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On-line Radioactive Waste Removal Request Form


 Click here to download a copy of this form.

Authorized User

Location Of Waste (Room / Bldg.)

Department

Department Safety Officer

Contact Person

Date

Phone  
CONTAINER # 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)

 

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:

Declaration:

I hereby certify that the above information is accurate to the best of my knowledge and ability to determine that no deliberate or willful omissions of composition or properties exist and that all known or suspected hazards have been disclosed and all infectious organisms/agents have been rendered nonviable.

Signature Date

 

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