Container ID # R_____________ (for use by H, S & S Officer)
RADIOACTIVE WASTE DISPOSAL FORM
REQUEST FOR STORAGE IN THE WASTE CHEMICAL STORAGE BUILDING
Complete one form for each waste container
1.
Isotope(s):
_______________________________________________________________
2.
Atomic Number(s):
_____________________________________________________________
2.
Mass or Volume (e.g. 500 g or 300 mL):
_____________________________________________
3.
Chemical Form:
_____________________________________________________________
4.
Activity (Bq):
_____________________________________________________________
6.
Storage Container (e.g. 4 L polyethylene gas container):
__________________________
7.
Scientist Name:
______________________________________________________________
Phone Ext. ________________
8.
Responsible Technician:
_______________________________________________________
Phone Ext. ________________
9.
Why is the chemical being disposed of? (e.g., surplus, out-of-date, used, spill).
_______________________________________________________________
_______________________________________________________________
10. Does the waste container contain anything other than the waste chemical? (e.g.,
contaminated gloves, etc.)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Continued…
GLP Form Number 0045/001
11. Describe other specific hazard(s) associated with this waste (e.g. caustic,
oxidizer, flammable)
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
12. Hazard rating of waste material (see attached guide)
Health _______
Fire _______
Reactivity _______
Environment _______
13. Is the material controlled or fall under the jurisdiction of any legislation? (e.g.,
WHMIS, TDG, Pest Control, Atomic Energy).
__________________________________________________________________
__________________________________________________________________
14. Is the material reactive (incompatible) with any particular class or type of material or
conditions?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Conditions for Storage
1) The requester is required to ensure that the product is stored properly.
2) ALL stored materials must have labels which clearly identify:
I) the contents of the container
ii) the safe handling and storage information
iii) who is responsible for the container (i.e., owner).
Request submitted by: ____________________ Date submitted: ______________
(DD-YY-MM)
Continued….
GLP Form Number 0045/001
Hazard Classification Guide
Health
4 Short exposure may cause death or major injury.
3 Prolonged or repeated exposure may cause serious injury.
2 Concentrations may be toxic.
1 No known health hazard.
Fire
4 Very flammable gases or volatile liquid.
3 Liquids and solids will burn readily under normal conditions.
2 Substances which must be heated before ignition can occur.
1 Substances which will not readily burn.
Reactivity (stability)
4 Readily detonates or explodes.
3 Can detonate or explode but requires strong initiating force or heating under
confinement.
2 Mild reaction, unlikely to be hazardous.
1 Normally stable.
Environment
4 Substances which cause major residual damage.
3 Substances which could cause serious damage.
2 Intense or continuous application could cause residual damage.
1 No environmental hazard.
GLP Form Number 0045/001