Advance Notification of
Intent to send radioactive material to SLAC/SSRL

The following table should represent the most complete and accurate isotopic characterization of all radioactive material anticipated to be sent to SLAC for your experiments. Please ensure that it is completed and submitted to SLAC at both 30 days and 7 days prior to start of proposed experimental run. More instructions for shipping radioactive materials to SSRL/SLAC are available at: http://www-ssrl.slac.stanford.edu/safety/radmat-at-ssrl.html. If you have any questions regarding completion of this form please contact Matt Padilla (mpadilla@slac.stanford.edu, 1-650-926-3861 or Radiation Protection Field Operations 1-650-926-3023).
30-Day Notification     7-Day Notification
        (for 1-Day Notification see: http://www-ssrl.slac.stanford.edu/safety/one-day-notice.html)

Date Submitted:
SSRL Proposal No. Ship Radioactive Materials To:
User Name and User Proposal #
SLAC/Radiation Protection Group
2575 Sand Hill Road,
Bldg 24 RPFO/MS 84
Menlo Park, CA  94025

Radiation Protection Field Operations
Carol Morris (650)926-3023 or (650)926-4299
Experimenter name:
Facility of Origin:
Area (if applicable):
Phone:
E-mail:
Beamline:
Dates on-site:
 
Maximum Amount of Radioactive Material and Sample(s) Holders to be sent to SLAC/SSRL
(Note: highest amount of activity for each isotope in mixed sample(s) must be listed)
Isotope
 		 Quantity
(grams)		 Activity
(Bq)		 Sample Holder Type
(select from sample holder catalog (i.e. 4a))

1)
2)
3)
4)
5)
6)

(note: if intended sample holder is not listed in the catalog, it must be reviewed and approved in advance of shipment. Please allow 90 days for approval process. Contact SSRL Safety Officer, 650-926-3861)
Tc99  
Th232  
U235  
U238  
Unat  
Am241  
Eu152/154  
Cm248  
Pu238  
Pu239  
Pu240  
Pu241  
Pu242  
Np237  
Other:
 
Other:
 
Other:
 
Comments:
  
  

 Safety Officer: Matt Padilla  
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10/22/07