# PROPOSAL DETAILS

*Please submit this form as soon as possible. It typically takes 3 weeks
to process a proposal package for the Division Director's signature.*

  ------------------------- ------------- --------------- ---------------
  2\. **TITLE**:                                          

  3a. **PRINCIPAL           Phone         Fax             E-mail
  INVESTIGATOR**                                          

                                                               

  3b. CO-PRINCIPAL                                        
  INVESTIGATOR                                            

                                                          
  ------------------------- ------------- --------------- ---------------

<table>
<colgroup>
<col style="width: 15%" />
<col style="width: 6%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 5%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 13%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 8%" />
<col style="width: 19%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="5">4a. <strong>SPONSOR</strong></td>
<td colspan="13">     </td>
</tr>
<tr class="even">
<td colspan="9">4b. Is the Sponsor a Small Business?</td>
<td colspan="9"> YES NO</td>
</tr>
<tr class="odd">
<td colspan="5">5. Contact Name</td>
<td colspan="13">     </td>
</tr>
<tr class="even">
<td colspan="5">6. Address</td>
<td colspan="13">     </td>
</tr>
<tr class="odd">
<td>7. Telephone:</td>
<td colspan="7">     </td>
<td colspan="2">8. FAX:</td>
<td colspan="4">     </td>
<td colspan="2">9. E-mail:</td>
<td colspan="2">     </td>
</tr>
<tr class="even">
<td colspan="5">10. Brief <strong>Description</strong> of Proposal:</td>
<td colspan="13">     </td>
</tr>
<tr class="odd">
<td colspan="2">11. This proposal is:</td>
<td colspan="5"> NEW</td>
<td colspan="11"><p> CONTINUATION/RENEWAL <em>(Provide</em> <em>Project
ID or Title):</em></p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="6">12. Other external organizations involved?</td>
<td colspan="12"><p> YES NO</p>
<p><em>If YES, list Organizations:</em>      </p></td>
</tr>
<tr class="odd">
<td colspan="6">13. Is this a formal solicitation (RFP or BAA)?</td>
<td colspan="12"><p> YES NO</p>
<p><em>If YES, please attach forms or type in URL of where documentation
can be found:</em> http://      </p></td>
</tr>
<tr class="even">
<td colspan="11">14. Proposal DUE DATE (To Sponsor)</td>
<td colspan="4">     </td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="3">15. START DATE</td>
<td colspan="9">     </td>
<td colspan="3">16. DURATION (years or months)</td>
<td colspan="3">     </td>
</tr>
<tr class="even">
<td colspan="12">17. Total Request of Funds ($K)</td>
<td colspan="6">     </td>
</tr>
<tr class="odd">
<td colspan="18"><strong>PROPOSAL REVIEW</strong> (signatures of
reviewers or an accompanying email required)</td>
</tr>
<tr class="even">
<td colspan="4"><p>18. Program Head</p>
<p>(or designated reviewer)</p></td>
<td colspan="9">     </td>
<td colspan="4"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="9">Print Name</td>
<td colspan="4">Signature</td>
<td>Date</td>
</tr>
<tr class="even">
<td colspan="4">19. Technical Reviewer</td>
<td colspan="9">     </td>
<td colspan="4"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="9">Print Name</td>
<td colspan="4">Signature</td>
<td>Date</td>
</tr>
</tbody>
</table>

BUDGET ESTIMATE WORKSHEET

ESD Division Office personnel will use this information to construct
proposal budget estimate

  ------------------ --------------------- ------------------ ------------
  1\. Lab Personnel                                           
  (example; John                                              
  Smith, Scientist,                                           
  ESSG, 2                                                     
  months---by fiscal                                          
  year)                                                       

  Name (if           Job Title/Department  Effort (in months) Fiscal Year
  available)\*                                                

                                                                   

                                                                   

                                                                   

                                                                   
  ------------------ --------------------- ------------------ ------------

\*(Name or classification if unnamed Scientist, Post Doc, etc.); payroll
acct; person-months; (please specify all or which FY); and Divisional
affiliation if not ES; list non-LBNL personnel as "Other".

