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RADIOACTIVE MATERIAL ORDER REPORT FORM

 
E-mail
Principal Investigator
End User
Location (Room & Building)
Permit Number
Radionuclide H-3 C-14 P-32 P-33 S-35 I-125 Other--Write in comments below.
Activity and form: (e.g. "250 uCi dATP" or "2 x 5mCi methionine" or "250 uCi dCTP, 1mCi UTP")
 
Company Ordered From GE Healthcare Perkin Elmer MP Biomedicals Other--Write in comments below.

Comments:
    

 
 
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