ML12095A382

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Reconnaissance Level Scan Survey Form - Women'S Bathroom #2102
ML12095A382
Person / Time
Site: University of Michigan
Issue date: 02/14/2012
From:
Occupational Safety & Environmental Health University of Michigan
To:
NRC/FSME
Shared Package
ML120950629 List:
References
Download: ML12095A382 (15)
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Text

FNR Decommissioning Project Reconnaissance Level Scan Survey Form Sheet / of _ _LC " k~l tlt Survey No: a007- /9! Survey Unit: A -/,0 Pkg. SP- O07-Date: a Co?Survey Location:

t.'o , e.I.I.Instrument Information Inst. HV THR 2nt Calibration Calibration Set Meter Scaler Detector Detector Setting Setting Inst. Due Date Due Date No. Model Serial No. Model Serial No. (Vdc) (mVdc) Eff. (Scaler) (Detector)

LI q3-1 ,21390,115-1- I-ao c67 / 7 -?-z-e,, ,3 2~q i qq-lq.. .k)33 /100 35" 3- 1__0,0 13s, NOTE: All cables 6-ft.RG-58 (LMI 44-142, 44-9, HP-210, or 44-92 probes) or 15-ft RG-58 (LMI 43-37 gas-flow hand-held) unless otherwise noted in the comments below.Comments:

,-v'tA-Initial Performance Test Performed

& Satisfactory:

11. Background Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)I-o I q 7I 3 _PO 9 I 50(-3 Initial / Date III. Total Siurfaice A Measuremnits Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)Comments: A'11,1 Each of the demarked grids (or locations) on the attached survey map has been scanned and do not exceed the action level of 1,750 dpm/1 00-cm 2 , unless otherwise noted on the attached survey map.Post-Survey Performance Test Performed

& Satisfactory:

P- f 9/, / " Initial / Date Survey Tech (print/sign):

Reviewed By (print/sign):

/ý". 2-0-(-, Filename:

FSS Characterization SCAN Survey FormsRev02 Retention:

LP+ 10 FNR Decommissioning Project Reconnaissance Level Scan Survey Form Survey No: -Survey Unit: Z I2d 1, kg. ,S P- M7 Sheet _ of Date: JQil/,x2 Survey Location:

2AM, Roar RoobM c2/1o9 I. Instrument Information N._., Inst. H THR 27t Calibration Calibration Set Meter Scaler Detector Detector Setting Setting Inst. Due Date Due Date No. Model Serial No. Model Serial No. (Vdc) (mVdc) Eff. (Scaler) (Detector) t a9-aL ,,,W-& o20/6 I1o 35 o.wo-2V I/ q3 IS-37 (q3q,.aV 1 0- o3A 62il 61A/;3 ,Pf 197Y3 q3,-37 A- 39,A,- 175-6 k- 12,'g-NOTE: All cables 6-ft RG-58 (LMI 44-142, 44-9, HP-210, or 44-92 probes) or 15-ft RG-58 (LMI 43-37 gas-flow hand-held) unless otherwise noted in the comments below.Comments:

ý2,5qt'? 1 eodd Coears, iA,7q3 l7q3,.' qted o f 1'r1', /1 7Y3 ,-',922t 'oA'Initial Performance Test Performed

& Satisfactory:

II. Backgro ndMeasurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)! F-10 I ,-93" F-- o4 37-I ,v& sd-f .N14 6bV F-01 1 1 7.4I 117Z AVG se#o A'/ ~ V--3 E-o 1 1 1757.3 F -3!Comments: S&PU AC+/- i~O1i ke"4 ý -et Initial / Date Ill. Total Surface Activi Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (rin.) (cpm)Acbo eyue4,2qg, Jel '3 AdC4ioe* 2?A,2'A Each of the demarked grids (or locations) on the attached survey map has been scanned and do not exceed the action level of 1,750 dpm/100-cm?, unless otherwise noted on the attached survey map.Post-Survey Performance Test Performed

& Satisfactory:

~Initial / Date Survey Tech (print/sign):

K) (4 1 Date: Ia l i/Date Reviewed By (print/sign):

ko'-t NpvO4u /Date: Rtto 07 Retention:

LP+l0 Filename:

FSS Characterization SCAN Survey FormsRev02 LSheet A, of Tr--Survey Log No. S cy :3 S eT veyt:3, Slassifi cnon:t Ur F. ,. / .....4 i go For2.d_ .Uk.W"S n-eyUr tDescri don: A- trucure Interior urface rw"7 ~ ~Sura ce Arco 109.9 sq. m r i:Ir Survey Technician:

Si rface A :52.55 .m (fl4o & Is, 2m&elow)Mark all grids and survey locations where scan surveys were 7 F RDP-D WG-l performed.

