Radioactive Waste Pick-up Request


Principal Investigator:  Person completing form: 
Your e-mail address for questions: 
Department: 
Your phone #: 
Building: 
Room: 
Date of Request (today's date):  Have wipes been taken on all containers?:  Yes  No



Total number of containers in this request: 
 
Type of Waste Container Color Isotope(s) & Total Activity (mCi) Constituents Replacement Containers
CONTAINER ONE:


Volume of Container: 

  Yellow

  Orange

  Green

     Activity: 
     Activity: 
     Activity: 

 

If this is a Liquid, what is the pH?: 

Do you need a new empty container to replace this one?
Yes 
No
CONTAINER TWO:

Type of Waste: 

Volume of Container: 

  Yellow

  Orange

  Green

     Activity: 
     Activity: 
     Activity: 

If this is a Liquid, what is the pH?: 

Do you need a new empty container to replace this one?
Yes 
No
CONTAINER THREE:
 

Type of Waste: 

Volume of Container: 

  Yellow

  Orange

  Green

     Activity: 
     Activity: 
     Activity: 

If this is a Liquid, what is the pH?: 

Do you need a new empty container to replace this one?
Yes 
No
CONTAINER FOUR:

Type of Waste: 

Volume of Container: 

  Yellow

  Orange

  Green

     Activity: 
     Activity: 
     Activity: 

If this is a Liquid, what is the pH?: 

Do you need a new empty container to replace this one?
Yes 
No
CONTAINER FIVE:
 

Type of Waste: 

Volume of Container: 

  Yellow

  Orange

  Green

     Activity: 
     Activity: 
     Activity: 

If this is a Liquid, what is the pH?: 

Do you need a new empty container to replace this one?
Yes 
No

Additional Comments: