Radioisotope Equipment Purchase Form | Environmental Health & Safety

Permit Holder:*

Permit Code:

Requisitioner:*

Prefix First Last Suffix

Email*

Phone

Institution:*

Boston University
Boston Medical Center

Equipment Type:

Detection Equipment:

Quantity:

Radioisotope Storage Equipment:

*Purchase of boxes comes with a lanyard and lock, as well as optional installation by RPO staff.

Quantity:

Shielding Type:

Lead
Lucite

Lead Shielding:

Lucite Shielding:

Quantity

Add Line Item (B):

Yes
No

Equipment Type (B):

Dection Equipment (B):

Quantity (B):

Radioisotope Storage Equipment (B):

*Purchase of boxes comes with a lanyard and lock, as well as optional instilation by RPO staff.

Quantity (B):

Shielding Type (B):

Lead
Lucite

Lead Shielding (B):

Lucite Shielding (B):

Quantity (B):

Add Line item (C):

Yes
No

Equipment Type (C):

Detection Equipment (C):

Quantity (C):

Radioisotope Storage Equipment (C):

*Purchase of boxes comes with a lanyard and lock, as well as optional instilation by RPO staff.

Quantity (C):

Shielding Type (C):

Lead
Lucite

Lead Shielding (C):

Lucite Shielding (C):

Quantity (C):

Account Code to be charged:*

*B.U. Only

BMC Activity Number:*

*BMC only

BMC Operating Accounting Unit:*

BMC Detail Account:*

BMC Account Category:*

Notes:

*Please describe the issues with the equipment

Email

This field is for validation purposes and should be left unchanged.