Radiation Waste Pickup Request

Please complete 1 request per radioactive waste container.

Radiation Waste Pickup Notice

Radiation waste pick up is conducted every Wednesday between 9:00 AM and 2:00 PM.

Please note that waste requests submitted after 5:00 PM on the Monday prior to the scheduled pick up will be deferred to the following Wednesday.

If you require a pick up outside of the listed time slots or need special accommodations, please use the Comments section below.

Thank you for your cooperation in maintaining safe and timely radioactive waste handling procedures.

Name of Principle Investigator (PI) / Authorized User (AU)

Name of Researcher on the Radiation Permit.

Name of Requester

Who is completing this form?

Requester Phone Number

Please list a reliable phone number where pick up can be coordinated.

Phone

Requester Email Address

Location of Waste

Please list Building name, and lab room #

Type of Waste Container

Please select the size and type of Radiation waste container

Radioactive Waste type

Please select the type of radioactive waste

Radioactive Isotope(s)

Please select the Isotopes in this container

Isotope 1 Activity

Enter the individual activity for Isotope 1.

(Note) If only 1 isotope is present, this box is the same as the Total Activity Below as found on your waste analysis form.

Total Activity

Please provide the total activity (mCi) calculated on the Dry Active Waste Log or the Liquid Radioactivity Analysis Form

Last Entry Date (LED)

What is the last date something was added to this container

mm/dd/yyyy

Requested window

Please be aware that the requested pick up time for your radioactive waste is subject to scheduling availability.

While Radiation Safety strives to fulfill all pick ups during requested windows, staffing constraints may occasionally necessitate adjustments to the pick ups schedule.

We will do our best to accommodate your preferred time and will communicate any changes to you.

Thank you for your cooperation.

Important Notes for Submitter

Please complete a separate waste pickup request form for each additional container you need picked up.

File Upload

Please upload the corresponding Dry Active Waste Container Log or Liquid Radioactivity Analysis form and Chematix waste card (in PDF format) if hazardous materials are in the waste.