DD FORM1348-1A.JUL 91 (EG) ISSUE RELEASE/RECEIPT DOCUMENT.

DD FORM1348-1A.JUL 91 (EG) ISSUE RELEASE/RECEIPT DOCUMENT

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3 POINT OF CONTACT
8 These electron tubes contain radioactive material (radioactivity) less than, equal es

to, in excess or unimportant quanitites as listed in CFR 10. SDS for Beryllium
Oxide and Rad. Cert are attached.

TELEPHONE NUMBER

\__ ess

Oxide and Rad. Cert are attached.

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3 These electron tubes contain radioactive material (radioactivity) less than, equal Pe

a to, in excess or unimportant quanitites as listed in CFR 10. SDS for Beryllium TELEPHONE NUMBER

PREVIOUS EDITION MAY BE USED

PerForm (DLA)

PREVIOUS EDITION MAY BE USED

PerForm (DLA)



Title: Radioactive Property Certification
i. Radioactive items or material shall not be turned into the DRMO unless the generator
Description: | provides a statement, signed by their Radiation Protection Officer (RPO) certifying that the

item/material is radiation free.
ae

DT@:N001648101RWO1) aty: 455

NSN or Description: 5960-01-157-7009 Electron Tube

Certification Statement:
| CERTIFY THAT THE ITEMS//MATERIAL ARE FREE OF RADIOACTIVE MATERIAL(S) AND
RADIOACTIVE COMPONENT(S).
TSCHAENN.KEVIN.RAY. 1 2. Sgtalsonetty Scvenuemnayaa7enen
‘0U=USN, cn=TSCHAENN.KEVIN.RAY.1207769602
Signature: 07769602 Date: 2018.04.16 08:56:26 -04'00" Date 16 APR 2018

Printed Name/Grade/Rank: Andrew C. Edwards / Kevin R. Tschaenn
Title, Command Radiation Safety Officer / Assistant Radiation Safety Officer

Phone (COM/DSN/FAX); 812-854-6839 / 1888
Address: COde 1024 Bldg 2 300 Highway 361 Crane, In 47522-5001

Code 1024 Bldg 2 300 Highway 361 Crane, In 47522-5001

Reference:

DLAI 4145.8/NAVSUPINST 4000.34C/AFJI 23-504/MCO P4400.105 current edition
“Radioactive Commodities in the DoD Supply System”
DoD 4160.21-M, "Defense Materiel Disposition Manual,” current edition