-If scan survey measurement results in a count rate that ____ " _ K Kill exceeds the action level, number the grid and record the total 9 920 K9 R1 surface activity on the corresponding survey form.eiig , -__ , ._Vl~~~ap] I egend "-ipe F netralion

  • Verified-ýinder Block Wall Comments:-,oncret b .9,/85qg -us-d on -fo inally tiled / masti .rema iant _ 7 ._7 q- Lsz.d on FlCor.C.)- Poured Concrete a .:- -'V fe FII-rsc 7ed Survey No: 20c07 1 /Date: 10 -3( -o-I. Instrument Informatio FNR Decommissioning Project Reconnaissance Level Scan Survey Form Survey Unit: SP-O01 Pkg. Wd/A Sheet / of Z.Survey Location:

FNA?" 2,M- 1(/ R ,1a J P 4 Inst. HV THR 21r Calibration Calibration Set Meter Scaler Detector Detector Setting Setting last. Due Date Due Date No. Model Serial No. Model Serial No. (Vdc) (mVdc) Eff. (Scaler) (Detector) t L-z2-2 I197,q3 43--3 r-U'o Z 3A, % 16zo f, /Z-,'/o Z L--2aZ/ 57-7-q3 Y3-3 II Zq.qqZ_. (7S't _O Z 3 % ,-% 1/1.'-/0 i /0 3 L-21 g2 1Z0c 44t-14_ tq.- z 0. z2oD 3-!5. q q /z/ o _ __NOTE: All cables 6-ft RG-58 (LIMI 44-142, 44-9, HP-210, or 44-92 probes) or 15-ft RG-58 (LMI 43-37 gas-flow hand-held) unless otherwise noted in the comments below.Comments: Initial Performance Test Performed

& Satisfactory:

H. BackgroundMeasurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)I 8

  • I I I~ ~ 6KJItt /__ Z1_a ~ ~ ~ 4 Aýi.ýi'V 10 2-1$ K67~ j- 2-6. iKeC--i:" 1l 2O1 3 6 K6 4t 2 3 J~~&1 ____Initial /Date Comments-1-.2 Each of the denarked grids (or locations) on the attached survey map has been scanned and do not exceed the action level of 1,750 dpm/1 00-cm 2 , unless otherwise noted on the attached survey map.Post-Survey Performance Test Performed Satisfactory:

A 0 1-31-0o7 SuInitial/

Date Survey Tech (print/sign):

IA ýý(1 Date: 16-3'1-0-7 Reviewed By (print/sign):

.Filenatne:

FSS Characterization SCAN Survey Forms-Rev02 Retention:

LP+ 10 Radiological Survey Report DATE: 1-3o0'7 LOCATION:

16 Ir%- & I 2(D SURVEY NO.: ,ZOO1- 2(q I TIME: ( 3o Smear Information ,J/A Survey Map Pa,6L Z 01 -z No. Beta/ Alpha Gamma (20%)3 4 6 7 9 10 12 e)13 14 15 16 17 919 20't a,,- w_" &I d-. " 'i,, ~ e.(oseT b~&eM~2,106 20.1 , egend: * = Contact; # / # = Contact Reading / General Area; # General Area. () = Smear location; A = Air Sample.Note: Readings in mrem/hr unless noted otherwise. 6ack MU~4O Tnsftrument Serial Number Cail. Dlue Date Efficiency Backeround (CPMVf M1)A m1DPMi Instrument Serial Number Cal. Due Date Background (CPM) MDA (DPM).clakee-Ekete-cl-or][111 I tector cable length--F :===i5cý ! Tbresbold Voltage mVdc De Print/Signature of Surveyor:

I)(.4M* ~ IiI)Date: /0-31-07 Commnts I, AA w-- '__a--, AA, U Review By: Date: Equivalent to HP-101, Rev. 5, Attachment 1 Retention:

