饲养保管施设等设置承认申请书.DOC

Application for Approval of Establishing Animal Experiment Facilities (New/Alteration) To the President of Kumamoto University: 　　　　　　　　　　　　　　　　　　　　　　　　　Manager (Dean, etc. of facility establishing faculty) Name of Department： Name of Manager： I hereby apply to request permission to establish animal experiment facilities, pursuant to Article 13-1, Regulations for Animal Experiments in Kumamoto University. UDate of Application year month day　UDate of Receipt year month dayU　 ＊Receipt (Approval) No.　　　　　　　　　　　　 * Not necessary for new applicationsf the application is for an alteration, write the approval no. * If facilities are to be altered, fill only the parts to be changed. 1. Name and location or animal experiment facilities Name: Location: 2. Animal experiment facilities management system <Care Manager> Department:　　　　　　　　　Title:　　　 Name: Contact: Related Certification: Date of Receiving Education or Training:　　　 year month day Years of Experience: （If there are other persons necessary to contact other than the Care Manager listed above, fill the following） Department:　　　　　　　　　Title:　　　 Name: Contact: Related Certification: Date of Receiving Education or Training:　　　 year month day Years of Experience: <Keeper>（If there are several people , attach additional sheets with the following information） Department:　　　　　　　　　Title:　　　 Name: Contact: Related Certification: Date of Receiving Education or Training:　　　 year month day Years of Experience: Outline of Animal Experiment Facilities 1) Structure of Animal Experiment Facilities (eg. Reinforced concrete structure) 2) Structure of floor, interior walls, ceiling of animal room 3) Condition setting in the animal room: temperature, humidity, air exchange rate, number of dark and light hours. 4) Species of experiment animals housed 3. Outline of Animal Experiment Facilities 5) Specifications and maximum capacity of breeding cages 6) Measures to pr