1. No category

SURVEY PACKAGE COVER SHEET
Building Information:
Survey Type: ReconnaissanceLevel Characterization Survey
BuildingType:
Classification:
0
class I El
Type 1
Type20
Type3
c1ass20
class3
Contaminantsofconcern:
Plutonium
TypesofSurveysRequM
Alpha
0 Uranium
Beta
0
0
0
0
unknown
Other
Gamma
Re-Demolition Survey
a
0
0
0
Justification for Classification: Area has been decontaminated and surveyed previously, it is not expected that contaminationgreater than
the DCGLw will exist
Special Support Requirements: A heated instrument storage location will need to be placed in B707. Natural lighting may
not illuminate some areas of survey unit - temperature andlor lighting set-up required for these areas as needed.
Special Wety Requirements:
Isolation Controls:
LEVEL10
LEVEL20
N/d7
No use, storage, or movement of radioactivematerial, with the exception d
instrument check sources, Is permittedin this survey unit.
Comments: Verification survey . Random sampling to cover 10% of the survey unit.
Labeling Requirements: Survey area surfaces shall be labeled per the attached survey map(s). AI1 areas surveyed will be marked on the
surveyed surface with indelible ink pen or equivilant.
B707 did not affect the instrumentsadversely during the m u s e of work.
L
B707-A-000165
I
SURVEY PACKAGE SURVEY/SAMPLING INSTRUCTION FORM
I
- -”. ’*--”---.-
’
’
Minimum Survey/SamplingMeasurement Requirements
>second count time required
I
‘dormscans in accordance with the attached Flow chart.
lote: All locations are denoted on survey package survey map.
innature
(PRO-475-RSP-16.01, effective 05/22/01)
a
Date
SURVEY PACKAGE SURVEY/SAMPLING INSTRUCTION FORM (cont)
Survey/SamplingInstructions
+
NOTE Any changes to the Survey Package must be logged in the “Survey Package CorrectiodChangeHistory Form.”
+ RCT - If not already completed, label the survey unit surfaces per the Survey Package Cover Sheet Grid Requirements Section and the
attached survey map(s).
+ RCT - If not a l d y completed,aanspose sample numbers from attached survey maps onto each correspondingsurvey location on the
survey unit surfaces.
Note: Work will be performed in cold conditions. Instrument operability may be affected. Increased operability checks are required.
+ RCT -Perform
pre-use performance checks of all instrumentation to be utilized in conjunction with this survey plan. Perform
operational checks with sources attached to the instrument frequently, at least once every survey location. If operational chodr
performed during work is 20% less than check performed prior to work, return instrument to the heated storage location. Obtain
new instrument from heated storage location, perform operational check and resurvey the square meter where previous
instrument failed operational check before proceeding to next area.
+
- A priori Minimum DetectableConcentrations(MDCs)listed in the R E T S Re-Demolition Survey Plan (PDSP) may be used. If
MDCs are calculated, use the formula indicated below in the sampling instructions. Verify that computed MDCs are less than 50% of the
RCT
applicable DCGb. Record all information on the Instrument Data Sheet.
3 + 3.29 Rbts(1 + -)
ta
MDC =
tb
E I ( A/ 1OO)ts
Where,
R = Background counting rate
r , = sample counting time interval
r = background counting time
E, =total eficiency
A = physical surface area of the detector (or area sampled for smears)
Note: Ensure that a 60 second count time is utilized when determining the MDC of the NE Electra.
+
RCT - Local Area Background values should be obtained at each survey block eitherjust before or just after obtaining the actual total
surface activity. Only one LAB per survey block is required.
(PRO-475-RSP-16.01,
effective 0 5 f Z ~ I )
SURVEY PACKAGE SURVEY/SAMPLING INSTRUCTION FORM (cont)
SurveyEampling Instructions
4
RCT - Obtain 100cm2total surface activity measurements (and local area background measurements) on areas that exceed 300
dpm/lOOcmz. Document results on the “ Investigation Data Sheet”
4
RCT - perform ALPHA scans and ALPHA investigation scans. Complete the “ Investigation Data Sheet” as appropriate.
4
RCT - Perform post-use performance checks immediately following use, typically following the conclusion of measurements on the
same day. The post-use performance checks SHALL fall within i 20%of the established range to be considered acceptable.
