Authorization for External Transfer of Radioisotopes

Case ODH Radioactive Material License 011001800111, expiration date 1/1/2010

Use this form when transferring any quantity of radioactive materials between Case Authorized Users (AU) and Non-Case Authorized Users (AU operating under another license, e.g., NRC, regardless of activity transferred. RSOF designates the Radiation Safety Office or equivalent site-specific authority for possession/transfer of radioactive material.

Note: Case RSOF approval must be given before the transfer takes place!

Transfer type:
Case AU name:
Case AU PI number:
Case AU email:
Case lab location:
Case lab phone:
Expected date of transfer:
Isotope:
Quantity:	(mCi)
Commercial transport company:
Packaging specification:
Other institution AU name:
Other institution RSO phone:
Other institution RSO fax:
Shipping address:

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