Instructions:

Fill in contact information completely.

For each container (bag, bottle, box):
     Select isotope
     Select waste type. If liquid,  fill in contents.
     Fill in volume of container in gallons
     Fill in estimated activity for each container
     Fill in parent vial approval number if known

UCF Environmental Health & Safety
Radioactive Waste Pickup Form

Principle Investigator: 

Name of Person Coordinating Pickup:

Email Address:

Phone Number: 
 Department:

Building:  

Room Number:
Container

Isotope

 Dry
Liquid or
Scintillation?

If Liquid, List Chemical Components
(in percent)

Container Volume:
(in gallons)

Estimated Activity
in Container:
(in millicuries)

Parent Vial
 Approval Number
           1
           2
          3
          4
         5
         6
         7
        8

Comments:                                                                                                                      
       

We will make every attempt to pick-up the waste within 7 days of receiving this form.  
Please call the Environmental Health and Safety Department at 3-0071 or email us with any questions.

For EH&S Use

Background Reading Instrument  Model S/N

Date of Pick Up    Signature

 


 
 

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