SURVEY PACKAGE COVER SHEET
Building Information:
Survey Type:
Reconnaissance Level Characterization Survey
Building Type:
Type 1 0
Classification:
Class 1
I3
Type 2 0
Type 3
class 2 0
Class 3
Contaminants of Concern:
Plutonium
TvoesofSurvevsReciuired:
Alpha
El
Uranium
Beta
0
0
0
0
Unknown
Other
Gamma
Pre-Demolition Survey
0
0
0
___
Justification for Classification: Area has been decontaminated and surveyed previously, it is not expected that contamination greater 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 and/or Lighting set-up required for these areas as needed.
IlSpecial Safety Requirements:
Isolation Controls:
LEVEL10
LEVEL2M
No use, storage, or movement of radioactive material, with the exception of
N l a
instrument check sources, is permitted in this survey unit.
/I
Comments: TSA and removable measurments are only required where elevated readings are found by scanning or where media samples are obtainec
Labeling Requirements:' Survey area surfaces shall be labeled per the attached survey map(s). All areas surveyed will be marked on the
surveyed surface with indelible ink pen or equivilant.
(PRO-475-RSP-16.01,
effective 05/22/01)
SURVEY PACKAGE SURVEY/SAMPLING INSTRUCTION FORM
I
Minimum SurveyISamplingMeasurement Requirements
NO-second count time required
/ a - 4-.”#
ignature
Date
I
’erform scans in accordance with the attached Flow chart.
Jote: All locations are denoted on survey package survey map.
,
lignature
(PRO-475-RSP-16.0 1, effective 05/22/01)
a
Date
Page 1 of 2
SCAN AND INVESTIGATION METHODS WITH SELECTED INSTRUMENTS
Continue
scan
Pause over
area for 3
seconds
'L:
Continue scan
Document results, continue scan. Radiological Engineer will
evaluate survey data to verify square meter average is less than
100 dpm/ 1OOcm2
\
Page 2 of 2
Investigation Method with DP6 (verify no areas >300 dpm/100cm2)
(Alpha)
=- 60 gross cpm.
_--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
I
i
I
I
NO
Investigation Complete.
to DOE added
I
I
I
I
I
Investigation Complete.
Decon. Required.
d p d l 0 0 cm2?
Collect additional
60-second
measurements
grid, if required by
Rad Engineering
YES
Complete.
SURVEY PACKAGE CORRECTION/CHANGE HISTORY FORM
\
(PRO-475-RSP- 16.0 , effective 05/22/01)
---+-.-br
.
,
L7---++
I$ +;--,
RADIOLOGICAL CLOSEOUT SURVEY FOR THE 707 CLUSTER
SurveyArea: C
survey Unit: 707030A
Classification: 2
Building: 707
Survey Unit Description: First floor (B Module walls and ceiling)
iI
:
;
-:
RADIOLOGICAL CLOSEOUT SURVEY FOR THE 707 CLUSTER
SurveyArea: C
Survey Unit: 707030A
Classlflcation: 2
Building: 707
Survey Unit Description: First floor (B Module walls and celling)
op*l-A”.
ILI d
.
3
1-ia
Random Set
707030
LEGEND:
C-NA= UNPAINTED CEILING
X-NA=> NUMBER OF SAMPLES
REQUIRED
REVIEWED BY SIGNATURE ON PAGE 4
Note 1: Moved due to inaccessiblity
page 1 12/6/04
~
~~
~
' Random Set
.
707030
LEGEND:
C-NA= UNPAINTED CEILING
X-NA=> NUMBER OF SAMPLES
REQUIRED
REVIEWED BY SIGNATURE ON PAGE 4
Note 1: Moved due to inaccessiblity
page 2 12/6/04
Random Set
707030
LEGEND:
C-NA= UNPAINTED CEILING
X-NA=> NUMBER OF SAMPLES
REQUIRED
REVIEWED BY SIGNATURE ON PAGE 4
Note 1: Moved due to inaccessiblity
page 3 12/6/04
Random Set
707030
LEGEND:
'
C-NA= UNPAINTED CEILING
X-NA=> NUMBER OF SAMPLES
REQUIRED
REVIEWED B
Note 1: Moved due to inaccessiblity
page 4 12/6/04
13
I
r
--
9
\
100% survey, Less than
Survey Date
rz/os/&
Instrument
Model
Inst. Serial #
Survey
Type'
uEc;rRc,
438
s
300 dpm/i00cm2 ( Yes or
Block#
3f5
No)
Y&5
\
N4
-
1 S
I
Instrument
,rC"
L/ 8 a c
RCT Supervision Printed Name
-
1 Survev TvDe:
s = scan only
I = Investigation
7 0
100% survey, Less than
300 dpm/100cm2 ( Yes
Survey
zoe 5
Employee U
L.'
