Radioactive Waste Pickup Request Form

All lab/personal information must be filled out completely.

Lab/Personal Information
Campus		Date: 05-26-2013
Requested By		PI name
Columbia email, including UNI
Phone Number	(xxx-xxx-xxxx)
Building		Lab/Room Number
		Location of waste in the lab

Check here if HHMI investigator

Click here if only requesting containers/supplies

Click here to add another Radioactive Waste Description

Replacement containers/items needed:

Labels

Amount Requested

Replacement containers/items needed (containers requested for pick up will be automatically replaced. If you wish to have additional containers/supplies or are requesting new containers/supplies, please select from the list below: )

Quantity

Comments/Special Instructions:

Important Information:

Radioactive and Mixed Waste-
For information or service options regarding radioactive and mixed waste please contact the Radiation Safety Office at (212) 854-4442 for Morningside, LDEO and NEVIS or (212) 305-0303 at CUMC.

Proper management of Radioactive Waste-
More information regarding the proper management of chemical/hazardous waste can be found at Morningside, CUMC, LDEO, NEVIS. Please contact EH&S at (212) 854-8749 (MS) or (212)305-0303 (CUMC).

Regulated Medical Waste (RMW) Supplies:

At Morningside only, RMW supplies (red bags, sharps boxes, grey bins) are provided through EH&S.
At Medical Center campus, RMW supplies (red bags, sharps boxes, grey bins) are provided through
Facilities Operations via a service request or by calling x5HELP extension 3. Please do not use a
chemical or radioactive waste pickup request for these items.
Do not use red bags for chemical or radioactive spill debris.
Pipette tips and other sharps must be collected in rigid, puncture resistant containers. Bags of any type are prohibited.

All chemicals of the the following conditions must be met
(Check each item):

A completed Radioactive Waste label is affixed to all containers.
Containers have all chemical components listed including chemicals & isotopes, if applicable
(Chemical formulae, abbreviations (except for isotopes & associated units of activity) and generic names are UNACCEPTABLE).

The radioactive waste label is complete and lists all isotopes, activities (including unit) and chemical names, as applicable,
including buffer names and water
Chemical constituents for aqueous radioactive waste must be listed.
Container is compatible with its contents and is properly closed.
For decayable radioactive materials, all radioactive material warnings/labels/tapes/signs have been removed from
the inside contents of the waste container.
All contaminated sharps, including pipette tips, are in rigid containers.
No red bags are present inside the containers, unless truly infectious material. If an infectious material is present,
please mark the outer container.
No liquid scintillation standards are present inside LSV or dry solid waste containers. These items must be marked with
a Chemical/Hazardous Waste and Radioactive Waste label affixed to the container to be accepted for pickup.
Mixed waste (hazardous chemical & radioactive material) must be marked with a Chemical/Hazardous Waste and
Radioactive Waste label for pickup.

