I certify that the radioactive material listed above does NOT contain any pathogenic or infectious material, pesticides, or PCB’s; and that it meets all of the requirements stated in the latest NRC- EPA regulations for mixed Low Level Waste. I further certify THAT THE IDENTIFICATION OF THE MATERIAL(S) LISTED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I TAKE FULL RESPONSIBILITY FOR ANY ERRORS ON THIS FORM.
