8/12/2019 Source Movement Form 2003 Nov 13

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 AERB/RSD/NG/SOURCE-MOVEGovernment of India

 Atomic Energy Reg!atory BoardRadio!ogica! Safety Divi"ion

Niyama# B$avan An"$a#tinagar% Mm&ai- '((()'

Application for permission to move nucleonic gauges/XRF Analysers/X-ray Units

This form duly filled in should be submitted IN DUPLICATE to Head, Radiologial !afety Di"ision, Atomi Energy Regulatory #oard, Niyama$ #ha"an, Anusha$tinagar, %umbai&'((()' *rior tounderta$ing any mo"ement of the soure from the *remises +here the soure is authorised to behandled by AER#

*+Name and de"ignation of t$e con"entee , t$e er"on in .$o"ename at$oriation .a" i""ed &y AERB to $and!e 0 Mr. Deepak Dongreradioactive materia!1 at t$e re"ent "ite Dy. General Manager2e!e$one 3$one No 0 +!-"#-$#!!"$% &'(t-!"!)4a5 No 0 +!-"#-*!"%,

6+ Addre"" of t$e !ocation .$ere t$e device i" re"ent!y 0 ermo 'lectron n0ia 1vt 2t0

at$oried to &e $and!ed  &'12)$!%3 $t floor34ity point3!,3 Dole 1atil Roa031U5'-$!! ##!.

 

7+ Addre"" of t$e "ite .$ere t$e device i" roo"ed to &e "ed 0 Reliance n0ustries 2imite06illage 7Mora3 18.9ata3:urat-;a<ira Roa03 :URA-,$%!#.

'+ Name and de"ignation of t$e er"on re"on"i&!e for t$e "afetyand t$e "ecrity of t$e device at t$e roo"ed "ite 0 Mr. 9anu Diman

Dy. General Manager 

2e!e$one No 0 +!-"*!-,#,%,4a5 No 0 +!-"*!-,#,%,

8+ 3artic!ar" re!ating to t$e device 0 1orta=le Alloy Analy<er 0evice =eingReturne0 =ack after 0ecaye0 40-!#source replacement an0 cali=ration ofte instrument.

Ma#e Mode! UDN Sorce Activity ,ondate of3rocrement1

Reference of at$ori"ationagain"t .$ic$ "orce .a"rocred and date of at$oriation

USN Nm&er of t$e "orce

Meta!!rgi"t )699 *+ Cd-*()6+ 4e-88

8 mCi'8 mCi

R3SD/ADV-NG-:R-*)7/6((*'/); dated May6*%

*));+

;+ Ma#e% Mode! and Sr+ No+ of t$e radiation "rvey meter to &e "ed at t$e roo"ed "ite 0Not A!ica&!e

9+ a1 Name of t$e Radio!ogica! Safety Officer at t$e roo"ed "ite 0 Mr+ Uday "$an#ar "ing$

&1 Detai!" of reference of AERB arova! of RSO 0

<+ 3roo"ed date of "orce movement from t$e re"ent "ite 0 *8t$ Novem&er% (7

)+ E5ected date of retrn of t$e device to t$e origina! "ite 0 7*"t Decem&er% (7

8/12/2019 Source Movement Form 2003 Nov 13

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ere=y certify tat te information furnise0 a=ove is correct to te =est of my kno>le0ge. ama>are of te ra0iological safety precautions to =e o=serve0 0uring te an0ling of te 0evice an0sall ensure tat all te precautions stipulate0 overleaf >oul0 =e o=serve0.

*(+ I $ere&y nderta#e t$at t$e fo!!o.ing condition" .o!d &e d!y com!ied .it$ &y me for en"ring "afetran"ort of t$e a&ove nc!eonic device 0

a1 2$e device d!y incororating t$e radioactive "orce .o!d &e tran"orted in t$e origina!container in .$ic$ it .a" received &y " from t$e "!ier of t$e device+&1 2$e device .o!d &e tran"orted a" an item of cargo and dec!ared a" "c$ in t$e a!ica&!etran"ort docment"+ It .o!d not &e tran"orted in t$e a""enger ca&in of any conveyance , e+g+&"/train/aircraft1+ I nder"tand t$at it co!d% $o.ever% &e tran"orted &y road in an e5c!"ive ve$ic!e+c1 2$e device .o!d di"!ay t$e radioactivity !a&e! and a!"o !a&e!" indicating t$e category of t$e ac#age+It .o!d &e en"red &y " t$at t$e artic!ar" regarding t$e content" of t$e ac#age di"!ayed in t$e!a&e!" are correct+ Name" and addre""e" of t$e con"ignor and t$e con"ignee .o!d &e roer!y di"!ayedon t$e e5terior of t$e ac#age+d1 2$e carrier .o!d &e in"trcted &y " t$at "$o!d any mi"$a invo!ving t$e ac#age occr dringt$e tran"ortation%

i1 Effort" "$o!d &e ta#en to re"ce t$e in=red%ii1 4ig$t fire% if any% and t$at

iii1 A me""age regarding t$e condition of t$e ac#age and intimating t$e name of t$e con"ignor andt$e !oca! contact artic!ar" "$o!d &e "ent to t$e Deartment of Atomic Energy EmergencyCommnication Room ,DAE-ECR1% Mm&ai ,2e!e$one0 (66-66(67)9< and (66-66<7(''* and4a5 0 (66-66<7(''*1 and t$at t$e ac#age "$o!d &e garded nti! frt$er advice i" received fromt$e DAE-ECR in t$i" regard+

e1 2$e device .o!d &e $and!ed on!y &y a er"on fami!iar .it$ t$e oeration of t$e device+f1 2$e oeration of t$e device .o!d &e "ervi"ed &y a Radio!ogica! Safety Officer% aroved &y t$ecometent at$ority+g1 2$e Radio!ogica! Safety Divi"ion% AERB .o!d &e informed &y t$e nder"igned% on t$e retrn of t$edevice to t$e origina! "ite+

,Mr+ Uday "$an#ar "ing$1Signatre and Name Signatre of t$e con"entee Signatre of t$e em!oyer of t$e RSO of t$e In"tittion Name 0 S$ B D D$iman Name 0 S$+ M M Sing$

  De"ignation 0 Dy+ Genera! Manager De"ignation 0 3re"ident

3!ace 0 SratDate 0 *7/**/(7

:eal of te nstitution

4or Officia! U"e on!yRef 0 RSD/NG/ /6((6/ Date 0

2$e movement of device,"1 a" de"cri&ed a&ove i" ermitted "&=ect to t$e condition t$at t$enderta#ing frni"$ed in Item *( a&ove "$a!! &e d!y com!ied .it$+

:ignature an0 5ame of A'R9 Representative

A00ress of te 4onsentee?

Re!iance Ind"trie" >imitedVi!!age ?Mora% 3O+B$at$a%Srat-@aira Road%SURA2-7)'8*(