Notification of Radioactive Material Shipment to SLAC/SSRL
The following is to be completed and sent by the shipper no later than the end
of the business day on which the shipment leaves the experimenter's facility.
If you have any questions regarding completion of this form, please contact
SSRL's Safety Officer, Matt Padilla (650-926-3861) or Radiation Protection
Field Operations (650-926-3023 or 650-926-4299).
Sample Container and Containment Checklist
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| Sample ID#: | |
| Date Submitted: |
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| SSRL Proposal No. |
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Ship Radioactive Materials To:
User Name and User Proposal #
SLAC/Radiation Protection Group
2575 Sand Hill Road,
Bldg 024/MS 84
Menlo Park, CA 94025
Radiation Protection Field Operations (RPFO)
Carol Morris (650)926-3023 or (650) 926-4299
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| Experimenter name: |
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| Facility of Origin: |
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| Area (if applicable): |
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| Phone: |
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| E-mail: |
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| Beamline: |
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| Dates on-site: |
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| Each sample should have a unique
identifier/number |
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Sample ID#
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Isotope
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Activity
(Bq) |
Isotope Mass
(mg) |
Physical Form
(solid, liquid,
gas) |
Containment #
Sample
Holder Catalog |
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