Radioactive Waste Disposal Request Form

Texas Tech University

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.

`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`	YesNo check the appropriate one
`Additional Information`	additional information (optional)


	Environmental Health and Safety \| 2903 4TH Street Rm 122 \| Lubbock \| Texas 79409-1090 Phone: 806.742.3876 \| Fax: 806.742.3895 \| Maintain By: Abdullah Muqim Copyright 2009 Texas Tech University \| All Rights Reserved \| Last Updated 05.14.2009