**If you are planning to hire personnel, please answer questions
regarding space.**

+----------------+-----------------+-----------------+-----------------+
| 2\. Space      |                 |                 |                 |
| (Send an email |                 |                 |                 |
| with details   |                 |                 |                 |
| to consult     |                 |                 |                 |
| with ESD Space |                 |                 |                 |
| Coordinators)  |                 |                 |                 |
|                |                 |                 |                 |
| Office:        |                 |                 |                 |
| Maryann        |                 |                 |                 |
| Villavert,     |                 |                 |                 |
| x7357,         |                 |                 |                 |
| mvil           |                 |                 |                 |
| lavert@lbl.gov |                 |                 |                 |
| Labs: Ernie    |                 |                 |                 |
| Majer, x6709,  |                 |                 |                 |
| e              |                 |                 |                 |
| lmajer@lbl.gov |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| a\. Will you   |                 |                 |                 |
| need           |                 |                 |                 |
| additional     |                 |                 |                 |
| space or       |                 |                 |                 |
| modification   |                 |                 |                 |
| to existing    |                 |                 |                 |
| space if       |                 |                 |                 |
| funded?        |                 |                 |                 |
|                |                 |                 |                 |
| ##   YES  NO   |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| b\. If YES,    |                 |                 |                 |
| have you       |                 |                 |                 |
| included funds |                 |                 |                 |
| for the        |                 |                 |                 |
| additional     |                 |                 |                 |
| space or       |                 |                 |                 |
| modifications  |                 |                 |                 |
| in your        |                 |                 |                 |
| budget?        |                 |                 |                 |
|                |                 |                 |                 |
| YES NO         |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| ## c. If YES,  |                 |                 |                 |
| what type of s |                 |                 |                 |
| pace is needed |                 |                 |                 |
| ?  Laboratory  |                 |                 |                 |
|  Office  Field |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| ## d. If Y     |                 |                 |                 |
| ES for modific |                 |                 |                 |
| ations, descri |                 |                 |                 |
| be the type of |                 |                 |                 |
|  modification  |                 |                 |                 |
| to existing sp |                 |                 |                 |
| ace is needed: |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| ##             |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| 3\.            |                 |                 |                 |
| Fa             |                 |                 |                 |
| brication/Shop |                 |                 |                 |
| time (estimate |                 |                 |                 |
| per/FY \$)     |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| Name of shop   | Job             | Hourly rate     | Fiscal Year     |
| or individual  | T               | Number of hours |                 |
|                | itle/Department |                 |                 |
+----------------+-----------------+-----------------+-----------------+
|                |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| 4\.            |                 |                 |                 |
| Subcontracts   |                 |                 |                 |
| (estimate      |                 |                 |                 |
| per/FY \$)\*   |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| Name of        | Job             | Estimated       | Fiscal Year     |
| Company or     | T               | Budget          |                 |
| Institution    | itle/Department |                 |                 |
| (if available) |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
|                |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
|                |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| #              |                 |                 |                 |
| # \*(Consultan |                 |                 |                 |
| ts, UCB collab |                 |                 |                 |
| orators (requi |                 |                 |                 |
| res IUT), incl |                 |                 |                 |
| ude documents) |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| 5\.            |                 |                 |                 |
| Equi           |                 |                 |                 |
| pment/Property |                 |                 |                 |
| (estimate      |                 |                 |                 |
| per/FY \$)     |                 |                 |                 |
| Fabrica        |                 |                 |                 |
| tion\~25-\>50K |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| Name of Item   | Vendor Quote    | LBNL Location   | Purchase in     |
|                | (add set up     | to be housed    | which FY?       |
|                | costs if        |                 |                 |
|                | applicable)     |                 |                 |
+----------------+-----------------+-----------------+-----------------+
|                |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+
|                |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+

BUDGET ESTIMATE WORKSHEET (Continued)

