The NSCL must be notified in advance if you intend to transport radioactive or hazardous materials to or from the NSCL. If you intend to bring in, or ship out, or take with you radioactive material to/from the NSCL, we must have in our files, prior to transportation, a copy of the receiver's NRC license or a letter from the receiver stating that the radioactive material will be accepted.

             REQUEST TO SHIP RADIOACTIVE MATERIAL TO/FROM THE NSCL
             =====================================================

RETURN FORM TO: KRISTIN ERICKSON, Radiation Safety Officer
		ORCBS
		C124 Research Complex-Engineering
		Michigan State University
		East Lansing, MI 48824-1326
		Phone:  (517)355-5008     Fax:  (517)353-4871
		INTERNET: ERICKS30@MSU.EDU

RADIOACTIVE MATERIALS MUST BE APPROVED BY MSU'S OFFICE OF RADIATION, CHEMICAL,
AND BIOLOGICAL SAFETY BEFORE THEY ARE BROUGHT ONTO THE CAMPUS. THE INFORMATION
YOU PROVIDE ON THIS FORM WILL BE SUFFICIENT IN MOST INSTANCES TO INITIATE THE
APPROVAL PROCESS.  YOU WILL BE NOTIFIED AS TO APPROVAL OR DENIAL OF YOUR REQUEST.
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IF YOU WILL BE SHIPPING RADIOACTIVE MATERIALS (SUCH AS SOURCES) TO THE NSCL:

1. Person in charge of material when at the NSCL:_____________________________

2. Dates at the NSCL:_____________________________________________________

3. List radionuclides and activities:_________________________________________

4. List source type (alpha, beta, gamma, or fission fragment) and configuration (give
    manufacturer's holder designation or, if unusual or modified, give details):

    _____________________________________________________________________

     _____________________________________________________________________

5. Name of your radiation safety officer:_____________________________________

6. Your RSO's address:_____________________________________________________

7. Your RSO's telephone number:_______________________________________________

IF YOU ARE SHIPPING OR TRANSPORTING RADIOACTIVE MATERIALS TO THE NSCL, THE 
AUTHORIZED RECEIVER IS MICHIGAN STATE UNIVERSITY.  ADDRESS SHIPMENTS C/O: 
KRISTIN ERICKSON AT THE ORCBS ADDRESS GIVEN ABOVE
_____________________________________________________________________
IF YOU WILL BE TAKING RADIOACTIVE MATERIALS (E.G. IRRADIATED TARGETS) FROM NSCL:

1. Authorized receiver:___________________________________________________

	Address:______________________________________________________________

	Phone number:_________________________________________________________

2. PLEASE HAVE AUTHORIZED RECEIVER SEND A COPY OF NRC OR OTHER APPROPRIATE 
   LICENSE, PRIOR TO YOUR EXPERIMENT, TO KRISTIN ERICKSON AT THE ORCBS ADDRESS.
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TO BE FILLED OUT BY MSU:

APPROVED / DENIED (circle one) NSCL Radiation Safety Officer:

				_______________________________________

APPROVED / DENIED (circle one) ORCBS:

		________________________________________