Branch / Office Location Office Address Customer Job Date Technician Name Technician Email

Camera Serial Number Source Serial Number Exposure Device Type Manufactured Source Survey Meter Manufacturer Survey Meter Model Survey Meter Number Survey Meter Calibration Due Transport Index Surface mR/hr (Reading at Top Center of Camera) Transport To Return To Truck Number Source Activity Ci Activity GBq

Camera Check Out(Reading at Top Center of Camera) Before Lunch(Reading at Top Center of Camera) After Lunch(Reading at Top Center of Camera) Camera Lock Out(Reading at Top Center of Camera) Vehicle Check-Out Exterior (1 meter from Overpack Area) Vehicle Lock-Out Exterior(1 meter from Overpack Area) Vehicle Check-Out Interior (Reading in Cab) Vehicle Lock-out Interior(Reading in Cab)

Elevation Above Elevation Below 2 MR/HR Distance Calculation Mins(Number of Minutes shooting in a hour) 2 MR/HR Distance FT North MR/HR East MR/HR West MR/HR South MR/HR North Footage South Footage West Footage East Footage Exposure Per Hour Exposure Per Shift Dose Per Shift(Total Exposure Time Per Shift Divided-By 60 Min x 2MR)