APPENDIX E

CONTAMINATED EQUIPMENT, MATERIALS AND WASTE

REGISTRATION/SHIPPING FORM
Date Field
Tag Number Location

EQUIPMENT, MATERIALS AND WASTE IDENTITY

Item
Quantity
No. Description

TRANSPORTATION

From To
KOC / Contractor KOC / Contractor
Sender Name Receiver Name
Sender Signature Receiver Signature

ACTIVITY CHECKED BY CONTRACTOR REPRESENTATIVE

Gamma:
Highest Readings Alpha: Bq/cm2 Beta: Bq/cm2
Sv/hr
Sample taken: Yes / No Analysis result:

Remarks:
Name
Signature Date

COPY TO: ASSET OWNER

NOTE: AFTER RECEIVING THE NORM CONTAMINATED MATERIAL RECEIVER SHALL SEND THE
COPY TO SENDER. SENDER SHALL MAINTAIN THE RECORDS.