Online Radioactive Waste Removal Request Form

Please fill out the following form and print and sign the confirmation page. Thank you.



Container Number 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
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)

Declaration: I 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.