ML20155F607

General License Static Eliminator Device Collection Form

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

_ _ _ _

' ~'

F66 UV '06 15 24 NkU REGION 3B P03' 3 '

amit:#iW Q%N GENERAL LICENSE STATIC ELININATOR DEVICE i 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

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 Activity of Po-210 source b.

c. Date Received:

aCl @ j 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/ 00 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 l i

3 l

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 1

b. Survey Perfonned by Inspector:

Serial Number of Device:

Direct Survey Of Device: _ alpha dpm/ cm8 l Direct Survey Of Work Area:

Smear Survey of Device: , alpha dpn/ car Smear Survey of Work Area:

l Survey Instrwnent Used: _

l Model: _

Serial No.: 1 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:

_ _ ___ _