GL-726474-29, GLTS: Annual General Licensee Registration from: Marathon Pipeline (GL-726474-29)

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GLTS: Annual General Licensee Registration from: Marathon Pipeline (GL-726474-29)
ML24254A273
Person / Time
Issue date: 05/13/2024
From: Grimes M
Office of Nuclear Material Safety and Safeguards
To: Cox V
Office of Nuclear Material Safety and Safeguards
References
GL-726474-29
Download: ML24254A273 (1)
v • d • e


Text

I 111111111111111 1111111111111111 IIIII IIIII IIIII IIII IIIIII IIIII IIII IIII 111111111111111111 IIII IIIIIII Ill llll llll GL-726474-29 04/11/2024 SECTION 1 PAGE 1 of 2 NRC FORM 664 (11 - 2022)

U.S. NUCLEAR REGULATORY COMMISSION 10 CFR 31.5 GENERAL LICENSEE REGISTRATION APPROVED BY 0MB: NO. 3150-0198 0MB EXPIRATION DATE: 11/30/2025 Estimated burden per response lo comply with this mandato,y collection request: 20 minutes. NRC will use this information to track general licensees and their devices to ensure a higher level of device accountability. Send comments regarding burden estimate to the FOIA, Libra,y, and Information Collections Branch (T-6 A10M), U. S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to lnfocoflecls. Resource@nrc.gov, and the 0MB reviewer at: 0MB Office of Information and Regulato,y Affairs, (3150-0198), Attn: Desk Officer for the Nuclear Regulato,y Commission, 725 17th Street NW, Washington, DC 20503; e-mail: oira submrss,on@omb eop gov.

The NRC may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the document requesting or requiring the collection displays a currently valid 0MB control number.

Complete all six sections of this registration form. If any of the preprinted information is incorrect, provide the changes in the applicable boxes. USE CAPITAL LETTERS.

General License Registration Number GL-726474-29 SECTION 1 - GENERAL LICENSEE INFORMATION Enter the company name and the street address for the physical location of use for your device(s). For portable devices, specify the primary storage location. Do not use P.O. Boxes.

Company Name: MARATHON PIPE LINE LLC I I I I I I I I I I I I I I I I I I I I I Department:

I I I I I I I I I I I I I I I I I I I I I Address Line 1:

1189 TANK FARM ROAD I I I I I I I I I I I I I I I I I I I I I Address Line 2:

I I I I I I I I I I I I I I I I I I I City:

POCATELLO I I l I I I I I I I I I I I I I I I I I I State: ID rn Zip Code: 83204 I I I I I I -I I I

For NRC Use Only (Do not write here)

Category: rn Packet Receipt Date (MMDDYYYY):

I I I I I I I I Accession Number:

I I I I I I I I I I I I I

I I

I IIIIIII IIIIII II llllll lllll lllll lllll lllll lllll llll 1111111111111111111 I llllllll llll lllll llll 111111111111111111 GL-726474-29 04/11/2024 SECTION 1 - GENERAL LICENSEE INFORMATION (Continued)

SECTION 1 PAGE 2 of 2 Enter the name, telephone number and title of the person who is the responsible individual for the device(s).

Last Name: GRIMES I I I I I I I I I I I I I I I I I I I I I I I I First Name: MATTHHEW Middle Initial: T 11111111111111 D

Business Telephone Number:

(419) 421-2197 Extension:

I I I 11 I I 11 I I I I I

I I I I I Business E-mail Address:

MGRIMES@MARATHONPETROLEUM.COM I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I

Title:

CURRENT SAFETY OFFICER I I I I I I I I I I I I I I I I I I I I I I I I Enter the mailing address where correspondence regarding your device(s) should be sent.

Department I I I I I I I I I I I I I I I I I I I I I I I I Address Line 1; 539 SOUTH MAIN STREET I I I I I I I I I I I I I I I I I I I I I I I I Address Line 2:

ROOM X-06-002 I I I I I I I I I I I I I I I I I I I I I I I I City:

FINDLAY I I I I I I I I I I I I I I I I I I I I I I I I State OH [I] Zip Code 45840 I I I I I I -I I I I I

I IIIIIII IIIIII II llllll lllll lllll lllll lllll lllll llll 1111111111111111111 I llllllll llll 11111111111111111 GL-726474-29 04/11/2024 SECTION 2 - DEVICES SUBJECT TO REGISTRATION Our records indicate that you have these devices. Please update the information as necessary.

NRC Device Key 826819 (Internal Control Number)

Distributor/Distributed By:

Thermo Process Instruments, LP I I I I I I I I I I I I I I I I I I I I I I I I Distributor License Number:

L01105 I I I I I I I I I I I I I I Manufacturer name:

TN TECHNOLOGIES, INC, I I I I I I I I I I I I I I I I I I I I I I I I Device Model (Not Source Model): 5202 I

I I I I I I I I I I I I I I I I I I I I I I I Device Serial Number:

8987 I I I I I I I I I I I I I I I I I I I I I I I I Transfer Date:

10/15/1988 SECTION 2 PAGE 1 of1 OJ[IJI I I I I Not in possession of device (Also complete Section 4.)

