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Lembar Isian Untuk Limbah Sumber Bekas

PUSAT TEKNOLOGI LIMBAH RADIOAKTIF

1. ASAL LIMBAH

a. Instansi

b. Alamat c. Telepon a. Email

d. Contact Person :

:

:

:

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

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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

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