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1431 Radiation Safety (202) 687-4712 fax (202) 687-5046 RADIOACTIVE WASTE TRANSFER FORM John W . Erickson 12 Authorized User's Name Authorization Number Basic Science Date Delivered to RSO Date of Transfer 498 Building Preparer s Name Rooms Printed Name of Transferee *Instructions* Description / examples of required data Waste tag date ............ date as shown on package tag Chemical Contents ....... list all chemical com pounds or solutions and percentages Radionuclide .
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