Radioactive Waste Pickup Request • CampusOptics

UW Risk Management and Safety Office

Regulated Materials Management Center

Please only one Radionuclide per sheet

Please put only ONE container in each “Container Type” box.Also specify size of container (i.e. 5 gallon carboy (jug)) and ID number if you have more than one container of the same type.

When selecting “Type of Waste” use table at bottom of form. Put only one waste type in each container.

RSO#- Each Rad order is given an RSO#. They are found on the Waste Disposal Report Form that is delivered with the order. ALL RSO #’s that have any activity in that container must be listed.

Properties of Waste = Liquid or Solid, pH if applicable, chemical ingredients, and any other helpful info or notes

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Name* Required

Additional Location Details

Accumulation Started Date

Container Type Description* Required

Amount* Required

Unit* Required

Container Contents

Current Total: 0%

Type

Percentage

Responsible Party/Faculty/Staff

Department

Your office number

Waste Generating Activity* Required

Has the chemical Waste been labeled

Do you need empty waste containers brought to you?

Radionuclide

RSO#'s

Type of Waste

Radioactivity

Is RSO# totally disposed of?

Properties of Waste

Signature* Required