Chemistry Preparation Room Application Form

   

Chemistry Preparation Room Application Form

   

I would like to apply for the use the Chemistry Preparation Room.
Details are provided below.

  

[mandatory] Name of Project Leader	e.g., Taro Kokido
[mandatory] ID No. of Project Leader	e.g., 1234567
[mandatory] Affiliation
[mandatory] Telephone No.
[mandatory] E-mail address
[mandatory] re-enter E-mail address
[mandatory] Proposal No.	e.g., 2009A1234
[mandatory] Beamline No.	e.g., BL64XU
[mandatory] Period of use: yy/mm/dd hh:mm (date of instruction) - yy/mm/dd hh:mm (date of check after use)	e.g., 2008/02/15 10:00 - 2008/02/18 10:00
List up the name(s), affiliation(s)(if different from that of Project Leader) and ID number(s) of member(s) who need(s) to enter the Room
[mandatory] Details of the operations to be carried out in the Room (be as specific as possible)
Instruments to be carried in and their quantities
[mandatory] Samples and chemicals to be carried in and their quantities
Needed instruments and equipment of the Room
Needed chemicals supplied by the Room and their quantities
Message

 

*One cannot proceed to the next page unless all the mandatory fields are filled.
*One cannot use the Chemistry Preparation Room unless the chief lab manager is fully notified at least 10 days in advance via this form.
*Entrance to the Room is cleared by a card reader. For this reason, one will not be admitted to the Room unless he/she has a valid ID card with a number identical to that input in this form. If you have two or more ID numbers (e.g., user ID and Riken ID), please input the number of the ID card you are sure to possess during the period of use.