Radioactive Waste Pickup Request Form

Please complete this form to request to schedule the removal of radioactive waste from your area. Please ensure that all requirements have been met prior to submitting the form. Failure to do so will result in a delay with processing your request. For questions or more information, please contact the Radiation Safety Office at (305)348-6625.

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Name of Requestor Name of Requestor First Last
Department
Phone Number Phone Number - ### - ### ####
Email
Pick up Location (Campus, Building, and Room Number)
Date Pickup Required Date Pickup Required / MM / DD YYYY
Are you the approved RAM Authorized User?

Are you the approved RAM Authorized User? Yes No
RAM Authorized User RAM Authorized User First Last
Survey Meter Used (include meter model number, serial number, and manufacturer)
Background Dose Rate (mR/hr)