LP+10 FNR Decommissioning Project Reconnaissance Level Scan Survey Form Survey No: 7-;,q'2 Survey Unit:_______

Pkg. Pe- 7 Sheet .1 of___Date: //- a -o 7 Survey Location:

CI) 0 141c-, T. Instrument Information Inst. ElV THR 21r Calibration Calibration Set Meter Scaler Detector Detector Setting Setting Inst. Due Date Due Date No. Model Serial No. Model Serial No. ( LVdc) (mVdc) Eff. (Scaler) (Detector)

I "Xa *aI IV77q3 qg-37 3 UPqq )J75 0 30.62 6 -.5-0Y " SI DVQ,,sIO qq-Wq 1&2 , '93 6 c 5 3 q.)7-0% (,o08 NOTE: All cables 6-ft RG-58 (LMI 44-142, 44-9, HP-210, or 44-92 probes) or 15-ft RG-58 (LMI 43-37 gas-flow hand-held) unless otherwise noted in the comments below.Comments:

1o00,, oi .Plo s q, sci.e4ede- , ,i.4 c .d- bel,.;w e"4 1*- 1 Initial Performance Test Performed

& Satisfactory:

if Y/-2 -J7 C,4.Se Initial / Date HI. Background Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)I o -I _,_3-7 A1 (9 ______ L3 2 ___ I _____i Q Q~~c __0 -9 ___ _3 v ?_ 3 ,-3 i Ii !7_3 (4 io ii-' I q o A qvo mI. Total Surface Acti Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (rin.) (Cpm)Loation Y__2____10 Comments: ACQ L.eNek. -Por -sek#I -q Se-+* Q -JU 7, gi~- IWO -7.Each of the demarked grids (or locations) on the attached survey map has been scanned and do not exceed the action level of 1,750 dpm/100-cin 2 , unless otherwise noted on the attached survey map.Post-Survey Performance Test Performed

& Satisfactory:

e //-;-,:: Initial / Date Survey Tech. (print/sign):'t 105 "q/2 Date: 11-2-6-7 Reviewed By (print/sign):

-.ate: I -, 7 Filename:

FSS Characterization SCAN Survey Forms_Rev02 Retention:

LP+10 FNR Decommissioning Project Reconnaissance Level Scan Survey Form SurveyNo: Survey Unit:,/. Pkg. 00 -oC7 Sheet 9 of Date: Survey Location:

O 9 -Survey Comment Sheet: Filename:

Survey ConmmentMapForm_RevOO Retention:

LP+ 10 FNR Decommissioning Project Reconnaissance Level Scan Survey Form Survey No: tZ)7- o7c*3 Survey Unit: Z6 Pkg. 5p-o0l Sheet__ of 2-Date: 11/07/__o_7 Survey Location:

o7Ae r'/o," Mens5 8aib &tl6h (,%,'i

  • I. Instrument Information Inst. HV TEIR 27c Calibration Calibration Set Meter Scaler Detector Detector Setting Setting Inst. Due Date Due Date No. Model Serial No. Model Serial No. (Vdc) (mVdc) Eff. (Scaler) (Detector)

/; 19'77q5 q3.-37? oq3 q.; q 750 ;20 17zg 3 qq-QL/ a vqo716 //01o 3-5 39 -4 1 o_ 1\ /.4- ____4 NOTE: All cables 6-ft RG-58 (LMI 44-142, 44-9, HP-210, or 44-92 probes) or 15-ft RG-58 (LMI 43-37 gas-flow hand-held) unless otherwise noted in the comments below.Comments:

o-' Room djvi c,, W,",h qq -/Q Poke.Initial Performance Test Performed

& Satisfactory:

II. Backgroud Measurements Counts Inst. Count per Set Time Minute No. .Grid or Location (min.) (cpm)__ G3__ .Y / 4 LG "k-I -I 193q/3 K &X *3- o-7 ilxi I IAefi3i kM iixf56~ l410)1 i*eV4 Nf V388-~ft~-__Ill. Total Surface Activuy Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)Comrn~ts-

~O 'X~/i0 RObe q.3-3-7,11..-7q3q,;?q I Eachof kor-- o R 5'oom 5ca L ' h g d sf /oMe aWM t/ Ie Ve,/the o emarked grids (or'locations) on the attach rvey map hasnbeen d .tine, xcee & qnevvlo 1750 dpm/1 00-m unless otherMse noted on the attached P V/,',, 04' ,)Vt.Post-Survey Performance Test Performed

&n Satisfactory: l/Date Survey Tech (print/sign):

A nn Q2 v" I r / .-Date: 1/ e57/,2C Reviewed By (print/sign).

