Rutgers Environmental Health and Safety

Instructions for Completing:
Request for Radioactive Waste Disposal Form

  1. Authoree #:  Enter the four-digit number assigned to the Authoree responsible for the waste.
  2. Authoree Name:  Enter the name of the Authoree responsible for the waste.
  3. Request Date:  Enter the date that your request was submitted.
  4. Bldg. Name/No.:  Enter the name or number of the building where the waste is located.
  5. Room #:  Enter the room number where the waste is located.
  6. Ticket #:  Enter the 5 digit serial number located in the bottom right corner of the yellow card.
  7. Isotope Type:  Select the isotope from the pull-down menu. If your selection is not listed, choose
    *Other and enter the isotope name in the space provided.
  8. Type of Waste:  Choose one of four choices:

    Animal:  Frozen animal carcasses contaminated with a radioisotope.
    Liquid:  Free standing, aqueous liquids (be sure to properly identify the chemical constituents of your liquid waste on the radioisotope disposal form - see certification statement).
    LSV:  Liquid scintillation vials containing liquid scintillation cocktail and radioactive sample in tightly capped vial.
    Solid:  Contaminated paper, glass, plastic, personal protective equipment, etc.
  9. Container Type:  Choose one of the five container types.
  10. Amount:  Enter a numerical value to describe the amount of waste.  Units will be chosen in the next field.
  11. Units:  Choose units to be assigned to the numerical value entered in Step #9.