ML20151E784
| ML20151E784 | |
| Person / Time | |
|---|---|
| Issue date: | 04/21/1988 |
| From: | Jensen J, Taylor M NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | |
| References | |
| REF-QA-99990001-880421 99990001-88-82, NUDOCS 8807260207 | |
| Download: ML20151E784 (5) | |
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3 Ng GENERAL LICENSE STATIC ELIMINATOR DEVICE COLLECTION FORM
- 1. Name and Address of General Licensee:
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- 2. Date of Inspection:
Signature of Inspector (s): b2m hem.t
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- 3. Principal Business of Licensee:
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- 4. Purpose for which device (s) are used :
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- 5. Device Specifics: Ned '
- 4. Model Number: d
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- d. Date lease expires: _ ~d 4V l
. 6. Did licensee receive 3M notification: *
- s Yes _ No _ -
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- 7. Survey:
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- a. Has survey been perfonned by 38: Yes / ho By Consultant: Yes _ No if Yes list consultant's name and lecation: I l
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- b. Survey Perfonned by Inspector: O dr % + ))/ Adm Serial Number of Device: unf a vai In. b l Direct Survey Of Device: r QA/ alpha dpm/ _ca Direct Survey Of Work Area: /h bibut ha-o' '/k ar d ex. Av-of /+ Yd imcs a .s <}
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Model: 6/
Serial No.: o e.B d / </ 'I e -M <//5 I Date of Calibration:
(If more than one unit use additional sheets)
If direct survey shows contamination, samoles of product must be obtained, s
Type of product: 4 h tv/de/ 'dtb L' + #cF' sh o d (2 ] e'[
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- fiouisne _ loplant ? -Urgent 1 - - UNITED STATES DEPARTMENT OF ENERGY IDAHO OPERATIONS OFFICE Offsite _X NRC Mod # ~ Envi on. RAolotocicAL AND ENVIRONMENTAL SCIENCES LABOR 1TRY ,
Non Routine _)L_ Date Neede ,
~ SAMPLE RECORD SHEET ' Serial No. 7 Sample From:._[ V f/3 [ [C_W ~ C I M b Samples Received: bM [# 8IdI'l 28/
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. collected By 7enien Date Sent 9.22/& Ana'tysis Completed: ~.
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- Random uncertainties reported are 1 standard deviation,10. small' negative and other results 6 20 are interpreted by RESL as -
_" irstudiry) **zero" or as not_ detected._lf agropriate. estimates o_f pessible gstematic errors are r_eported inparentf_teses.
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UNITED STATES DEPARTMENT OF ENERGY X
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IDAHO OPERATIONS CFFICE ' OfIsite NRC Mod # 1 Environ. ' RADIOLOGICAL AND ENVIRONMENTAL SCIENCES LABORATORY Non Routine _)(_ Date Needed __ _ SAMPLE RECORD SHEET Serial No. / 7[ Sample From: N /1- f lO W ~ O d Y M I! Samples Received:. ??2SlW; //h AH W1" .) Analyzed dy~ // / $ '" [ Collected By SASF/1 Date Sent Y).2/M Analysis Completed: ( /
- Organizati l/IC fg'Is E j Notified: Yhd l'/ t Ni/'I Date: ? [/ /*
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count esult i1 o, g' e) Date, ' Hour : ' y - 7)(, .f r. ,,, f ^ No. 9,
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' Random uncertainties reported are 1 standard deviation',10. small negative and other results.5 20 dre interpreted by RESL as incl _udig) **zero** or as not detected. If appropriate. estimates of possible systematic errors are reported in parentheses.
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