wcn1
STEP
ACTION/EXPECTED{sp}RESPONSE
RESPONSE{sp}NOT{sp}OBTAINED
Warning: Violation of
Section 147 of the
Atomic Energy Act,
"Safeguards
Information" is subject
to CIVIL and CRIMINAL
Penalties.
Safeguards Information determination made by:
Name/Title:
Organization:
Date:
Basis:
Signature:
{sp}
{sp}{sp}{sp}{sp}/
{sp}
{sp}{sp}{sp}{sp}/
{sp}
IV{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}/
{sp}
{sp}{sp}{sp}{sp}/
{sp}
CV{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}/
{sp}
{sp}{sp}{sp}{sp}/
{sp}
Checked by:{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}/
{sp}
{sp}{sp}{sp}{sp}/
{sp}
IV{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}/
{sp}
{sp}{sp}{sp}{sp}/
{sp}
CV{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}/
{sp}
{sp}{sp}{sp}{sp}/
{sp}
Checked by:{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}{sp}/