Radioactive Reclamation

Do you have spent flood, Ge-68, Gd-153 and Na-22, reference sources, rods, spot markers, etc, that you would like to dispose of?

QUOTE REQUEST FOR SOURCE DISPOSAL

For United States and Canada Only

1. Please list the Model Number, Serial Number, Nuclide, Original Activity, and Reference Date(s) of the Sources.

Source 1- Model Number

Source 1- Serial Number

Source 1- Nuclide

Source 1- Original Activity

Source 1- Reference/Calibration Date

Source 2- Model Number

Source 2- Serial Number

Source 2- Nuclide

Source 2- Original Activity

Source 2- Reference/Calibration Date

Source 3- Model Number

Source 3- Serial Number

Source 3- Nuclide

Source 3- Original Activity

Source 3- Reference/Calibration Date

Source 4- Model Number

Source 4- Serial Number

Source 4- Nuclide

Source 4- Original Activity

Source 4- Reference/Calibration Date

Source 5- Model Number

Source 5- Serial Number

Source 5- Nuclide

Source 5- Original Activity

Source 5- Reference/Calibration Date

Do you require boxes for your return? Do you require boxes for your return? Yes, please list model number or serial number for the sources that will go in the box(es). If returning a flood source, please also indicate if returning the source in a wheeled case. No

Enter Comments

Facility Name

Facility Address

Contact Name

Phone

Account Number

Do you plan to order any replacement sources in the next 3 months? Do you plan to order any replacement sources in the next 3 months? Yes No

Are you decommissioning your Nuclear Department? Are you decommissioning your Nuclear Department? Yes No