21/2122 Filename:

FSS Characterization SCAN Survey Forms_Revo02 Retention:

LP+ 10 Survey No: _?___-___Date: ///07/4007 I. Instrument Information FNR Decommissioning Project Reconnaissance Level Scan Survey Form Survey Unit: di]. Pkg. 50b-J Sheet , of 0-Survey Location:

JA4- FI/tOr &A 0&5M tM :d,.2105 Inst. HV TER 2n Calibration Calibration Set Meter Scaler Detector Detector Setting Setting Inst. Due Date Due Date No. Model Serial No. Model Serial No. (Vdc) (mVdc) Eff. (Scaler) (Detector)

NOTE: All cables 6-ft RG-58 (LMI 44-142, 44-9, HP-210, or 44-92 probes) or 15-ft RG-58 (LMI 43-37 gas-flow hand-held) unless otherwise noted in the comments below.Comments: Initial Performance Test Performed

& Satisfactory:

Initial / Date H. Background Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)3 &tlz ro-xwdS 4/0,;_j% &?. Gro~i !3 / 58 (P/A 71.3 Ac-'eve-t A4 1 A '7q Commpnts-&cid/'o 4 o.IH. Total Surface Activi Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)I I01-_rloor ,2mel-~ers c~j Ivall cZ// Rea-mcf-S i_)U1W /'"-IPA) He VP-1-Each of the demarked grids (or locations) on the attached survey map has been scanned and do not exceed the action level of 1,750 dpm/100-cm 2 , unless otherwise noted on the attached survey map.Post-Survey Performance Test Performed

& Satisfactory:

0 ./t 1 10712007 Survey Tech (print/sign): 0 2)nor //i/A j. ,,)Date: I Z6 Reviewed By (print/sign):

____Date:

-.Retention:

LP+10 Filenarne:

FSS Characterization SCAN Survey Forms_Rev02 FNR Decommissioning Project Reconnaissance Level Scan Survey Form Survey No: o1.O7 " a30? Survey Unit: NiJA Pkg. 07Z-e--Sheet / of /Date:. I// -0 7 I. Instrument Information Survey Location: , -'Inst. HV THR 27c Calibration.

Calibration Set Meter Scaler Detector Detector Setting Setting Inst. Due Date Due Date No. Model Serial No. Model Serial No. (Vdc) (mVdc) Eff. (Scaler) (Detector) ral 9C&J& /A3-37 1 L c i1fC Ve 010 6 7-/-oF/0 ,~ A'A/1 AZA 1,4 ZiIi NOuI E:: All cables 6-f t (LMI 44-142, 44.-9=, IP-II--0, or 44-92 probes) or 15- RGt-58u (LMVI 43-37" gas-flow hand-held) unless otherwise noted in the comments below. Zow -,'-Comments:.

R i 1, P. .s. i,ýr. ',y/t,,.e Initial Performance Test Performed

& Satisfactory:

II. Background Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)L A1k6-g d I I __ _7/

r", c31707 Comments: i~' /Ay,,q 4 fi 4 k,2 ere Scja LA~e/V/ Initial / Date III. Total Surface Acti

  • Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)/adioC ,_ctcf~,u .)Each of the demarked grids (or locations) on the attached survey map has been scanned and do not exceed the action level of 1,750 dpm/1 00-cm 2 , unless otherwise noted on the attached survey map. J Post-Survey Perform Survey Tech (print/sign):

1 Reviewed By (pint/sign):

Test Performed

&Filename:

FSS Characterization SCAN Survey Retention:

LP+I 0 Survey No:,Z)1 -;-33q Date: U -/M FNR Decommissioning Project Reconnaissance Level Scan Survey Form Survey Unit: NI__

-Sheet _ of /Survey Location:

, 2 nd A/lo, /Pip. Chase-. J,, z1tp I. Instrument Information Inst. HV THR 27c Calibration Calibration Set Meter Scaler Detector Detector Setting Setting Inst. Due Date Due Date No. Model Serial No. Model Serial No. (Vdc) (mVdc) Eff. (Scaler) (Detector)

M , 0-3-7 _.2q3q2;_.

