SIF Materials Processing Request

REQUESTER INFORMATION

Last Name

First Name

Ames Laboratory Employee Number

*If associated with ISU, do not provide ISU University ID. Enter "ISU" instead.

Contact Email

Contact Phone

Work Address

U.S. Citizen

Yes

Organization Name

Department

Group Leader Name

Group Leader Phone Number

Group Leader Email

FUNDING

Funding Type

Ames Laboratory

Iowa State University

Other

Project Funding Account/ISU Worktag

REQUEST

Research

Provide a detailed explanation of your materials processing request. Specify your needs, preferred methods, and outcomes.

SAMPLE SET

All materials coming to the SIF must comply with DOT transportation regulation

Common sample name

Molecular Formula

Approximate size and mass *per sample

Report all quantities in grams; if liquid, report in milliliters. Please list g/ml in your answer. (eg, 5 ml or <1g)

*per sample = amount per vial/membrane box, ect

Number of samples

# of vials/membrane boxes to be transported for this request

Known Hazards

Check all that apply

Is this material being transported in a solvent?

Yes

SAFETY

Have any of your samples been irradiated with neutrons or ion beams?

Yes

Will you be bringing human tissue, cell lines, or materials to the SIF?

Yes

If yes, specify

Will you be bringing regulated foreign or domestic soil to the SIF?

Yes

If yes, specify

Would you like your samples returned?

Yes

Would you like to be present when your materials are processed?

If you are a foreign national, an approved foreign national request will need to be processed and approved before you may be on-site.

Yes

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