4
RCT Supervisor -Review the applicable forms in the s w e y package for completeness. complete the “Survey Signature Sheet,” and
/
forward the survey package to Characterization Radiological Engineering for final disposition.
(PR0475-RSP-16.01.
effective 05/2u)I)
Page 1 of 2
SCAN AND INVESTIGATION METHODS WITH SELECTED INSTRUMENTS
Scan Method with DP6 (example)
(Ahha)
I
Scan at 2"/sec (maximum)
I
YES
NO
Pause over
area for 3
seconds
Continue
scan
-
NO
$.
Continue scan
Collect a @-second LAB & a 60second TSA with the DP6 probe at
the area@)of elevated activity
No
Document results, continue scan. Radiological Engineer will
evaluate survey data to verify square meter average is less than
5
4
>60 cpm
gross?
Page 2 of 2
Investigation Method with DP6 (verify no areas >300 dpm/100cm2)
(Alpha)
> 60 gross cpm.
.
---I
I ,
NOTE: Area may be sealed and
allowed to decay to eliminate shortlived radon daughters or isotopic
analysis may be used to identify
radionuclide(s) present. Contact
Radiological Engineering for specific
guidance.
I
i
NO
Investigation Complete.
to DOE added
I
II
I
I
I
I
----.I
I
dpd100 cm2?
Investigation Complete.
L
Collect additional
60-second
measurements
within the
grid, if required by
Rad Engineering
YES
Complete.
707065
Random Scan Set
LEGEND:
C-NA= UNPAINTED CEILING
X-NA=* NUMBER OF SAMPLES
REQUIRED
12/6/04
-
1 Survev
S = Scan o
I = Investigation
,
I
-
I
I
I
100% survey, Less than
Survey Date
Instrument
Model
Inst. Serial #
I Z l S / d ELE~~RA3 5 7 5
Survey
Type'
Xr
300 dpml100cm2 ( Yes or
Block#
2
No)
9%
-
PnRTABLE SCALER CONTAMINATION INSTRUMENr-"YRF'ORMANCETEST LOG
(Alpha only)
ELECTRA I
1933
klpha
31 2 0
BLDG.
CAL. DUE DA"Ezh$&
INSTRUMENT EFFICIENCY:
2O7
Beta
I
( ~ a n g e , Z 5 6 q /3471
70
INSTRUMENT FLUSHIRE-
TIME/
IN
BATT
COUNT
BKG
DATE
CAL
Yes
No
SAT
Yes
No
TYPE
(cpm)
Beta
Alpha
Beta
Alpha
Beta
Alpha
Beta
Alpha
Beta
Alpha
Beta
NIA
N/A\
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NfA
Rev 0410 1
2
-
i
'
INST. TYPWSERIAL #:
PROBE S I N :
RSFORMS-02-01
C:Unstrument Forms\CoversElectra.doc
Page 1
READING
(Net cpm)
CHARGE
(NIA if not gas
prop. det.)
NIA
* Guidance for use of this form is located on the back of the form
NIA
RSFORMS-02.01-04
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
I
SOURCE ISOTOPE (Alpha): PU-239 (CSL)l(SM)/(RegistryNo.):
(Circle One)
Range (cpm) f 15%:
2564
Source (dpm):
14578
SOURCE ISOTOPE (Beta)
Source (dpm):
NIA
NIA
2707
'
NIA
347(
(CSL)/(S/N)/(Registry No.):
Range (cpm) f 20%:
Certificatioflecay Chart Date:
(Circle One)
N/A
CertificatiodDecay Chart Date:
(Circle One)
NIA
N/A
1
I
Approved by:
RS Supervision:
k-
I
I .
*
4
'
/z I( (uy
Date
Name (print)
*
(Net c p m + e f f ) -Source dpm
%Error=
x (100)
Source dpm .
Instrument background response check is within tolerances of expected values (typically 1 minute count) .
Instrument corrected source count reading falls within an acceptable range (-4.15%of source value typically using a 1 minute count)
Performance test data is recorded (as applicable) to each portable contamination survey instrument with signa'me upon completion.
..
:
,
. ',: .. . .
.
'
..
.. .. .
I
.
.
Rev 04/01
..
'.
.
Page
.'.
.
_
.
a
I
.
