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CERTIFIED TRANSLATION FROM THE POLISH LANGUAGE

The document, certificate No. PUOO18/5-05 (Rev.1) concerning a radioactive material

in
special form, issued on 09.09.2014 by the President of the Nationat Atomic Energy
Agency has been drawn up on two sheets. ___

PRESIDENT ---
OF THE NATIONAL ATOMIC ENERGY AGENCY ---

Warsaw, 09. September ZOj4 ---

File No. DORyO1 -01.201.45t1930t201 4 ---

CERTIFICATE No. PL/0018/S-0S (Rev.1) ---

for radioactave material in speciat form ---

Pursuant to Art. '109 par. 1 of the Act on Atomic Law of zg11.2000 (Journat
of Law of
2012 item 264 as amended), Art. I par.1 subpar. 5 of the Act of 19.0g.2011 on the
transport of hazardous materials (Journal of Law No.227, item 1367 as amended),
iri
relation with the requirements as defined in section 5.1.5.2.1 of schedule A to the
European Agreement concerning the lnternational Carriage of Dangerous Goods by
Road (ADR) (i.e. Journal of Law of 2013, item 815), undersection 5.1.5.2.1 of Schedule
to the Regulations concerning the lnternational Carriage of Dangerous Goods by Rail
(RlD) representing Schedule C to the Convention on International Carriage by Rail
(COTIF) (Journal of Law of 2013 item 840), under section 5.1.s.2.1 of the European
Agreement concerning the International Carriage of Dangerous Goods by Inland
Watenvays (ADN) (Journal of Law of 2010 No. 235, item 1537), under section 5.1.5.2.1
of the International Maritime Dangerous Goods Code lncorporating Agreement 36-12 -
2012 Edition (the IMDG Code), under section 1.2.2.1 in part 5 of the ICAO Technical
Instructions for the Safe Transport of Dangerous Goods by Air 2013-2014 Edition, as
well as Art. 104 S 1 and Art. 155 of the Act of 14.06.1960 - The Code of Administrative
Procedure (Journal of Law of 2013 item 26T as amended), -__
 taking into account: ---
Regulations for the Safe Transport of Radioactive Material, 2009 Edition Safety

{ Standards Series No. TS-R-1, issued by the International Atomic Energy Agency (IAEA),
the Act of 15.11.1984 - the Carriage Law, in particular Art. 36 par.1 subpar. 3 (Journal of
Law of 2012, item 'l 173 as amended), ---

I hereby declare that the model of the radioactive source specified herein below
complies with the requirements for radioactive material in specia! form as defineo
in international regulations and regulations being in force in Poland concerning safe
carriage of radioactive materials. ---

1. Description of the radioactive source in special form.

This certificate regards a model of lr-192 radioactive source sealed in protective

housing of HB type (source code lR'lHB), manufactured by the Radioisotopes Center
POLATOM of the National Center for Nuclear Research in Otwock, with the
construction, dimensions and mode of manufacture thereof being defined by the
"Technological and Dosimetric Instruction. The Manufacture of lr-192 and Co-60
Encased Industrial Sources". The active part of the source is encased in a capsulc
made from 1H18NgT steel hermetically sealed by argon-shielded welding. ---

2. Description of the radioactive material

The radioactive material concerned is lr-192 in the form of pellets of metallic

iridium. The maximum size of the radioactive part is a 3.0 mm x 3.0 mm. The maximum
activity of the radioactive source in a HB-type housing amounts to 6.5 TBq. ---

Address for correspondence: ---

The Nationa|Atomic Energy Agency - the Radio|ogica| Protection Depańment --
00-522 Warsaw, ul. Krucza 36 Tel. 22 695.98 48, f ax. 22 695 98 71 ---

,,ł,..*
 r

Page2of2---
Certificate No. PL/0018/5-05 (Rev.1) ---

3. Certificate validity ---

This certificate is valid until 18th October 2017 ---

This certificate rep|aces Ceńificate No. PL/00,1B/S-05 and has been issued at the
order of the Director of Radioisotopes Center POLATOM of the National Center for
Nuclear Research, based on the analysis of the enclosed documents: ---

a) The Quality Assurance Program with regard to nuclear safety and

radiological protection of the Radioisotopes Center POLATOM (No. NJ
4OO1t4) approved by the Director of Radioisotopes Center POLATOM on
4th February 2011; ---

b) The Technological and Dosimetric Instruction. The Manufacture of k-192

and Co-60 Industrial Sources (No. DP 231116) approved by the Deputy
Manufacturing Director on 18th January 2013', --

c) Reports No. 01/2002 of 9th January 2OO2 and No. 5/2001 of 13th November
2OO1 from tests performed by the lsotope Research and Development
Center POLATOM. ---

An official sealwith Poland's emblem, Authorized by

reading: The President of the National Atomic
THE NATIONAL ATOMIC ENERGY Energy Agency ---
AGENCY --- A stamp, reading: --
*1* ---
Vice-President of the National Atomic
Energy Agency ---
/ --- / Stamped Signature ---
Maciej Jurkowski ---
 /

lnstructions: ---

A dissatisfied pańy may app|y to the President of the Nationa| Atomic Energy Agency for re-
examination of the case within 14 days of this decision being served thereto (Art. 127 3 in
$
re|ation with Ań. 129 s 2 of the Code of Administrative Procedure). A comp|aint against a re-
examination decision can be submitted before the voivodeship Administrative Court in Warsaw
through the agency of the President of the National Atomic Energy Agency within 30 days of the
petitioner being served the re-examination decision in the case (Ań. 52 1 in re|ation with Ań'
s
13s2andAń.53s1andArt.54s1oftheActof30thAugust2oo2-theLawonproceedings
before administrative couńs (uniform text in JournaI of Law of 2012' item 27o\, ---

Copies to: ---

1. The Radioisotopes Center POLATOM ---
of the National Center for Nuclear Research ---
u|. Andrzeja Sołtana 7,05-400 otwock ---
2. File copy ---

Address for correspondence: ---

The NationalAtomic Energy Agency - the Radiological protection Department ---
00-522 Warsaw, ul. Krucza 36 Tel. 22 695'98 48, fax.22 695 98 71 ---

l, the undersigned, Krystyna Sachmacińska, sworn translator of the English language

registered under No. TP/1920/06 on the List of Sworn Translators kept by the Minister of
Justice of the Republic of Poland, certify that this is a true ancl correct translation of an
original document drawn up in the Polish language.
Warsaw, 23" September 2014 Repertory No. 277 / 2014.