Areas greater than 300 dpd100cm2 will be documented on the investigation documentation sheet sheet.
RCT Supervision Signature
.
-
, -*
4
P"p*TABLE SCALER CONTAMINATION INSTRUMENT
WORMANCE TEST LOG
RSFORMS-02.014
9
r
(Alpha only)
INST. TYF'EISERIAL #:
PROBES/N:
Beta
Aipha
ELECTRA /
CAL.DUE DATE:
BLDG.
70
mange,
Z
~
t
M'd
w
(INsmmim EFFICIENCY: 2 /, 7
/
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
epair or service are returned to Instrumentation Repair Facility.
TIME/
DATE
Rev 04/01
IN
CAL
C:UnstrumentForms\Covers\Ele&ra.doc
BATT
SAT
COUNT
TYPE
Page 1'
BKG
(cpm)
INSTRUMENT FLUSHIREREADING
CHARGE
* Guidance for use of this form is located on the back of the form
I
I =L
RSFORMS-02.01-04
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
SOURCE ISOTOPE (Alpha): PU-239 (CSL)/(S/N)/(Registry No .);
(Circle One)
Source (dpm):
Range (cpm) f: 15%: 2 I ) U
1
!4/6?
SOURCE ISOTOPE (Beta)
Source (dpm):
Approved by:
RS Supervision
.
Name (print)
Range (cpm) f 20%:
I
367(
(CSL)/(S/N)/(Registry No.):
NIA
J<W*
683/4s-NIA
CertificatiodDecay Chart Date:
(Circle one)
NIA
CertificatiodDecay Chart Date:
(Circle One)
NIA
N/A
%Error=
(
I
Z
Signhue
(Net cprn + eff)
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 suivey instrument with signature upon completion.
Rev 04/01
Page 2
x (100)
]Net corn = Source cDm - Backmound cDm I
GUIDANCE:
The appropriate instrument data and building location
o
Obtain an appropriate certified source or decay chart s o u z for the instiument being tested.
0
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
*
Source dpm
I
Where
*
- Source dpm
'
Q
PQRTABLE SCALER CONTAMINATION INSTRUMENT,nTRFORMANCETEST LOG
RSFORMS-02.01
(Alpha only)
INST. TYPEBERIAL #:
PROBE S/N:
ELECTRA I
20 6%
Alpha
+bf3
BLDG.
CAL. DUE DATE: 01-)9-DhSTRUMENT EFFICIENCY:
(Range, 2 2 b 3-
707
' 17
&eta
I
1.3063 )
repair or servicc are returned to Instrumentation Repair Facility.
TIME1
DATE
BATT
SAT
Yes No
IN
CAL
Yes No
COUNT
TYPE
BKG
(cpm)
INSTRUMENT FLUSWREREADING
CHARGE
(Net cpm)
(NIA if not gas
prop. det.)
ioos
12-l/-0y
2000
12-lf -e+
I
/ Beta
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
Alpha
I
Beta
NIA
,
AlDha
~
~~~~
Beta
N/A
.
"
AlDha
Beta
NIA
Alpha
Beta
MDha
NIA
I Beta
Rev 04/01
C:Unstrument Forms\Covers\Electra.doc
Page 1
I
I
NIA
I
4
* Guidance for use of this form is located on the back of the fofm
NIA
I
v
Y
RSFORMS-02.01-04
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
I
SOURCE ISOTOPE (Alpha): PU-239 (CSL)/(SfN)/(Registry No.):
(Circle One)
Range (cpm) f 15%: 2 Z b
Source (dpm): I 227 5
b-a0/3S
3
' 217
SOURCE ISOTOPE (Beta)
Source (dpm):
N/A
N/A
/ 306 3
ICSL)/(S/N)/(Registry No.):
Range (cpm) k 20%:
N/A
CertificatiodDecay Chart Date:
(Circle One)
N/A
CertificationlDecay Chart Date:
(Circle One)
N/A
N/A
I
Approved by:
RS Supervision.
%Error-
(Net cpm +e#)
z--@/ez I
*
*
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
- Source dpm x (100)
Source dpm
I
'
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
?3
RSFORMS-02.01-04
(Alpha only)
INST. TYPE/SERIAL #:
PROBE S/N:
ELECTRA I
m 3
Alpha
397 7>
BLDG.