'
I
I
-
PnRTABLE SCALER CONTAMINATION INSTRUMEN“ TRFORMANCE TEST LOG
RSFORMS-02.01
4
. (Alpha only)
INST. TYPEBERIAL #:
PROBE S/N:
c\
Alpha
ELECTRA /
/\p6 /
BLDG.
(Range,
70
2637 1
2( 3
INSTRUMENT EFFICIENCY:
CAL. DUE DATE:
Yr7’0
6
Beta
/
N/A
,
This form is used to record parameters noted during daily performance checks on NE Electra, Bicron Frisk-Tech, Portable instruments with gas proportional detector. Instruments that require additional
repair or service are returned to Inshumentation Repair Facility.
TIME/
DATE
IN
BATT
CAL
SAT
Yes No
Yes No
prop. det.)
(Initials)
Alpha
C:Unstrument Forms\CoversElectra.doc
b
7,o
NIA
NIA
3,075
Beta
NIA
N/A
N/A
Alpha
Beta
NIA
NIA
NIA
Page 1
NIA
3/3z
Alpha
Beta
Rev 04/01
S
I
-
* Guidance for use of this form is located on the back of the form
’
=
i
RSFORMS-02.01-04
PUK'rABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
:
4
SOURCE ISOTOPE (Alpha): PU-239 ICSL]/(S/N)/(Registry No.):
Source (dpm):
/vJ7p
SOURCE ISOTOPE (Beta)
Source (dpm):
(Circle One)
Range (cprn) f 15%: gL
'
N/A
NIA
TJ 2 7 7
- 3 J' 7Q
38- 3/
(CSL)/(S/N)/(Registry No .):
Range (cpm) f 20%:
NIA
CertificationlDecay Chart Date:
(Circle One)
:N/A
Certificatiodllecay Chart Date:
(Circle One)
NIA
NIA
. .
Approved by:
RS Supervision:
%Error=
I
Name (print)
Signature
fi
ate
~~~
where
*
e
Instrument background response check is within tolerances of expected values (typically 1 minute count) .
Instrument corrected source count reading falls within an acceptable range (k 15%of source value typically using a 1 minute count)
Performance test data is recorded (as applicable) to each portable contamination survey instrument with signature upon completion.
.
Rev 04/01
.
Page & .
~
-
Net cpm = Source cpm Background cpml
GUIDANCE:
0
The appropriate instrument data and building location is recorded on RSFORMS-02.01-04.
Obtain an appropriate certified source or decay chart source for the instrument being tested.
0
A general inspection is performed on the instrument for the following:
* Physical condition of the detector, cables, and instrument
* Instrument batteryjpower supply check is satisfactory
* Instrument audio check is satisfactory, as applicable
* Instrument light leak check is satisfactory, as applicable
*
-
(Net cprn + eff) Source dpm
x (100)
Source dpm
-
PnRTABLE SCALER CONTAMINATION INSTRUMENT “FAWORMANCE TEST LOG
RSF0RM.S-02.01
(Alpha only)
INST. TYPWSERIAL #:
PROBE S / N :
4
t
d / 06
ELECTRA /
beta
Alpha
,
q/7L
BLDG.
CAL. DUE D A T E : ~ T I N S T R U M E N T EFFICIENCY: -72,
31,
mange. 2
70
I
NIA
Z Z L l ~ )
This form is used to record Parmeters noted during daily performance checks on NE Electra, Bicron Frisk-Tech, Portable instruments with gas proportlonal detector. Instruments that require additional
:pair or service are returned to Instrumentation Rep& Facility.
TIME/
IN
BATT
SAT
Yes No
COUNT
TYPE
Beta
Alpha
Beta
Alpha
Beta
Alpha
Beta
Rev 04/01
C:Unstrument Forms\CoversElectra.doc
Page I1
BKG
(cpm)
INSTRUMENT FLUSHREF2EADdG
(Net cpm)
CHARGE
(NIA if not gas
prop. det.)
