NUCLEAR TLD BADGE CERTIFICATION

I HEREBY CERTIFY THE FOLLOWING:

1. The operator(s) has attended the training course in nuclear testing conducted by the Central Laboratory.

2. All safety practices outlined in Materials IM 206 have been followed.

3. The following individual(s) was wearing a nuclear exposure badge on his/her front waist, while operating nuclear testing equipment, and that the exposure as determined on the enclosed badges should be indicative of radiation received for the appropriate time period.

EXPOSURE PERIOD/DATE: From: ____________________ To:

APPROX.TIME

NAME TLD BADGE NO. GAUGE NO. WITH GAUGE

__________________________ _________________ ___________

COMMENTS:

The above information, to the best of my knowledge, is complete and accurate.

District Office Person in Charge Date

cc: Construction and Materials Bureau

District File