Radioisotope Equipment Purchase Form Please allow 7-10 business days for standard orders to be completed. Any Liquid Scintillation Counters or Repair services should be detailed in the "Notes:" section below. *Please note that prices are subject to change without notice. Permit Holder:* Permit Code: Requisitioner:* Prefix First Last Suffix Email* Phone Institution:* Boston University Boston Medical Center Equipment Type: -Choose-Radiation DetectionRadioisotope StorageRadiation Shielding Detection Equipment: -Choose-Ludlum GM Model 3 ($532)Pancake Probe 44-9 ($231)Cylinder Probe 44-88 ($328)NaI Probe 44-3 ($548)Connector Cable Series C ($59)Connector Cable Series BNC ($54)Liquid Scintilation Counter (Request Quote)Repair (Variable) Quantity: -Select-12345 Radioisotope Storage Equipment: -Choose-Large Lucite Box ($149)Small Lucite Box ($132)5 Button Combination Lucite Box ($380)Replacment Lanyard & Lock ($35) *Purchase of boxes comes with a lanyard and lock, as well as optional installation by RPO staff. Quantity: -Select-12345 Shielding Type: Lead Lucite Lead Shielding: -Choose-Brick ($63)Foil 14" x 6" ($10)Leaded Lucite (Varies) Lucite Shielding: -Choose-Work Station ($895)Bench Top Bin 6” x 6” x 7” ($570)Bench Top Bin 6.5” x 5.5” x 12” ($185)Rolling Floor Bin 15.5" x 15.5" x 27" ($525)Bench Top Shield 12” x 18” x 6” @15 deg ($110)Bench Top Shield 18” x 24” x 8” @15 deg ($130) Quantity -Select-12345 Add Line Item (B): Yes No Equipment Type (B): -Choose-Radiation DetectionRadioisotope StorageRadiation Shielding Dection Equipment (B): -Choose-Ludlum GM Model 3 ($532)Pancake Probe 44-9 ($231)Cylinder Probe 44-88 ($328)NaI Probe 44-3 ($548)Connector Cable Series C ($59)Connector Cable Series BNC ($54)Liquid Scintilation Counter (Request Quote)Repair (Variable) Quantity (B): -Select-12345 Radioisotope Storage Equipment (B): -Choose-Large Lucite Box ($135)Small Lucite Box ($120)5 Button Combination Lucite Box ($345)Replacment Lanyard & Lock ($30) *Purchase of boxes comes with a lanyard and lock, as well as optional instilation by RPO staff. Quantity (B): -Select-12345 Shielding Type (B): Lead Lucite Lead Shielding (B): -Choose-Brick ($63)Foil 14" x 6" ($10)Leaded Lucite (Varies) Lucite Shielding (B): -Choose-Work Station ($895)Bench Top Bin 6” x 6” x 7” ($570)Bench Top Bin 6.5” x 5.5” x 12” ($185)Rolling Floor Bin 15.5" x 15.5" x 27" ($525)Bench Top Shield 12” x 18” x 6” @15 deg ($110)Bench Top Shield 18” x 24” x 8” @15 deg ($130) Quantity (B): -Select-12345 Add Line item (C): Yes No Equipment Type (C): -Choose-Radiation DetectionRadioisotope StorageRadiation Shielding Detection Equipment (C): -Choose-Ludlum GM Model 3 ($532)Pancake Probe 44-9 ($231)Cylinder Probe 44-88 ($328)NaI Probe 44-3 ($548)Connector Cable Series C ($59)Connector Cable Series BNC ($54)Liquid Scintilation Counter (Request Quote)Repair (Variable) Quantity (C): -Select-12345 Radioisotope Storage Equipment (C): -Choose-Large Lucite Box ($149)Small Lucite Box ($132)5 Button Combination Lucite Box ($380)Replacment Lanyard & Lock ($35) *Purchase of boxes comes with a lanyard and lock, as well as optional instilation by RPO staff. Quantity (C): -Select-12345 Shielding Type (C): Lead Lucite Lead Shielding (C): -Choose-Brick ($63)Foil 14" x 6" ($10)Leaded Lucite (Varies) Lucite Shielding (C): -Choose-Work Station ($895)Bench Top Bin 6” x 6” x 7” ($570)Bench Top Bin 6.5” x 5.5” x 12” ($185)Rolling Floor Bin 15.5" x 15.5" x 27" ($525)Bench Top Shield 12” x 18” x 6” @15 deg ($110)Bench Top Shield 18” x 24” x 8” @15 deg ($130) Quantity (C): -Select-12345 Account Code to be charged:* *B.U. Only BMC Activity Number:* *BMC only BMC Operating Accounting Unit:* BMC Detail Account:* BMC Account Category:* Notes: Notes: *Please describe the issues with the equipment Name This field is for validation purposes and should be left unchanged.