INTERNAL RADIOISOTOPE PERMIT AMENDMENT APPLICATION - OPEN SOURCE
Permit Holder:
1. Complete the pertinent section below:
A) Add a new nuclear substance
Radioisotope
Use Room(s) Storage Room(s)
Use limits (activity in Bq or mCi)
This radioisotope will be monitored by (wipe testing or hand held contamination meter)
% for the new nuclear substance. Make sure to update your record of contamination monitoring monthly log to
Detector efficiency
include the new radioisotope.
B) Change Use Limit
Radioisotope
change use limit to
(activity in Bq or mCi)
C) Change of nuclear substance location
Radioisotope
Add a room
OR delete a room
Is decommission of the room required?
Yes
No
(http://www.uottawa.ca/services/ehss/docs/roomF.pdf)
D) Deletion of nuclear substance
Radioisotope
2. Other needs:
I,
certify that the information given in this application is true, correct, and complete. I agree to use radioisotopes only in
the manner for which they have been authorized.
Permit Holder Signature:
(Print your name)
Date:
Print Form
E-mail
University of Ottawa, ORM September 17, 2012