Republic of Iraq Iraqi Radioactive Sources Regulatory Authority Authorization Directorate Form No: IRSRA-A-٠١ Required documents and information for approval of radioactive sources store construction A: Safety Requirements Existence of utilization log Provided with (PPE) Scheme for nears explosives bunker Committing with capacity of storage Record of personal exposure for employs in the store Existence of extinguisher and illumination Taking protection procedures in radiological event Dose rate outside and inside the store Dimensions of the store and distance between the pits Informing IRSRA when the store is closed or decommissioned B: Securty Requirements Availability of means of detection (camera, lighting, sensor, and guarding point ) Availability of defense in depth ( fencing, locks ) Availability of response (security force) C:Design of storage GPS coordinates for store location Scheme for the construction details for The store and it's wall thickness and type of universal designs in used& material used Determine the details of pit lining and thickness of pit cover Type of window and door and floors The level of aquifer and precipitation and influxes in the area The site plane (as its build) of store and neighbors facility Iraq-Baghdad/ AL-Farddos Sq P.O.Box : ٢٠٢٥ AL-Jadarya Tel: ٠٧٧٠٦٢٤٣٢٧٩ Email: irsra٢٠٠٤@yahoo.co.uk Web: www.irsra.gov.iq (٥-١) Republic of Iraq Iraqi Radioactive Sources Regulatory Authority Authorization Directorate Form No: IRSRA-A-٠١ Approval form of Radioactive Sources store construction First: Type of radiological practice: well logging industrial radiography other Second: Authorization applicant Information: Name: Government: Private: mixed Sector: For IRSRA Purposes Recommendation and Remark of Authorization Directorate : Foreign Address: Governorate: City/town: District: Recommendation and Remark of Inspection Directorate : Store location: Recommendation and Remark of Research & Development Directorate: Governorate: City/town: District: Type of storage: Permanent Store code : Store Validity: Date of Issues: Interim Third: Information of responsible person: Name: IRSRA Chairman Approval: Position: Tel.: Email: Iraq-Baghdad/ AL-Farddos Sq P.O.Box : ٢٠٢٥ AL-Jadarya Tel: ٠٧٧٠٦٢٤٣٢٧٩ Email: irsra٢٠٠٤@yahoo.co.uk Web: www.irsra.gov.iq (٥-٢) Republic of Iraq Iraqi Radioactive Sources Regulatory Authority Authorization Directorate Form No: IRSRA-A-٠١ Fourth: Information for contract institution: Name of institution: Contract duration: Name of following company: Name of subcontract institution: When the Contract institution uses the bunker, the owner should officially inform IRSRA. Fifth: Information of the number & location of stores in the company: No. Store code Authorization state In case of transport or radioactive sources from bunker to another you should inform IRSRA. Sixth: Describe of the required procedures for decontamination: Contamination of surface bunker (wall, ground): Contamination of equipments: Seventh: describe of field storage: Iraq-Baghdad/ AL-Farddos Sq P.O.Box : ٢٠٢٥ AL-Jadarya Tel: ٠٧٧٠٦٢٤٣٢٧٩ Email: irsra٢٠٠٤@yahoo.co.uk Web: www.irsra.gov.iq (٥-٣) Republic of Iraq Iraqi Radioactive Sources Regulatory Authority Authorization Directorate Form No: IRSRA-A-٠١ Commitment I hereby ( ) director of company office ( ) attend to headquarter (IRSRA) and I: ١. I commit that all the mentioned information in this form was true and corresponding with fact. ٢. I directly inform IRSRA about any change in design of radioactive source store. ٣. I notify IRSRA in case of stealing, losing, and incident of radioactive source. ٤. I notify IRSRA in case of closing and disassembling of radioactive source store. Difference that I will carry all lawful responsibility Signature ( ) date / /٢٠١٣. Approval of manager of authorization directorate: Company name: Authorized name: Signature: Address: Tel.: Date: Approval of lawful department director: Iraq-Baghdad/ AL-Farddos Sq P.O.Box : ٢٠٢٥ AL-Jadarya Tel: ٠٧٧٠٦٢٤٣٢٧٩ Email: irsra٢٠٠٤@yahoo.co.uk Web: www.irsra.gov.iq (٥-٤) Republic of Iraq Iraqi Radioactive Sources Regulatory Authority Authorization Directorate Form No: IRSRA-A-٠١ Table (١) radioactive sources details: Item Isotope Physical form Activity Date of activity Birthday Serial No Iraq-Baghdad/ AL-Farddos Sq P.O.Box : ٢٠٢٥ AL-Jadarya Tel: ٠٧٧٠٦٢٤٣٢٧٩ Email: irsra٢٠٠٤@yahoo.co.uk (٥-٥) Web: www.irsra.gov.iq
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