Radioactive Waste Pickup Request

Radioactive Waste Pickup Request*

Please let us know what you wish to have picked up, answer all questions, and indicate what supplies you need then click the SUBMIT button.

Date:
Building:	Room:	Authorization #:
Name:	Phone:	Email:

WASTE TO BE PICKED UP
Containers must be labeled completely and sealed before pickup:

Number of Liquid Containers:		Isotopes Listed?	Yes No
Number of Solid Containers:		Activities Listed?	Yes No
Number of Boxes of Vial :		Authorization on Label?	Yes No
All Containers Sealed?	Yes No	Dates on Label?	Yes No
Liquid Chemical Constituents Listed and Total 100%? (Use Commercial Names - No Abbreviations* )*		Yes No
Liquids have pH on Label?	Yes No

SUPPLIES How many of the following supplies do you need?
Large Liquid Containers: (5 Gallon/20 L)		Comments and/or Other Supplies Needed:
2 Liter Liquid Container(s):
1 Liter Liquid Container(s):
Metal and Glass Pail(s):
Large Yellow Waste Bag(s):
Roll(s) of 6 Yellow Bags:
Pack of 10 Waste Labels:

* This request must be received prior to 5:00 pm Monday for Tuesday pickup.
If you have questions concerning radioactive waste or this form, call 49-40207 or
Click here to send Jim Vetzel an email message.