CUMC Home |Columbia University | LDEO | NEVIS |EH&S

<table cellspacing="5" cellpadding="5">
        <tbody><tr>
          <td colspan="6"><h1>Radioactive Waste Description </h1></td>
        </tr>
        <tr>
          <td colspan="6"><p><br>
          </p></td></tr><tr bgcolor="#eeeeee">
              <td width="29%"><h2>Type of Waste</h2></td>
              <td nowrap="" width="68%" style="font-family: verdana,arial,sans-serif; font-size: 10px;">
              <select class="hazardous lab_required" style="font-family: verdana,arial,sans-serif; font-size: 10px; background-color: rgb(212, 208, 200);" id="unit4" name="Type of Waste" disabled="">
                <option value="">--Select--</option>
                <option value="Aqueous radioactive waste (buffer or water only)">Aqueous radioactive waste (buffer or water only)</option>
                <option value="Animal carcasses">Animal carcasses</option>
                <option value="Biological radioactive waste">Biological radioactive waste</option>
                <option value="Clean Lead for recycling – all radioactive markings must be removed or defaced">Clean Lead for recycling – all radioactive markings must be removed or defaced</option>
                <option value="Dry solid waste">Dry solid waste</option>
                <option value="Liquid scintillation vials">Liquid scintillation vials</option>
                <option value="Mixed waste(hazardous chemical & radioactive material)">Mixed waste(hazardous chemical & radioactive material)</option>                
                <option value="Radioactive sharps">Radioactive sharps</option>
                <option value="Other">Other</option>
              </select></td>
            </tr>
            <tr>
              <td width="19%"><h2>Physical State</h2></td>
              <td nowrap="" width="78%" style="font-family: verdana,arial,sans-serif; font-size: 10px;">
              <select class="hazardous lab_required" style="font-family: verdana,arial,sans-serif; font-size: 10px; " id="unit4" name="Physical State" disabled="">
                <option value="">--Select--</option>
                <option value="Dry Solid">Dry Solid</option>                
                <option value="Liquid">Liquid</option>
                <option value="Clean Lead for recycling">Clean Lead for recycling</option>
                <option value="Other">Other - please specifiy in comments</option>
              </select></td>
            </tr>
                        <tr bgcolor="#eeeeee">
              <td width="19%"><h2>Isotope</h2></td>
              <td nowrap="" width="78%" style="font-family: verdana,arial,sans-serif; font-size: 10px;">
              <select class="hazardous lab_required" style="font-family: verdana,arial,sans-serif; font-size: 10px; background-color: rgb(212, 208, 200);" id="unit4" name="Isotope" disabled="">
                <option value="">--Select--</option>
                <option value="Am-241">Am-241</option>                
                <option value="C-11">C-11</option>
                <option value="C-14">C-14</option>
                <option value="Ca-45">Ca-45</option>
                <option value="Co-60">Co-60</option>
                <option value="Cr-51">Cr-51</option>
                <option value="Cs-137">Cs-137</option>
                <option value="Fe-55">Fe-55</option>
                <option value="Fe-59">Fe-59</option>
                <option value="Ga-67">Ga-67</option>
                <option value="H-3">H-3</option>
                <option value="I-125">I-125</option>
                <option value="I-131">I-131</option>
                <option value="Na-22">Na-22</option>
                <option value="Ni-63">Ni-63</option>
                <option value="P-32">P-32</option>
                <option value="P-33">P-33</option>
                <option value="Ra-226">Ra-226</option>
                <option value="Rb-86">Rb-86</option>
                <option value="S-35">S-35</option>
                <option value="Tc-99m">Tc-99m</option>
                <option value="Th-nat.">Th-nat.</option>
                <option value="U-nat.">U-nat.</option>
                <option value="Other">Other - please specifiy in comments</option>
              </select> </td></tr>
			 <tr >
              <td width="19%"><h2>Activity per isotope</h2></td>
              <td nowrap="" width="78%" style="font-family: verdana,arial,sans-serif; font-size: 10px;"><input type="text" class="hazardous lab_required" maxlength="64" size="42" id="unit6" name="Activity per isotope State" disabled="" style="background-color: rgb(212, 208, 200);"> 
                Units 
                  <select class="hazardous lab_required" style="font-family: verdana,arial,sans-serif; font-size: 10px; background-color: rgb(212, 208, 200);" id="Phase" name="Units" disabled="">
                    <option value="">--Select--</option>
                    <option value="microcurie">microcurie</option>
                    <option value="millicurie">millicurie</option>
                  </select><div id="isotope_clone"></div></td>
            </tr> 
            <tr>
            <td colspan="2" bgcolor="#eeeeee"><strong>Click <a onClick="return add_enable($(this), 'isotope');" href="#">here</a> to add another Isotope</strong></td>
            </tr>

<tr>
              <td><h2>Size of container</h2></td>
              <td nowrap="" style="font-family: verdana,arial,sans-serif; font-size: 10px;">
              <select class="hazardous lab_required" style="font-family: verdana,arial,sans-serif; font-size: 10px; background-color: rgb(212, 208, 200);" id="unit5" name="Size of container #" disabled="">
                  <option value="">--Select--</option>
                  
