Format:KUSC#1

ApplicationFormfortheMeasurementatKyushuUniversityBeamline

DateofApplication(MM/DD/YYYY) / /

UserCategories

Public*[ ], Private [ ]

(*Some restrictions are present for applying to public category.)

ProjectLeader

First/LastName :

Title :

Affiliation :

Address :

TEL/FAX :

E-mail :

(NB: The lead scientist should be present at SAGA-LS during the experiment)

Information on the Experiment

  1. RequestofExperimentalSetup

XAFS( ), SAXS( ),Other( )

  1. TitleofExperiment

(NB: Please include keywords related to experimental methods and samples)

  1. NumberofDaysNeeded

Days

  1. RequestDates

Nonespecified ( )

Specified ( )

Firstchoice:MM/DD/YYYY - MM/DD/YYYY

Secondchoice:MM/DD/YYYY - MM/DD/YYYY

(Unavailable dates)

Nonespecified ( )

Specified ( )

MM/DD/YYYY - MM/DD/YYYY

MM/DD/YYYY - MM/DD/YYYY

Project Team Members

  1. MemberNames,Affiliations,Titles

(NB: Please include project leader. Registration of more than one person to participate on each day of the experiment is necessary for safety requirements)

(NB: Please print names of members with experience of using the beamline in italics)

Name / Affiliation / Title

SafetyHazardsandMeasurement Details

  1. Required Procedure for Safety

Inform toRCSLAofficebeforethe experiment if substancesorexperimental proceduresare related to subjects mentionedbelow. Special procedures are need such experiments.

( )N.A.
( )Internationallycontrolledmaterials**
( )Radioactivesubstances (sealed only)
( )Microbes
( )Artificialrecombinationofgenes
( )Gases in highpressure

**)Internationallycontrolledmaterials:In short, uranium and thorium below fixed amount. Precise definition is described at in Japanese.

  1. DetailsofSamples,Gases,andChemicals

Describeallthecarried-insamples,gascylinders,andchemicals. Allhavetobebroughtbackoncompletion.

Allthecarried-insamples,etc.mustmeetthesafetystandardsofapplicants’organization.

We withhold the right to restrict the use of certain samples, etc. in with adherence the law, or for the safety of both the applicant and our staff.

ContacttheUsers’Officein advance ifyouwanttouselivinganimals,microorganisms,sealedradioactivematerials,etc.

Measurement of extra samples outside the scope of the original application is limited to materials defined as harmless substances.

  1. Materialname
(Chemicalformula) /
  1. Shape
/
  1. Number,
quantity,
size /
  1. Characteristics
  2. Safetymeasures
/
  1. MSDS
/
  1. Purposeofuse

-1:Usegeneralnames,structuralformulae,e.g.,titaniumdioxide(TiO2),etc. Listall samplenames independentlyfordifferentcomposition,orconcentrationetc.

-2:e.g.,thinfilm(on wafer),powder(in a capillary),liquid(in a sealedbag),etc.

-3:e.g.,5sheets,0.5gr/sheet,2cmindiameter,etc.,inSIunit.

-4:e.g.,flammable,toxic,harmless,etc.

-5:Safetymeasuresagainstpossibleharm,e.g.,wearinggloves,guardglasses,masks,sealingoffsamples,etc.

-6:AttachanMSDSforeachharmfulsample,andmarkthecolumnofthetablewithacircle.

-7:e.g.,measurements,cleaningofsamples,etc.

8.Required Equipment/ Instruments Provided at the Beamline

XAFS / IonizationChamber( ),CEYdetector( ),SiliconDriftDetector( )
SAXS / CameraLength( mm)
Other

9.Equipment/ Instrumentstobe Brought tothe Beamline

-Describedetailsofpowersupplies,measurementinstruments,laserequipment,highpressuregastanks,etc.

Equipment/Instruments
(Manufacturer,Model number, or Self-designed) / Specifications
(Voltage,Current,Pressure,Temperature,etc.) / Safetyplanning

10.Useof Preparation Rooms

-Indicate if samples will be processed in the preparation rooms on site.

BL06
preparation room
SAGA-LS chemicallab

Description of project

11.Project Outline

-Simplydescribeyourprojectoutline in around600words; including purpose,significance,necessityofexperimentsusingsynchrotronradiation,expectedresultsetc.

12.ExperimentalMethods

-Describemeasurementdetails(XAFSorSAXS,measurementconditions,informationtobetakenbyexperiment). Indicatephotonenergyattheexperiment definitely.

ExpectedExperimentalData,PhotonEnergyRange,etc.
(e.g.XANESand/orEXAFSdataofFe-Kedge(7.2keV)ofsinglecrystallineFe(100)thinfilmsatasampletemperaturewithinarangeof300-500K,etc.(~400-600words))
RequiredExperimentalSetupandMethods
(Note: Includeexperimentalapparatuses,detectors,sampleholders,etc.( ~300words))
Elements,Concentrations,Conditions,EstimationofMeasurementTime,etc.
(Detailedinformationofsamplesshouldbedescribedatthesection7.Samplemeasurementconditionsaree.g.“appliedvoltage,”“ambientgascondition,”“powdersamplesinvacuum,”“volatilesample,”or“corrosivesubstance.”(~300words))

Privacypolicy:Theinformationdescribedhereisusedonlywithintheproceduresrelatedtotheproposal andisneverusedforanyotherpurposes,exceptincaseswhenarequesthasbeenmadetodisclosetheinformationbylaw,orwhentheapplicantconsents.

●Checklist

Checkagainfollowingsentencesdescribedbelow.

1Haveyoufilledinrequireditems? YES / NO

2Aretheretwoormoremembersincludingaprojectleader? YES / NO

3Haveyouwrittenaboutallthemeasurementsamples? YES / NO

4HaveyouattachedMSDSsonharmfulsamplestobecarriedin? YES / NO

5Doesdescriptionofcarried-insamplesandmaterialsfollowtheexamples?

YES / NO