Form Limbah Sumber Bekas

download Form Limbah Sumber Bekas

of 2

Transcript of Form Limbah Sumber Bekas

111

Lembar Isian Untuk Limbah Sumber Bekas

PUSAT TEKNOLOGI LIMBAH RADIOAKTIF

1. ASAL LIMBAH

a. Instansi

b. Alamat c. Telepon a. Email

d. Contact Person :

:

:

:

:...................................................................................................................................................................................................................................................................................................

..................................................................................................................................................................................................

2. Nomor Surat Persetujuan Pengiriman Zat Radioaktif : . (Dilampirkan)3. KARAKTERISTIK SUMBER BEKAS :

No.RadionuklidaNo. SeriAktivitas/Tgl.Dimensi/

BeratPenampung/

PembungkusPaparan (Sv/j, mRem/J)

Kontak1 m

Catatan :

Aktivitas : Ci Dimensi/Berat : panjang x lebar x tinggi / kg

EMBED Microsoft Word Picture

_79271612.doc