Environment, Health & Safety Radiation Safety Service RADIONUCLIDE RECEIPT, UTILIZATION AND DISPOSAL RECORD Authorized User:________________________________________ Radionuclide:____________________________________________ Room # / Bldg.:_________________________________________ Chemical Form:__________________________________________ PACKAGE CONTAMINATION SURVEY RESULTS (cpm) Date Received: __________Survey __________Smear/Swipe Meter Supplier: Background (cpm): ___________ Inner Package (cpm): ___________ Activity Received: (packing material, vial & container) Batch / Lot #: Box Labels / Markings Defaced ? __________ Initials: ___________ ACTIVITY DISPOSED PO Number: (Ci) DATE OF DATE LSC ANIMAL INITIALS USE ACTIVITY VOLUME DISPOSED SOLID LIQUID VIALS CARCASS
Environment, Health & Safety Radiation Safety Service RADIONUCLIDE RECEIPT, UTILIZATION AND DISPOSAL RECORD Authorized User:________________________________________ Radionuclide:____________________________________________ Room # / Bldg.:_________________________________________ Chemical Form:__________________________________________ Date Received: PACKAGE CONTAMINATION SURVEY RESULTS (cpm) Supplier: __________Survey Meter __________Smear/Swipe Activity Received: Background (cpm): ___________ Inner Package (cpm): ___________ (packing material, vial & container) Batch / Lot #: Box Labels / Markings Defaced ? __________ Initials: ___________ PO Number: ACTIVITY DISPOSED (Ci) INITIALS DATE OF USE ACTIVITY VOLUME DATE DISPOSED SOLID LIQUID LSC VIALS ANIMAL CARCASS
pkgrecpt.docx