Subject: Military Movement of Radioactive Material

Office Symbol

( ) Date: 5 Sep 08_

MEMORANDUM FOR Commander, I Corps and Fort Lewis, ATTN: IMNW-LEW-SO (Mr. Dougherty), MS 66, Bldg 2007A, Ft. Lewis, WA 98433-5000

Subject: Military Movement of Radioactive Material

1. Unit: __2/75 Ranger Battalion (Airborne)_____

2. UIC: _AORG-SN____

3. Purpose of movement: __Repair or Proper Disposal___

4. Date of departure: ______5. Date of Return:______

6. Departing from: __Fort Lewis Washington______

7. Destination: ______

8. Military Personnel responsible for Items during movement:

Name/Rank:______Phone:______

9. Visual inspection required of devices containing radioactive material. Inspect for cracks, deformity, leaks, or power. If found, contact RSO for assistance.

a. Prior to departure: ______Date:______

b. On arrival Location: ______Date:______

c. Prior to return: ______Date:______

d. On arrival at Home Station:______Date:______

10. Inventory of end Items containing radioactive material:

Item SN: / Cell SN: / Nomenclature / QTY / Radionuclide / Activity
005174 / N/A / ACOG
NSN: 1240-01-412-6608 / 1 ea / H-3 / 100 mCI

Printed Name: Thomas A. Dougherty////Signature:______

“THIS PACKAGE CONFORMS TO CONDITIONS AND LIMITATIONS SPECIFIED IN 49 CFR 173.424 FOR RADIOACTIVE MATERIAL, EXEPTED PACKAGE FOR ARTICLES AND INSTRUMENTS, Per Table 7, “declare that all of the applicable air transport requirements have been met.” UN2911