                  <option value="Size of container">Size of container</option> 
                  <option value="2 gal(small red)sharps box">2 gal(small red)sharps box</option>                 
                  <option value="5 gal(18.9L)">5 gal(18.9L) for use with LSV or dry solid waste</option>
                  <option value=">5 gal (18.9L)">>5 gal (18.9L)</option>
                  <option value="8 gal(large red)sharps box">8 gal(large red)sharps box</option>
                  <option value="Biohaz grey bin">Biohaz grey bin</option>
                  <option value="Blue bin contaminated glass">Blue bin Contaminated Glass</option>
                  <option value="Blue bin other (describe in comments section)">Other (Describe in comments section)</option>
                  <option value="Lecture Bottle/Cylinder">Lecture Bottle/Cylinder</option>                  
              </select></td>
            </tr>
            <tr bgcolor="#eeeeee">
              <td ><h2>Radioactive waste label number</h2></td>
              <td><input class="hazardous lab_required" id="unit4" name="Radioactive waste label number" disabled="" style="background-color: rgb(212, 208, 200);"></td>
            </tr>
            <tr >
              <td width="19%"><h2>Chemical Constituents</h2></td>
              <td nowrap="" width="78%" style="font-family: verdana,arial,sans-serif; font-size: 10px;"><input type="text" class="hazardous lab_required" maxlength="64" size="42" id="unit14" name="Chemical Constituents" disabled="" style="background-color: rgb(212, 208, 200);"></td>
            </tr>
            <tr bgcolor="#eeeeee">
              <td width="19%"><h2>Date of last entry for storage and decay purposes only</h2></td>
              <td nowrap="" width="78%" style="font-family: verdana,arial,sans-serif; font-size: 10px;"><input type="text" class="hazardous lab_required" maxlength="64" size="42" id="unit15" name="Date of last entry" disabled="" style="background-color: rgb(212, 208, 200);"></td>
            </tr>                        
            <tr>
              <td><h2>Comments</h2></td>
              <td><input type="text" class="hazardous lab_required" maxlength="42" size="42" id="unit7" name="Comments" disabled="" style="background-color: rgb(212, 208, 200);"></td>
            </tr>
            </tbody></table>

<tr bgcolor="#eeeeee">
  <td width="19%"><h2>Isotope</h2></td>
  <td nowrap="" width="78%" style="font-family: verdana,arial,sans-serif; font-size: 10px;">
  <select class="hazardous lab_required" style="font-family: verdana,arial,sans-serif; font-size: 10px; background-color: rgb(212, 208, 200);" id="unit4" name="Isotope" disabled="">
    <option value="">--Select--</option>
    <option value="Am-241">Am-241</option>                
    <option value="C-11">C-11</option>
    <option value="C-14">C-14</option>
    <option value="Ca-45">Ca-45</option>
    <option value="Co-60">Co-60</option>
    <option value="Cr-51">Cr-51</option>
    <option value="Cs-137">Cs-137</option>
    <option value="Fe-55">Fe-55</option>
    <option value="Fe-59">Fe-59</option>
    <option value="Ga-67">Ga-67</option>
    <option value="H-3">H-3</option>
    <option value="I-125">I-125</option>
    <option value="I-131">I-131</option>
    <option value="Na-22">Na-22</option>
    <option value="Ni-63">Ni-63</option>
    <option value="P-32">P-32</option>
    <option value="P-33">P-33</option>
    <option value="Ra-226">Ra-226</option>
    <option value="Rb-86">Rb-86</option>
    <option value="S-35">S-35</option>
    <option value="Tc-99m">Tc-99m</option>
    <option value="Th-nat.">Th-nat.</option>
    <option value="U-nat.">U-nat.</option>
    <option value="Other">Other - please specifiy in comments</option>
  </select></td></tr>
  <tr >
              <td width="19%"><h2>Activity per isotope</h2></td>
              <td nowrap="" width="78%" style="font-family: verdana,arial,sans-serif; font-size: 10px;"><input type="text" class="hazardous lab_required" maxlength="64" size="42" id="unit6" name="Activity per isotope State" disabled="" style="background-color: rgb(212, 208, 200);"> 
                Units 
                  <select class="hazardous lab_required" style="font-family: verdana,arial,sans-serif; font-size: 10px; background-color: rgb(212, 208, 200);" id="Phase" name="Units" disabled="">
                    <option value="">--Select--</option>
                    <option value="microcurie">microcurie</option>
                    <option value="millicurie">millicurie</option>
                  </select><div id="isotope_clone"></div></td>
            </tr>

Radioactive Waste Pickup Request Form

Lab/Personal Information

Campus

Requested By

PI name

Columbia email, including UNI

Phone Number

Building