Standard document to be used pursuant to Council Regulation (eec) No 1493/93




Yüklə 13.36 Kb.
tarix16.04.2016
ölçüsü13.36 Kb.
Annex I
SHIPMENT OF SEALED SOURCES BETWEEN THE MEMBER STATES OF THE EUROPEAN

COMMUNITY

Standard document to be used pursuant to Council Regulation (EEC) No 1493/93


___________________________________________________________________________________________________________

Notice

- The consignee of sealed sources must complete boxes 1 to 5 and send this form to the relevant competent authority in his country.

- The competent authority of the consignee Member State must fill in box 6 and return this form to the consignee.

- The consignee must then send this form to the holder in the forwarding country prior to the shipment of the sealed sources.

- All sections of this form must be completed and boxes ticked, where appropriate.





1. THIS DECLARATION CONCERNS:

ONE SHIPMENT (This form is valid until the shipment is completed unless otherwise stated in box 6)

Expected date of shipment (if available):
SEVERAL SHIPMENTS (This form is valid for three years unless otherwise stated in box 6)

_________________________________________________________________________________________________________________________


2. DESTINATION OF THE SOURCE(S)

Name of consignee:

Person to contact:

Address:

Tel.: Fax:

________________________________________________________________________________________________3. HOLDER OF THE SOURCE(S) IN THE FORWARDING COUNTRY

Name of holder:

Person to contact:

Address:

Tel.: Fax: ___________________________________________________________________________________________________________



4. DESCRIPTION OF THE SOURCE(S) INVOLVED IN THE SHIPMENT(S)


  1. Radionuclide (s):

  2. Maximum activity of individual source (MBq):

  1. Number of sources:

  2. If this (these) sealed source(s) is (are) mounted in (a) machinery/device/equipment, short description of the machinery/device/equipment:

(e) Indicate (if available and requested by the competent authorities):

  • national or international technical standard with which the sealed source(s) complies(y) and certificate

number:

  • date of expiry of certification:

  • name of the manufacturer and catalogue reference:


5. DECLARATION OF THE AUTHORIZED OR RESPONSIBLE PERSON

  • I, the consignee, hereby certify that the information provided in this form is correct.

  • I, the consignee, hereby certify that I am licensed, authorized or otherwise permitted to receive the source(s) described in this form.

License, authorization or other permission number (if applicable) and validity date there of:


___________________________________________________________________________________________________________


Name: Signature: Date:


________________________________________________________________________________________________
6. CONFIRMATION BY THE COMPETENT AUTHORITY OF THE CONSIGNEE COUNTRY THAT IT HAS TAKEN NOTE OF THIS DECLARATION.
Stamp:
Name of the authority:

Address:

Tel: Fax:

Date:


This declaration is valid until (if applicable):

________________________________________________________________________________________________



Please see box 1, page 1, for guidance on the length of time this form is valid.


Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©azrefs.org 2016
rəhbərliyinə müraciət

    Ana səhifə