Ref. No.		
Material list
	
	Material description	Mat’l category	Chemical formula	WEIGHTS	Material acquisition details	Storage location		
				Gross	Compound	Element	Isotope				

											

											

											

											

											

											

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

Explanatory Notes

Using this form		Use as many ASO323 forms as is necessary to provide a complete list all materials held.  	
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).	
Material Description		Include, where applicable, unique identifiers such as serial numbers.	
Material category, and Units of measure		
For each line entry, use one of the following letters in brackets corresponding to the material listed, and to the precision indicated.
Material Category	
Unit	
Minimum Requirements	

(N)atural and (D)epleted uranium, (T)horium, Heavy (W)ater, and (G)raphite	
Kilograms (kg)	
≥0.01 kg  - two decimal places. If <0.01 kg  -  as precise as known	

(E)nriched uranium and (P)lutonium	
Grams (g)	
≥0.01 g  - two decimal places. If <0.01 g  - as precise as known	

Chemical formula		Complete if known. Many jars of uranium and thorium compounds have the chemical formula written on the label.	
Gross weight		Total weight of the jar and contents.	
Compound and element weights		
•	For small jars of chemicals, the compound weights can be estimated from the apparent volume in the jar. In the “worked example” below, a 100 gram jar of uranyl acetate (as listed on the label) is estimated to be three quarters full – hence 75 g, which translates to 0.075 kg.
•	For the element weight, and again using the “worked example” below, uranyl acetate is 56.1% uranium (compare with chemical formula) – 75 g × 0.561 = 42.08g, which translates to 0.04 kg.
•	For heavy water and graphite, record the material weight in the ‘Compound’ weight column.	
Mat’l acquisition details			Where available. It is important for ASNO to know the origin of the listed items to ensure they are not being double-counted in ASNO’s records. 	
Signature/permit details		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 	ASO323 issued as version 1 on 22 December 2005.	
WORKED EXAMPLE	
Material description	
Mat’l category	
Chemical formula	
WEIGHTS	
Material acquisition details	
Storage location	

	
	
Gross	
Compound	
Element	
Isotope	

1 x jar of uranyl acetate. Item no. 412-002	
N	
UO2(CH3CO2)2.2H2O	
0.112 kg	
0.075 kg	
0.042 kg	
	
Rec’d from Uni. Of Birdsville, April1988	
Chem. Store, Room 217	

Sentinel 660 source projector. Serial no. 6172518	
D	
metal	
24 kg	
16.80 kg	
16.80 kg	
	
Imported from UK, March 2005	
Radiation Store,
XYZ Company P/L	

2% enriched uranium oxide powder	
E	
UO2	
154.52 g	
150.00 g	
130.29 g	
2.61 g	
Imported from Belgium, December 2010	
Radiation Store