CAL. DUE DATE: (z(2z(o4INSTRUMENT EFFICIENCY:
70
mange,
2232
/
I
2\ 4
Beta
I
NIA
3O\c\ 3
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
epair or service a
TIME/
IN
BATT
COUNT
BKG
INSTRUMENT
DATE
CAL
Yes
No
SAT
Yes
No
TYPE
(cpm)
READING
(Net cpm)
Rev 04101
C:Unstrument Forms\CoversElectra.doc
Page 1
FLUSWRECHARGE
(N/A if not gas
* 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): PU-239 (CSL)l(Sn\r)l(Registy No.):
(Circle One)
Range
(cpm)
+_ 15%: z?z
Source (dpm):
\2!x2.5
,
.2//
SOURCE ISOTOPE @eta)
',
I
Source(dpm):
T S 269Z
N/A
N/A
N/A
CertificationDecay Chart Date:
(Circle One)
NIA
N/A
NIA
%Error=
Approved by:
Name (print)
SigndKuure
(Net cpm-ceff) -Source dpm
.
.
Instrument background response check is within tolerances of expected values (typically 1 minute count)
Instrument corrected source count reading falls within an acceppble range (t 15% of source value typically using a 1 minute count)
Performance test data is recorded (as applicable) to each portable contaminationsurvey instrument with signature upon completion.
Rev 04/01
x (100)
Net cpm = Source cpm - Background cpm
GUIDANCE:
0
The appropriate instrument data and.building location is recorded
Obtain an appropriate certified source or decay chart source for
0
0
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
.
Source dpm
. Date
Where
*
*
,.
2626 . 30 \?
(CSL)/(S/N)/(RegistryNo.):
Range (cpm) f 20%:
CertificationIDecay Chart Date:
(Circle One)
.
.. .
Page 2
RSFORMS-02.01-04
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
SOURCE ISOTOPE (Alpha): PU-239 (CSL)/(S/N)/(Registry No.):
(Circle One)
Source (dpm):
Range (cpm) k 15%:
32s
/ys7p
373P
271:2-
CerCificationlDecay Chart Date:
(Circle One)
NIA
CertificationDxay Chart Date:
(Circle One)
N/A
*t%.
SOURCE ISOTOPE (Beta)
Source (dpm):
N/A
N/A
(CSL)/(S/N)/(Registry No.):
Range (cpm) +- 20%:
N/A
N/A
%Error=
Name (print)
Date
Signature
.
.. ,.
,
. ..._.
.. .
GUIDANCE:
:
e
The appropriate instrument data and building location is recorded on RSFORMS-02.01-04. .. '
e
Obtain an approprjate certified source or decay chart source for the instruinent.peing.tested.
A general inspection is performed on the instrument €or 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
,
,
:
~
Where
...
. .. ,
(Net cpm +.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 (5 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
Source dprn
x (100)
1
(Net cDm = Source cDm - Backmound c ~ r n
'
I
- Source dpm
j
I
VIN
VIN
VIN
n
I
'
-
VIN
VIN
VIN
VIN
VIN
I
VIN
VIN
VIN
VIN
.LLV0
RSFORMS-02.01-04
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
\
\
SOURCE ISOTOPE (Alpha): PU-239 (CSL)/(S/N)/(Registry No.):
(Circle One)
Range (cpm) f 15%: &tf-31L 3
Source (dpm): L v .F 7p
C W P
- Y'64c7
CertificatiodDecay Chart Date:
(Circle One)
N/A
CertificatiodDecay Chart Date:
(Circle One)
N/A
2/7
SOURCE ISOTOPE (Beta)
Source (dpm):
Approved by:
RS Supervision:
Name (print)
*
*
N/A
NIA
(CSL)/(S/N)I(Registry No.):
Range (cpm) f 20%:
NIA
NIA
,'
JT@. /oEy L]OSignaftire
.
i
%Error=
(Net cpm+efl) -Source dpm
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 (f 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 04101
Page 2
Source dpm
x (100)
a3
-0
RSFORMS-02.01-04
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
t
(Alpha only)
INST. TYPE/SERIAL #:
PROBE S / N :
,a
79
ELECTRA /
Alpha
3 9 77
BLDG.
70
c a .DUE DATE&/><
(Range,
223 3 I
3Oa-O
INSTRUMENT ~ m c m c Y r7/:
:
~3
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
detector. Instruments that require additional
- proDortiona1
- .
