Attachment A: Department of Energy Application fo Accreditation For Indirect Radiobioassay

DOE-STD-1112-98

ATTACHMENT A

DEPARTMENT OF ENERGY

APPLICATION FOR ACCREDITATION

FOR INDIRECT RADIOBIOASSAY

1. DOE site or facility:

2. DOE Operations/Field Office:

3. Other DOE facilities using your laboratory for radiobioassay:

4. Contractor laboratory identification, if outside service is used:

5. Name of authorized representative for Indirect Radiobioassay DOELAP accreditation:

Name:

Title:

Department:

Contractor:

Address :

City:

State:

Zip:

Telephone:

Fax:

e-mail:

Backup Contact:

Telephone:

e-mail:

6. Shipping Address:

Attn:

Telephone:

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