Radioactive Material Requisition Form - University Of North Dakota

UNIVERSITY OF NORTH DAKOTA

RADIOACTIVE MATERIAL REQUISITION FORM

This form must be completed and accompany the Purchase Requisition Form sent to the RSO for

approval prior to purchasing radioactive material.

Authorized User:_____________________________________________

Date: ______________________________________________________

INFORMATION ON REQUESTED ORDER

INVENTORY

Principal

Activity

Physical and Chemical Form

Activity on Hand *

Radioisotopes

(µCi, mCi, Ci)

Expected delivery date, if known_________________________________

*Decay corrected activity of requested isotopes at time of procurement, include stock material and any waste

on hand.

____________________________

Today's Date

Signature of Authorized User

Form UND-RSP-4 must be completed at the time this shipment arrives.

(Revised 9-97)

UND-RSP-3

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