+--------------------+---+-----------+---------+-------+--------------+
| 6\. Supplies or    |   |           |         |       |              |
| Purchases          |   |           |         |       |              |
| (estimate per/FY   |   |           |         |       |              |
| \$)                |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
| Name of Item\*     |   | Total     |         | Pur   |              |
|                    |   | Cost      |         | chase |              |
|                    |   | Estimate  |         | in    |              |
|                    |   |           |         | which |              |
|                    |   |           |         | FY?   |              |
+--------------------+---+-----------+---------+-------+--------------+
|                    |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
|                    |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
| \*(List of items   |   |           |         |       |              |
| to be purchased:,  |   |           |         |       |              |
| i.e. chemicals,    |   |           |         |       |              |
| small parts,       |   |           |         |       |              |
| publication costs, |   |           |         |       |              |
| etc.)              |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
| 7\. Travel (\$     |   |           |         |       |              |
| per/FY)            |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
| Destination(s)     | C |           | \# of   |       | Fiscal Year  |
|                    | o |           | Partic  |       |              |
|                    | s |           | ipants/ |       |              |
|                    | t |           | \# of   |       |              |
|                    | p |           | Trips   |       |              |
|                    | e |           |         |       |              |
|                    | r |           |         |       |              |
|                    | T |           |         |       |              |
|                    | r |           |         |       |              |
|                    | i |           |         |       |              |
|                    | p |           |         |       |              |
|                    | \ |           |         |       |              |
|                    | * |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
|                    |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
|                    |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
| \                  |   |           |         |       |              |
| *(Domestic/Foreign |   |           |         |       |              |
| destination;       |   |           |         |       |              |
| Estimate airfare,  |   |           |         |       |              |
| per diem,          |   |           |         |       |              |
| incidentals, etc.) |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
| 8\. Other Direct   |   |           |         |       |              |
| Costs              |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
| List Direct Cost   |   | Total     |         | Dur   |              |
| Item               |   | Cost      |         | ation |              |
|                    |   | Estimate  |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
|                    |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
|                    |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
| \*(Include         |   |           |         |       |              |
| recharges for      |   |           |         |       |              |
| ES&H, space,       |   |           |         |       |              |
| telephone,         |   |           |         |       |              |
| computing          |   |           |         |       |              |
| services/support,  |   |           |         |       |              |
| administrative     |   |           |         |       |              |
| support, etc).     |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
| 9\. Special        |   |           |         |       |              |
| Requirements       |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
|                    |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
| 10\. Review        |   |           |         |       |              |
| Factors (DOE       |   |           |         |       |              |
| requirement)       |   |           |         |       |              |
|                    |   |           |         |       |              |
| Proposed work      |   |           |         |       |              |
| requires LBNL's    |   |           |         |       |              |
| special expertise, |   |           |         |       |              |
| unique capability, |   |           |         |       |              |
| or unique          |   |           |         |       |              |
| facilities;        |   |           |         |       |              |
| private facilities |   |           |         |       |              |
| are inadequate for |   |           |         |       |              |
| performance of     |   |           |         |       |              |
| proposed work.     |   |           |         |       |              |
| Explanation given  |   |           |         |       |              |
| below:             |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
|                    |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
| 11\. What DOE      |   |           |         |       |              |
| Program is this    |   |           |         |       |              |
| project related    |   |           |         |       |              |
| to? **What ESD     |   |           |         |       |              |
| Program is this    |   |           |         |       |              |
| project related    |   |           |         |       |              |
| to?**              |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+
|   --               |   |           |         |       |              |
| ------------------ |   |           |         |       |              |
| - ---------------- |   |           |         |       |              |
|   Office of Sc     |   |           |         |       |              |
| ience     Division |   |           |         |       |              |
|                    |   |           |         |       |              |
| (formerly Office o |   |           |         |       |              |
| f   Administration |   |           |         |       |              |
|   Ener             |   |           |         |       |              |
| gy Research)       |   |           |         |       |              |
|                    |   |           |         |       |              |
|                    |   |           |         |       |              |
| Energy Efficiency  |   |           |         |       |              |
| and Climate Change |   |           |         |       |              |
|   Renewable Ener   |   |           |         |       |              |
| gy      and Carbon |   |           |         |       |              |
|                    |   |           |         |       |              |
|         Management |   |           |         |       |              |
|                    |   |           |         |       |              |
|   En               |   |           |         |       |              |
| vironmental        |   |           |         |       |              |
|   Energy Resources |   |           |         |       |              |
|   Mana             |   |           |         |       |              |
| gement             |   |           |         |       |              |
|                    |   |           |         |       |              |
|                    |   |           |         |       |              |
|  Non-Proliferation |   |           |         |       |              |
| ,    Environmental |   |           |         |       |              |
|   Counter-Terrori  |   |           |         |       |              |
| sm     Remediation |   |           |         |       |              |
|                    |   |           |         |       |              |
|   F                |   |           |         |       |              |
| ossil Energy       |   |           |         |       |              |
|    Fundamental and |   |           |         |       |              |
|                    |   |           |         |       |              |
|        Exploratory |   |           |         |       |              |
|                    |   |           |         |       |              |
|           Research |   |           |         |       |              |
|                    |   |           |         |       |              |
|                    |   |           |         |       |              |
|  Civilian Radioact |   |           |         |       |              |
| ive  Nuclear Waste |   |           |         |       |              |
|   Wast             |   |           |         |       |              |
| e Management       |   |           |         |       |              |
|                    |   |           |         |       |              |
|                    |   |           |         |       |              |
|                    |   |           |         |       |              |
|   --               |   |           |         |       |              |
| ------------------ |   |           |         |       |              |
| - ---------------- |   |           |         |       |              |
+--------------------+---+-----------+---------+-------+--------------+

PLEASE USE BACK OF FORM or add pages

TO PROVIDE ADDITIONAL INFORMATION

*Please submit this form as soon as possible.*

*It typically takes 3 weeks to process a proposal package for the
Division Director's signature.*

