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Revision 08 08/10 RS - 19g Proc. 9290 9501 Form G Radioactive Waste Disposal Form General Instructions 1. Do not mix different waste forms together. Keep dry liquid and scintillation vials separate. 2. Do not mix waste of different isotopes. 3. Entries are to be made on this form each time waste is placed in the container. 4. Use a separate copy of this form for each container. 5. Sample waste descriptions paper plastic glass aqueous waste source biological waste specify hazardous chemical waste specify chemical and quantity etc* Note Prior permission is needed from the Radiation Safety Committee for mixed waste. 6. To schedule a waste pickup request visit www. ors. gatech. edu/Secured/Waste. php or call ORS at 404 894-3605. For ORS Use Only Physical Form Date Source Number Radionuclide Package ID Number W - - Activity mCi Description AU Signature Received By Initials. Do not mix different waste forms together. Keep dry liquid and scintillation vials separate. 2. Do not mix waste of different isotopes. 3. Entries are to be made on this form each time waste is placed in the container. 4. Use a separate copy of this form for each container. 3. Entries are to be made on this form each time waste is placed in the container. 4. Use a separate copy of this form for each container. 5. Sample waste descriptions paper plastic glass aqueous waste source biological waste specify hazardous chemical waste specify chemical and quantity etc* Note Prior permission is needed from the Radiation Safety Committee for mixed waste. 5. Sample waste descriptions paper plastic glass aqueous waste source biological waste specify hazardous chemical waste specify chemical and quantity etc* Note Prior permission is needed from the Radiation Safety Committee for mixed waste. 6. To schedule a waste pickup request visit www. ors. gatech. edu/Secured/Waste. php or call ORS at 404 894-3605. 6. To schedule a waste pickup request visit www. ors. gatech. edu/Secured/Waste. php or call ORS at 404 894-3605. For ORS Use Only Physical Form Date Source Number Radionuclide Package ID Number W - - Activity mCi Description AU Signature Received By Initials. Do not mix different waste forms together. Keep dry liquid and scintillation vials separate. 2. Do not mix waste of different isotopes. 3. Entries are to be made on this form each time waste is placed in the container. 4. Use a separate copy of this form for each container. 5. Sample waste descriptions paper plastic glass aqueous waste source biological waste specify hazardous chemical waste specify chemical and quantity etc* Note Prior permission is needed from the Radiation Safety Committee for mixed waste. 3. Entries are to be made on this form each time waste is placed in the container. 4. Use a separate copy of this form for each container. 5. Sample waste descriptions paper plastic glass aqueous waste source biological waste specify hazardous chemical waste specify chemical and quantity etc* Note Prior permission is needed from the Radiation Safety Committee for mixed waste. 6. To schedule a waste pickup request visit www. ors. gatech. edu/Secured/Waste. php or call ORS at 404 894-3605.

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