FORM
RADWSTFX – 1
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August 2010
PURDUE UNIVERSITY
Radiological and Environmental Management
RADIOACTIVE WASTE PICKUP REQUEST *
Date:
Building:
Room:
Name:
Phone:
Authorization #:
Email:
WASTE TO BE PICKED UP
Containers must be labeled completely and sealed before pickup:
Number of Liquid Containers:
Isotopes Listed?
Yes
No
Number of Solid Containers:
Activities Listed?
Yes
No
Number of Boxes of Vials:
Authorization on Label?
Yes
No
Dates on Label?
Yes
No
All Containers Sealed?
Yes
No
Liquid Chemical Constituents Listed and Total 100%?
Yes
No
(Use Commercial Names – No Abbreviations)
Liquids pH Listed?
Yes
No
(Per U.S. Department of Transportation (DOT), the pH must be 6 - 9 to be transported.)
SUPPLIES
How many of the following supplies do you need?
Large Liquid Containers (5 Gallon/20 L):
Comments and/or Other Supplies Needed:
2 Liter Liquid Container(s):
1 Liter Liquid Container(s):
Metal and Glass Pail(s):
Large Yellow Waste Bag(s):
Roll(s) of 6 Yellow Bags:
Pack of 10 Waste Labels:
Fill out this form completely and choose one of the submission methods below to request a pick up:
1. Email as an attachment by using the “Submit by Email” button
2. FAX to 49-47403
3. Campus Mail (RAD Waste, REM, CIVL)
If you have questions concerning radioactive waste or this form, call 49-40207.
* This request must be received prior to 5:00 pm Monday for Tuesday pickup.
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Total
Nuclide
Type *
Pkg Date
Nuclide/Quantity (mCi)
Date:
By:
(mR/Hr)
Surface
Exposure
Pkg
Type**
1 Liter
M&G
Wipe
#
(Y/N)
<0.5
mR/hr
surface
2 Liter
Ybag
(Y/N)
***
Walk
Other
Label
Revision Date: 8/6/2010
** Pkg Types include: 2L, BK, BX, CB, D, HC, LB, Lt, O, YB
(6-9)
pH
Lbag
Cboy
Bldg/Room:
*** Only needs filled out when > DOT quantity limit and/or > 0.5 mR/hr at drum surface
* Waste Types include: SMG, STR, SHT, LAL, LAS, VBDL, VBDS, LOGL, LOGS, VOGL, VOGS, ABWL, ABWS
RAW #
Auth #:
Radioactive Waste Pickup Form
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reserved for REM.