**PROJECT / FACILITY SAFETY REVIEW QUESTIONNAIRE (SRQ)**

+-----------------------------------------+----------------------------+
| 1\. PROJECT TITLE:                      |                            |
+-----------------------------------------+----------------------------+
| 2\. PI or Project Leader:               | 3.Project ID No.:          |
+-----------------------------------------+----------------------------+
| 4\. Which best describes this           |                            |
| project/facility (number in sequence if |                            |
| more than one applies)                  |                            |
|                                         |                            |
| > \_\_Hardware design, fabrication, or  |                            |
| > testing \_\_Experimental work at LBL\ |                            |
| > \_\_Computation or theory (Also check |                            |
| > "Ergonomics" in item 9)\              |                            |
| > \_\_Off-site work                     |                            |
| > (                                     |                            |
| where?\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_) |                            |
| > (Safety Plan Required \[OSSEPP\])     |                            |
+-----------------------------------------+----------------------------+

+---+----------+-----------------+---+---+---------------------------------+
| 5 |          | Div. Staff      |   |   |                                 |
| \ |          | \_\_\_          |   |   |                                 |
| . |          | GSRA's\_\_\_    |   |   |                                 |
| S |          | Other LBL       |   |   |                                 |
| t |          | (               |   |   |                                 |
| a |          | matrixed)\_\_\_ |   |   |                                 |
| f |          | Guests\_\_\_    |   |   |                                 |
| f |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| ( |          |                 |   |   |                                 |
| F |          |                 |   |   |                                 |
| T |          |                 |   |   |                                 |
| E |          |                 |   |   |                                 |
| ) |          |                 |   |   |                                 |
| : |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| 6 |          |                 |   |   |                                 |
| \ |          |                 |   |   |                                 |
| . |          |                 |   |   |                                 |
| W |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| b |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| ( |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| ) |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| m |          |                 |   |   |                                 |
| ( |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| ) |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| j |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| / |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| ? |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| 7 |          |                 |   |   |                                 |
| \ |          |                 |   |   |                                 |
| . |          |                 |   |   |                                 |
| D |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| j |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| / |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| / |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| v |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| : |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| > |          |                 |   |   |                                 |
|   |          |                 | Y |   |                                 |
| A |          |                 | E |   |                                 |
| c |          |                 | S |   |                                 |
| t |          |                 | N |   |                                 |
| i |          |                 | O |   |                                 |
| v |          |                 | D |   |                                 |
| i |          |                 | O |   |                                 |
| t |          |                 | N |   |                                 |
| y |          |                 | ' |   |                                 |
| > |          |                 | T |   |                                 |
|   |          |                 | K |   |                                 |
| H |          |                 | N |   |                                 |
| a |          |                 | O |   |                                 |
| z |          |                 | W |   |                                 |
| a |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| D |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| m |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| ? |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| > |          |                 |   |   |                                 |
|   |          |                 | Y |   |                                 |
| R |          |                 | E |   |                                 |
| a |          |                 | S |   |                                 |
| d |          |                 | N |   |                                 |
| i |          |                 | O |   |                                 |
| o |          |                 | D |   |                                 |
| l |          |                 | O |   |                                 |
| o |          |                 | N |   |                                 |
| g |          |                 | ' |   |                                 |
| i |          |                 | T |   |                                 |
| c |          |                 | K |   |                                 |
| a |          |                 | N |   |                                 |
| l |          |                 | O |   |                                 |
| > |          |                 | W |   |                                 |
|   |          |                 |   |   |                                 |
| W |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| k |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| A |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| z |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| ? |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| > |          |                 |   |   |                                 |
|   |          |                 | Y |   |                                 |
| S |          |                 | E |   |                                 |
| e |          |                 | S |   |                                 |
| a |          |                 | N |   |                                 |
| l |          |                 | O |   |                                 |
| e |          |                 | D |   |                                 |
| d |          |                 | O |   |                                 |
| > |          |                 | N |   |                                 |
|   |          |                 | ' |   |                                 |
| S |          |                 | T |   |                                 |
| o |          |                 | K |   |                                 |
| u |          |                 | N |   |                                 |
| r |          |                 | O |   |                                 |
| c |          |                 | W |   |                                 |
| e |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| A |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| z |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| ? |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| > |          |                 |   |   |                                 |
|   |          |                 | Y |   |                                 |
| G |          |                 | E |   |                                 |
| e |          |                 | S |   |                                 |
| n |          |                 | N |   |                                 |
| e |          |                 | O |   |                                 |
| r |          |                 | D |   |                                 |
| a |          |                 | O |   |                                 |
| l |          |                 | N |   |                                 |
| > |          |                 | ' |   |                                 |
|   |          |                 | T |   |                                 |
| L |          |                 | K |   |                                 |
| i |          |                 | N |   |                                 |
| c |          |                 | O |   |                                 |
| e |          |                 | W |   |                                 |
| n |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| A |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| z |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| ? |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| > |          |                 |   |   |                                 |
|   |          |                 | Y |   |                                 |
| L |          |                 | E |   |                                 |
| a |          |                 | S |   |                                 |
