PWS Attachment 8 RFP 75N98020R00014.pdf

NATIONAL INSTITUTES OF HEALTH

RADIOACTIVE MATERIAL UTILIZATION AND DISPOSAL

RECORD-Attachment #8 0.001

17264

H 3

09/15/2010

CAT. NO.

NIH 88 - 1 No.

SUPPLIER

NUCLIDE ACTIVITY

USER ID FULL NAME USER ID FULL NAME USER ID FULL NAME

STORAGE LOCATION :________________________________

PERSON(S) DESIGNATED TO USE THIS MATERIAL

USER ID FULL NAME USER ID FULL NAME

ARRIVAL DATE

(NEW DESIGNATED USERS MAY USE THIS ORDER PROVIDED THE AUTHORIZED USER HAS INDICATED APPROVAL BY SIGNATURE ANY WHERE ON THIS FORM.)

ENTER BELOW WHEN ANY MATERIAL IS USED OR DISPOSED IN RADIOACTIVE WASTE CONTAINERS. YOU ARE REMINDED THAT THE NIH RADIATION SAFETY RULES DO NOT PERMIT ANY RADIOACTIVE RELEASES TO THE SEWER .

( TO BE COMPLETED BY USERS ) RECORD OF TRANSFER, USE, AND DISPOSAL OF THIS SHIPMENT

Name of User User ID Date of Use Activity Used (uCi)

I HEREBY CERTIFY THAT THIS MATERIAL IS COMPLETELY USED AND /OR DISPOSED

(SIGNATURE OF AUTHORIZED USER OR DESIGNEE)

(DATE)

COMMENTS FROM PACKAGE INSPECTION :

Disposal Act.(uCi)

Date Physical Form, e.g.

(Liq.,Solid,Carcass) mCi

DISPOSAL

USER ID FULL NAME

Vo eg tli ,V ic to r(

4)

It em

P ho ne

|N |1

ASSAY DATE :______________________ :

: AUTHORIZED USER # : ITEM # : 18003524

COMPOUND NAME : UNQUENCHED STANDARD,1215-111 02/23/2018DELIVERY DATE : XFR12003841PO # :

FOR QUESTIONS ABOUT THIS SHIPMENT CALL RADIATION SAFETY 301-496-3277

Date Activity (uCi) Name & User Id of Person Receiving MaterialTRANSFERS :

Usage Loctions

As soon as possible after the material is completely used or disposed, notify DRS to remove this item from your possession inventory. If no additional Designated Users were added above, you may utilize the Authorized User Portal (https://DRSPortal.ors.od.nih.gov), FAX a copy to 301-480-9708, or campus mail a copy to Bldg 21, Room 116. If additional Designated Users were added, please use FAX or campus mail only. File the original copy in your laboratory and have it available for inspection for 3 years after the material is completely used or disposed.

EMITTER. A DAILY CONTAMINATION SURVEY USING H 3 IS REQUIRED AFTER EACH USE. LOW ENERGY BETA SMEARS COUNTED ON AN LSCIS A