User Form

All fields are required except indicated separately. Missing information may delay the processing of your application.

Submit Type

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User Information

User From :
MCB 481 Course :
First Name :
Last Name :
User Status :
E-mail :
Work Phone :
Other Phone :
Department :
Insititution / Company :
Work Address :

Supervisor Information

PI First Name :
PI Last Name :
PI Phone :
PI Email :

Billing Information

Please provide the billing account number of a Acct-Fund-Org-Pgm-Sub type (eg: 12345-67890-44--ABCDE ) or a 10 letter Speedtype (eg: CE01234567). For LBNL users, please provide the Purchase Order(PO) Number.
Please provide the federal tax ID and a purchase order (PO) number. We only accept checks for payments.
Federal Tax ID :
Billing Account / PO :
Billing Address :
Billing Contact Person :
Billing Phone :
Billing Email :

Reason for Use EML

This description should indicate the nature, scope, and expected results of your research project.
EM facility to use :
Reason for Use :

I certify that I have taken all required EH&S compliance training for researchers and task specific training for the types of samples I will be using ( EH&S UC Berkeley, EH&S LBL). If asked, I will supply all hazard and safe handling data for samples I bring into the laboratory. Additionally, I have read and am aware of Radiation Hazards in the EML and have reviewed the General Radiation Safety Documentation for non-users.
I certify that I have reviewed the EML Standard Operating Procedure for the type of instrument that I will use.
I agree to comply with the EML Terms of Use and agree that any costs incurred over the authorized amount will be paid for myself.
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