Ref. No.		
Location and material involved
	
Facility or LOF where seals are located			
	
Facility or LOF address:			
	
Brief description of material under seal:			
	
Justification
	
Reason(s) for removing seals:			
	
List of seals to be removed
	
	SEAL NUMBER	SEAL TYPE	PLANNED DATE of REMOVAL		

					

					

					

					

Signature and permit details	
	
Name :			
	
Position:			
	Signature:	_____________________________________	Date:	____/____/________	
	
Permit Holder:		Permit No:			

ASNO use only	
IAEA notified of removal of above seals		Date:	____/____/________

Signature:	__________________	
Explanatory Notes

Ref. No.	 	A sequential reference number is required for each form of this type submitted by the Permit Holder (eg, 001, 002, 003, etc).  Where amendments are made to a previously submitted form, please use the same reference with a sequential revision number (eg, 003-Rev.1).	
Planned date of removal		
ASNO must be notified at least 14 calendar days prior to the expected date of removal.	
Signature		This form must be signed by a representative of the Permit Holder (ie, the organisation) who will take responsibility for, and sign documents on behalf of, the organisation.

		

		

		

This form replaces the following forms 	ASO229 (Original issued 1 January 2002)