ML20195C808

Insp Rept 99990001/88-83 on 880504.No Contamination Present

ML20195C808
Person / Time
Issue date:	05/04/1988
From:	NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I)
To:
Shared Package
ML20195C537	List: ML20195C530 ML20195C808
References
REF-QA-99990001-880614 99990001-88-83, NUDOCS 8806220288
Download: ML20195C808 (4)

Text

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. GENERAL LICENSE STATIC ELIMINATOR DEVICE COLLECTION F0m

1. Name and Address of General Licensee:

A]F/ t'// ??b6 D s f a - / kilt 7/fxS7 fisir

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2. Date of Inspection: M#u Y /f/2 Signature of Inspector (s): [ 4/g[Y8d ,/

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3. Principal Business of Licensee: V

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4. Pspose for which device (s) are used :

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5. Device Specifics:

REnfRN ORIGINALg Model Number: $7 D $7 f#7[

RDGION I- b. Activity of Fo-210 source aCl

c. Date Received: Gl 7 7 &l , sf/() y,us/ s./ /h t a b

d. Date lease expires: ' S * '

f i.

Did licensee receive 3M notification:

l$smv/ &f'Yf35 Yes No /@

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Wekh' FOODS

,r-THOM As 11. Ettin Aar Nonn E6st P A 16426 PW1 in@new i814;725-4577 Wee Foods rc

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FEB 09 '88 15:24 HRC REGION 3B PO4

7. Survey:

c. Ns s"rvey been performed by 3K: Yes _ No Y By Consultant: Yes _ No Y

{gg ,, Q g If Yes Ifst consultar.t's name and location:

%cA,e wM % wut %t/ w eLa A< n s ru v. s& .-

b. Survey Perfomed by Inspector:

Serial Number of Device:

Direct Survey Of Device: alpha dpm/ cm' Direct Survey Of Work Area:

N Smear Survey of De ce: alpha dprn/ cat i Smear Survey of Work Area: __

l Survey Instrunent Used:

Model:

Serial No.:

Date of Calibration:

(If more than one unit use additional sheets)

If direct survey shows contamination, samples of product must be obtained.

Type of product:

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Serial Number of Device: _

Direct Survey Of Device: _

alpha dpe/ cm8 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:

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