NAME: 4. Radionuclide Information (Complete A through H only) Isotope Isotope A. Radionuclide Requested B. Chemical Form Group(s) (example: nucleotides) C. Physical Form (gas, liquid, solid) D. Solubility Class E. Possession Limit (mCi) F. Max. Stock Vial Activity (mCi) Potential for RAM in G. Monthly Hot Sink Disposal Limit H. (To be completed by RS) License and Line No. I. (To be completed by RS) 4. Continued (for more than 4 isotopes attach additional Section 4 pages, which can be found on our website.) Isotope Isotope A. Radionuclide Requested B. Chemical Form Group(s) (example: nucleotides) C. Physical Form (gas, liquid, solid) D. Solubility Class E. Possession Limit (mCi) F. Max. Vial Activity (mCi) Potential for RAM in G. Monthly Hot Sink Disposal Limit H. (To be completed by RS) License and Line No. I. (To be completed by RS)
NAME: 4. Radionuclide Information (Complete A through H only) Isotope Isotope A. Radionuclide Requested B. Chemical Form Group(s) (example: nucleotides) C. Physical Form (gas, liquid, solid) D. Solubility Class E. Possession Limit (mCi) F. Max. Stock Vial Activity (mCi) G. Potential for RAM in H. Monthly Hot Sink Disposal Limit (To be completed by RS) I. License and Line No. (To be completed by RS) 4. Continued (for more than 4 isotopes attach additional Section 4 pages, which can be found on our website.) Isotope Isotope A. Radionuclide Requested B. Chemical Form Group(s) (example: nucleotides) C. Physical Form (gas, liquid, solid) D. Solubility Class E. Possession Limit (mCi) F. Max. Vial Activity (mCi) G. Potential for RAM in H. Monthly Hot Sink Disposal Limit (To be completed by RS) I. License and Line No. (To be completed by RS)
rs-01-section_4_extra_page.docx