Online Radioactive Waste Removal Request Form
Authorized User:
Authorized Number:
Department:
Contact Person:
Phone:
Email:
Location of Waste (Room/Bldg.)
 
Container
Number
Nuclide
Activity
in (┬ÁCi)
Assay Date
Container Type
B = Box
J = Jar
D = 30 Gal Drum
P = 5 Gal Pail
Physical Form
D/S = Dry Solid
LIQ = Liquid
LSV = Liquid
Scintilliation Vial
O = OTHER
Chemical Type and Percentages
(for liquid waste ONLY)

Request for additional containers: Box Jar 30 Gal Drum
(120 Liters)
5 Gal Pail - Open Top (for LSV) (20 Liters) 5 Gal Pail - Closed Top (for Liquids) (20 Liters)

Comments:

Date Submitted:

   

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Date Modified: January 5, 2006