Request for Amendment to Nuclide Authorization (Form 99s) Request for Amendment to Nuclide Authorization (Form 99s) Authorized User* Phone*Address* Street Address NUCLIDE Additions or Changes Indicate desired New nuclides or changes in Order or Possession limits. If this is because of a change in protocols, include a summary of protocol changes. Nuclide 1: Current Limits (mCi)Nuclide Order Possession Nuclide 1: Requested Limits (mCi)Order Possession Nuclide 2: Current Limits (mCi)Nuclide Order Possession Nuclide 2: Requested Limits (mCi)Order Possession Nuclide 3: Current Limits (mCi)Nuclide Order Possession Nuclide 3: Requested Limits (mCi)Order Possession This change may require you to purchase a Survey Meter, if so, indicate.Survey Meter Make: Probe Type: ROOM Additions or Deletions Add Delete Building Room Add Delete Building Room Add Delete Building Room Please type your name into the signature field below. In doing so you certify this form, agree to comply with its conditions, and accept responsibility for radiation safety in your labAuthorized User Signature:* For a copy of this form, please print it from your browser now.EmailThis field is for validation purposes and should be left unchanged.