N/A
NIA
N/A
NIA
N/A
N/A
NIA
N/A
N/A
NIA
NIA
NIA
I
* Guidance for use of this form is located on the back of the form
-
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
RSFORMS-02.01-04
1
d
SOURCE ISOTOPE (Alpha): PTI-239 (CSL)l(SM)l(RegistryNo.): /
(Circle One)
Source (dpm): / * y 5 7 g
Range (cpm) f 15%: 3 7 G Lq
~
SOURCE ISOTOPE (Beta)
Source (dpm):
I
NIA
c
(CSL)I(SlN)/(Registry No.):
Range (cpm) f 20%:
N/A
-
2 707
3%
NIA
'
NIA
CertificatiodDecay Chart Date:
(Clrcle One)
NIA
N/A
I
Approvedby:
CertificatiodDecay Chart Date:
(Circle One)
,
I
1
I
I
1
%Error-
whm
(Net cpm + e#)
-
!Net cpm = Source cpm Background cpm
GUIDANCE:
0
The appropriate instrument data and building location is recorded on RSFORMS-02.01-04.
9
Obtain an appropriate certified source or decay chart source for the instrument being tested.
A general inspection is performed on the instrument for the following:
* Physical condition of the detector, cables, and instrument
* Instrument batterylpower supply check is satisfactory
* Instrument audio check is satisfactory, as applicable
* Instrument light leak check is satisfactory, as applicable
.
*
*
0
Instrument background response check is within tolerances of expected values (typically 1 minute count)
Instrument corrected source count reading falls within an acceptable range (k 15% of source value typically using a 1 minute count)
Performance test data is recorded (as applicable) to each portable contamination survey instrument with signature upon completion.
.
Rev 04/01
.
I
- Source dpm
I
-
PnRTABLE SCALER CONTAMINATION INSTRUMENT "~RFORMANCETEST LOG
(Alpha only)
INST. TYPEISERIAL #:
e
RSFORMS-02.01
4
1
&ha
ELECTRA I
CAL.DUE DATE:\
\a 10sINSTRUMENT EFFICIENCY:
\
A,--
"r"
I
0
Beta
I
NIA
-
This form is used to record parameters noted during daily performance checks on NE Electra, Bicron Frisk-Tech, Portable instruments with gas proportional detector. Instruments that require additional
pair or service are returned to Instrumentation Repair Facility.
TIME/
IN
CAL
Yes No
Yes No
BKG
(CPm)
prop. det.)
1
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
.
-
.
NIA
=Is
NIA
NIA
N/A
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
Al ha
I Beta
Rev 04/01
C:Unstrument Forms\CoversElectra.doc
Page 1
* Guidance for use of this form is located on the back of the form
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
SOURCE ISOTOPE (Alpha): PU-239 CCSL)l(SIN)/(RegistryNo.):
SOURCE ISOTOPE (Beta)
Source (dpm):
NIA
N fA
,-p
2707
(CSL)f(S/N)l(RegistryNo.):
Range (cpm) 2 20%:
NIA
RSFORMS-02.01-04
<
CertificationlDecayChart Date:
(Circle One)
CertificatiodDecay Chart Date:
(Circle One)
NIA
Where
(Net cpm -c eff)
GUIDANCE:
The appropriate instrument data and building location is recorded on RSFORMS-02.01-04.
Obtain an appropriate certified source or decay chart source for the instrument being tested.
A general inspection is performed on the instrument for the following:
* Physical condition of the detector, cables, and instrument
* Instrument batteryIpower supply check is satisfactory
* Instrument audio check is satisfactory, as applicable
* Instrument light leak check is satisfactory, as applicable
Instrument background response check is within tolerances of expected values (typically 1 minute count) .
Instrument corrected source count reading falls within an acceptable range (k 15% of source value typically using a 1 minute count)
Performance test data is recorded (as applicable) to each portable contamination survey instrument with signature upon completion.
Page
- Source dprn
Source dpm
Net cpm = Source cpm - Background cpm
v
Rev 04/01
NIA
NIA
%Error=
.*
*
'
\
u)
-
PnRTABLE SCALER CONTAMINATION INSTRUMEW “YRFORMANCE TEST LOG
RSFORMS-02.01
Npha
(Alpha only)
INST. TYPE/SERIAL #:
PROBE S/N:
ELECTRA I
2aq7
3417
BLDG.
- -
CAL.DUE DATE: bt 3 I o ~NSTRUMENTEFFICIENCY:
.