| s |          |                 | N |   |                                 |
| e |          |                 | O |   |                                 |
| r |          |                 | D |   |                                 |
| > |          |                 | O |   |                                 |
|   |          |                 | N |   |                                 |
| A |          |                 | ' |   |                                 |
| u |          |                 | T |   |                                 |
| t |          |                 | K |   |                                 |
| h |          |                 | N |   |                                 |
| o |          |                 | O |   |                                 |
| r |          |                 | W |   |                                 |
| i |          |                 |   |   |                                 |
| z |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| ? |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| > |          |                 |   |   |                                 |
|   |          |                 | Y |   |                                 |
| B |          |                 | E |   |                                 |
| i |          |                 | S |   |                                 |
| o |          |                 | N |   |                                 |
| s |          |                 | O |   |                                 |
| a |          |                 | D |   |                                 |
| f |          |                 | O |   |                                 |
| e |          |                 | N |   |                                 |
| t |          |                 | ' |   |                                 |
| y |          |                 | T |   |                                 |
| > |          |                 | K |   |                                 |
|   |          |                 | N |   |                                 |
| A |          |                 | O |   |                                 |
| u |          |                 | W |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| z |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| ? |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| > |          |                 |   |   |                                 |
|   |          |                 | Y |   |                                 |
| X |          |                 | E |   |                                 |
| - |          |                 | S |   |                                 |
| R |          |                 | N |   |                                 |
| a |          |                 | O |   |                                 |
| y |          |                 | D |   |                                 |
| > |          |                 | O |   |                                 |
|   |          |                 | N |   |                                 |
| A |          |                 | ' |   |                                 |
| u |          |                 | T |   |                                 |
| t |          |                 | K |   |                                 |
| h |          |                 | N |   |                                 |
| o |          |                 | O |   |                                 |
| r |          |                 | W |   |                                 |
| i |          |                 |   |   |                                 |
| z |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| ? |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| 8 |          |                 |   |   |                                 |
| \ |          |                 | Y |   |                                 |
| . |          |                 | E |   |                                 |
| D |          |                 | S |   |                                 |
| o |          |                 | N |   |                                 |
| e |          |                 | O |   |                                 |
| s |          |                 | D |   |                                 |
| t |          |                 | O |   |                                 |
| h |          |                 | N |   |                                 |
| i |          |                 | ' |   |                                 |
| s |          |                 | T |   |                                 |
| p |          |                 | K |   |                                 |
| r |          |                 | N |   |                                 |
| o |          |                 | O |   |                                 |
| j |          |                 | W |   |                                 |
| e |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| v |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| S |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| D |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| m |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| , |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| E |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| v |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| m |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| P |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| m |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| ? |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| 9 |          |                 |   |   |                                 |
| \ |          |                 |   |   |                                 |
| . |          |                 |   |   |                                 |
| W |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| w |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| z |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| j |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| ? |          |                 |   |   |                                 |
| ( |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| k |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| ) |          |                 |   |   |                                 |
| : |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
|   | Co       |                 |   | H |                                 |
|   | mpressed |                 |   | e |                                 |
|   | gas      |                 |   | a |                                 |
|   |          |                 |   | v |                                 |
|   |          |                 |   | y |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | b |                                 |
|   |          |                 |   | j |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | c |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | ( |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | q |                                 |
|   |          |                 |   | u |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | g |                                 |
|   |          |                 |   | c |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | h |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | m |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | v |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | g |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | q |                                 |
|   |          |                 |   | u |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | p |                                 |
|   |          |                 |   | m |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | ) |                                 |
+---+----------+-----------------+---+---+---------------------------------+
|   | Chemical |                 |   | H |                                 |
|   | hazards  |                 |   | i |                                 |
|   | (e.g.    |                 |   | g |                                 |
|   | toxic,   |                 |   | h |                                 |
|   | carci    |                 |   | o |                                 |
|   | nogenic, |                 |   | r |                                 |
|   | caustic, |                 |   | l |                                 |
|   | ex       |                 |   | o |                                 |
|   | plosive) |                 |   | w |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | m |                                 |
|   |          |                 |   | p |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | u |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | ( |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | . |                                 |
|   |          |                 |   | g |                                 |
|   |          |                 |   | . |                                 |
|   |          |                 |   | h |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | d |                                 |
|   |          |                 |   | d |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | v |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | c |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | c |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | y |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | g |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | c |                                 |
|   |          |                 |   | f |                                 |
|   |          |                 |   | l |                                 |
|   |          |                 |   | u |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | d |                                 |
|   |          |                 |   | ) |                                 |
