Radioisotope Inventory/Survey Record

Radioisotope:			CSUSM Ref #:
Date Received:			Activity Received:
Chemical:				Volume Received:

Vial Information:

Date	User	Amnt Used	Amnt Rmn

Vial Disposal Date:____________________
Method:______________________________________________________

Survey Information

Date	Area	Inst.	Results

Background__________

Aliquot Inventory

# of Aliquots            ________________
Activity per Aliquot  ___________
Aliquot/Survey        ______________

Date	User	Amnt Used	Amnt Left	Area	Inst.	Results