ML20195C808
| ML20195C808 | |
| Person / Time | |
|---|---|
| Issue date: | 05/04/1988 |
| From: | NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | |
| Shared Package | |
| ML20195C537 | List: |
| 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:
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Date of Inspection:
M#u Y /f/2 Signature of Inspector (s):
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Principal Business of Licensee:
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Pspose for which device (s) are used :
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Device Specifics:
REnfRN ORIGINALg Model Number:
$7 D $7 f#7[
RDGION I-b.
Activity of Fo-210 source aCl c.
Date Received:
Gl 7 7 &l, sf/()
y,us/ s./ /h t a b d.
Date lease expires:
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f l$smv/ &f'Yf35 i.
Did licensee receive 3M notification:
Yes No
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Survey:
c.
Ns s"rvey been performed by 3K: Yes _
No Y By Consultant: Yes _
No Y
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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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