~——THEADING) (DATE) SUBJECT: Request for Waiver of Maximim Permissible (Radiation) Exposure (IPE) THRU: TO: Commander, Joint Task Force SEViN APO 187 (HOW), c/o Postmaster Sean Francisce, California 1. Request is hereby submitted for waiver of the currently established MPE for Joint Task Force SiViN on-site activities at the Pacific Proving Grounds. This request for waiver of the WE is submitted on benalf of, and has the concurrence of, the individual(s) named below. (Omit above statement in the evert request for waiver is submitted directly by individual concerned. ) Nane Current Dose estimated Dose Increase Required 2. The following information is submitted in justification of this recuest (Include pertinent statements in substantiation of the indicated factors. a. Technical import of the proposed work. b. Pre-operatiénal planning for completion of the proposed work within the established MPE. Cc. Unforeseen on-site difficulties requiring an increase in WFE ad. Other individual(s) qualified as a substitute. to insure completion of the proposed work. (Project Officer or equivalent, or IncivicusQ-3 Incl No. 1