707
(Range,
/
4
Beta
i . 3 90 I
NIA
35 70)
This form is used to record Parmeters noted during daily performance checks on NE Electra, Bicron Frisk-Tech, Portable instruments with gas proportional detector. Instruments that require additional
pair or servi
TIME/
BATT
COUNT
BKG
IN
INSTRUMENT FLUSWRE-
DATE
CAL
Yes No
/GO@
2 -I - 0 Y
2230
g.-(
-0
SAT
Yes No
TYPE
~
(cpm)
READING
CHARGE
(NIA if not gas
(Net cpm)
yes
Beta
NDha
Beta
NIA
NIA
NIA
I
NIA
I
NIA
Alpha
-t
Rev 04/01
.. .. ,
C:Unstrument FoF\CoversElectra.doc
Page 1
* Guidance for use of this form is located on the back of the form
RSFORMS-02.O 1-04
PORTABLE SCALER CONTAMINATION INSTRUMENT
PERFORMANCE TEST LOG
.
(Circle One)
Range(cpm)f15%:
I* 5 76
Source (dpm):
SOURCE ISOTOPE (Beta)
Source (dpm):
NIA
t(0
/ 3 570
(CSL)/(S/N)/(Registry No .):
Range (cpm) f’20%:
N/A
26
I
bs I s
SOURCE ISOTOPE (Alpha): PU-239 (CSL)/(S/N)/(Registry No.):
,NIA
CertificatiodDecay Chart Date:
(Circle One)
NIA
CertificatiodDecay Chart Date:
(Circle One)
WIA
NIA
..
Approved by:
RS Supervision:
Name (print)
.(d1oy
%Error=(Ner cpm + e f f ) - Source dprn x (100)
Source dpm
I ,
Date
I
Signature
Where
lNet cam = Source cbm - Backmound cDm
GUIDANCE:
The appropriate instrument data and building location is recorded on RSFORMS-02.01-04.
Obtain an appropriate certified source or decay chart source for the instrument being tested.
A general inspection is performed on the instrument for the following:
* Physical condition of the detector, cables, and instrument
* Instrument batterylpower supply check is satisfactory
* Instrument audio check is satisfactory, as applicable
* Instrument light leak check is satisfactory, as applicable
*
*
Instrument background response check is within tolerances of expected values (typically 1 minute count)
Instrument corrected source count reading falls within an acceptable range (k 15% of source value typically using a 1 minute count)
Performance test data is recorded (as applicable) to‘each portable contaminationsurvey instnunen\*withsignature upon completion.
.
.
.
.
Rev 04/01
Page
.
I
RSFORMS-02.01
PnRTABLE SCALER CONTAMINATION INSTRUMENT-“KXFORMANCE TEST LOG
4
1
.
ELECTRA
LfLfoA
Alpha
INST. TYPE/SERIAL #:
/
Z I5q
PROBE S f N :
CAL. DUE DATE:!@/O!
,
BLDG.
70
(Range,
270I
I
21
8
INSTRUMENT EFFICIENCY:
Beta
I NIA
3654)
This form is used to record parameters noted during daily performance checks on NE Electra, Biaon Frisk-Tech, Portable instruments with gas proportional detector. Instruments that require additional
epair or service are returned to Instrumentation Repa&Facility.
IN
FLUSHIRETIME/
CHARGE
DATE
CAL
Yes No
(N/A if not gas’
prop. det.)
(Initials)
1600
I
NIA
-
NIA
N/A
NIA
9
N/A
.
NIA
NIA
N/A
N/A
NIA
.
Rev 04/01
C:Unstrument Forms\CoversElectra.doc
Page 1
_.
N/A
’
N/A
N/A
* Guidance for use of this form is located on the back of the form
RSFORMS-02.01-04
rws ~ . A B L E
SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
L
I
2707
SOURCE ISOTOPE (Alpha): PU-239 (CSL)l(SM)/(RegistryNo.):
(Circle one)
Range. (cpm) f 15%: .
145%
Source (dpm):
SOURCE ISOTOPE (Beta)
N/A
NIA
Source (dpm):
-
3-tf
270
NIA
(CSL)/(S/N)/(Registry No.):
Range (cprn) f 20%:
-NfA
CertificatiodDecay Chart Date:
(Circle One)
N fA
N/A
95E r r o r
Approved by:
RS Supervision:
Name (pnnt)
CertificatiodDecay Chart Date:
(Circle One)
El
/
-
(Net cprn + eff 1 Source dprn
Source dpm
I
I
Date
Signature
where
-
Net cpm = Source cpm Background cpm
GUIDANCE
The appropriate instrument data and building location is recorded on RSFORMS-02.01-04.
