TO WHOM IT MAY CONCERN This is to certify that the isotopic waste removed from our premises on this day by Chemsal has been decayed to: Specific Activity of less than 100 becquerels per gram (Bqg-1) Company: Name (Print): Please tick: Radiation Safety Supervisor Radiation Health and Safety Coordinator laboratory/Technical Manager Services/Logistics Manager Other ……………………………… Signature: Date: NB: - The above items are accepted in good faith as being accurately represented to Chemsal. In the event that they are otherwise it is agreed that they will be returned to the consignor. -----------------------------------------------------------------------------------------Chemsal A division of Dolomatrix Australia Ltd 40 Christie Street St Marys NSW 2760 P: 02 9833 4399 F: 02 9833 4588