Email: 
      Name: 
Supervisor: 
   Address: 
          : 
 Day phone: 

Waste Tag Number:


Isotope: P-32 S-35 Rb-86 Na-22 H-3 C-14 Other (click for choices) If "Other" is selected above state isotope here:
Waste Form:

Dry Solid Aqueous Liquid Organic Liquid Scintillation Vials Sharps Sealed Sources Other (click for choices)

If "Other" is selected above state waste form here:


Waste Volume: liters gallons cubic feet (click for choices)

Is a replacement container needed? Yes No (click for choices)

NOTE: Radioactive waste pick ups will be scheduled and
completed by Radiation Safety staff