CERTIFICATE OF ORIGIN ‘Bookighipmen man: — [oe AWB aie est conse se ouosuese1 Gononrn arene umuineron ca vsns ipo in CNTED STATES OF AMERICA Cos0ss In 20080 Consign ame an rey Forwarding agent ame and adres Pere STARINTL NDT SERVICES Citrowett co NORTH ALKHORAR STREET DBA-TANDEM GLOBAL LOGISTICS {AT PRINCE THAMER CROSS 240 W.F, MCCLELLAN HIGHWAY ALAORAR 31 EBOSTON, MASS €2128 Tact conan par ranean dares) Patt ate nd ogo oige= BURLINGTON, Mass Downes aig eRport asractons= TARP Pras of Eiporng carer For af oadngexpant | Tranipriaton metho: Lorraansaairuines | BosTONLocan alk Foreign por of unloading (vessel and air only Pia of dlr by om carien ——| Contacte (ie on ‘DAMMAM, SAUDI ARABIA Yes “No Coated Meters ont | Number of Desrnion of commode, uma Pucage! | __ Sod Sra amb armed number ros eh Measarenent ASADDR: —|2PCS__| MODEL 880 DELTA 50KG 2@ 7x1XI3 RADIOGRAPHY CAMERA SIN D14483 INCHES CONTAINING: RADIOACTIVE MATERIAL IR-192 SIN 332786 MODEL 880 DELTA RADIOGRAPHY CAMERA SIN Dida CONTAINING: RADIOACTIVE MATERIAL IR-192 SiN 332966 G00DS OF USA ORIGIN ed LABAGARELLA_(Owner or Agent), does hereby declare forthe above named shipper, the goods as described on the above date and consigned as indicated and are products ofthe United States of America, Dated at E.BOSTON__on the 6th 4 day of $6pi, 2016 day off Sep 2016, is Ess a eid \d— Ea recognized Chamber of Commerce unde the las ofthe State of fgh examined the manufacturer's invoice or shippers affidavit concerning the origin of the ‘merchandise, and, according tothe best of its knawledge, fins thatthe products named originated in the United States of Ametig@pQWELL, TANDEM GLOBAL 240 McClellan Hy East Boston. MA 0212! LoGisTICS Secretary 8SHIPPER'S DECLARATION FOR DANGEROUS GOODS, ‘Shipper QSA GLOBAL INC. 40 North Ave: Burlington, MA 01803 UNITED STATES OF AMERICA | AirWaybil No. 020-9414 8331 Page 01 of 02 Pages Shipper's Reference Number CO 308528 ‘Consignee STAR INT'L NDT SERVICES NORTH ALKHOBAR STREET 17 PRINCE THAMER CROSS ALKHOBAR 31952 ‘SAUDI ARABIA, d “Two complbted and sgned copies of tie Dectaation must ba handed ta the an WARNING ‘TRANSPORT DETAILS Failure to comply in all respects with “This shipment is within the fimitations Airport of Departure: the applicable Dangerous Goods pect i or: (ate non-appcebe) Regulations may be in broach of the | Raa NEW YORK applicable law, subject to legal fNoeango | AlteRAeT penalties AIRGRAFE ONLY Altpor of Destination: DAMMAM ‘Shipment Tipe aro peeabe) | a Q q a a a Q q q Q a ig a a q Q a q a a a a NATURE AND QUANTITY OF DANGEROUS GOODS Dangerous Idsinieation UN eID Glass or} Packing Ne. Proper Shipping Name Bision | Coup Ro RADIOACTIVE MATERIAL UN2916 | TYPE B{U) PACKAGE vanity ana Packing | Authorization Typo of Packing | Inst, (92, SPECIAL FORM | TT] Specartenn TTYPESU) PACKAGE | Yolo | Genifcate usA03355:96| 15,0968 Gg Th | ateched roverrack useo" — | me, | Type BIU) armors | BMS | Package Ka | Cerbfeate Gne | USA9255) BCU 86 aitached ‘Adaiional Handing iermation ICAOAATA REGS USED ‘This shipment may be carried on passenger arcraft outside U.S. jurisdiction, 24 Hour Emergency contact number : 001 708 527 3887 CHEMTREC. \ hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are’ classified, packaged, marked and labellediptacarded, and are in all respects in proper condition for transport according to the applicable international and national governmental regulations. | declare