<table>
<colgroup>
<col style="width: 18%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 20%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 22%" />
<col style="width: 6%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 6%" />
<col style="width: 5%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="14"><p><strong>Laboratory Directed Research and Development
Program</strong></p>
<p>Berkeley Lab FY 2006 Coversheet</p></td>
</tr>
<tr class="even">
<td>Project Title:</td>
<td colspan="13"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="13"></td>
</tr>
<tr class="even">
<td>Investigator(s):</td>
<td colspan="13"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="13"></td>
</tr>
<tr class="even">
<td>Division(s):</td>
<td colspan="13"></td>
</tr>
<tr class="odd">
<td colspan="4">Funds Requested (FY 2006):</td>
<td colspan="10"></td>
</tr>
<tr class="even">
<td colspan="4">Proposed Project Duration:</td>
<td colspan="2"></td>
<td colspan="5">Out Year Funds Requested:<br />
(for multiyear projects only)</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td>New Proposal</td>
<td></td>
<td colspan="3">Continuation</td>
<td colspan="2"></td>
<td colspan="7"></td>
</tr>
<tr class="even">
<td colspan="4">Collaborating Divisions or Institutions:</td>
<td colspan="10"></td>
</tr>
<tr class="odd">
<td colspan="4">Long-Term Funding (amount, source, likelihood):</td>
<td colspan="10"></td>
</tr>
<tr class="even">
<td colspan="14"></td>
</tr>
<tr class="odd">
<td colspan="14">Summary</td>
</tr>
<tr class="even">
<td colspan="3">Purpose /Goals:</td>
<td colspan="11"></td>
</tr>
<tr class="odd">
<td colspan="14"></td>
</tr>
<tr class="even">
<td colspan="3">Approach/Methods:</td>
<td colspan="11"></td>
</tr>
<tr class="odd">
<td colspan="14"></td>
</tr>
<tr class="even">
<td colspan="8">Anticipated Outcomes/ Results (end of FY 2006):</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td colspan="14"></td>
</tr>
<tr class="even">
<td colspan="14">Relationship to other Berkeley Lab projects sponsored
by DOE or other agencies:</td>
</tr>
<tr class="odd">
<td colspan="14"></td>
</tr>
<tr class="even">
<td colspan="9">Will human subject data, cells, or tissues and/or animal
be used on this project? If yes, fill in the Human/Vertebrate Animal Use
form.</td>
<td>Yes</td>
<td colspan="2"></td>
<td>No</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="14"><em>On an attachment (3 pages, maximum), please provide
a brief description of the scientific project.</em></td>
</tr>
</tbody>
</table>

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+---+----+---+---------+---+----------------------------+--------+--------+
| # |    |   |         |   |                            | # %    | # E    |
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+---+----+---+---------+---+----------------------------+--------+--------+
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+---+----+---+---------+---+----------------------------+--------+--------+
| P |    |   |         |   |                            |        |        |
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+---+----+---+---------+---+----------------------------+--------+--------+
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+---+----+---+---------+---+----------------------------+--------+--------+
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| # |    |   |         |   |                            |        |        |
|   |    |   |         |   |                            |        |        |
| S |    |   |         |   |                            |        |        |
| u |    |   |         |   |                            |        |        |
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|   |    |   |         |   |                            |        |        |
+---+----+---+---------+---+----------------------------+--------+--------+
| # |    |   |         |   |                            |        | ###    |
| # |    |   |         |   |                            |        | \_\_\_ |
| # |    |   |         |   |                            |        | \_\_\_ |
|   |    |   |         |   |                            |        |        |
| T |    |   |         |   |                            |        |        |
| O |    |   |         |   |                            |        |        |
| T |    |   |         |   |                            |        |        |
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| L |    |   |         |   |                            |        |        |
|   |    |   |         |   |                            |        |        |
| L |    |   |         |   |                            |        |        |
| D |    |   |         |   |                            |        |        |
| R |    |   |         |   |                            |        |        |
| D |    |   |         |   |                            |        |        |
|   |    |   |         |   |                            |        |        |
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| U |    |   |         |   |                            |        |        |
| D |    |   |         |   |                            |        |        |
| G |    |   |         |   |                            |        |        |
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| T |    |   |         |   |                            |        |        |
|   |    |   |         |   |                            |        |        |
| R |    |   |         |   |                            |        |        |
| E |    |   |         |   |                            |        |        |
| Q |    |   |         |   |                            |        |        |
| U |    |   |         |   |                            |        |        |
| E |    |   |         |   |                            |        |        |
| S |    |   |         |   |                            |        |        |
| T |    |   |         |   |                            |        |        |
+---+----+---+---------+---+----------------------------+--------+--------+

