IPL Form329 Revision H

Please Read

Step 1 – Check Return Source

Check source for damage and removable contamination. Wipe source to confirm removable activity is less than 5nCi (10 CFR 35.67). Do not return if wipe test results are 5nCi or above, or source is leaking or damaged. Please contact your RSO if wipe test results exceed the limits.

Step 2 – Packaging Your Return

Place source in original container and shipping package, center and securely package it to reduce movement during transit. Seal package with heavy duty tape and keep one side open to insert necessary forms. If package is damaged, please request a new one.

Confirm radiation surface reading (on-contact) on all sides of package is greater than 0.5 mR/hr. If above 50 mR/hr, contact your RSO.

Step 3 – Complete Emergency Response Information (B1)

Check second box - UN2915, Class 7, Radioactive Material, Type A Package, Non-special Form, Non-fissile, or Fissile Excepted

Complete item 2 by filling in your 24 Hour Emergency Response Phone Number.

This information will be needed for the Shipper’s Declaration.For a Decay Chart and Radioactive Unit Converter, please visit: http://sales.isotopeproducts.com/tools

Step 4 – Complete Return Packing List (B2)

Please see helpful hints on sheet B2 before completing.The original two-sided Sheet B1/B2 is to be used as your external packing list. You will need to make copies of Sheet B2 as stated below:

Place one copy of sheet B2 in each package with source(s)

Keep one copy of sheet B2 for your records

Fold the completed original two-side Sheet B1/B2 and place in the provided small packing list pouch. Set aside for further instructions under Sheet D2, Outer Package Labeling and Pouches.

Step 5 – Determine source nuclide activity in MBq

Step 6 – Seal and Label Package

Seal package with heavy duty tape. Write “security” along the length of the tape or use tamper evident security tape.

Do not cover the following Type A information preprinted on the package: “RADIOACTIVE MATERIAL, TYPE A PACKAGE, NON-SPECIAL FORM, NON-FISSLE OR FISSLE EXCEPTED, UN2915 USA-DOT-7A, TYPE A.”

Determine the TI, Transportation Index = max dose rate in mR/hr at 1 meter (3 feet) from the package surface. The TI must be <1.0 mR/hr on all sides of the package in order to be labeled as Yellow II (49 CFR 173.403). Round up to the first decimal point. Hint: 0.42 = >rounds up to 0.5

Fill in the nuclide(s), total activity and TI in blank sections on the “Radioactive Yellow II labels.” Adhere 2 “Radioactive Yellow II” labels, one each on opposing sides of each package, over original or existing Radioactive Yellow II label.

Adhere 2 “Cargo Aircraft Only” Labels next to each of the two Radioactive Yellow II labels on each package.

Do not use the the candy stripped UN2910 Label.

Step 7 – Wipe Test Package

Perform a dry wipe on the outside surface of the package. Removable activity cannot exceed 22 dpm/cm2 beta or gamma emitters and 2.2 dpm/cm2 of alpha emitting nuclides [49 CFR 173.443(a)(1)]. Please contact your RSO if wipe test results exceed the limits.

Step 8 – Complete FedEx Air Waybill

Ship to: Attention: ReceivingEckert & Ziegler Isotope Products1800 North Keystone StreetBurbank, California 91504

Field 5 - Packaging, check box “Other”

Field 6 - Special Handling, check box “Yes, as per attached Shipper’s Declaration.”

Field 7 - If shipping multiple packages. Mark the total number of packages.

Please note that the Shipper is responsible for ALL return shipping costs

CONTINUE TO STEP 9

UN2915-Yellow II Package Return InstructionsComplete and check each step before going on to the next step.

Your return must ship as a UN2915 – Yellow II, if the surface reading of your package on any side is greater than 0.5 mR/hr but less than 50 mR/hr. A qualified Shipper must prepare package for shipment in accordance with Title 49 CFR 172.101, 172.704, 173.403, 173.421, 173.423, and 173.425. Other requirements apply. Most return kits include multiple labels should your RA# allow for the return of multiple packages.

D1

ExpressUS Airbill FedEx

TrackingNumber

Packages up to 150 lbs.For packages over 150 lbs. use the new

FedEx Express Freight US Airbill

8075 2398 5196

1 From Please print and press hard.

2 Your Internal Billing ReferenceFirst 24 characters will appear on invoice

3 To

DateSenders FedExAccount Number

Recipient’sName

Sender’sName Phone ( )

Phone ( )

Company

S E N D E R S F E D E X A C C O U N T N U M B E R O N L Y

O P T I O N A L

Company

Address

AddressHOLD WeekdayFedEx location addressREQUIRED. NOT available forFedEx First Overnight.

