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The following information was received via email: This is notification of an event in Washington State as reported to or investigated by the WA Department of Health, Office of Radiation Protection. STATUS: new Licensee: Lakeside Industries City and State: Issaquah, Washington License Number: WN-I0233-1 Type of License: Portable Gauge Date of Event: October 10, 2004 Location of Event: Port Angeles, Washington

ABSTRACT: (where, when, how, why; cause, contributing factors, corrective actions, consequences, Dept. of Health (DOH) on-site investigation; media attention): In a written report dated October 14, 2005 the Licensee's RSO reported that a Troxler model 3440 moisture/density gauge had been damaged when a single drum of a roller struck and rolled over a portable gauge before the roller operator could stop. The gauge operator had stepped 15 feet away from the gauge prior to the incident. It was then the roller rounded a corner and the roller operator's view of the gauge was obstructed by some large concrete blocks. The gauge was in the back scatter mode when struck. The gauge housing was left intact with only some deep scratches in the base. The source rod was bent, the index rod broken, with slight damage to the plastic top shell and no apparent damage to the electronics. The Cesium source was in the shielded position and the Americium source intact. (Photographs submitted with the report substantiate this description). Based on this information, the RSO, trained in the service and repair of Troxler gauges, instructed the operator to remove the gauge from the site and return it to the licensed storage area. When the RSO arrived, he took readings of the gauge with a Troxler 3105 survey meter and the readings were the same as the replacement gauge he brought with him. The damaged gauge is now stored at Lakeside Industries' licensed storage facility in Centralia, Washington awaiting repair or disposal by a license service provider. To prevent reoccurrence, gauge operators have been instructed by the RSO to be no more than 5 feet from the gauge when it is in an exposed location. Notification Reporting Criteria: WAC 246-221-250 Notification of Incidents. Isotope and Activity involved: 8 mCi of Cesium 137, and 40 mCi of Americium 241 Beryllium.

Overexposures? (number of workers/members of the public; dose estimate; body part receiving dose; consequence): None expected. Lost, Stolen or Damaged? (mfg., model, serial number): Troxler, model 3440, serial number 23475. Disposition/recovery: Stored at a licensed storage facility awaiting repair or disposal by a licensed service provider. Leak test? None reported post incident. Vehicle: (description; placards; Shipper; package type; Pkg. ID number) NA Release of activity? None reported. Activity and pharmaceutical compound intended: NA Misadministered activity and/or compound received: NA Device (HDR, etc.) Mfg., Model; computer program: NA Exposure (intended/actual); consequences: NA Was patient or responsible relative notified? NA Was written report provided? NA Was referring physician notified? NA Consultant used? No.