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Radioactive Materials Waste Pick-Up Request Form

Instructions:

  • Complete all applicable fields. Please be as specific as possible.
  • List the quantity of each item of waste.
  • List the isotope, and activity.
  • Send the form to the RSO by clicking on the submit button below.
  • The RSO will contact you in order to schedule a date for a waste pickup.
   
Requestor Name:    
Authorized User Name:    
Phone Number:    
Building:    
Room Number:    
Email Address:    

Waste Type Quantity   Isotope(s)   Activity
Dry Solid (bags)    
Aqueous (jugs)    
Non Hazardous Scintillation Vials (trays)    

Comments: