UNMC
Department of
Environmental Health & Safety

Radiation Safety Waste Pick-up Form

Date: 03/28/2023 Time: 09:09:59 AM

Tag Number:

Authorized User Name (Last, First):

Nuclide: State:

Containment:
example: 2 yellow bags

Activity (mCi): Location BLDG/RM:

Special Instructions:

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