<p> California Institute for Quantitative Biosciences</p><p>To: BNC Applicant From: BNC Management</p><p>Subject: BNC User Information (Rev 2014 Aug 08)</p><p>The following information is required for approval for use of the BNC facilities. Please follow the steps below:</p><p>1). Please fill in the appropriate boxes and print legibly. It is the user’s responsibility to ensure that the information below is accurate. Inaccurate information will result in immediate access revocation.</p><p>2). Interview and signoff by BNC management can be done by Paul Lum located in 121 Stanley (1st floor).</p><p>3). Sign off for Safety and microfabrication training will be done by Paul Lum per arrangement.</p><p>4). Completed form must be submitted to the BNC Management office, 121 Stanley.</p><p>First Name: Last Name: PI name:</p><p>Applicant Email Address: Grant Expiration Date:</p><p>Chartstring Fund Org Prog Project Flex</p><p>Name of PI Grant/Accounting/Lab Administrator: Phone # of Administrator: ( ) - Email Address of Administrator:</p><p>Have you completed Lab Have you completed MicroFab Date of Training: Safety Training? Orientation and Safety Training? Yes/No Yes/ No I acknowledge that it is the PI or fund I acknowledge that it is my responsibility and manager’s responsibility to notify BNC or CSS accountability to follow all proper EH&S and Team 9 Finance when the above BNC user is BNC safety, operations, and processing no longer associated with my research lab or protocols. Such protocols are located in the group. No refunds greater than 3 months will BNC website. http://qb3.berkeley.edu/bnc be allowed. Violations can result in revocation of my access. PI Signature and Date: User Applicant Signature and Date:</p><p>Sign off by QB3/BNC (To be filled in by QB3 personnel only) BNC Managing CSS Team 9 Finance Director</p><p>QB3-Berkeley  121 Stanley Hall  Berkeley, CA 94720-3220  Tel: (510) 666-3356 Fax: (510) 666-3380  www.qb3.org Paul Lum Finance/Recharge Manager Ver. 3.0</p>