ML16019A014
| ML16019A014 | |
| Person / Time | |
|---|---|
| Site: | North Anna  |
| Issue date: | 12/18/2015 |
| From: | Gerald Bichof Virginia Electric & Power Co (VEPCO) |
| To: | Office of Nuclear Material Safety and Safeguards |
| References | |
| 15-581 | |
| Download: ML16019A014 (8) | |
Text
VIRGINIA ELECTRIC AND POWER COMPANY RICHMIOND, VIRGINIA 23261 December 18, 2015 Director, Office of Nuclear Material Safety Serial No.15-581 and Safeguards NAPS/J HL ATTN: GLTS Docket Nos. 50-338/339 U. S. Nuclear Regulatory Commission License Nos. NPF-4/7 Washington, DC 20555-0001 Gentlemen:
VIRGINIA ELECTRIC AND POWER COMPANY (DOMINION)
NORTH ANNA POWER STATION UNITS 1 AND 2 ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICES In accordance with 10 CFR 31.5, enclosed is NRC Form 664, General Licensee Registration, for registration of generally licensed devices maintained at North Anna Power Station.
If you have any questions, please contact Mr. R. B. Evans at (540) 894-2107.
Sincerely, Site Vice President Enclosure Commitments made by this letter: None cc: U.S. Nuclear Regulatory Commission Attention: Document Control Desk Washington, D. C. 20555-0001 U.S. Nuclear Regulatory Commission Region II Marquis One Tower 245 Peachtree Center Ave., NE Suite 1200 Atlanta, Georgia 30303-1257 NRC Senior Resident Inspector North Anna Power Station
' IIIIIIII MIIIIIIII IIIii IIIII Ilil IIIII IIIIIIIII MIIIII IIII IIII SECTION 1 GL-7001 15-20 10/30/2015 PAGE 1 of 2 NRC FORM 664 U.S. NUCLEAR REGULATORY COMMISSION 07 -2015 10 CFR 31.5 GENERAL LICENSEE REGISTRATION APPROVED BY 0MB: NO. 31 50-01 98 EXPIRES: 04/30/2016 Estimated burden per response to comply with this mandatory 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, Privacy, and Information Collections Branch (T-5 F53), U. S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1 0202, (3150-0198), Office of Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a currently valid 0MB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.
Complete all six sections of this registration form. Ifany of the preprinted information is incorrect, provide the changes in the applicable boxes. USE CAPITAL LETTERS.
General License SECTION 1 - GENERAL LICENSEE INFORMATION Registration Number GL-700115-20 Enter the company name and the street address/physical location of use for your device(s). For portable devices, specify the primary storage location. Do not use a P.O. Box address.
Company Name: DOMINION VIRGINIA POWER Department: NORTH ANNA POWER STATIC Address Line 1: 1022 HALEY DRIVE Address Line 2: END OF ROUTE 700 City: MINERAL State: VA Zip Code: 23117 - 0402 For (Do NRC Use Only; not write here) category::* y:* i A A
t III 1111111111111 IIII III 1111 ll III111n III l 1111 III 11III1 IIII 1III IIIIIIIII IIII 1111 11M11 III IIIIII GL-700115-20 SECTION 1 10/30/2015 PAGE 2 of 2 SECTION 1 - GENERAL LICENSEE INFORMATION (Continued)
Enter the name, teleiphone number and title of the person who is the responsible individual for the device(s).
Last Name: EVANS First Name: ROBERT Middle Initial: B Telephone: (540) 894-2107 Extension:
WEZZIIEWE WI
Title:
CURRENT SAFETY OFFICER Enter the mailing address where correspondence regarding your devicels) should be sent.
This address should be specific to the use or storage location of your device(s).
Department: NORTH ANNA POWER STATION Address Line 1: 1022 HALEY DRIVE Address Line 2: END OF ROUTE 700 City: MINERAL Stte V Z Coep 31 00 - EII I A A
GL-7001 15-20 10/30/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION IuIIII SEC*,TION 2 Our records indicate that you have these devices. Please update the information as necessary. PAG El1 of 1 NRC Device Key 595514 (Internal Control Number)
Distributor/Distributed By: OXFORD INSTRUMENTS ANALYTICAL Distributor License Number: 29-30342-02G Manufacturer Name: METOREX, INC Device Model (Not Source Model): DOPS Device Serial Number: 128018 Transfer Date (Receipt Date): 08/12/1 999 I I* II~*Not _Jl D]
inpossession of device (Also complete Section 4.)
MM DD YYYY Isotope (e.g. AM241 ) Activity (e.g. 100) Unit (e.g. mCi) 1 AM241 30.000000000 mCi 2
EW 3
EW 4
EW 5
WE 6
WE WE A A
111111II II~III GL-7001 15-20 IIHiII 11111 IIII Ii11 111IIIII 11III 11II IIIIII II1111 II IIIIIII111 II I1IIII IIIII IIII 10/30/2015 SECTION 3 SECTION 3 - ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1 Provide information about other devices you have that are subject to registration. Do not report specifically licensed devices.
Manufacturer Name Initial Transferor Name I
Initial Transferor License Number (if known)
I Device Model Number (Not Source Model)
Device Serial Number I
0 Manufacturer/initial Transferor listed above How acquired and date (e.g.,I' jj jj J l
from a distributor/manufacturer, 0 Other General Licensee Date Transferred: jj* I I other licensee, other source)? -
UJ Other Source (Received) MM DD Y YY Y Isotope (eg. AM241) Activity (eg. 100) Unit (e.g. mCi) 1.
II III il II WE 2.
III II 3.
DWZZ* hb II WE 4.
