NEIDL Irradiator Use Request Form Requisitioner Name:* First Last Requisitioner Email:* Phone #: Department* Date Requested:* DD slash MM slash YYYY # of Samples:* Dose Requested (Megarads):* Select Agent*SELECTYESNOComments (Please describe Sample Container, Geometry, and culture medium):*NameThis field is for validation purposes and should be left unchanged.