UNIVERSITY OF CALIFORNIA SANTA BARBARA ENVIRONMENTAL HEALTH AND SAFETY

HRATCH PAPAZIAN 8TH EGYPTOLOGICAL TEMPELTAGUNG – WARSAW UNIVERSITY OF
Calisia Universitykalisz Poland Nowy Świat 4 62800 Kalisz
CHARLES UNIVERSITY OF PRAGUE FACULTY OF SCIENCE

DUGHUG CONFERENCE 6TH 8TH JULY 2005 EXETER UNIVERSITY
EARTHQUAKE ENGINEERING RESEARCH INSTITUTE OREGON STATE UNIVERSITY
EDUCATION 998504 DMA MUSIC COMPOSITION CORNELL UNIVERSITY DISSERTATION

PERMIT HOLDER’S STATEMENT OF

University of California, Santa Barbara Environmental Health and Safety


PERMIT HOLDER’S STATEMENT OF

TRAINING AND EXPERIENCE USING IONIZING RADIATION



Full Name: Position Title:


Department: Phone #:


Education/training

Education specifically applicable to use of radioactive material or radiation-producing machines.

(include degree(s) and courses, if any, in radiation safety):

EXPERIENCE

Experience with use of radioactive material or radiation-producing machines.


A. List relevant experience beginning with most recent dates:


1). From: to: Employer:

Title and duties:

2). From: to: Employer:

Title and duties:

3). From: to: Employer:

Title and duties:

B. For radioactive materials previously used, list typical radioisotopes and amount (millicuries):

Sealed (encapsulated) sources:

Unsealed sources:

C. For radiation-producing machine(s) previously used, describe machine(s):

I hereby certify that all information contained in this Statement of Training and Experience is

true and correct..


Applicant’s Signature Date




10/15/2004 (APPENDIX B-15)


ERASMUS INSTITUTIONAL KEY DATA NORWEGIAN UNIVERSITY OF
FO GUANG UNIVERSITY CHINESE LANGUAGE INSTRUCTION CENTER
IGNOU THE PEOPLE’S UNIVERSITY INDIRA GANDHI NATIONAL OPEN


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