Online Radioactive Material Approval Form

Please complete this form to receive approval to order a radioactive isotope:
 
Radioactive Material Information
Isotope:** Chemical Form:
Activity (in µCi)* Vendor:
Cost of this item: $ Departmental Reference #:
Anticipated Delivery Date: (format: mm/dd/yy)
 
Sub-licensee Information
For the lab of Dr. from:
For use and/or storage in room: Account Number:
Confirmation and Contact Information
Your Name: Phone:
Email address where confirmation will be sent:
You should check this box if:
  • The estimated cost of this order is in excess of $2000
  • The Vendor does not accept MasterCard®
  • Your department does not have a MasterCard® for chemical purchases
**If the desired Isotope is not on this list, call the Radiation Safety Office at 743-2597 to place the order.
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