175 ;20 51 7 1 !Z/k NOTE: All cables 6-ft RG-58 (LMI 44-142, 44-9, HP-210, or 44-92 probes) or 15-ft RG-58 (LMI 43-37 gas-flow hand-held) unless otherwise noted in the comments below.Comments:

Ti ., Initial Performance Test Perkormed

& Satisfactory:

I. Backeround Measurements Ak ni4 L'JcLLL Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)I c , K w / /S 7G5 I 13aiqvGq,,ndlý3

/8I756 MIA/ /S127 Comments:ý- Initial / Dat6 'HI. Total Surface Activi Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)IV ,S a4 A/i Ded646i___

AboVe- Akn _ __ ___Each of the demarked grids (or locations) on the attached survey map has been scanned and do not exceed the action level of 1,750 2 dpm/1 00-cm , unless otherwise noted on the attached survey map.Post-Survey Performance Test Performed

& Satisfactory:

Survey Tech (print/sign):A n 4 (1VO r )iI}4 1 6 A-t al / Date Date: I l s ? l R i e Bypn :- D :-Reviewed By (print/sign,:

Date: // io Filename:

FSS Characterization SCAN Survey Forms_Rev02 Retention:

LP+10 FNR Decommissioning Project Reconnaissance Level Scan Survey Form Survey No:,2C)6 -c 23Y 7 Survey Unit: A,- Pkg.SPi7L

_ Sheet /.-_ of 2__Date: Ji/[b07 _ Survey Location:

A'C)/4 A lev a o4m Vei 6 I. Instrument Information Inst. HV THR 27t Calibration Calibration Set Meter Scaler Detector Detector Setting Setting Inst. Due Date Due Date No. Model Serial No. Model Serial No. (Vdc) (mVdc) Eff. (Scaler) (Detector) 1 222-1 1877Y q3-37 1:2,/39.-

175b, 20 3__,6-;Z -2A /87'7q3 p35 ,q , q 1 7 56 ýAO o _____ I _________

1 ___________

1 ________ .1 ____________

_______ 1 _______ 1 _______ 1 ___________

1 ____________

NOTE: All cables 6-ft RG-58 (LMI 44-142, 44-9, HP-210, or 44-92 probes) or 15-ft RG-58 (LMI 43-37 gas-flow hand-held) unless otherwise noted in the comments below.Comments: Initial Performance Test Performed

& Satisfactory:

Initial / Dat&LI. Background Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)/ i Zo;,C*n 1/ ' 61-/AV& V1A //3q 2- ar -I //W'?a- t&ckgn. i _____&2l.opý 13 / ____P- AVG /ei' 3 Co- mm4en tsv: NA .4i57 Comments: 11. Total Surface Activhy Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)waIs a& f//V, o/p ,%eaO/ed I-ee/S Each of the demarked grids (or locations) on the attached survey map has been scanned and do not exceed the action level of 1,750 dpm/100-cm 2 , unless otherwise noted on the attached survey map. I k Post-Survey Survey Tech (print/sign):

_Reviewed By (print/sign):

111' r? 0-7 Filename:

FSS Characterization SCAN Survey FormsRevO2 Retention:

LP+ 10 FNR Decommissioning Project Re~onnaissance Level Scan Survey Form Survey No: C& Survey Unit: .2- 7 Pkg. a2 CW-7 Sheet c2 of Date: " Survey Location:

Rem)Cfl sc Lf[-c-/- Oý gcOpq 216 I. Instrument Information Inst. HV THR 2n Calibration Calibration Set Meter Scaler Detector Detector Setting Setting Inst. Due Date Due Date No. Model Serial No. Model Serial No. (Vdc) (mVdc). Eff. (Scaler) (Detector),fliaA*.NoI I r-: mill cabls m- zio '. k.- ILIVII -+-'- Iq 1 .1./-, 1 I-II-2 10, or ,l.4-92/held) unless otherwise noted in the comments below.Comments: Initial Performance Test Performed

