IPL Form062 Revision L

Please Read

UN2910-Excepted Package Return Instructions

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 less than 0.5 mR/hr.

If a reading greater than 0.5 mR/hr is found on any one side of box, and proceed to instruction Sheet D1/D2 .

Step 3 – Complete Emergency Response Information (B1)

Check first box - UN2910, Class 7, Radioactive Material, Excepted Package, Limited Quantity of Material.

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

Step 4 – Complete Return Packing List (B2)

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 C2, Outer Package Labeling and Pouches.

Step 5 – Seal and Label Package

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

Fully cover any existing labels, red printed Type A information and/or radiation marking found on the package(s).

Adhere 2 each only of the provided UN2910 candy striped labels on opposing sides of each package.

Do not use the Radioactive Yellow II label.

Do not use the Cargo Aircraft Only label.

Step 6 – Wipe Test Package

Perform a dry wipe on the outside surface of the package. Removable activity cannot exceed 22 dpm/cm2 beta and 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.

Your return qualifies as a UN2910-Excepted Package if the surface reading of your package on all sides is less than 0.5 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.

C1Complete and check each step before going on to the next step.

PROCEED TO STEP 7

IPL Form062 Revision L

UN2910-Excepted Package Return Instructions

Step 7B – Complete FedEx Ground Label Online

Log on to: https://getstarted.van.fedex.com

Go to: New FedEx.com Users Options and select one

Choose payment option

Create User ID for Shipping with an Account

Please call 1(800) GO FEDEX (800-463-3339) directly with any ground service questions. EZIP has only FedEx Air shipment experience.

C2

Step 7A – Complete FedEx Air Waybill (written)

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, Shipper’s Declaration not required.”

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

Please note that the Shipper is responsible for ALL return shipping costs Please note ground paperwork is NOT included in this Return Kit.

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

Before proceeding to Step 7 – Alternative Carrier OptionIf you do not have a FedEx Collect Account and believe you have located a DOT Certified small package carrier that can legally transport a UN2910 Limited Quality package, you may proceed, and assume the full responsibility for the transport of the package(s) to EZIP. If you wish to ship via FedEx ground, you are welcome to proceed with option 7B.EZIP does not accept returns through the US Postal Service.

Special Note

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 OR

Once you have carefully completed the steps 1-8, your source is ready to ship to Eckert & Ziegler Isotope Products!

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

Adhere large FedEx pouch for FedEx Airway Bill to package.

Step 8 – Outer Package Labeling and Pouches

All Steps Complete! Return Acknowledgment Form

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.

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

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