transported before processing:

-

Transportationstorage:

D/y ice

Wet ice

Other:

Ambient weather condition:
Interim storage of tissue:

Teflon bag

Teflonjar

Other:

Remarks:
-

Time of tissue processing....

Place of tissue processing:
Ambient temperature at processing:

Time of interim freezing .....

~reezertype:

LN2

-80degC

-30degC

Mher:

Time shipped to MESB........
Time received at MESB.......

1

Additional comments:

-

ohts:

Blubber (g):

A
B

OMB Control No.: 0648-0468
Expiration Date: 1013112011

Liver (g):

Kidney (g):

Whole
Blood (mL):

Plasma (mL)

Serum (mL):

Mher:

Animal Information
Page 2

National Marine Mammal Tissue Bank Form
Field ID:

Genus species:

Total weight:
Age Class:
(choose one)

@ Adult

@

Subadult

@ Actual

Age:

@

@

Yearling

@

Method used:

Pupjcalf

Estimated

GLG's:

@ Actual

@

Estimated

kg Actual

@

Estimated

Other:

imm
/W

Date aged: dd

By whom:

@

Epiphysis:

Open

@

Closed fused

@

Fused invis

Reproductive condition:

Length:

(cicle one)

Pregnant
Lactating

Corpora lutea #:

Fetus length:

@ cm @

Specify Units of Measurement:

Mid-depth:

Weight:

- Right:
- - -Corpora albicantia #: -Corpora hemmorghagicum #: -

TestisJOvaries:

Sexually Mature

Mid-Width:

Left

in

Cetaceans:

Snout to ant. ins. of flipper:

Girth:

Axillary:

Snout to center of genital aperture:

Max:

Flipper length:

(Location)

Blubber thickness:

Fluke width:

Dorsal:

Fluke notch to anus:

Lateral:

Total counts:

....

- Anal:

Snout to center of anus:

..............

ULJLL:

URJLR:

Ventral:

Pinnioeds:

Nose to tail length:

Ant. length of hind flipper:

Ant. length of foreflipper:

Blubber thickness over post. end of sternum:

Axillary girth:

Other blubber thickness:

~~~~

(Location)

Bacculum length:
Polar Bears:

Girth of neck of axis:

Skull length:

Girth of neck at shoulders:
Sea Otters:

Snout to angle of mouth:

Right forepaw width:

Skull length:

Skull width:

Axillaly girth:

Tooth Wear:

Extimate of body fat stores:

Groin: c
Kidneys:

OMB Control No.: 0648-0468
Exairation Date: 1013112011

@ Med.

None: Little:
Subcutaneous:

-

@ Heavy

Mesenteric:

m

Average:

@

Excessive:

@

@

@

@

@

@

8

8

O

8
O

8
O

0
O

Light

@

None

1

Additional Samples List Page 3

National Marine Mammal Tissue Bank

Field I D Number:

Genus species:

Was animal necropsied?

ddImm/n

Necropsied by:

(Please attach necropsy rep@)
S a m ~ l e scollected:

Histoloaical sam~les:
IndividualjOrganization:
Tissues sampled:

(Choose all
that apply)

Final destination:

rn Liver

rn Kidney
rn Pancreas
rn Spleen

Lung

rn Trachea
Other:
(Please /is9

Lymph Nodes:

Date

rn Blubber

rn Stomach

Adrenals

rn Thymus

rn Heart

Brain

Muscle

rn Colon

rn Thyroid

rn Submandibular rn Prescapular rn Axillary

Hilar

rn Intestine
Skin

rn Esophagus

rn Mesenteric

Other 1.n.:

Other sam~lescollected:

Teeth:
Genetics (skin):
Skull:
Reproductive tract:
Mammary tissue:
Ovaries:
Gonadsjtestes:
Parasites:

List type and locaton:
Stomach:

T v ~ eof storaae:
(Z-frozen, F-formalin, DMSO, ETOH)

...........

List contentr i f applicable:
Mher contaminant samples:
(List tissue type, storage
type and where located/

Additional samples:
(List tissue type, purpose of
collection, storage type and
where located)

.......

-

OMB Control No.: 0648-0468
Expiration Date: 1013112011

Where located fInd.1Ora.l:

National Marine Mammal Tissue Bank
Field ID Number:

General Notes Page 4

Genus species:

Photos taken:

I f yes, how many?

(send copy with samples for NIST archive)

Video taken:
Disposition: -

(primaw locaton
for photos and/or
video)

General comments:

(Feld notes)

-

General appearance of individual:

-

-

General appearance of organs:

-

-

NMMTB Protocol:

@

Standard

Please note any moditications:

@

Modified

P
A copy of this form and Level A Data Form
should be shipped with samples to:

Form prepared by:
Name

Affiliation

OMB Control No.: 0648-0468
Expiration Date: 1013112011

A n N : Rebecca Pugh
National Institute of Standards and Technology
Hollings Marine Laboratory
331 Fort lohnson Rd
Charleston, SC 29412
(843) 762-8952

National Marine Mammal Tissue Bank

Chain of Custody
Page 5

NMMTB's Chain of Custody
Field I D Number:
Mher ID Number:
NMMTB Referencejstorage ID Numbers:

1.

Collector's signature

Method of transfer to processing stage

Date

Processor's signature

Method of transfer to shipping stage

Date

Shipper to NMMTB's signature

Method of transfer to MESB

Date

2.

3.

4.

Receiver's signature

Date

Each person in possession of the tissue must sign and date the form.

PAPERWORK REDUCTION ACT INFORMATION

OMB Control No.: 0648-0468
Expiration Date: 10/31/2011