Radioactive Waste Pick-Up Form

Date
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Item #1

Item 1
Is Item 1 a Solid, Liquid or Liquid Scintillation Vial? Please select one below.



If Item 1 is a solid, how many lbs. need to be picked up?
If Item 1 is a liquid, what is the amount that needs to be picked up? (ml)
If Item 1 contains Liquid Scintillation Vials, please enter the number of vials that need to be picked up?
Is Item 1 a Biohazard?


Is Item 1 a Chemical Hazard?


Item #2

Item 2
Is Item 2 a Solid, Liquid or Liquid Scintillation Vial? Please select one below.



If Item 2 is a solid, how many lbs. need to be picked up?
If Item 2 is a liquid, what is the amount that needs to be picked up? (ml)
If Item 2 contains Liquid Scintillation Vials, please enter the number of vials that need to be picked up?
Is Item 2 a Biohazard?


Is Item 2 a Chemical Hazard?


Item #3

Item 3
Is Item 3 a Solid, Liquid or Liquid Scintillation Vial? Please select one below.



If Item 3 is a solid, how many lbs. need to be picked up?
If Item 3 is a liquid, what is the amount that needs to be picked up? (ml)
If Item 3 contains Liquid Scintillation Vials, please enter the number of vials that need to be picked up?
Is Item 3 a Biohazard?


Is Item 3 a Chemical Hazard?


Item #4

Item 4
Is Item 4 a Solid, Liquid or Liquid Scintillation Vial? Please select one below.



If Item 4 is a solid, how many lbs. need to be picked up?
If Item 4 is a liquid, what is the amount that needs to be picked up? (ml)
If Item 4 contains Liquid Scintillation Vials, please enter the number of vials that need to be picked up?
Is Item 4 a Biohazard?


Is Item 4 a Chemical Hazard?


Item #5

Item 5
Is Item 5 a Solid, Liquid or Liquid Scintillation Vial? Please select one below.



If Item 5 is a solid, how many lbs. need to be picked up?
If Item 5 is a liquid, what is the amount that needs to be picked up? (ml)
If Item 5 contains Liquid Scintillation Vials, please enter the number of vials that need to be picked up?
Is Item 5 a Biohazard?


Is Item 5 a Chemical Hazard?


If you need containers, please indicate in this box.

Department of Environmental Health And Safety

Main Office

1800 Arthur Street

Louisville, Kentucky 40208

Phone

tel (502) 852-6670

fax (502) 852-0880

Department of Environmental Health And Safety

Radiation Safety Office

319 Abraham Flexner Way

Louisville, Kentucky 40202

Phone

tel (502) 852-5231

fax (502) 852-8911

Office Hours

M-F 8:00 am to 4:30 pm

No holiday hours

IH Service Account

dehsih@louisville.edu

IBC Service Account

biosafe@louisville.edu