(Form 7)*Safety Staff

Date:
Staff:*(*) For Safety Staff

Application Form of Experimental Samples and Chemicals at UVSOR (2013)
Dear Chemical Safety Committee at UVSORApplied Person:

Taro Bunshi<<IMS>>

Department
Facility<<User>>Affiliation
Position

Professor, Example University

TEL+81-564-55-1111

FAX+81-564-55-1111

e-mailtaro@example.ac.jp

TEL

We report the list of experimental samples and chemicals used at the UVSOR facility.
Usage TypeTitle
Beamlinea. Cooperative Work, b. Use of UVSOR, c. Internal Use, d. Nanotech Platform

The structures of liquid measured by STXM.

Exp. Period (After decision）
Researcher (Affiliation)

OT
HERS

8/July/2013

T. Ohigashi–12/July/2013

Taro Bunshi (Example University)

Phase

Amount(Gas: Pressure)(Include Units)

OxygenCis-2-Buten
Carbon dioxide
Carbon monoxide

3 atom, Metal
100 g, Metal
3 atom, Metal
3 atom, Metal

10 L, 1 piece
5 L, 2 pieces
10 L, 2 pieces
1 L, 1 piece

BenzeneAcetonitrile
Sulfuric acid
Potassium Permanganate
SodiumLiquidLiquid
LiquidSolidSolid

500 ml500 ml500 ml100 g
10 g

Name of ChemicalsGAS

Beamline Master

BL4U

Hanako Hikari (Example University)
R
E
GI
S
TE
R
E
DHazardousness

NO
N
E

FI
R
ECO
N
B
UST
I
B
LE

E
XPL
O
SIO
NO
OO
O

OO

O
X
I
DA
TI
O
N

A
NT
I
PO
S
I
C

A
C
I
DC
O
R
R
O
S
I
O
N

PO
I
S
O
NO
O

O
O

O
O

O
O

O

O
O

Remarks: It has a possibility to submit report for after-treatment of chemicals when you use hazardous chemicals.

Use of Experimental Samples and Chemicals at the UVSOR Facility
Chemical Safety Committee at UVSOR

1. Outline
When you have a plan to use experimental samples and chemicals at the UVSOR facility, it isnecessary to submit the application form. The detail of the submission is described below.
1. Please send the application form to the office of International & Research Cooperation with otherdocuments.
2. The corresponding researcher should display the copy of the application form on the white board set
at the entrance of the storage ring room. It is also necessary to send the copy to the beamline master.
3. It has a possibility to submit a report for after-treatment of hazardous chemicals. We will inform you
if the submission of the report is necessary. If you have any questions, please contact the safety staff
at the UVSOR facility.
4. You should submit the application form regardless of use of experimental samples and chemicals.
5. If you modify the experimental plan after the submission, please submit the application form again to
the beamline master.
6. In principle, you should take all the experimental samples and chemicals back from the UVSORfacility. If you have any problems to take back, please contact the beamline master.

2. Guidelines for filling the application form
Here are guidelines for filling the application form. If you have any questions, please contact thesafety staff or the beamline master at the UVSOR facility.
1. Experimental period is filled when you visit the UVSOR facility. You will fill the names andaffiliations of one or two researchers.
2. If you have no plan to use chemicals, please write “none” at the name of chemicals. The chemicals
described below are excluded:
Nitrogen gas, rare gas, acetone, ethanol, sodium salicylate, and dry ice.
3.

Please distinguish gas at atmospheric condition from other chemicals. When you describe a gaseous
sample, please fill gas pressure (mass of samples when you use liquefied gas) and bottle type (metal,glass, etc.) in the item “Phase”, and the capacity and number of the bottle in the item “Amount”.
When you describe other samples, please fill phase (liquid or solid) in the item “Phase”, and the massor capacity of samples in the item “Amount”.
4. Please check the registered item, if you have already submitted the report for after-treatment ofhazardous chemicals. It has a possibility to excuse you from the submission of the report of theafter-treatment.
5. If the chemical has hazardousness, please mark “O” at the items.
6. “Explosion” means that a chemical explodes when it has a shock or heating.
7. “Oxidation” means that a chemical is easily oxidized by heating, compression, or addition of acid oralkali.
8. “Antiposic” means that a chemical generates heat, takes fire, or produces hazardous gas when itabsorbs moisture or touches water.
9. “Acid” means that a chemical is strong acid of inorganic or organic compound.
10. “Corrosion” means that human skins and mucous membranes are strongly stimulated or broken whena chemical contacts.
11. “Poison” means that acceptable concentration of hazardousness is below 200 ppm or 200 mg/m3, or afatal dose is below 300 mg. It includes all gaseous samples that are assigned as poison.
12. It is definitely prohibited to use radioactive substances and nuclear materials.