MM DD YYYY Isotope (e.g. AM241)

Activity (e.g. 1005)

Unit (e.g. mCi}

1 CS137 500 mCi 2 I I I I I I I I I I I I I I I I I I I ~I I ~I I 3 I I I I I I I I I I I I I I I I I I I I I I I

~~

I I I I I I I I I I I I I I I I I I I I I I I 4

~~

I I I I I I I I I I I I I I I I I I I I I I I 5

~~

I I I I I I I I I I I I I I I I I I I I I I I 6

~11~1~1~1 I 1111111111111 1111

1111111111111111111111111111111111111111111111111111111111111111111111 111111111111111111111111111111 GL-726474-29 04111/2024 SECTION 3. ADDITIONAL DEVICES SUBJECT TO REGISTRATION SECTION 3 PAGE 1 of 1 Provide information about other devices' you have that are subject to registration. Do not report specifically licensed devices.

Manufacturer Name I I I I I I I I I I I I I I I I I I I I I I I I I I I I Initial Transferor Name I I I I I I I I I I I I I I I I I I I I I I I I I I I I lnitiarTransferor License Number (if known)

! I I I I I I I I I I I I Device Model Number (Not Source Model)

I I I I I I I I I I I I I I I I I I I I I I I I I I I I Device Ser'1al Number

! I I I I I I I I I I I I I I I I I I I I I I I I I How acquired and date (e.g.,

0 Manufacturer/Initial Transferor listed above froni a_ distributor/manufacturer, 0 Other General Licensee Date Transferred; [I] [I]

I I

j I

I other licensee, other source)?

O Other Sources MM DD YYYY Isotope (e.g. AM241) 1*

I I I I I I 2

I I I I I 3

I I I I I 4

  • I I I I I s

I I I I I 6

I I I I I

7.

I I I I I s

I I I I I 9

I I I I I 10 I I I I I I Activity (e.g. 100)

I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I Unit (e.g. mCI)

I I I I I I I I I I I I I I I I I

I I

I I I I I I I I I I I I I I

I I

I I I I I

1111111111111111111111111111111111111111111111111111111111111111111111 I 11111111111111111111111111111 GL-726474-29 04/11/2024 SECTION 4 - NOT IN POSSESSION OF DEVICE SECTION 4 Provide information about devices listed in Section 2 or 6, but no longer in your possession.

PAGE 1 of 1 Location of the Devlce:

MM DD yyyy 0 Whereabouts Unknown (Comp!ete Part 1 only) 0 Transferred to another general licensee (Complete Parts 2 and 3) 0 Never Possessed the Device (Complete Part 1 only) 0 Transferred to a Specific Licensee (Not the manufacturer) 0 Returned to Manufacturer (Complete Part 1 only)

(Complete Part 2)

Part 2 License Number of Recipient (if transferred to a specific licensee):

I I I I I I I I I I I I I Company Name; I I I I I I I I I I I I I I I I I I I I I I I I I I I I Department I I I I I I I I I I I I I I I I I I I I I I I I I I I I Address Line 1:

I I I I I I I I I I I I I I I I I I I I I I I I I Address Line 2:

I I I I I I I I I I I I I I I I I I I I I I I I I I I I City:

I I I I I I I I I I I I I I I I I I I I I I I I I I I I State DJ Zip Code I I I I I I -I I I I I Part 3 Enter the name of the individual responsibe for this device:

Last name:

I I I I I I I I I I I I I I I I I I I I I I I I I I I First name:

Middle Initial:

11111111111111 D

~~~~~~s Telephone I I I 11 I I 11 I I I I Extension

,--I,-I,-I,--I 1,-----1

Title:

I I I I I I I I I I I I I I I I I I I I I I I I I I I

11111111 IIIIII II llllll lllll lllll lllll lllll lllll llll 1111111111111111111 GL-726474-29 04/11/2024 I hereby certify that:

SECTION 5 - CERTIFICATION I llllllll llll 11111111111111111 SECTION 5 PAGE 1 of 1 A.

All information contained in this registration is true and complete to the best of my knowledge and belief.

B.

A physical inventory of the devices subject to registration has been completed, and the device information on this form has been checked against the device labeling.

C.

I am aware of the requirements of the general license, provided in 10 CFR 31.5.

(Copies of applicable regulations may be viewed at the NRG website at:

http://www.nrc.gov/reading-rm/doc-collections/cfr)

  • 2?(aµbt/) >

SIGNATURE* RESPONSIBLE INDIVIDUAL (Listed in Section 1)

DATE WARNING: FALSE STATEMENTS MAY BE SUBJECT TO CIVILAND/OR CRIMINAL PENALTIES. NRG REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRG BE COMPLETE AND ACCURATE IN ALL MATERIAL ASPECTS. 18 U.S.C SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY WRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER IN ITS JURISDICTION.

1111111111111111111111111111111111111111111111111111111111111111111111 I 11111111111111111111111111111 G l-726474-29 0411112024 SECTION 6 - DEVICE NOT SUBJECT TO REGISTRATION SECTION 6 PAGE 1 of 1 NRC Device Key:

Manufacturer License No:

Manufacturer Name:

Model Number:

Serial#:

Transfer Date:

Isotope:

Activity:

Unit:

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