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Radiation Safety - Indianapolis

A-16 E-Form
Removal of Radionuclide Lab(s)

Lab to be Removed:

Permit Holder:
Address (Bldg & Room):
Campus Phone:

Removal of Lab(s):
By completing this form, you are requesting the removal of radionuclide lab(s) from your Radionuclide Use Permit. By checking each item, you are confirming all of the following have been completed:

Labs to be removed:

All unused radioactive material and/or radioactive waste has been transferred to an approved lab on your permit or to the RSO.

If transferred to another lab, provide location

If transferred to another PH, provide name and location

All empty waste containers have been transferred to another approved lab, PH, or removed by the RSO.

All radioactive tape and bench paper has been removed from bench tops, hoods, etc.

A final wipe survey has been completed in the lab(s) with no areas exceeding 200cpm/100cm2 above background.

A final direct (GM) radiation survey has been completed in the lab(s) with no contamination found, if applicable.


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