+----------------------------------+-----------------------------------+
| **[NOTE:]{.underline}** Human    |                                   |
| Subject and/or Vertebrate Animal |                                   |
| Use Questionnaire is required at |                                   |
| proposal stage ***only*** for    |                                   |
| those LDRD proposals that do     |                                   |
| have human subject and/or animal |                                   |
| use, including the use of        |                                   |
| human-derived data, cell lines,  |                                   |
| or DNA as well as animal         |                                   |
| tissues. Information for         |                                   |
| NEPA/CEQA/EH&S Review form(s)    |                                   |
| will be required of all          |                                   |
| proposals ***after***            |                                   |
| preliminary selection (see check |                                   |
| list below).                     |                                   |
+----------------------------------+-----------------------------------+
| **Status**                       | **Form Requirements**             |
+----------------------------------+-----------------------------------+
| Proposal Stage                   | Cover sheet (1 page limit) and    |
|                                  | Budget page required of all       |
|                                  | proposals.                        |
|                                  |                                   |
|                                  | Human Subject and/or Animal Use   |
|                                  | Questionnaire required only if    |
|                                  | project does have human subject   |
|                                  | and/or animal use.                |
+----------------------------------+-----------------------------------+
| Preliminary Selection (prior to  | NEPA/CEQA and EH&S Review form.   |
| start of fiscal year)            |                                   |
+----------------------------------+-----------------------------------+

**Human and/or Vertebrate Animal Use - LDRDs**

To maintain compliance with federal regulations on the use of vertebrate
animals and human subjects, Berkeley Lab must be able to show that all
usage (including the use of data, human cell lines or animal tissues) in
LDRD projects is properly certified. **Note that as principal
investigator you are responsible for accurately assessing and reporting
your human or animal research approval needs.** You may contact the
Human and Animal Regulatory Committee (HARC) office at x5507 for
assistance in making this determination. Please return the completed,
signed form to your Division Office.

  ------------------------------------------------- ---------------------
  [Title]{.underline}:                              *[B&R
                                                    Code:]{.underline}*

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

Human Subjects

  ---- --- ------------- --- -------------------------------------------------------------
  A.       There **is        
           no** human        
           subject           
           involvement       
           in this           
           project.          

  B.       There **is**      
           human subject     
           involvement       
           in this           
           project.          

                             We will use protocols with current human subject approval.

                             CPHS Reference \#

                             \#

                             New human subject protocol(s) to be submitted for approval.

                             Protocol requirements are uncertain at this time.
  ---- --- ------------- --- -------------------------------------------------------------

Vertebrate Animals

  ---- --- ---------- --- ----------------- ----------------- -----------------------------
  A.       There **is                                         
           no**                                               
           animal use                                         
           in this                                            
           project                                            

  B.       There                                              
           **is**                                             
           animal use                                         
           in this                                            
           project.                                           

                          We will use                         
                          protocols with                      
                          current AWRC                        
                          approval.                           

                          [AWRC             [Approval         
                          \#]{.underline}   \#]{.underline}   

                          \#                \#                

                          \#                \#                

                          \#                \#                

                          New animal use                      
                          protocol(s) will                    
                          be submitted for                    
                          approval.                           

                          Use of animals                      
                          not certain at                      
                          this time.                          
  ---- --- ---------- --- ----------------- ----------------- -----------------------------

If you responded **"A"** for both human subjects and animals, then no
further action is required.

If you checked **"B"** in either category, your project must be
certified prior to initiating the research. Please contact the Human and
Animal Regulatory Committees (HARC) office at ext. 5507 if you need
assistance in determining what approvals are needed for certification.
Two (2) extra copies of the FTP/A must be enclosed which CFO/BRP will
forward to the HARC office.

