Radioactive Waste Pickup Request

1 Start 2 Complete

Number of solid containers to be picked up

Number of solid replacement containers needed

Number of liquid containers to be picked up

Number of liquid replacement containers needed

Number of scintillation vial containers to be picked up

Number of scintillation vial replacement containers needed

Other

Use this field to describe requests not defined in other options on this webform.

Authorized User *

Isotopes to be picked up *

Contact Name *

Phone number *

Lab building name and room number *

Proposed date for waste pickup *

Year

Month

Day

Proposed time for waste pickup *

Hour

Minute

Email Address *

Additional Comments

Leave this field blank

Georgia Institute of Technology Environmental Health & Safety