ML20155F607
| ML20155F607 | |
| Person / Time | |
|---|---|
| Issue date: | 06/16/1988 |
| From: | Wallace W NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | |
| References | |
| REF-QA-99990001-880616 88-067, 88-67, NUDOCS 8806160443 | |
| Download: ML20155F607 (3) | |
Text
_ _ _ _
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F66 UV '06 15 24 NkU REGION 3B P03' 3
amit:#iW Q%N GENERAL LICENSE STATIC ELININATOR DEVICE COLLECTION F0lm 1.
Name and Address of General Licensee:
Fisher ce;edik.
chem;c~l oasis ~
one Recd Lne Fa:< L wn, NT 03w o 2.
Date of Inspection:
824rck
/l,
, /'} f f Signature of Inspector (s):_
// 24xe
[d b t/
3.
Principal Business of Licensee:
AC1N M hackv re r Ch hlNC Cf1&n1 Eca J l
4.
Purpose for which device (s) are used :
P> \\ ow i on ;ze-cl a;e i <>
Ne to loo Oles k,
remo n dush l>eSer S'll;)v9 5.
Device Specifics:
a.
Model Number:
g g
b.
Activity of Po-210 source aCl j
c.
Date Received:
RENRN ORIoINAL M rag 10s I d.
Date lease expires: _
6.
Did it*ensee receive 3M notification: Yes No _
li c e u s e_ c_ Oogha d
- JoIW Sk l.e r bogt # [Jol) 7% -7/ 0 0
m4ie_:_57., sJJy,J t q N~~4 a-Cow b eo_kee Pcc. stet X
'6 s
-- No.
M e - ard. er ene W ea h cle k % d : _ soo o oem 8806160443 880616 REG 1 OA999 ENVFSC
._2(__. rn t.k e A 5 tr uut 99990001 PDR
FEB 09 '80 15:24 NRC REGION 3B PO4 i
3 7.
Survey:
a.
Has survey been performed by 3M:
Yes No By Consultant: Yes 1 No If Yes list consultant's name and location:
% W w M % c n rA % t/.7 m eL a &<nnrT k v.s& :
1 b.
Survey Perfonned by Inspector:
Serial Number of Device:
Direct Survey Of Device:
_ alpha dpm/
cm8 Direct Survey Of Work Area:
Smear Survey of Device:
, alpha dpn/
car Smear Survey of Work Area:
Survey Instrwnent Used:
Model:
Serial No.:
Date of Calibration:
(If more than one unit use additional sheets)
If direct survey shws contamination, samples of product must be obtained.
Type of product:
a
Phb UV '80 lb:2b NRC REGION 3B P05 s
I llo,'
Serial Number of Device: _
Direct Survey of Devica:
alpha dps/
co' Direct Survey Of Work Area:
Smear Survey of Device:
alpha dpm/
cm8 Smear Survey of Work Area:
Survey Instrument Used:
Model:
Serial No.:
Date of Calibration: _
Serial Number of Device:
Direct Survey Of Device:
alpha dpm/
cm' Direct Survey Of Work Area: __
Smear Survey of Device:
alpha dpm/_cm2 Smear Survey of Work Area: _
Survey Instrument Used:
Model:
Serial No.:
Date of Calibration:
_ ___ _