Contaminated Equipment Clearance Request

Radioactive Waste Pickup Form

Chemical Waste Pickup Form

Requester Information:
Name:
Phone:
E-mail:
Dept: (abbreviate)


An active EMAIL address is required so we can contact you if there are questions.

Please Make Sure Your Equipment Is Visible and Clearly Marked

Equipment Location (not office):

Building Abbreviation:

Room:


Comments: describe equipment


Type of Contamination (change matching boxes to "Y"):
Radioactive
Chemical
Biological


Equipment Release policy