ML14057A390

Single Positive Test Form, for Random, Collected on 12/16/2013

ML14057A390
Person / Time
Site:	Palisades
Issue date:	02/13/2014
From:	Dotson B, Rabideau B Entergy Nuclear Operations
To:	Document Control Desk, Office of Nuclear Security and Incident Response
Shared Package
ML14057A574	List: ML14057A389 ML14057A390 ML14057A391 ML14057A392 ML14057A393 ML14057A395 ML14057A397 ML14057A398 ML14057A399 PNP 2014-016, Single Positive Test Form, for Pre-Access, Collected on 11/25/2013
References
2013-PAL-005, PNP 2014-016
Download: ML14057A390 (1)

Text

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Uniaue Reference Number CUcenoee SUDDliadl popu/olod/nlo

_"""'_ 12013-PAL-OOS I I} U.oA_R_' ",_for IN. """' ---'Y. 4} Hold YOIII' mow. ov.,. fonn field Mi "' .. alltlHJoMllnfonnUJon.

Select Facility Ipalisades

[50-255] I Date of Collection (mmld<llyyyy) 112116/2013 I Reason fo, T_ng-26.717(b)(5)

Please elaborate (optional)

IRandom I I I Emp/oytMnl Type -26.717(b)(3)

IContractorNendor I

IMaintenance (Craft) I Refusal* 26.717(b)(7)

& 26.75 EJ was this collection refu.ed (ye.' No)? Test Reaulta-26.717(b)(4)

Test Validity IValid I Test Typa(s) for Result(s)

Reported -26.717(b)(2)

Drug Testing IDrug Only I lurine I Wa. thIs collection o_twd (yea' No)? -26.717(b)(7)

& 26.75 INo I Sub.mnce -26.717(b)(2)

& (b)(6) Additional Sub.r.nca (a. appllcabla)

Additional Sub.r.nca ( .. applicable)

IMarijUana I I Please Select I Iplease Select I Use NRC Cutoff (yes' No)? Is this a Z4-Hou, Reporting Event (YasINo)?

-

Subve",'on Attempts -26.717(b)(7) and 26.75 (b) O l d this coHaction involve a subversion allampl (Yes/No)?

INO I Manal18lfl8lll Attlona -26.717(b)(8)

& 26.75 Reason for the Action IFirst drug or alcohol positive I Sanction Applied (NRC Minimum or Licensee Administrated)

I Licensee Administrated I Specific Sanction Applied 13-Year Denial I Pel'lJOn(s)

Reapons/bla fo, Information Provided Person 1 (requfred)

IBrion First Name list Name IISUpotVlo.r. A<ce .. AutharizotianIFFO PositionTIlla I brabideGentergy

.cam Company Email Addre.s Person 2 (optional)

F irst Name Last Name II Utenslng Spe cl ollst Position Tide I bd.tsonlltentorgy.com Company Email Addres. Final Step (RequIred)

-NRC will consider this form authentic in accordance with 2B.11 only when the 'Validate

& Loci<" bullon has been selected and all errors (i.e .. those highlighted in red) have been corrected.

The 'Validate

& LocI<-bullon will change to -LocI<ed" after the data validation process has bean successfully completed and the fonn is ready for submission.

_ Form Locked on: IFeb 13. 2014 at 1: 56: 15 PM I I Save \0 Local PC I I Print this Report I Single Positive Test Form (version 1.5.0 -January 1. 2014)