+---+----------+-----------------+---+---+---------------------------------+
|   | El       |                 |   | H |                                 |
|   | ectrical |                 |   | i |                                 |
|   | (i       |                 |   | g |                                 |
|   | ncluding |                 |   | h |                                 |
|   | stored   |                 |   | p |                                 |
|   | energy)  |                 |   | o |                                 |
|   |          |                 |   | w |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | R |                                 |
|   |          |                 |   | F |                                 |
|   |          |                 |   | f |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | l |                                 |
|   |          |                 |   | d |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | ( |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | d |                                 |
|   |          |                 |   | d |                                 |
|   |          |                 |   | f |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | l |                                 |
|   |          |                 |   | d |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | g |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | h |                                 |
|   |          |                 |   | ) |                                 |
+---+----------+-----------------+---+---+---------------------------------+
|   | Fire     |                 |   | P |                                 |
|   | (flamm   |                 |   | o |                                 |
|   | ability) |                 |   | s |                                 |
|   | hazards  |                 |   | s |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | b |                                 |
|   |          |                 |   | l |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | x |                                 |
|   |          |                 |   | y |                                 |
|   |          |                 |   | g |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | d |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | f |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | c |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | c |                                 |
|   |          |                 |   | y |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | c |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | f |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | d |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | p |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | c |                                 |
|   |          |                 |   | e |                                 |
+---+----------+-----------------+---+---+---------------------------------+
|   | R        |                 |   | P |                                 |
|   | adiation |                 |   | e |                                 |
|   | hazards  |                 |   | r |                                 |
|   | (sealed  |                 |   | s |                                 |
|   | sources, |                 |   | o |                                 |
|   | i        |                 |   | n |                                 |
|   | sotopes, |                 |   | a |                                 |
|   | X-ray    |                 |   | l |                                 |
|   | sources, |                 |   | P |                                 |
|   | work at  |                 |   | r |                                 |
|   | accel    |                 |   | o |                                 |
|   | erators) |                 |   | t |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | c |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | E |                                 |
|   |          |                 |   | q |                                 |
|   |          |                 |   | u |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | p |                                 |
|   |          |                 |   | m |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | ( |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | . |                                 |
|   |          |                 |   | g |                                 |
|   |          |                 |   | . |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | p |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | c |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | , |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | p |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | , |                                 |
|   |          |                 |   | g |                                 |
|   |          |                 |   | l |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | v |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | ) |                                 |
+---+----------+-----------------+---+---+---------------------------------+
|   | High     |                 |   | P |                                 |
|   | voltage  |                 |   | o |                                 |
|   | or High  |                 |   | s |                                 |
|   | current  |                 |   | s |                                 |
|   | (add     |                 |   | i |                                 |
|   | desc     |                 |   | b |                                 |
|   | ription) |                 |   | l |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | E |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | v |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | m |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | l |                                 |
|   |          |                 |   | I |                                 |
|   |          |                 |   | m |                                 |
|   |          |                 |   | p |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | c |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | s |                                 |
+---+----------+-----------------+---+---+---------------------------------+
|   | Laser    |                 |   | B |                                 |
|   | (class 3 |                 |   | i |                                 |
|   | or 4)    |                 |   | o |                                 |
|   |          |                 |   | - |                                 |
|   |          |                 |   | h |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | z |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | d |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | ( |                                 |
|   |          |                 |   | B |                                 |
|   |          |                 |   | S |                                 |
|   |          |                 |   | L |                                 |
|   |          |                 |   | 2 |                                 |
|   |          |                 |   | , |                                 |
|   |          |                 |   | 3 |                                 |
|   |          |                 |   | , |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | 4 |                                 |
|   |          |                 |   | ) |                                 |
+---+----------+-----------------+---+---+---------------------------------+
|   | High     |                 |   | E |                                 |
|   | pressure |                 |   | r |                                 |
|   | gas or   |                 |   | g |                                 |
|   | fluid?   |                 |   | o |                                 |
|   |          |                 |   | n |                                 |
|   | 150 psi  |                 |   | o |                                 |
|   | gas      |                 |   | m |                                 |
|   |          |                 |   | i |                                 |
|   | 1500 psi |                 |   | c |                                 |
|   | liquid   |                 |   | s |                                 |
|   |          |                 |   | ( |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | . |                                 |
|   |          |                 |   | g |                                 |
|   |          |                 |   | . |                                 |
|   |          |                 |   | V |                                 |
|   |          |                 |   | D |                                 |
|   |          |                 |   | T |                                 |
|   |          |                 |   | ' |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | , |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | x |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | v |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | k |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | y |                                 |
|   |          |                 |   | b |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | d |                                 |
|   |          |                 |   | u |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | , |                                 |
|   |          |                 |   | b |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | c |                                 |
|   |          |                 |   | k |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | n |                                 |