that all of the applicable air transport requirements have been mot. NamerTive of Sknatory Joe Stavotta / Raciaton Technician Ploce ra Date: Burington, MA \ HHGGGGGHGGHGGGegeue si GH s7HSHIPPER'S DECLARATION FOR DANGEROUS GOODS. STAR INT'L NDT SERVICES NORTH ALKHOBAR STREET 17 PRINCE THAMER CROSS ALKHOBAR 31952 ‘SAUDI ARABIA, ‘Shipper ‘AirWaybill No. 020-9414 8331 ryteryehanas Page 02 of 02 Pages Onno eee 2 ANERIGA Shipper's Reference Number CO 306528 Consianee Two completed and signed copio o hie Declaration mus be herded to tho pera. WARNING TRANSPORT DETAILS Failure to comply in all respects with “This shipments wihin the linia prescribed [or (delete nor-appicabie) ‘Aitport of Departre the applicable Dangerous Goods ions may be in breach of the Q Q a a Q q q a a Q a & a q Q a Q Q a a a Q PASSENGER ‘CARGO NEW YORK law, subject to legal anpcance | AIRCRAFT [arses | “ont Aiport of Destination DAMMAM Shipment Type: ste nar apa | NoNRABIOAGTIME | RADIOACTIVE | NATURE AND QUANTITY OF DANGEROUS GOODS a ___, Dangerous Goods lseniiaton uvor10 ces or | Facing ie feat popes we Proper Sipping Name | Suet | El Gusmiyans | pang | aurora | Seon | | 7 RADIOACTIVE MATERIAL [7 —HRciaa, SPECIAL FOR UN2a16 | TYPE &{U) PACKAGE ‘Tree aw packace | Yotow | “Contcate uswoase-06 f 1X 8013.5 GBq, ai Attached as | “OVERPACK USED” | ping, | Type BCU) 2 SINDI4e44 aga | Package | 2 | Coneate | | oe | USNazo6) | BKU)-96 ‘tse ‘Adalional Honig information 24 Hour Emergency contact number : 001 703 827 3887 CH ICAOATA REGS USED, ‘This shipment may be carried on passenger aircraft outside U.S. jurisdiction. EMTREC | hereby declare that the contents of this consignment aro fully and accurately described above by the proper sh pping ‘name, and ate classified, packaged, marked and {abelieg/placarded, and aro in all respecte in proper cordition for transport according to the applicable international and national governmental regulations. | declare that all of the applicable air transport requirements have been mat. NamesTile of Signatory ‘Joe Stavolta / Raciation Technion Proce and Date: Burington, MA 0603-12 August Signature (420 ugg eno) SHeGS FAH AGH AFF GF HH HFG sg BQSA GLOBAL QSA Global, Inc. 40 North Avenue Burlington, MA 01803 Telephone: (781) 272-2000 Toll Free: (800) 815-1383 Pocsimile: (781) 359-9191 CERTIFICATE OF CONFORMANCE QSA Global, Inc. certifies that the Model 880 Exposure Device, Serial Number D14444 was manufactured under a Quality Assurance Program that has been approved as meeting the requirements of both the U.S. Nuclear Regulatory Commission (10 CFR 71 Subpart H) and ISO 9001 (2008). ‘The Model 880 Series meets the requirements of IS0-3999:2004(E), “Apparatus for Industrial Radiography - Specifications for performance, design and tests” and ANSI N432-1980 “Radiological Safety for the Design and Construction of Apparatus for Gamma Radiography”. The highest dose rate extrapolated to the maximum activity is less than 200 mR/br (2 mSv/ht) at the surface and less than 2 mRvhr (0.02 mSv/hr) at one meter. ‘The 880 series conforms to the equipment performance standards specified in USNRC 10 CFR. 34 Subpart C, Section 34.20. For compliance with USNRC 10 CFR 34 Subpart C, Section 34.20, the Model 880 device must be used with controls and guide tubes that have been. satisfactorily tested to meet ANSI/ISO, For the Model 880 Delta, 880 Elite & 880 Omega style exposure devices only: ‘The device has been tested for depleted uranium (DU) contamination at the time of manufacture in accordance with the requirements of USNRC 10 CFR 34.27(e). The amount of removable contamination from this DU test did not exceed 0.005 microcuries. 