ML20195E199
| ML20195E199 | |
| Person / Time | |
|---|---|
| Issue date: | 05/03/1988 |
| From: | Elizabeth Ullrich NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | |
| References | |
| REF-QA-99990003-880503 NUDOCS 8806230318 | |
| Download: ML20195E199 (5) | |
Text
t-t:.0 W '60 1b:24 NkU RE.610N 36 P03 GENERAL LICENSE STATIC ELIMINATOR DEVICE COLLECTION F0 M 1.
Name and Address of General Licensee:
ff'AM1M rMV14's c h bt6' 2.
Date of Inspection:
v_& 3 8 I
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[/d Signature of Inspector (s):
3.
Principal Business of Licensee:
f>7tber m hanadms ue i
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4.
Purpose for which device (s) are used :
RhbN Obuc<.
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Device Specifics:
b27374
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a.
Model Number:
(2[/ f((5-8I]3y REltRN ORIGURL TO EEGIOA 3; b.
Activity of Po-210 source aCi c.
Date Received:
1G' 4 77 ghmd4k b
M d.
Date lease expires: _
6.
Did licensee receive 3M notification:
Yes _
No 1 A li c e o s o c. boghd.*
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FEB 09 '88 15:24 HRC REGION 38 PO4
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7.
Survey:
a.
Has survey been performed by 3M:
Yes -
No Y
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By Consultant: Yes No [
Feb A M d. /m if Yes list consultant's name and location:
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Survey Performed by Inspector:
Serial Number of Device:
Direct Survey Of Device:
alpha dpm/
car Direct Survey Of Work Area:
Smear Survey of Device:
,_ _ alpha dpm/
car Smear Survey of Work Area:
Survey Instrument 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:
M _
,.,-.,.-,-,.,.....-.,.,-,-..-,,n-,,
l FFB 09 '88 lb: 2b NRC REGION 38 P05
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Serial Number of Device:
Direct Survey of Device:
alpha dps/
cm8 Direct Survey Of Work Area:
Smear Survey of Device:
alpha dpm/
cm8 Smear Survey of Work Area:
i Survey Instrument Used.
Model:
Serial No.:
Date of Calibration: _
Serial Number of Device:
Direct survey Of Device:
alpha dpm/
cm8 Direct Survey Of Work Area: __
Smear Survey of Device:
alpha dpm/ _ car Smear Survey of Work Area: _
Survey Instrument Used:
Model:
Serial No.:
Date of Calibration:
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