Breadcrumb Home Radioactive Waste Pickup Request You must have JavaScript enabled to use this form. Requestors First Name Requestors Last Name Requestors E-mail Address Requestors Phone Number Pickup Location (Room/Bldg) Department Principal Investigator (First & Last Name) Application Number Container Information Dry Waste > 90 day half-life Dry Waste < 90 dry half-life Liquids - Small (1.5 gallon) Liquids - Large (5 gallon) LSC Vials Sealed Source Animals/Animal Bedding Lead Shielding Stock Vials Sharps Comments Certification HawkID Signed Date Signed Date: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Signed Date: Day Day12345678910111213141516171819202122232425262728293031 Signed Date: Year Year20232024202520262027 Leave this field blank