2halee ‘Technician Signature & Date of DU Test Results Date:_ 18 Tely Le Quality Assurance F-Q-1805-7 Rev 2QSA GLOBAL QSA Global, zn. 40h Avene Darnton, MA 808 Tlghen: (181) 272-2000 ‘oll Free: (800) 815-1383, Facsimile: (781) 359-9191, CERTIFICATE OF CONFORMANCE QSA Global, Inc. certifies that the Model 880 Exposure Device, Serial Number D14443 was manufactured under a Quality Assurance Progran that has been approved as meeting the requirements of both the U.S. Nuclear Regulatory Commission (10 CFR 71 Subpart H) and ISO 9001 (2008). The Model 880 Series meets the requirements of ISO-3999:2004(E), “Apparatus for Industrial Radiography - Specifications for performance, design and tests” and ANSI N432-1980 “Radiological Safety for the Design and Construction of Apparatus for Gamma Radiography”. The highest dose rate extrapolated to the maximum activity is less than 200 mR/r (2 mSv/hr) at the surface and less than 2 mKV/ar (0.02 mSv/hr) at one meter. ‘The 880 series conforms to thie equipment performance standards specified in USNRC 10 CFR 34 Subpart C, Section 34.20. For compliance with USNRC 10 CFR 34 Subpart C, Section 34.20, the Model 880 device must be used with controls and guide tubes that have been satisfactorily tested to meet ANSI/ISO. For the Model 880 Delta, 880 Elite & 880 Omega style exposure devices only: ‘The device has been tested for depleted uranfum (DU) contamination at the time of manufacture in accordance with the requirements of USNRC 10 CFR 34.27(e). The amount of removable contamination from this DU test did not exceed 0.005 microcuries. La eines yaa ‘Technician Signature & Date of DU Test Results Date:_ /€ Tuly & Quality Assurance F-Q-1805-7 Rev 2Source Certificate Radionuclide: 1192 ISO/ANSI Classification: 97864515 IAEA Special Form Reference Number: Usaro3a9/8-96 QSA Global, Inc. 4ONovth Averue Burlington, MA 01803, “Telephone: (781) 272-2040 ‘Toll Free (800) 815-1383 Facsimile: (781) 273-2216 Holder/Capsule# — 33296G Source Model: As269 Product Code: ICUCFI20 ‘Measured Equnlen Atvigson AM Sites Oe: 08629STAR INTL NOT SERVICES ek mae i conga Ta pao inner 2700" ia Visi Re er Ped ings! 4107 0.65 Tenge dh Technica Decay Data: ‘Activity in Curies [ Co Aetivity in Tera-Bequerels Date _Datset Dste42 Dale} Date paers pater | Date | Dae _Due-4) Dutev2 Due #3 Dale +4 Date +5 Date +6 335.5 33.2 192.0 123.7 130.5 129.3 nug-zo-16 [S01 4.96 ¢.92 4.97 4.82 4.78 4.73 ides 495.) 1243 123'4 32212 Tata Rivas | des ales 4160 ise a’s2 41a7 4 dele U7') Use sis tale 1a! ie | $053 453 237 4137 3:33 fia 4 met ea22 07-2 toe ot yea ios? 103.2 102.2 191.3 10013 38.4 Bas glen 3.79 37a 3.72 de? 3 S918 "94.6 "86.7 "sale "939 33.1 go 3.37 bigs 3.g0 3047 34a 3 $078 aoe as arr SPs Sr ae 3 : bee an) 8 ws oaa ale Pie Ris Pio 3.07 3.o: 3.er 2s Bo.) 79:3 301g 37:8 993 46.4 2c 3:3) 3:30 3iee 2:88 2:92 2 ts Ee Hoh ite per fe 2 Wed 8 Gb Gad ere are 2as 287 24a 2.52 2/80 2147 2 1p g2.3 ers 639 639 34a 2.0 3.30 246 303¢ 3°32 3 SET end sada Ea i a Sie §7:2 S68 $6.0 $515 38.0 Bag aaa 3.08 2.07 2/08 2/03 2 Salo 85.5 319 §a.5 $2.0 51:3 fiap iis7 igs is, ice: iso 7 [Sasso ase a e ar tas ear a ao 876] 73 46.8 aed 48.0 age, a2 aay | ils 93 iin in iiss 167 2 M3 383 Es a bse Se | besconag | gh aie tig0 usp 1is7 tise 1 HES EE i as eae Pee ne tar ass dso ae Tay bag 3e.3 gee sed gfe are va 3e.9 | oeczi-ze | 143 2'82 ala 1133 rae 237 3! 