  --------------------- ------------------------- ---------------------------- -----------------------
  *[FTP/A               *[Principal Investigator  *[PI                         *[Date:]{.underline}\
  I.D.#]{.underline}\   (name)]{.underline}\      (Signature):]{.underline}\   *
  *                     *                         *                            

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

<table>
<colgroup>
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 2%" />
<col style="width: 9%" />
<col style="width: 9%" />
<col style="width: 8%" />
<col style="width: 6%" />
<col style="width: 28%" />
<col style="width: 17%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="16"><h1
id="lawrence-berkeley-national-laboratory-nepaceqa-and-ehs-review">Lawrence
Berkeley National Laboratory NEPA/CEQA and EH&amp;S Review </h1></td>
</tr>
<tr class="even">
<td colspan="7">Proposal #:</td>
<td colspan="5"></td>
<td colspan="3">Type (e.g., WFO, CRADA, FTP, LDRD, DOE M&amp;O,
Gift):</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="7">Project Title:</td>
<td colspan="9"></td>
</tr>
<tr class="even">
<td colspan="16"></td>
</tr>
<tr class="odd">
<td colspan="16">1. Identify LBNL, UCB, DOE facility, and any other
offsite locations where work will be performed:</td>
</tr>
<tr class="even">
<td colspan="16"></td>
</tr>
<tr class="odd">
<td colspan="3">Yes</td>
<td colspan="3">No</td>
<td colspan="10"><strong>Uncertain</strong> <em>If "yes" or "uncertain,"
please explain on separate page(s).</em></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="6"><blockquote>
<p>2. For LBNL locations: Does the project involve room or building
modifications?</p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="16"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="6">3. Would the project disturb hazardous substances or
contaminants that preexist in the environment, such that there would be
a release not covered by agency permits?</td>
</tr>
<tr class="odd">
<td colspan="16"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="6">4. For work at non-DOE locations only: Would the project
disturb any of the following environmentally sensitive resources?</td>
</tr>
<tr class="odd">
<td colspan="16"></td>
</tr>
<tr class="even">
<td colspan="16"><p> Property (e.g., sites, buildings, structures,
objects) of historic, archeological or architectural significance
designated by Federal, state or local governments or property eligible
for listing on the National Register of Historic places;</p>
<p> Federally-listed threatened or endangered species or their habitat,
Federally-proposed or candidate endangered species or their habitat; or
state-listed endangered or threatened species or their habitat;</p>
<p> Wetlands regulated under the Clean Water Act and floodplains;</p>
<p> Federally- and state-designated wilderness areas, national parks,
national natural landmarks, wild and scenic rivers, state and Federal
wildlife refuges, and marine sanctuaries;</p>
<p> Prime agricultural lands;</p>
<p> Special sources of water, such as sole-source aquifers, wellhead
protection areas, or other water sources vital to the region;</p>
<p> Tundra, coral reefs, or rain forests.</p></td>
</tr>
<tr class="odd">
<td colspan="16"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="6">5. Would the project result in hazardous emissions,
wastes, or effluents outside permit limits?</td>
</tr>
<tr class="odd">
<td colspan="10"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td colspan="6">6. Is new or additional safety documentation needed for
the work?</td>
</tr>
<tr class="odd">
<td colspan="10"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="11"></td>
<td colspan="3"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="11">Division</td>
<td colspan="3"></td>
<td>Principal Investigator</td>
<td>Date</td>
</tr>
<tr class="even">
<td colspan="16"><strong>To be completed prior to beginning
work:</strong></td>
</tr>
<tr class="odd">
<td colspan="16">Proposed classification:</td>
</tr>
<tr class="even">
<td colspan="16"></td>
</tr>
<tr class="odd">
<td colspan="11"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="11">LBNL NEPA/CEQA Program</td>
<td colspan="2">Date</td>
<td></td>
<td>DOE NCO</td>
<td>Date</td>
</tr>
<tr class="odd">
<td colspan="16">Submit original form w/copy of proposal to LBNL
NEPA/CEQA Program</td>
</tr>
</tbody>
</table>