Rev 04/01
C:Unstrument Forms\CoversElectra.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): PU-239 (CSL)/(SM)/(Registry No.):
Source (dpm):
12; 37s-
'
.?/f
SOURCE ISOTOPE (Beta)
Source (dpm):
(Circle One)
Range(cpm)+,15%:
NIA
2 a33-3030
(CSL)l(S/N)/(Registry No.):
Range (cpm) f 20%:
N/A
7s 2 672
I
.
NIA
N/A
CertificatiodDecay Chart Date:
(Circle One)
N/A
CertificatiodDecay Chart Date:
(Circle One)
N/A
'
Approved by:
%Error=
SigKture
Name (print)
Date
( N e t cprn + eff)
lNet 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 foliowing:
* 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
I
*
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 (* 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
,
Paoe 3.
Source dprn
'
Where
*
- Source dpm
-
bo
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
RSFORMS-02.01-04
(Alpha only)
INST. TYPE/SERIAL #:
PROBE SM:
ELECTRA /
/o
/A6 6
BLDG.
70
c a .D mD A T E : + +
mange,
J7f3
I
m s T R w mEmcmcY:
Alpha
Beta
J A 7 43
N/A
3l7 /
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
/
Rev 04/01
C:Unstnunent Forms\CoversElectra.doc
Page 1
* Guidance for use of this form is located on the back of the form
e,
e9
RSFORMS-02.01-04
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
SOURCE ISOTOPE (Alpha): PU-239 (CSL)/(S/N)/(Registry No.):
(Circle One)
t 15%: 97r7 3/?
Range
(cpm)
Source (dpm): /r's
-
7p
..a/?
SOURCE iSOTOPE (Beta)
Source (dpm):
NIA
NIA
fl@&b/
NIA
.
,I/.
NIA
.
a0-
SiGature
CertificationtDecay Chart Date:
(Circle One)
NIA
Range (cpm) f 2 0 % @ 3
.L
Name (print)
NIA
Ld
(CSL)/(S/N)/(Registry No.):
?9
Approved by:
RS Supervision
CertificatiodDecay Chart Date:
(Circle One)
%Error=
1 ,
Date
.
L
Where
Rev 04101
(Net cpmt-eff) -Source dpm
x (100)
Source dprn
Page 2
Net cpm = Source cpm - Background cprn
'
-
PORTABLE SCALER CONTAMINATION INSTRUMENT D-F;I,RFORMANCE
TEST LOG
RSFORMS-02.01-~*
-
0.
Alpha
INST. TYPUSERIAL #:
ELECTRA /
[??o
PROBESN:
3r2d
BLDG.
cK.D m D A m : Y-zs-85
70
2 9
~ ~ T R U M E NE TF F I C ~ C Y :
/
.3
'j
-La
N/A
mange, ZLLL/-.Z&-I
This form is used to record parameters noted during daily performance checks on NE Electra, Bicron Frisk-Tech, Portable instruments with gas proportlond detector. Instruments that requlre additional
are returned to Instrumentation Repair Facility.
IN
BATT
CAL
SAT
Yes No
Yes No
COUNT
TYPE
BKG
(cpm)
INSTRUMENT
READING
(Net CPm)
N/A
Rev 04/01
NIA
C:Unstrument Forms\Covers\Electra.doc
Page 1
'
* Guidance for use of this form is located on the back of the form
YVK'I'ABLESCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
RSFORMS-02a 0 1-04
4
SOURCE ISOTOPE (Alpha): PU-239 (CSL)/(S/N)/(Registry No.):
(Circle One)
3/C\
Source (dpm).
Range (cpm) k 15%:
.
7(
SOURCE ISOTOPE (Beta)
I
(b$S?
4
Source (dprn):
At5
- 7&7/
Rev 04/01
N/A
Certification/Decay Chart Date:
(Circle One)
N/A
-
(
CSL)/(S/N)/(Registry No.):
Range (cpm) f 20%:
N/A
Approved by:
Name (print)
CertificationlDecay Chart Date:
(Circle One)
%Error=
,
Signature
Date
Page
A
(Net cprnGeff) -Source dpm
x (100)
PORTABLE SCALER CONTAMINATION INSTRUMENT Dr;l,RFORMANCETEST LOG
(Alpha only)
INST. TYPEKERIAL #:
ELECTRA /
'
RSFORMS-02.01-"
PClpha
712 d
CAL. DUE DATE: Y-Z5/35 INSTRUMENT EFFICIENCY: -2 11
9
L.