32:2 386 36:7 gis Salo 34.7 30a | beowteae | 133 2003 132 130 age aa ES Gh it Sancoeat [tae ae ar eae BES gue a3 318 3oc7 30.9 30.2] dandza? | is ite Vis dia ais aaa 1 253 35'¢ 253 39.0 25'a 3 | Santacay_| 210 3209 tloe i107 498 2 Bt HS SI feasts 2022100058 Be. 35.3 ob) 35.8 25.2 2510 bala | Feb-o2-17 | 0196 0195 019s 0.94 0.83 0. 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Bp ogo Se Ee 8 | magcoatis Leiiz oan ous 0117 oteSource Certificate QSA Global, Inc. 40 Nonh Avene Burlington, MA 01803, ‘Telephone: (781) 272-2000 ‘oll Free: (800) 815-1383 Facsimile: (781) 272-2216 Radionuclide: irig2 Hoider/Capsule# 332786 ISO/ANSIClassiisation: 97654516 Source Model: 4424-9 IAEA Special Fom Reference Numbse: USA/0995/6.98 Product Code: icucet20 Measured Equivalent Activity on Aug-10-2016 Sales Order: 306528STAR INTL NOT SERVICES wed Sh aq Source Physical Size Quality Control Tests Aug-10-2076 ‘am cin Wipe Tes uci Diameter 2700" 01706 seca aig Tee oie Lengih 3478 0.197 enn oe _— Diagonal 4401 0.179 7 Decay Data: Techniclen:, 2” Sy \ elivity ia Caries Caetivity in TeracBequerels ] ae wet ous? ‘Die Dole Dees vues | Date | puis Daev1 Ons2 Buus} Died BuasS Deve Tye? a7. ae2 36.8 3.¢ 3999 212] Aas-10-36 “98 80 4.89 4.88 ey Bis BED Bes Bae is wad | MewuE PR OLE LE OS wg he ues ues Heh qe tag | Mare PE 4S 28 os Heese tS Ss tat tae toe |e bie hoi Toeg tose ibae 1007 ton? ton tone | supeeae ps 33 sie ace ge-6 eo § Nie MeL Meg aes Meee | eels 3 08 28 3G ES eh I a eet PES Ee 2.0 81.2 80.4 79.7. 9 78:2 77.3 | Oct-05-36 2.94 2.92 3.85_2.86| feb ea dh ee ae He nf toa gs aa ae one Pa ise as aa O38) 25 89 89 oo ge 2G 23 be 23 sett Sih if : So goa sro sa ses sea 34's fas 20 be ES 3 g3 hs aed 38 fe ioe 235 Ht PES-EB ie 23 BE? eg ia Gr: ago ed tee | sersoae | iss tar ios tim ies aed eS ae ks) Shp ey nee | bee ies bat ta A tae bee SSSR i in -t Le Se She dea go agp aba aha ize ER qa iat ia ida las is Mi jes ee 322 3} Gee 8 bop i3¢ 232 EN EN PSt id aE ES eS PS | ES be Ea SEP US) G83 gv? ga gid go3| gaeaiay [ago ids tae tae age tas ius abe 43 8 ee ee aaa eetects | be tae nae bag Ges Eien bag SEL Se et heh ee bash Seb deg i] Get dss eg as3| eeb-ai-ay | 088 vga pia 0:38 a's8 0134 o-33 gee deg He Rp NS ges Gn | ebay | bosh 038 85y ods 888 88s 88e ib + t BRST Poe ose toes BeBe OO EO HG Hd att a3 2a aoe| febteas [oat og 0099 oo om 07) Ove apo Bt GS dhe Bb Bo Bel eet | ke of ok oe os oa cs $$ bs RE GE | ES oe Teo Baga 83 ae i a Bi] Meee [tee cee tes ger or ges cer ie iss ise ies 163 23 ee foes boa oles 23 Hee} tee ete HES PORES tee wy ue ice ia dea dee a pst gas a3 o.23 9.88 825) HS Bee 3 Ba ed bgt so 050 a8 a Ht eG PH Sed ba ii ue ie as ie ine Saf ou ga oad bal oa 6.43] Ha HS GS ib ie 3 dee S48 8 be Bes ote to 8.a8 it Het et i bs Ge st oe TS ho 435 8 33 ae ease Sac eae bs 0:38 ba2 oa oa 33 33 32 ak be 63638 $33 933 933 9.33 $3 BS sab] Bi gi da fe $3 98 tel short | eae 030 $a 33 fae ocae Ee a a a fbr oa7_ 9.37 9.3¢ $—RRB FE-BH EE Sas ci G3 ¢8 €e 8 €4 @2| aumaety | bas 0.30 a oat 93 9.33 f) 6) 63 ef EP ba ba] micas | 038 038 $25 bu bas 33 p34 SSE teas pe o8f og: ga a3 3 ea| snasay | ogo ove Gas O43 8.8 6.a3 BP OEP ORD go Ee i) 53) MISEH | oi oc Gi Gib ola ots EpOEP bp ES BP Ge bel mich Legh ot $i 63 $5 Sie