|   |          |                 |   | j |                                 |
|   |          |                 |   | u |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | y |                                 |
|   |          |                 |   | h |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | z |                                 |
|   |          |                 |   | a |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | d |                                 |
|   |          |                 |   | s |                                 |
|   |          |                 |   | ) |                                 |
+---+----------+-----------------+---+---+---------------------------------+
|   |          |                 |   | W |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | k |                                 |
|   |          |                 |   | f |                                 |
|   |          |                 |   | r |                                 |
|   |          |                 |   | o |                                 |
|   |          |                 |   | m |                                 |
|   |          |                 |   | h |                                 |
|   |          |                 |   | e |                                 |
|   |          |                 |   | i |                                 |
|   |          |                 |   | g |                                 |
|   |          |                 |   | h |                                 |
|   |          |                 |   | t |                                 |
|   |          |                 |   | s |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| 1 |          |                 |   |   |                                 |
| 0 |          |                 |   |   |                                 |
| \ |          |                 |   |   |                                 |
| . |          |                 |   |   |                                 |
| G |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| v |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| m |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| k |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| k |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| w |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| z |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| I |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| m |          |                 |   |   |                                 |
| 9 |          |                 |   |   |                                 |
| ( |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| . |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| . |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| k |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| , |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| , |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| v |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| w |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| , |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| , |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| m |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| / |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| v |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| , |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| . |          |                 |   |   |                                 |
| ) |          |                 |   |   |                                 |
| : |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| 1 |          |                 |   |   |                                 |
| 1 |          |                 |   |   |                                 |
| \ |          |                 |   |   |                                 |
| . |          |                 |   |   |                                 |
| N |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| m |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| ( |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| P |          |                 |   |   |                                 |
| I |          |                 |   |   |                                 |
| ) |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| j |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| / |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| ? |          |                 |   |   |                                 |
| : |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| 1 |          |                 |   |   |                                 |
| 2 |          |                 |   |   |                                 |
| \ |          |                 |   |   |                                 |
| . |          |                 |   |   |                                 |
| W |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| j |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| z |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| w |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| ? |          |                 |   |   |                                 |
| Y |          |                 |   |   |                                 |
| E |          |                 |   |   |                                 |
| S |          |                 |   |   |                                 |
| N |          |                 |   |   |                                 |
| O |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| 1 |          |                 |   |   |                                 |
| 3 |          |                 |   |   |                                 |
| \ |          |                 |   |   |                                 |
| . |          |                 |   |   |                                 |
| I |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| z |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| w |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| w |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| b |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| , |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| v |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| h |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| w |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| m |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| : |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| > |          |                 |   |   | Annual Amount::                 |
|   |          |                 |   |   | [     ]{.underline}             |
| T |          |                 |   |   |                                 |
| y |          |                 |   |   |                                 |
| p |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| w |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| : |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| [ |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| ] |          |                 |   |   |                                 |
| { |          |                 |   |   |                                 |
| . |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| } |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| L |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| c |          |                 |   |   |                                 |
| a |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| f |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| S |          |                 |   |   |                                 |
| A |          |                 |   |   |                                 |
| A |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| ( |          |                 |   |   |                                 |
| B |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| & |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| R |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| o |          |                 |   |   |                                 |
| m |          |                 |   |   |                                 |
| ) |          |                 |   |   |                                 |
| : |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| [ |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| ] |          |                 |   |   |                                 |
| { |          |                 |   |   |                                 |
| . |          |                 |   |   |                                 |
| u |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| d |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| r |          |                 |   |   |                                 |
| l |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| } |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| E |          |                 |   |   |                                 |
| x |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| s |          |                 |   |   |                                 |
| t |          |                 |   |   |                                 |
| i |          |                 |   |   |                                 |
| n |          |                 |   |   |                                 |
| g |          |                 |   |   |                                 |
| > |          |                 |   |   |                                 |
|   |          |                 |   |   |                                 |
| N |          |                 |   |   |                                 |
| e |          |                 |   |   |                                 |
| w |          |                 |   |   |                                 |
+---+----------+-----------------+---+---+---------------------------------+

