Unsealed Radioisotope Inventory Control Form

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UNSEALED RADIOISOTOPE INVENTORY CONTROL
FORM
LOCATION
RADIOISOTOPE
SHIPMENT
Permit Number: ________________
Isotope: ______________________
Date received: ______________________
Permit Holder: __________________
Product:______________________
Received by: _______________________
Supplier:_____________________
Package information
Lab room number:________________
verified on receipt:
________ (initials)
Total activity:__________________
Package checked for
Radioisotope
Volume:______________________
Contamination:
________ (initials)
location: _______________________
Record and report any anomalies to the
I.D. #:___________________
1 Vial/Kit or sample set per control sheet
Project Supervisor and Health Physics.
Quantity
Disposal
Quantity used
User's
remaining
Date
Units_________
Solid (µCi or KBq)
Liquid (µCi or
Initials
Units______
KBq)
Product holder (i.e. lead/plastic) checked for radioactive contamination and provided to Health Physics.
Final date of disposal: ______________________________
Initials: __________________

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