RWD Request Form

Radioactive Waste Disposal Request Form
Environmental Health and Safety

Please read and follow these instructions carefully -

Please fill out the form completely - incomplete forms will result in pickup delays.
Room must be the location of the waste.
Under Types of Radioactive Waste enter either Solid or Liquid or Vials or other and the corresponding number of containers needed.
Paperwork must be completed.
Once the form is submitted, a copy of the information is sent to you and the concerned persons through e-mail.
If you have any questions, please contact EH&S at 742-3876.

Designed, Developed and Maintained by Krishna Rayavaram

`Requestor Name`	enter your Name
`Requestor Phone No`	enter your phone number (xxx-xxx-xxxx)
`Department`	enter your department name
`Room No`	location of the waste
`Email`	enter your email (eg. Kris.Ray@TTU.EDU)
`Types of Radioactive Waste`	`# of Containers # of Containers # of Containers # of Containers (eg. Solid) (eg. 4)`
`Is the Paperwork Completed`	Yes No check the appropriate one
`Additional Information`	additional information (optional)