EML Userform

User Form

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

Submit Type

Submit Type :

User Information

User From :

MCB 481 Course :

First Name :

Last Name :

UC ID :

User Status :

E-mail :

Work Phone :

Other Phone :

Department :

Work Address :

Supervisor Information

PI First Name :

PI Last Name :

PI Phone :

PI Email :

Billing Information

Please provide the billing account number. UC users should provide a complete chartstring. (UCB format Acct-Fund-Org-Pgm-Sub type (e.g. 12345-67890-44--ABCDE); other UC formats may vary, use CCOA if possible). For LBNL users, please provide the IUT Number.

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 following instrument that I will use. Tecnai-12 TEM JEOL TEM S-5000 SEM TM-1000 SEM UA Staining
	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.