Your Email: PI: (Last, First, Middle Initial) RUA/MUA #: Lab Manager/Contact:(if changed) (Last, First, Middle Initial) Lab Manager/Contact e-mail: Phone: Work locations To add or change: Building Room No. Room Use (iodination, TC, warm room, cold room, etc.) Choose One animal studies classroom/teaching lab cold room darkroom equipment exam room fluoro hot room human studies imaging room injection area iodination irradiator laboratory Mossbauer shared/common use lab storage surgery TC room teaching lab therapy room treadmill warm room waste x-ray Choose One animal studies classroom/teaching lab cold room darkroom equipment exam room fluoro hot room human studies imaging room injection area iodination irradiator laboratory Mossbauer shared/common use lab storage surgery TC room teaching lab therapy room treadmill warm room waste x-ray Choose One animal studies classroom/teaching lab cold room darkroom equipment exam room fluoro hot room human studies imaging room injection area iodination irradiator laboratory Mossbauer shared/common use lab storage surgery TC room teaching lab therapy room treadmill warm room waste x-ray To delete: Building Room No. Room Use (iodination, TC, warm room, cold room, etc.) Choose One animal studies classroom/teaching lab cold room darkroom equipment exam room fluoro hot room human studies imaging room injection area iodination irradiator laboratory Mossbauer shared/common use lab storage surgery TC room teaching lab therapy room treadmill warm room waste x-ray Choose One animal studies classroom/teaching lab cold room darkroom equipment exam room fluoro hot room human studies imaging room injection area iodination irradiator laboratory Mossbauer shared/common use lab storage surgery TC room teaching lab therapy room treadmill warm room waste x-ray Choose One animal studies classroom/teaching lab cold room darkroom equipment exam room fluoro hot room human studies imaging room injection area iodination irradiator laboratory Mossbauer shared/common use lab storage surgery TC room teaching lab therapy room treadmill warm room waste x-ray To add a new project summary, describe: Indicate any new techniques: Nucleic Acid Sequencing Hybridization Nick Translation Protein Isolation Metabolic Studies Labeling of Proteins Labeling of Tissue Cultures In Vivo Labeling of MIcrobial Cultures In Vivo Plant Studies In Vivo Animal Studies In Vitro Animal Studies Radioiodination of Proteins Radioimmunoassays Other (describe below) Radioisotopes To add or change: Radioisotope Chemical form mCi per experiment mCi per year To delete: Radioisotope Chemical form Survey meteres, LSCs, gamma counters, etc. To add: Make Model Serial Number Calibration Date To delete: Make Model Serial Number Calibration Date