~——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