On-line Radioactive Waste Removal Request Form
Authorized User:
Authorized Number:
Department:
Contact Person:
Phone:
Email:
Location of Waste (Room/Bldg.)
Department of Safety Officer:
Container
Number
Nuclide
Activity
in (µCi)
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)
None
Box
Jar
Drum
Pail
None
Dry Solid
LIQ
LSV
Other
None
Box
Jar
Drum
Pail
None
Dry Solid
LIQ
LSV
Other
None
Box
Jar
Drum
Pail
None
Dry Solid
LIQ
LSV
Other
None
Box
Jar
Drum
Pail
None
Dry Solid
LIQ
LSV
Other
None
Box
Jar
Drum
Pail
None
Dry Solid
LIQ
LSV
Other
None
Box
Jar
Drum
Pail
None
Dry Solid
LIQ
LSV
Other
None
Box
Jar
Drum
Pail
None
Dry Solid
LIQ
LSV
Other
None
Box
Jar
Drum
Pail
None
Dry Solid
LIQ
LSV
Other
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:
top
Date Modified: January 5, 2006