\*Please note that ES&H costs are born by the project.

14\.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date
\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date
\_\_\_\_\_\_\_\_\_

Signature of PI submitting proposal SRQ Reviewed by Division Safety
Coordinator

### INSTRUCTIONS FOR 

### COMPLETING THE PROPOSAL INTIATION FORM

(Items do not need to be completed in the order numbered.)

**Page 1. Proposal Details**

**Budget/Resource Analyst**

1.  Double click in the header to activate and enter Proposal Tracking
    numbers after Principal Investigator returns the completed Proposal
    Initiation Form (PIF).

## Principal Investigator

2.  Enter title of proposal.

3\. (a-b) List name of 1 principal investigator and 1 co-principal
investigator. Include Phone, Fax, and Email.

> 4--9 Provide the Sponsor information as requested.

10. Write a brief description of the scope of work being proposed.

> 11a. Check box for proposal type (new or renewal/continuation). If the
> proposal is a renewal / continuation, provide the current Project IDs
> (account numbers) or the title of current ESD project.
>
> 12\. If there are other external organizations involved, list their
> names.
>
> 13\. If this is a formal solicitation, type in the URL of the website
> where proposal documentation can be located, email the forms to the
> Budget/Resource Analyst, or attach the forms to the PIF.
>
> 14\. Indicate the Sponsor's proposal due date.
>
> 15\. Enter the start date of the work being proposed.
>
> 16\. Enter the duration of the proposed work.

17\. Enter the total funds being requested in \$K. Make sure you include
in-direct costs, burdens, and other charges.

18. Print name of the Program Head or designated reviewer. Obtain the
    Program Head's signature and date to indicate completion of review.

19. Print name of the technical reviewer. Obtain the technical reviewer
    signature and date to indicate completion of review.

**Page 2-3. Budget Estimate Worksheets**

## Principal Investigator

1.  Enter the information on Lab personnel you intend to join in the
    proposed work. Include any unnamed Lab and Non-LBNL personnel. Enter
    title and duration of effort for each fiscal year.

2.  (a-d) If you are planning to bring in new personnel, will require
    additional office or laboratory space, or will require modifications
    to existing space, you must send and email to the Space
    Coordinators:

> Office: Maryann Villavert, x7357, mvillavert@lbl.gov
>
> Labs: Ernie Majer, x6709, elmajer@lbl.gov
>
> Provide details as needed and include estimated costs in budget
> formulation.

3.  Indicate any shop or fabrication time and effort costs.

4.  If you plan to subcontract services, indicate time and effort costs
    per fiscal year.

5.  If you require any equipment/property, such as computers, laser
    printers, tools, etc. indicate item description, possible vendors
    and quotes, and location of where equipment will reside.

6.  If you require any supplies or small purchase, such as chemicals,
    small parts, publication costs, etc. indicate item description,
    estimated cost.

7.  If you plan to travel, indicate locations, total cost of each trip,
    and length of trip.

8.  Direct costs include recharge costs for ES&H, space, telephone,
    computing services and support, administrative support, etc. You
    must take these into account and include these cost estimates since
    you are using LBNL facilities and resources to support this work.

9.  Indicate if the work has any special requirements, which have not
    been addressed on the form.

10. If you are submitting a proposal to DOE, you must include a
    statement related to LBNL's unique expertise in the area of the
    work.

11. Indicate what DOE Program the project is related to.

**(Continued on next page)**

**Page 4. Project/Facility Questionnaire**

## Principal Investigator

1.  Enter title of proposal. (Copy/paste from page 1).

2.  Enter the PI or Project Leader's name

3.  Enter the LBNL Project ID if this is a continuation/renewal. Leave
    blank if it is a new project unless you know what the Project ID
    will be.

4.  Check the applicable box. If more than one applies, enter the number
    in sequence to the right of the box on the line provided. If you
    select off-site work, please indicate a specific location, city,
    state. Note that you will need to complete ESD's OSSEPP form prior
    to any travel to the site. Computation or theory implies extensive
    computer use poses ergonomic hazards (complete Item 9).

5.  Check the applicable box(es) and indicate the number of FTE

6.  Identify the building(s) and room(s) for this project. Be specific
    if it is an off-site project.

7-8. Check the box, YES, NO, or DON'T KNOW per item. Consult with the
ESD Safety Coordinator if there are questions.

9.  Check all that apply.

10. Identify a list of safety measures you will take to reduce risk
    while working on this project.

11. Identify the person who will be the safety contact on this project.
    Typically this is the PI.

12. Indicate if this project generates hazardous waste. Contact the ESD
    Safety Coordinator, Jil Geller or refer to
    http://www-esd.lbl.gov/ESDEHS/safequest.html

13. If the answer to item 12 is "Yes," please identify the type of waste
    (Mixed waste handling is charged to project), the annual amount
    (volume), and the location of the Satellite Accumulation Area (SAA),
    or if a new SAA will need to be set up.

## Principal Investigator

14. Sign and date the PIF once you have completed the form and forward
    it to the Budget/Resource Analyst to route for additional reviews
    and signatures.