Form Rhf - 1pg - Application For Radioactive Material License

ATTACHMENT B (continued)

RADIATION SAFETY PROGRAM

FOR PORTABLE GAUGE LICENSE

14.

Exposure records shall be kept in a manner which includes names, dates of birth, and social security numbers for

all dosimetry users. Each entry shall be for a period of time not to exceed one calendar quarter. Department

form RHF-5 or equivalent may be used.

15.

The company shall maintain on file indefinitely the training certificates and exposure records of employees and

past employees, and supply such employees with exposure date (on request) at termination of employment or

hiring by another radiation work employer.

16.

The nuclear gauges shall be securely restrained with two methods, independent of each other, within the

transportation vehicle and away from the passenger compartment to prevent theft or loss in an accident and to

keep personnel exposure to a minimum.

17.

The Radiation Safety Officer shall maintain a current copy of the following along with the nuclear gauge license:

State of Washington Department of Health “Rules and Regulations for Radiation Protection.” An updated copy of

Attachment ‘C’ shall also be carried with each nuclear gauge.

The storage cabinet or door to the storage area shall be posted with a CAUTION RADIOACTIVE MATERIALS

sign. Properly completed Form RHF-3, “Notice to Employees,” shall be posed in a conspicuous place wherever

individuals work in or frequent any portion of a restricted area. Licensed operators shall be responsible for

posting the above at all field storage locations.

Leak testing of the sealed sources is required at six month intervals, or at the manufacturer’s specified interval,

19.

and shall be performed in the manner designed in the application form. Records of leak test results shall be kept

in units of microcuries and maintained for inspection by the Department.

20.

Transportation activities shall be carried out in accordance with the requirements of 10 CFR Part 71 and

Department of Transportation regulations (49 CFR Parts 100 to 199).

21.

Radiation labels or placards (if any) shall be removed from vehicles when not actually transporting the nuclear

gauge(s) to avoid confusion should an accident occur to the vehicle when it does not contain the gauge(s).

22.

Licensee must comply with Department of Transportation requirements, including but not limited

to the following:

•

When transporting portable gauge, carry at all times:

 Shipping Paper

 Attachment C Emergency Procedures for Portable Gauge License

•

Shipper’s Emergency contact information per 49 CFR 172.604.

•

Gauge packaging must meet TYPE A package specifications.

•

Storage must comply with 49 CFR 177.842.

•

Hazmat employees must be trained per 49 CFR Subpart H (49 CFR 172.700 through

49 CFR 172.704), and 49 CFR 177.817 shipping papers.

•

Upon purchase or receipt of gauges, licensee must maintain receipt records from the

manufacturer which include safety analysis that the special form radioactive materials

meets 49 CFR 173.469. The special form certificate for each source, must match

“Shipper’s Declaration for Dangerous Goods” shipping paper authorization number.

APPROVED BY: ___________________________________ DATE: ___________________________

(Applicant)

322-028 JAR 4/17/12 Page 5 of 8

Form Rhf - 1pg - Application For Radioactive Material License - Portable Gauge Page 5

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