Radioactive Waste Disposal Form

Full Name

PI Full Name

Department

E-mail Address

Building

Room Number

Phone Number

Phone

Billing Account Number

FOAPAL i.e. 261112-010209-357709-027000-910209

Radioactive Waste Information

Type of Waste

Select or enter value

Other

Radionuclide(s) Present

Activity of Each Nuclide

Additional Information

Please describe waste, the number of containers to be picked up, the number of replacement containers needed, and any additional information deemed necessary.

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