University of South Carolina
Radioactive Material Use Form
Baruch Marine Field Laboratory, Georgetown, SC
Date(s) of visit: ____________________________ thru ____________________________________________
Licensed Investigator: _______________________________________________________________________
Individual(s) using Isotopes: __________________________________________________________________
1). Isotope(s) being used: ________H-3, ________C-14, ________S-35, ________Other
2). Activity in millicuries (mCi) transported/shipped to Baruch:
__________H-3, __________C-14, __________S-35, __________Other
Record Waste Generated
(Radioactive waste generated while at Baruch can only be removed from the lab by USC Radiation Office )
Isotope
Solid (mCi)
Liquid (mCi)
Scint. Vials (mCi)
Carcasses (mCi)
Stock vials(mCi)
Total activity of non-used isotope to be shipped/transported with the user (mCi):_______
CHECKLIST
Initial
______ All areas free of removable contamination.
______ Wipe test performed and recorded in logbook.
______ Radiation waste recorded and tagged properly.
______ Form signed with the original remaining in the log book and a copy mailed to:
University of South Carolina
Radiation Safety Office
306 Benson School
Columbia, SC 29208
____________________________________
Signature of User
____________________
Date
RADIATION USE ONLY: Date of waste pick-up: __________________________
EHS-F-RAD-41
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Destroy Previous Revisions
Issue Date: 6/16/07
Reviewed: DMZ