/
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
Y
Rev 04/01
C:Unstrument Forms\CoversElectra.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): PU-239 (CSL)/(S/N)/(Registry No.):
(Circle One)
Source (dpm):
Range (cpm) f 15%:
Iq77 {
I
SOURCE ISOTOPE @eta)
4
6 B814f
TIL\
.
363/
N/A
NIA
CertificatiodDecay Chart Date:
(Circle One)
NIA
-
(bL5-Y (
3L9
Source (dpm):
CertificationIDecay Chart Date:
(Circle One)
Range (cpm) k 20%:
Approved by:
Name (pnnt)
%Error=
Date
Signature
Where
GUIDANCE:
0
The appropriate instrument.dataand building location is recorded on RSFORMS-02.01-04.
0
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
checkas
is applicable
satisfactoj
,.: .
Instrument battery/power
audio check is supply
satisfactory,
;,
...:..
0
(Ner cprn t e f f ) - Source dpm
x (100)
Source dpm
-
Net cpm = Source cpm Background cpm
.
' i'
..
*
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
.,
*
b
3
Pr
'ABLE SCALER CONTAMINATION INSTRUMENT
(Alpha only)
'LFORMANCE TEST LOG
RSFORMS-02.014'
Alpha
)
Beta
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
epair or servicc are returned to Instrumentation Repair Facility.
TIME/
DATE
IN
CAL,
Yes No
y-3
-8 y
Rev 04/01
C:Unstrument Forms\Covers\Electra.doc
RSFORMS-02.01-04
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
\
SOURCE ISOTOPE (Alpha): PU-239 (CSL)/(S/N)/(RegistryNo.):
(Circle One)
Range (cpm) f 15%: a
7
1
Source (dpm):
\ &k 7 Ef
SOURCE ISOTOPE (Beta)
Source (dpm):
I
N/A
N/A
L FG I 4
a-3612
(CSL)/(S/N)/(Registry No.):
Range (cpm) k 15%:
CertificationlDecay Chart Date:
(Circle One)
. NIA
N/A
CertificationDecay Chart Date:
(Circle One)
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 battery/power supply check is satisfactory
..
* Instrument audio check is satisfactory, as applicable
* Instrument light leak check is satisfactory, as applicable
0
.
,
i
.
.
Instrument background response check is within tolerances of expected vahes (typically 1 minute count)
Instrument correctedsource count reading falls within an acceptable range (f- 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 2
I
N/A
Net cpm = Source cpm - Background cpm
,
'
1
N/A
'
Where
*
.*
'
~
w
4
PORTABLE SCALER CONTAMINATION INSTRUMENT PERFORMANCE TEST LOG
(Alpha only)
INST. TYPEISERIAL #:
ELECTRA /
/o
PROBE S f N :
Alpha
/ x6
BLDG.
70
RSFORMS-02.01-04
(Range,
3713
Beta
/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 addltional
repair or service are returned to Instrumentation Repair Facility.
I
TIME/
IN
CAL
Yes No
Rev 04/01
~
C:Unstrument Forms\Covers\Electra.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): PU-239 (CSL)/(SM)/(Registry No.):
&Au
(Circle One)
Range(cpm)k 15%: a 7 1 1 - 3 / 9 L - 3G7/
7)
Source (dpm): &??
SOURCE ISOTOPE (Beta)
Source (dpm):
N/A
(CSL)/(SM)/(Registry No.):
Range (cpm) k 20%:
N/A
N/A
Certificatioflecay Chart Date:
(Circle One)
N/A
NIA
Approved by:
RS Supervision:
Name (print)
CertificatiodDecay Chart Date:
(Circle One)
YoError=
e
Signature
Date
GUIDANCE:
0
The appropriate instrument data and building location is recorded on RSFORMS-02.01-04.
0
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 batterytpower supply check is satisfactory
* Instrument audio check is satisfactory, as applicable
* Instrument light leak check is satisfactory, as applicable
*
0
Source dpm
‘-(Net cpm = Source cpm - Background cpm
&
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
x (100)
I
Where
*
(Net cpm + eff ) - Source dpm
Page 2
I
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I
Total Surface Act ivitv
707O30A I
Dates Counted:
12/6/04
A riori MDA:
Av .LocalBk d
I
Local Bkgd (cpm)
(dpd100cm2) .
2.0
3.0
32
2.0
8.0
8.0
2.0
5.0
5.0
0
9
32
32
.
f.