Radioactive Waste Manifest Form

Generator Information

Generator Name

Address

Contact Person

Waste Description

Manifest Number

Date Generated

Description of Waste

Physical & Chemical Form

Physical Form

Chemical Form

Radioisotope Information

Radioisotope

Activity (Bq or Ci)

Activity Reference Date

Container Details

Container Number

Type

Volume (L)

Weight (kg)

Disposal Method Method

Certification

Certified By

Date