Unauthorized translation in English
Pre-notification form import/export/transport and temporary storage in
connection with the transport of radioactive sources and elements *
according to the Dutch Nuclear law and the Dutch transport decree
1. information notifier:
A.
name:
Notifier:
(Full name of the
address:
entity)
country:
contact person:
telephone:
fax:
B.
Name and address of the consignor:
C.
Name and address of the consignee :
2. information concerning the material and package(s):
A.
Kind of radioactive material:
B.
Type and quantity of the radioactive sources per
shipment:
radionuclide and mass number:
−
−
weight:
−
activity:
−
chemical formula:
−
physical state:
−
form:
C.
Type of package:
(for example excepted package, type A, type B, etc.)
3. information concerning the transport
A.
The kind of shipments involved:


open sources
sealed sources
Type and quantity of the radioactive sources per
shipment:
radionuclide and mass number:
−
−
weight:
−
activity:
−
chemical formula:
−
physical state:
−
form:
C.
Type of package:
(for example excepted package, type A, type B, etc.)
3. information concerning the transport
A.
The kind of shipments involved:
(import/export/transit/ transport by road/rail/air/sea)
B.
Country of origin of the radioactive sources/materials:
C.
The location (border crossings/ports) where
theradioactive sources/ materials enter or leave Dutch
territory:
D.
The expected date of import/export/transit/transport or the
period of validity of this pre-notification:
4. justification
A
Is the import, export, transport or transit justified
according to the Dutch Ministerial order “Regeling
bekendmaking rechtvaardiging gebruik van ioniserende
straling” and if so please note down the reference of the
justification as mentioned in the Ministerial order and if
the import, export or transit is not justified please describe
the economic, social and other advantages of the import,
export or transit and also give information about the
possible health damage that can be inflicted.
B.
Measures taken in the context of alara-principle:
•
•
•
•
In case of import, export, transit of radioactive consumer items (above the exemption levels of table 2.2.7.2.2.1 ADR) and
radioactive medicaments a permit is needed.
The pre-notification must be submitted three weeks before the transport will take place.
Changes in the pre-notification can be made not later than 3 working days before the transport is going to take place.
In case of movements of sealed radioactive sources between member states of the European Union the document 1493/93 must
also be completed and submitted together with the pre-notification form (to be downloaded from the website of Rijksdienst voor
Ondernemend Nederland www.rvo.nl/stralingsbescherming).
Name and Signature:
Date:
Send form also to:
Rijksdienst voor Ondernemend Nederland
Team Stralingsbescherming,
Postbus 93144
2509 AC Den Haag
Telephone +31 88 602 58 12 or +31 88 042 42 42
Fax
+31 88 602 90 23
E-mail: stralingsbescherming@rvo.nl
Inspectie Leefomgeving en Transport
Handhaving Gevaarlijke Stoffen
E-mail adres: gsinfo@ilent.nl
Postbus 10700 – 2501 HS Den Haag
Telefoon +31 (0)70-456 2444 (info)