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Initial Activity:

  Ci mCi uCi nCi  

Radioisotope:

H-3 C-14 P-32 P-33 S-35 I-125 I-131 Ca-45 Cr-51 Co-57 Co-60 In-111  

Assay/Receipt Date
in the form mm/dd/yyyy:

/  /   

Date for Decay
Correction:

/  /