HOLD SaturdayFedEx location addressREQUIRED. Available ONLY forFedEx Priority Overnight and FedEx 2Day to select locations.

Address

City State

FedEx Envelope*

Zip

Dept./Floor/Suite/Room

Dept./Floor/Suite/RoomWe cannot deliver to P.O. boxes or P.O. ZIP codes.

Use this line for the HOLD location address or for continuation of your shipping address.

City State Zip

No

FedEx Pak* FedExBox

FedExTube Other

FedEx Priority OvernightNext business morning. *Friday shipments will bedelivered on monday unless SATURDAY Deliveryis selected.

FedEx Priority OvernightNext business afternoon.*Saturday delivery NOT available.

Easy new Peel-and-Stick airbill. No Pouch needed.Apply airbill directly to your package. See directions on back.

FormID No. 0200

4 Express Package Service *To most locations NOTE: Service order has changed. Please select carefully.

5 Packaging *Declared value limit $500.

6 Special Handling and Delivery Signature Options

7 Payment Bill to:

Sender’s Copy

FedEx First OvernightEarliest next business morning delivery to selectlocations. Friday shipments will be delivered onMonday unless SATURDAY Delivery is selcted.

SATURDAY DeliveryNOT available for FedEx standard Overnight, FedEx 2Day A.M., or FedEx Express Saver.

SenderAcct. No in Section1 will be billed. Recipient Third Party Credit Card Cash Check

Does this shipment contain dangerous goods? One box must be checked.

No Signature RequiredPackage may be left withoutobtaining a signature for delivery.

YesAs per attachedShipper’s Declaration.

Dangerous goods (including dry ice) cannot be shipped in FedEx packagingor placed in FedEx Express Drop Box.

lbs. .00

FedEx Acct. No.Credit Card No.

†Our liability is limited to US$100 unless you declare a higher value. See back for details. By using this Airbill youagree to the service conditions on the back of thie Airbill and in the current FedEx Service Guide, including termsthat limit our liability.

Total Packages Total Weight Total Declared Value†

Enter FedEx Acct. No. or Credit Card No. below.

YesShipper’s Declarationnot required.

Dry IceDry ice, 9, UN 1845 ___________x__________kg

Cargo Aircraft

Direct SignatureSomeone at recipient’s addressmay sign for delivery. Fee applies.

Indirect SignatureIf no one is available at recipient’saddress, someone at a neighboringaddress may sign for delivery. Forresidential deliveries only. Fee applies.

FedEx 2DaySecond business afternoon.* Thursday shipmentswill be delivered on Monday unless SATURDAYdelivery is selected.

FedEx Express SaverThird business day.*Saturday delivery NOT available.

FedEx 2Day A.M.Second business morning.*Saturday delivery NOT available.

Next Business Day 2or 3 Business Days

644

IPL Form329 Revision H

D – Shipper’s 24 hour Emergency Phone Number

Under “Additional Handling Information”, record the Shipper’s 24 hour Emergency phone #. This is your 24 hour phone number should an emergency arise with your package during transit. This number is also recorded on the Emergency Response Information Sheet, B1.

Once all information is typed, the DG form is complete

Print 3 copies on candy striped paper. If using a black & white printer, put the provided candy striped paper in your printer. The typed DG Form must have the colored candy stripe or it will be rejected by the carrier (i.e. FedEx). Hint: we recommend you print a practice DG on plain paper first.

Mark RA# on provided EZIP return label and adhere to package.

Place 3 DG copies and FedEx Air Waybill in large FedEx pouch and adhere to package.

Adhere small packing list pouch (containing the original B1/B2 Emergency Response/Return Packing List) to the package. If shipment contains multiple packages, place all documents on primary shipping package.

Note: Shipper’s Declaration for DG Form must be completed and signed by a qualified DOT trained shipper.

1800 North Keystone StreetBurbank, California 91504

Phone (661) 309-1010Fax (661) 257-8303

RA#

Return Authorization Label 8048-3 Rev.D

TO:

Attention: ReceivingEckert & Ziegler Isotope Products1800 North Keystone StreetBurbank, California 91504

Once you have carefully completed the steps 1-9, your source is ready to ship to Eckert & Ziegler Isotope Products!

All Steps Complete!

UN2915-Yellow II Package Return Instructions

A – Complete Shipper and Consignee boxes

You are the Shipper and Eckert & Ziegler Isotope Products, 1800 N Keystone Street, Burbank, CA 91504, is the Consignee.

B – Transportation Details:

1. Airport of Departure: Contact your local FedEx office for location code.2. Airport of Destination: LAX3. For disposals only: cross out “Passenger and Cargo Aircraft”.4. Air Waybill #: this is the 12 digit FedEx tracking number from your FedEx Air Waybill.5. Shipper’s Reference No.: notate EZIP issued Return Number.6. Shipment Type: cross out “Non-Radioactive”.

