ANNUAL WASTE MANAGEMENT PLAN/APPLICATION FOR APPROVAL TO DISPOSE OF UNSEALED RADIOACTIVE SUBSTANCES FOR THE PERIOD 1 OCTOBER 20 –30 SEPTEMBER 20 (Insert year) PLEASE POST COMPLETED APPLICATION/PLAN TO: THE DIRECTOR RADIATION PROTECTION DIVISION ENVIRONMENT PROTECTION AUTHORITY GPO BOX 2607 ADELAIDE SA 5001 Enquiries: Dr Tony Hooker Tel: (08) 8463 7825 Email: tony.hooker@epa.sa.gov.au NAME & ADDRESS OF ORGANISATION: NAME OF APPLICANT: APPLICANT’S TITLE: CONTACT NO: EMAIL ADDRESS: SIGNATURE: DATE: ESTIMATED QUANTITIES OF UNSEALED RADIOACTIVE SUBSTANCES PURCHASED & DISPOSED OF –30 September 20 (1 October 20 ) (Insert year) RADIONUCLIDES ACTIVITY PURCHASED Chemical & Physical Form (MBq) TOTAL: ACTIVITY DISPOSED OF VIA PROPOSED PATHWAYS Gaseous Aqueous Liquid Solid/Liquid Via fumehood Via sinks or sewers Via Veolia incinerator at Kilburn (MBq) (MBq) (MBq) Total: Total: Total: Solid/Liquid Allow for decay, then via general waste (MBq) Total: Solid/Liquid Interim storage pending disposal (please specify proposed pathway) (MBq) Total: NOTE: The application must also include a Waste Management Plan containing details like record-keeping, working rules, segregation, packaging, labelling, storage, monitoring and transport of the waste (refer to attached Guidelines for waste management application/plan) (Cont’d) ESTIMATED QUANTITIES OF UNSEALED RADIOACTIVE SUBSTANCES PURCHASED & DISPOSED OF –30 September 20 (1 October 20 ) (Insert year) RADIONUCLIDES ACTIVITY PURCHASED Chemical & Physical Form (MBq) TOTAL: ACTIVITY DISPOSED OF VIA PROPOSED PATHWAYS Gaseous Aqueous Liquid Solid/Liquid Via fumehood Via sinks or sewers Via Veolia incinerator at Kilburn (MBq) Total: (MBq) Total: (MBq) Total: Solid/Liquid Allow for decay, then via general waste (MBq) Total: Solid/Liquid Interim storage pending disposal (please specify proposed pathway) (MBq) Total: NOTE: The application must also include a Waste Management Plan containing details like record-keeping, working rules, segregation, packaging, labelling, storage, monitoring and transport of the waste (refer to attached Guidelines for waste management application/plan)