& Satisfactory:

probes) or 10-it M.7-00 kLIVI -to-at gas-How hand-Init&I / E&e HI. Background Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)3 9jl4k6trflcJ

'1 T q.5 ajY , An I q( t 3 Comments:i Comments: III. Total Surface Acti Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (n.) (c m)____ Oie-d /1 Each of the demarked grids (or locations) on the attached survey map has been scanned and do not exceed the action level of 1,750 dpm/100-cmn , unless otherwise noted on the attached survey map.Post-Survey Performance Test Performed

& Satisfactory:

20- 0 Initial / Date Survey Tech (print/sign):

1 , X.2 -/ b, Date: I /)-20 7 Reviewed By (print/sign):

K [.-t7 i-IIK ate: 11i 9 07 Filename:

FSS Characterization SCAN Survey FormsRev02 Retention:

LP+10 FNR Decommissioning Project Reconnaissance Level Scan Survey Form Survey No: 007-9,4 (l Survey Unit: Z- -Z Pkg. $5p107 Sheet I of___Date: IDIU. SurveyLocation:

ROOivM Aid I. Instrument Information Inst. HV THR 27c Calibration Calibration Set Meter Scaler Detector Detector Setting Setting Inst. Due Date Due Date No. Model Serial No. Model Serial No. (Vdc) (mVdc) Eff. (Scaler) (Detector) a -=i JTy5 A 63-3.- a4oYLj 50, 1 35,i1 2/J1Lza 1ulaa-3 AP 1~ 17-751 qiq-lrnz ;L4636~ w~ 35 QUJqi ha~Jj 2A 11/-1v____ ______ _______I_____

________I J I I_______ __ NOTE: All cables 6-ft RG-58 (LMI 44-142, 44-9, HP-210, or 44-92 probes) or 15-ft RG-58 (LMI 43-37 gas-flow hand-NOTE: All cables 6-ft RG-58 (LMI 44-142, 44-9, HP-210, or 44-92 probes) or 15-ft RG-58 (LMI 43-37 gas-flow hand-held) unless otherwise noted in the comments below.Comments:

COrfnhýS dfIbm .1 WC4t +0 F/oor doii lV/I-h I /8 7 751 Probe " qý21 Initial Performance Test Performed

& Satisfactory:

1'- i.70io/Zc,&, Initial / Date 1I. Background Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)I E3K/3a- I _____e4& 03 / q 51;S KCA1n 1-eveý NA a- _-3 B 0: 39q-3 wt-L I 3cjj 3 OL&1:3 I _ _3 Akcit-i& 1-eý4 MAI/ 36q III. Total Surface Activity Measurements Counts Inst. Count per Set Time Minute No. Grid or Location (min.) (cpm)AbovFe AcA46-Ves -for Q_ C:V's 5a q r__ .1 _______ 1 ____ .1 ____Comments-~

a~o+f/~LA~

ZP~k~~.4F

_ ý.gkLk 4/ibJ I I ...-Each of the demarked grids (or locations) on the attached survey map has been scanned and do not exceed the Ac inflIveIlf

,750 dpm/1 00-cm 2 , unless otherwise noted on the attached survey map.Post-Survey Performance Test Performed

& Satisfactory:

L i* ID Qco Initial / Date Survey Tech (print/sign):

Date:_/___Dte Reviewed By (print/sin):

_ Iflae4.-hAox

.Filename:

FSS Characterization SCAN Survey FormsRev02 Retention:

LP+10

-" FNRDP SECOND FLOOR SURVEY MAP Ky, SURVEY NO.: " DATE: ____67 TIME: II 1NO SURVEY PURPOSE _SP-__-7 Instrument Serial Number Efficiency Cal. Due Date SMEAR RESULTS IN DPM/100CM 2 Beta/No. Gamma Alpha 1 PI Ni 2 __3 4 6 7 8.9 10 11 12 13 14 15 16 17 18 19 20 Legend:

  • Contact; # / # = Contact Reading / General Area; # = General Area. (I) = Smear location; A = Air Sample location.Note: Readings in mR/hr unless no otherwise.

Print/Signatue of Surveyor:

Date -Comments: C -- 7 Review By: KJ/6I(A4t, (tK ate RetientionLF+1 0

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