KUEHSHMWMAppendixE
WD-IV.897
Radioactive Source Summary/Waste Manifest
FROM:
Exchange Drums
Permit Supervisor _________________________________
Laboratory _________________________ RSS
____|____
This form must acknowledge any waste which is removed
from your laboratory by the Radiation Safety Service. All radioactive waste
must be removed from the laboratory by the Radiation Safety Service. Unless
authorized, there will not be any storage of waste. Therefore, when an
exchange of waste containers is necessary, please prepare this form, and
notify the Radiation Safety Service, 102 Burt Hall, at 4-4089.
Source Information
The following information is essential because it specifies
the appropriate source from which the waste was generated. To accurately
describe the waste, please use volume fractions.
| Source
Number |
Isotope |
Original
Activity |
Activity
Date |
Activity
(mCi) |
Fraction
vol/vol |
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Waste Packaging/Container Information
The following information is essential for proper identification
of each container of radioactive waste which is removed from your laboratory.
These containers must be properly packaged. The activities reported below
should be the same as the activities reported above. For aqueous waste
verify that the pH is between 5 and 9. For scintillation vials include
the type of scintillation fluid. For organic waste document the composition
(%) of waste. Document a cpm/vial for scintillation vials or cpm/ml for
aqueous waste.
To:
RSS, Burt Hall
Disposal
Method |
Trac# |
Container
Ident |
*Type |
Isotope |
Activity
(mCi) |
Physical/Chemical Description
solid, liquid, LSC Fluid |
pH |
Concentration
cpm/(vial or ml) |
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*f-20 gal fiber /b-cardboard box Completed
only if container is transported.
Survey of Waste Containers
Package
Ident |
cpm
top |
cpm
Side |
dpm
top |
dpm
side |
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Package
Ident |
cpm
top |
cpm
side |
dpm
top |
dpm
side |
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Unless specified, the waste described above does not contain
any EPA hazardous (Resource Conservation and Recovery Act - RCRA) material
nor any solid waste tainted by RCRA material nor any biological material.
This is to certify that the waste materials are properly classified, described,
and packaged.
Printed Name ___________________________________________________________
Date____ ________________
Signature______________________________________________________________
This package conforms to the conditions and limitations
specified in 49 CFR 173.421 for excepted radioactive material, limited
quantity, n.o.s., UN2910.