Shipping Samples to SSRL
General Information
Your Name
*
Institution
*
Contact Phone
*
Access Information
Type of Access
Assigned Beam Time
Beamline Xpress / FCFS
Staff Collaboration
Access Additional Information
Assigned Beamline
Leave at SSRL Shipping and Receiving
BL12-1
BL12-2
BL9-2
BL14-1
BL7-1
Screening Program
Leave at SSRL Shipping and Receiving
Leave at MC Long Term Storage
BL9-3 (XAS)
BL4-2 (SAXS)
LCLS-MFX Standard Goniometer Setup
Proposal Number
*
Date of Experimental Start
Preferred Beamlines
*
BL12-1
BL12-2
BL9-2
BL14-1
BL7-1
Proposal Number
*
Name of Collaborator
*
- Select -
Aina Cohen
Tzanko Doukov
Darya Marchany
Irimpan Mathews
Silvia Russi
Clyde Smith
Mike Soltis
Are you the spokesperson on the proposal?
Yes
No
Proposal Spokesperson's Name
*
Sample Information
Number of Liquid Nitrogen Dewars:
Total Number of Cassettes:
Total Number of Uni Pucks:
Number of Blue Shipping Containers for Elevated Temperature:
Temperature Inside Blue Shipping Containers
5 Degrees
20 degrees
Total Number of Elevated Temperature Plates:
International Shipments
Is this an international shipment?
Yes
No
Customs Broker
*
JAS
FedEx
other
Read about US Customs delays in the
Shipping Samples Manual
Remote Information
Is this an remote experiment?
*
Yes
No
Do you want to Generate Return Shipping Request Forms Now?
*
Yes
No
Return Samples Request
Return Delivery Contact
Name
*
Phone
*
Return Ship To Information
Name
*
Institution
*
Address Line 1
*
Address Line 2
City
*
State/Province
*
Zip Code
*
Country
*
Return Shipment Payment
Carrier
*
FedEx
UPS
other
Fedex Account Number (9 digits only)
*
Fedex Options
2-Day
Overnight
International
UPS Account Number (6 digits only)
*
UPS Options
*
Ground
Overnight
Carrier Name
*
Account Number
*
CC Number For Reference Field
Insurance
*
Yes
Decline
Declare Value (USD)
*
Agreement Signature
I certify that dewar(s) contain only liquid nitrogen and less than 50 mg of protein or class I biohazard.
I certify that dewar(s) contain only liquid nitrogen, less than 50 mg of protein and no biohazards. No proprietary research will be performed.
I certify that blue shipping containers contain less than 50 mg of protein and no biohazards.
I certify blue shipping containers contain less than 50 mg of protein and no biohazards. No proprietary research will be performed.
I acknowledge that by not using JSA, this shipment may be delayed at US Customs.
I certify that I have read, concur with and carried out the terms, conditions and requirements for export as outlined in the
Instructions for International Shipments
.
I certify that I have sent a Power of Attorney Form to SSRL.
Email for electronic signature:
Submit
