Rutgers Environmental Health and Safety
Instructions for Completing:
Request for Radioactive Waste Disposal Form
Enter the four-digit number assigned to the Authoree responsible for the waste.
Enter the name of the Authoree responsible for the waste.
Enter the date that your request was submitted.
Enter the name or number of the building where the waste is located.
Enter the room number where the waste is located.
Enter the 5 digit serial number located in the bottom right corner of the yellow card.
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.
Type of Waste:
Choose one of four choices:
Frozen animal carcasses contaminated with a radioisotope.
Free standing, aqueous liquids (be sure to properly identify the chemical constituents of your liquid waste on the radioisotope disposal form - see certification statement).
Liquid scintillation vials containing liquid scintillation cocktail and radioactive sample in tightly capped vial.
Contaminated paper, glass, plastic, personal protective equipment, etc.
Choose one of the five container types.
Enter a numerical value to describe the amount of waste. Units will be chosen in the next field.
Choose units to be assigned to the numerical value entered in Step #9.
For more information, contact
Last Updated: 02/03/2013
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