* Obtain an appropriate certified source or decay chart source for the instrument being tested.
A general inspection is performed on the instrument for the following:
* Physical condition of the detector, cables, and instrument
* Instrument battery/power supply check is satisfactory
* Instrument audio check is satisfactory, as applicable
* Instrument light leak check is satisfactory, as applicable
*
*
a
Instrument background response check is within tolerances of expected values (typically 1 minute count)
Instrument corrected source count reading falls within an acceptable range (* 15% of source value typically using a 1minute count)
Performance test data is recorded (as applicable) to each portable contamination survey instrument with signature upon completion.
.
3
.. . . .
I
.
.
. . a .
I
*
Rev 0410~
x (100)
Page
. . .. .
-
(Alpha only)
INST. TYPEBERIAL #:
ELECTRA /
RSFORMS-02.01
PQ.RTABLESCALER CONTAMINATION INSTRUMENr “EXF’ORMANCE’TESTLOG
PROBE S/N:
Rev 04/01
4
t
/dJ&
klpha
CAL.DUE DATE: i :J.P.-o$INSTRUMENTEFFICIENCY: JL. 4 2,
h?b&
BLDG.
707
(Range, dW./
C:Unstrument Forms\CoversElectra.doc
Beta
I
N/A
134.7/)
Page 1
-
* Guidance for use of this form is located on the back of the form
RSF0RM.S-02.01-04
YVKTABLE SCALER CONTAMINATION INSTRUMENTPERFORMANCE TEST LOG
bB01 4
SOURCE ISOTOPE (Alpha): PU-239 (CSLJ/(S/N)/(Registry No.):
(Circle One)
Range (cpm) f 15%: 2
Source ( d p m ) : / J ~ 576
SOURCE ISOTOPE (Eleta)
Source (dpm):
NIA
CertificatiodDecay Chart Date:
(Circle One)
N/A
CertificationlDecayChart Date:
(Circle One)
%Error-
I
Date
Instrument background response check is within tolerances of expected values (typically 1 minute count)
Instrument corrected source count reading falls within an acceptable range (k 15%of source value typically using a 1 minute count)
Performance test data is recorded (as applicable) to each portable contamination survey instrument with signature upon completion.
.
.
Page
,.
-
x (100)
Net cpm = Source cprn Background cpm
GUIDANCE:
The appropriate instrument data and building location is recorded on RSFORMS-02.01-04.
Obtain an appropriate certified source or decay chart source for the instrument being tested.
A general inspection is performed on the instrument for the following:
* Physical condition of the detector, cables, and instrument
* Instrument batterylpower supply check is satisfactory
* Instrument audio check is satisfactory, as applicable
* Instrument light leak check is satisfactory, as applicable
Rev 04/01
NIA
(Net cpm+eff)-Source dpm
'
Whcrc
*
N/A
N/A
A
*
I
/
fCSL)/(S/N)/(Registry No.):
Range (cpm) f 20%:
N/A
7/c/
4
5
PWTABLE SCALER CONTAMINATION INSTRUMEW TRFORMANCE TEST LOG
-
INST. TYPWSERIAL #:
PROBE SM:
RSFORMS-02.01
A
4
c
(Alpha only)
ELECTRA /
610'
Alpha
faqs
BLDG.
CAL. DUE DATE:
70
mange,
repair or service are returned to Instrumentahon Repair Facility.
TIME/
IN
CAL
DATE
Yes No
3769
BATT
SAT
Yes No
I
2/23!DJ
INSTRUMENTEFFICIENCY:
da' 3
tieta
I
NIA
7733)
COUNT
BKG
(cpm)
TYPE
INSTRUMENT FLUSHIREREADING
CHARGE
(Net cpm)
(N/A if not gas
prop. det.)
