Detailed Enquiry Form  

Customer Name :
Company Name:
Company Address :
Telephone :
Fax :
Email :

Service Required :
Please tick service(s) required.
Consignment Documentation
Transportation door to door/airport only*
Packaging/marking/labelling/monitoring/consigning* !
Packaging assessment to determine appropriate packaging
Packaging hire specify if known,
DN
Importation
Insurance packaging/contents

Value £

Location of Material :
Destination Address :

Radionuclide(s) :
(use further info box if required)
Activity(s) (Bq) :
(use further info box if required)
Physical Form :
Chemical Form :

Quantity Of Material (volume & weight) :

 † note 1
Surface Dose Rate (mSv/hr) :
(if packaging assessment requested) 		† note 2
Other Hazards : † note 3
Special Form Certificate No. : † note 4

Container approval type :
Design number :
 		† note 5
Dimensions (mm) :
Surface dose rate (mSv/hr) :
Container approval type :
Container description :
Gross Weight (kg) :

Dose rate @ 1 m (mSv/hr) :

Further information :

DECLARATION :
The information above is correct to the best of my knowledge