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DEPARTMENT OF HEALTH SERVICES Division of Public Health F-45009 05/12 STATE OF WISCONSIN Bureau of Environmental and Occupational Health Radiation Protection Section 608 267-4797 APPLICATION FOR RADIOACTIVE MATERIAL LICENSE AUTHORIZING THE USE OF SEALED SOURCES IN FIXED GAUGE DEVICES Department of Health Services is requesting disclosure of information. Failure to provide any information may result in denial or delay of a radioactive material lic.

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