Radiation Safety Pick-Up Form

Date: 07/25/2014 Time: 03:58:14 AM

Tag Number:

Authorized User Name (Last, First):

Nuclide: State:

Containment: example: 2 yellow bags

Activity (mCi): Location BLDG/RM:

Special Instructions:

Image of Text Type the text on the left
into the space below.

Visual Help...       Why...

Please let us know if there are any problems or suggestions tcarritt@unmc.edu