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SMAST TEST TANK USAGE REQUEST

Date(s) and Time(s) of Use:


Name of Organization: Date:

Billing Information:

Name: Day Phone: Email:

Billing Address: Purchase Order #

City: State: Zip:

Billing Rates Category:
Check One Category

CAT 1 INTERNAL USERS
(Student / Faculty / Staff of UMass): day 1/2 day
CAT 2 COMMUNITY SERVICES
(Safety Training, Community Awarness): $200 / day $100 / 1/2 day waived
CAT 3 EXTERNAL USERS
(Corporate / Companies / Private): $800 / day $400 / 1/2 day waived
CAT 4 COLLABORATIVE PARTNERS WITH UMD
(Users with UMD involvement, e.g. interns, research, projects, etc.): $200 / day $100 / 1/2 day waived

CAT 4 ONLY:

Students Name: Advisor:

Authorized By: Topic:

WATER REQUIRED: Sea Water Fresh Water Not Applicable
Special Water Conditions: $4000 Water Switch Over Fee Will Apply (Allow 4 Weeks Prior)
Check Online Calendar For Current Water Condition.

SPECIAL REQUIREMENTS: Instruments, environmental, handling, preparation, etc. (list):

LIABILITY AND INSURANCE AND CONTRACT REQUIRED: On File To Be Sent
(External Groups Only)

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UMass Dartmouth • School for Marine Science and Technology • 706 Rodney French Blvd • New Bedford, MA 02744-1221
Phone: 508 999-8193 • Fax: 508 999-8197