WPC 0K'|hhz(Ǹz]HiǴ԰ iOB;e?$Dǩv |`OlPeOo ˼'ntEb`S"a^mmH~X j NP\9N}Ahӕ> K`LjF/ΡPA~nqao9ML2sK_tFX/zj ɗtp6fQkv-+ zz,WzrkGNl^mtA6]kC}-V$ށ1yHlJ27dʊ{ڬ䊪( eУU}J7ɶ4 ,'1  XXXʵMonitoringtechniques#XʵXXx #   ЀAmountofRadiationSafetyTrainingtime______hrsand/or_____yrsAmountofonthejobtrainingtime______hrsand/or_____yrsπ. B Describetechniquesutilized:   _______________________________________________________________ J  _______________________________________________________________  *  XXXʵ PrinciplesofRadiationProtection #XʵXX~# 2  AmountofRadiationSafetyTrainingtime______hrsand/or_____yrsAmountofonthejobtrainingtime______hrsand/or_____yrsWhataretheimportantprinciplesofradiationprotection:______________________________________________________________  ______________________________________________________________ \ XXXʵ Instrumentation #XʵXXx#  AmountofRadiationSafetyTrainingtime______hrsand/or_____yrsAmountofonthejobtrainingtime______hrsand/or_____yrsListthetypeofinstrumentandisotopesmonitoredforeach:>____________________________________________________________________________________________________________________________> .!  XXXʵBiologicalEffects#XʵXXR#󀀀   # AmountofRadiationSafetyTrainingtime______hrsand/or_____yrs B"% Amountofonthejobtrainingtime______hrsand/or_____yrs  #Z& Whatarethebiologicaleffectsofradiation: $( ?񀀀π̀π?A@____________@ABBDC)CDFE)EFG______________________________________________________________ *&z!* ____________________________________________________________________________________________________________________________GBB J)$.    j,'2  /  TRX3' LetterX3' Letter3' Letter3' LetterT      Listallplaceswhereyouhavereceived classroom trainingin @ RadiationProtectionandcheckthoseforwhichyouhaveprovideddocumentation. Note (documentationintheformofacertificate, " letterorcopyofatrainingcardmustbeprovidedforatleastoneoftheplaceslistedbelowforthisrequesttobeconsidered)   `    `     h      p   DocumentationLocationofClassroomTraining   p   Attached(check)    1.____________________________________________________________ L   2.____________________________________________________________ ,  3.____________________________________________________________ l  4.____________________________________________________________ L  Listallexperienceintheuseofisotopes,completeeachcolumn T fortheisotopelisted:Isotope󀀀 Activityperuse󀀀0  InclusiveDate(s)󀀀Type  󀀀ofuset(#(# ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Individual completingform:  \# ________________________0 h 0h(#h(#___________________0 (#(#0x (# (#_________!%x(#x(# 0  PrintName0(#(#0h(#(#0h(#h(#Signature0p(#(#0p(#p(#0 (#(#0x (# (#Datef"&x(#x(#  PrincipalUser requestingAuthorizedUserStatusforIndividual: % * ________________________x0 h xy0h(#h(#yz___________________z{z_z{|0 (#(#|}0x (# (#}~_________~~_~'h",x(#x(# 0  PrintName0(#(#0h(#(#0h(#h(#Signature0p(#(#0p(#p(#0 (#(#0x (# (#Date'0#-x(#x(#  +'2  /  TRX3' LetterX3' Letter3' Letter3' LetterT       ReceiptofRadiationSafetyManual   #$ x A$  ThismanualconstitutestheUMRadiationProtectionProgramandwithadditionalproceduresanddirectivesisaguidetotheregulatoryrequirementsgoverningtheuseofradioactivematerialsandradiationproducingdevicesattheUniversityofMarylandCollegeParkCampusandsatellitefacilities.Allpersonnelusingradioactivesourcesareexpectedtobefamiliarwithandabidebytherequirements.AspartoftherequesttobecomeanAuthorizedUserallindividualsmustsignanddatethisreceiptandreturnitwiththeattachedTrainingandExperienceForm.&  IhavereadandIunderstandthecontentsoftheUM,CPRadiationSafetyManual.IagreetoadheretoallrulesandrequirementscontainedinthesaidManual,whichgovernsthesafeuseofRadioactiveMaterialsatUM,CPCampusandSatelliteFacilities.____________________________________+_񀀀 0 Date  _񀀀______________________________________ 8 PrintName    h    P _____________________________________  Signature X ___  __ ` __ __  __ h __  _