(Initials)
16
6b
ye1
/./I/P9
l
223e
Y
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La
Alpha
Beta
Alpha
Beta
Alpha
Beta
Alpha
Beta
Alpha
Beta
Alpha
Beta
NIA
& *Q
Alpha
1
'
Beta
Alpha
Beta
Alpha
Beta
Alpha
Beta
Alpha
- -~
Beta
,
Rev 04/01
C:Unstrument Forms\Covers\Electra.doc
Alpha
Beta
Page 1
,
33 2-9
NIA
N/A
3255
NIA
NIA
N/A
NIA
NIA
N/A
NIA
NIA
NIA
NIA
N/A
NIA
N/A
NIA
NIA
N/A
NIA
NIA
NIA
NIA
NIA
N h -
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
N/A
NIA
N/A
A
I\ /
I
N/A
/I 1
1
1
I
* Guidance for use of this form is located Qn the back of the form
J
RSFORMS-02.01-04
YUKI'ABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
I
7J270'7
SOURCE ISOTOPE (Alpha): PU-239 (CSL)/(S/N)l(RegistryNo.):
Source.
Source (dpm):
'
SOURCE ISOTOPE (Beta)
Source (dpm):
(Circle One)
Range (cpm) f 15%:
'
/$--7p
N/A
NIA
37 6 3 -32
2''~-
CCSL)/(S/N)/(Registry No .):
Range (cpm) f 20%:
- 7737
NJA
CertificatiodDecay Chart Date:
(Circle One)
. NIA
CertificatiodDecay Chart Date:
(Circle One)
NIA
NIA
%Error- (Net cpm+eff) -Source dpm x (100)
Source dpm
Approved by:
RS Supervision:
Name (print)
I
w - '
Signature
/Iu
Date
I
J
where
Net cpm = Source. cpm - Background cprn
GUIDANCE:
The appropriate instrument data and building location is recorded on RSFORMS-02.01-04.
Obtain an appropriate certified source or decay chart source for the instrument being tested.
A general inspection is performed on the instrument for the following:
* Physical condition of the detector, cables, and instrument
* Instrument batterylpower supply check is satisfactory
* Instrument audio check is satisfactory, as applicable
* Instrument light leak check is satisfactory, as applicable
*
*
Instrument background response check is within tolerances of expected values (typically 1 minute count)
Instrument corrected source count reading falls within an acceptable range (k 15% of source value typically using a 1 minute count)
Performance test data is recorded (as applicable) to each portable contamination survey instrument with signature upon completion.
.
Rev 04/01
.
.
Page A
.
I
N
4
RSFORMS-02.01-04
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
t
(Alpha only)
INST. TYPE/SERIAL #:
*
PROBE S/N:
L
?
&
s?
ELECTRA /
Alpha
3 9 77
BLDG.
70
CAL. DUE DATEQ&/>~
(Range,
INSTRUMENT EFFICIENCY:
,g/!y.z
Beta
I
N/A
223 3- 1
This form is used to record parameters noted.during daily performance checks on NE Electra, Bicron Frisk-Tech, Portable instruments with gas proportional detector. Instruments that require additional
re air or servicc
IN
BATT
COUNT
BKG
INSTRUMENT FLUSHIRE,CAL
SAT
TYPE
(cpm)
READING
CHARGE
Yes No Yes No
(Net cpm)
(N/A if not gas
F
Rev 04/01
C:Unstrument Forms\CoyersUElectra.doc
. .
Page 1
* Guidance for use of this form is located on the back of the form
RSFORMS-02.01-04
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
SOURCE ISOTOPE (Alpha):
(Circle One)
CertificationlDecay Chart Date:
(Circle One)
N/A
CertificationlDecay Chart Date:
(Circle One)
N/A
Source (dpm):
SOURCE ISOTOPE (Beta)
Source (dpm):
N/A
(CSL)l(SM)l(Registry No.):
Range (cpm) +- 20%:
NIA
N/A
NIA
I
Approved by:
. RS Supervision:
%Error=
(Net cpm + e#) - Source dpm
x (100)
Source dpm
I
*
*
0
Instrument background response check is within tolerances of expected values (typically 1 minute count)
Inskment corrected source count reading falls within an acceptable range (k 15% of source value typically using a 1 minute count)
Performance test data is recorded (as applicable) to each portable contamination survey instrument with signature upon completion.
Rev 04/01
Page 2
3977
,
..
.
(PRO.475-RSP-16.01, dfenivc 0SRu)I)
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