This form authorizes EH&S to recharge the account specified below for radiation safety services. To establish your radiation safety account, complete and submit this form. Following receipt of this completed form, the account will be activated/updated. It will be debited automatically for annual RUA fees or after special Radiation Safety services have been provided. Services are recharged at the rates posted on the website of the Office of the Controller at http://controller.berkeley.edu/recharge/.
Directions for completion:
- Complete all of the information on the form. For additional instructions, double click on the question marks on the PDF.
- Print one copy to sign and send to EH&S and print one copy to keep for your records.
- Fax or mail the completed Recharge Authorization Form to the Office of Environment, Health & Safety.
FAX number: 643-7595
Campus Address: EH&S, University Hall, Room 317, MC 1150
Questions about this form or your recharge account?
If you have any questions, please contact the Recharge Administrator at 642-3073 or e-mail at email@example.com.