C – Nature & Quantity of Dangerous Goods:

1. UN or ID #: UN29152. Proper Shipping Name: Radioactive material, Type A package3. Class or Division: 74. Packaging Group: skip this field5. Quantity and type of packaging: Isotope to be returned, Physical & Chemical form (metallic salt solid for most medical returns), Activity in MBq, and number of Type A Packages.6. Packaging Instructions: II Yellow , TI , & dimensions of package in centimeters7. Authorization: skip this field

D2Complete and check each step before going on to the next step.

Step 9 - The Shipper’s Dangerous Goods Form

The Shipper’s Dangerous Goods (DG) template and a completed sample Dangerous Goods (DG) Form (with steps A to D) can be found at: http://sales.isotopeproducts.com/support . A completed sample (with steps A to D), is illustrated below. Please note that the DG form must be typed and signed by a qualified & trained shipper.

SHIPPER'S DECLARATION FOR DANGEROUS GOODS (Provide at least three copies to the airline.)

Name/Title of Signatory

RADIOACTIVENON-RADIOACTIVE

This shipment is within thelimitations prescribed for:(delete non applicable)

CARGOAIRCRAFTONLY

Airport of Destination:Shipment type: (delete non-applicable)

Air Waybill No.

Page of Pages

Shipper's Reference Number

PASSENGERAND CARGOAIRCRAFT

Signature(see warning above)

Place and Date

I hereby declare that the contents of this consignment are fully andaccurately described above by the proper shipping name, and areclassified, packaged, marked and labelled/placarded, and are in allrespects in proper condition for transport according to applicableInternational and National Governmental Regulations. I declare thatall of the applicable air transport requirements have been met.

NATURE AND QUANTITY OF DANGEROUS GOODS

Shipper

Consignee

Two co

Eckert & Ziegler Isotope Products1800 North Keystone StreetBurbank, California 91504

LAX

Your NameYour CompanyYour Street AddressYour City, State and Zip

UN2915, Radioactive material, Type A package, Class 7, C0-57, Metallic Salt solid. 1 Type A package x 37 mBq. II Yellow, TI 0.1 dims (L) 71 x (W) 33 x (H) 97 cm

mpleted and signed copies of this Declaration mustbe handed to the operator

TRANSPORT DETAILSAirport of Departure

WARNING

Failure to comply with all respects with the applicableDangerous Goods Regulations may be in breach ofthe applicable law, subject to legal penalties.

FOR RADIOACTIVE MATERIAL SHIPMENT ACCEPTABLE FOR PASSENGER AIRCRAFT, THE SHIPMENT CONTAINS RADIOACTIVE MATERIAL INTENDED FOR USE IN OR INCIDENT TO RESEARCH, MEDICAL DIAGNOSIS, OR TREATMENT. ADR EUROPEAN TRANSPORT STATEMENT: CARRIAGE IN ACCORDANCE WITH 1.1.4.2.1

Emergency Telephone Number

Additional Handling Information

A

B1

C

D

B2B3

B4

B5

B6

Your AirportCode

1234 1234 1234

123-456-7890

EZIP’s issued Return Number

C1

C5

C3 C5

C6

C2

SAMPLE O

NLY

Return Acknowledgment Form

Please allow a minimum of five (5) business days for disposal processing and generation of your emailed RAF (Return Acknowledgment Form).

Telephone........................: (661) 309-1010Fax...................................: (661) 257-8303Giro ..................................:Tax exempt number.........: SRAC11-638175Recipient..........................:

Receiving1800 Facility1800 N. Keystone St.Burbank, CA 91504US

Shipped From:ABC Hospital1234 StreetHappytown, OH 41010

Return acknowledgmentReturn Number: ...............: 543210RMA number....................: RMA_12345Date .................................: 4/28/2017Page ................................: 1 of 1Customer account............: Customer ACustomer reference .........:Contact ............................:Customer requisition........:

Dear Valued Customer, Eckert & Ziegler Isotope Products Laboratories has received your radioactive source(s) and takes responsibility for tracking and storage of the source(s) listed below. If you have any further questionsabout the source(s), please contact EZIP and reference the return number listed above. Thank youfor your business.

Item number Batch number Serial number Quantity returned Received on Description

EXCHANGE xxxxxxx 1.000000 10/11/2013 Vial Source ( NASI )

Nuclide Info: Co-57 10.950000 mCi Ref. Date: 2/1/2008

Outer Package Labeling and Pouches

Regulatory References: Title 49 CFR 172.101, 172.204, 172.403, 172.704, 173.403, 173.425, 173.433. Other requirements may also apply.

Dangerous Good (DG) Instruction Page