Ir II WE 5.
fl I I I II I I 4 I WE 6.
II I I I II I t I f LW 7.
II W I I II WE 8.
r l I I I II I i I I WE 10.
WE A A
/ I lIII1I11 GL-0/0/1201 11II I 11 HIIIill I1I1 111111 HIill11111 111111il1l11II1 Il111I11 I11111111 SECTION 4 - NOT IN POSSESSION OF DEVICE IIII i i IIII I11III Il SECTION 4 Provide information about devices listed in Section 2 or 6, but no longer in your possession. PAGE 1 of 1 Part 1 Transfer Date:
NRC Device Key: * ** _ L - J (from Section 2 or 6)
MM DD YYYY Location of the Device:
o Whereabouts Unknown (complete Part 1 only) 0 Transferred to another general licensee (complete Parts 2 and 3) o Never Possessed the Device (complete Part 1 only) 0 Transferred to a Specific Licensee (Not the manufacturer) o Returned to Manufacturer (complete Part 1 only) (complete Part 2)
Part 2 License Number of Recipient (if transferred to a specific licensee):
Company Name:
Department:
Address Line 1:
Address Line 2:
City:
Part 3 Enter the name of the individual responsible for this device:
Last Name:
First Name: Middle Initial:
Title:
1K K A A
I111IIII11111I11I11IIIII11ii 1I1ii1I1111 III 011I1111 IIIIMIlIII IIII IMII111 IIII IIIIIIIIIIIII GL-7001 15-20 SECTION 5 - CERTIFICATION SECTION 5 10/30/2015 PAGE 1 of 1 I hereby certify that:
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. Ilam aware of the requirements of the general license, provided in 10 CFR 31.5.
(Copies of applicable regulations may be viewed at the NRC website at:
http:llww.nrc. gov/reading-rm/doc-collections/cfr)
SIGNATURE - RESPONSIBLE INDIVIDUAL (Listed in Section 1) DATE WARNING: FALSE STATEMENTS MAY BE SUBJECT TO CIVILAND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIALASPECTS. 18 U.S.C. SECTION 1001 MAKES ITACRIMINAL OFFENSE TO MAKEAWILLFULLY WRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER IN ITS JURISDICTION.
A A
/ l~III II~III GL-700115-20 III11111 III111 II~IlIIII I IlI 1111!1 IIII lIiiIIIll IIIIIIIIIIIII IIIII IIIIIIIIIIII 10/30/2015.. . .= . . .. . . . ..
................... .q FI*.TI N kl R PAGE 1 of 1 NRC Device Key: 825331 Manufacturer License No: 12-04933-04G Manufacturer Name: PERKINELMER LIFE SCIENCES Model Number: B31 0000 Serial #: DG08129527 Transfer Date: 07/20/2012 Isotope: BA133 Activity: 0.020000000 Unit: uCi NRC Device Key: 689428 Manufacture r License No: 20-15525-04G Manufacturer Name: GE ION TRACK Model Number: ITEMISER Ill Serial #: 09-8424 Transfer Date: 06/30/2003 Isotope: NI63 Activity: 10.000000000 Unit: mCi NRC Device Key: 707159 Manufacturer License No: 455-01G Manufacturer Name: METOREX, INC.
Model Number: 880 Serial #: 128018 Transfer Date: 02/27/2002 Isotope: CD109 Activity: 10.0'00000000 Unit: mCi NRC Device Key: 547351 Manufactt urer License No: MD-31-076-01 Manufacturer Name: CONCO SERVICES CORP.
Model Number: 101 Serial #: N596 Transfer Date: 02/1 5/1 994 Isotope: NI63 Activity: 5.000000000 Unit: mCi
VIRGINIA ELECTRIC AND POWER COMPANY RICHMIOND, VIRGINIA 23261 December 18, 2015 Director, Office of Nuclear Material Safety Serial No.15-581 and Safeguards NAPS/J HL ATTN: GLTS Docket Nos. 50-338/339 U. S. Nuclear Regulatory Commission License Nos. NPF-4/7 Washington, DC 20555-0001 Gentlemen:
VIRGINIA ELECTRIC AND POWER COMPANY (DOMINION)
NORTH ANNA POWER STATION UNITS 1 AND 2 ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICES In accordance with 10 CFR 31.5, enclosed is NRC Form 664, General Licensee Registration, for registration of generally licensed devices maintained at North Anna Power Station.
If you have any questions, please contact Mr. R. B. Evans at (540) 894-2107.
Sincerely, Site Vice President Enclosure Commitments made by this letter: None cc: U.S. Nuclear Regulatory Commission Attention: Document Control Desk Washington, D. C. 20555-0001 U.S. Nuclear Regulatory Commission Region II Marquis One Tower 245 Peachtree Center Ave., NE Suite 1200 Atlanta, Georgia 30303-1257 NRC Senior Resident Inspector North Anna Power Station
' IIIIIIII MIIIIIIII IIIii IIIII Ilil IIIII IIIIIIIII MIIIII IIII IIII SECTION 1 GL-7001 15-20 10/30/2015 PAGE 1 of 2 NRC FORM 664 U.S. NUCLEAR REGULATORY COMMISSION 07 -2015 10 CFR 31.5 GENERAL LICENSEE REGISTRATION APPROVED BY 0MB: NO. 31 50-01 98 EXPIRES: 04/30/2016 Estimated burden per response to comply with this mandatory 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, Privacy, and Information Collections Branch (T-5 F53), U. S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1 0202, (3150-0198), Office of Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a currently valid 0MB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.
Complete all six sections of this registration form. Ifany of the preprinted information is incorrect, provide the changes in the applicable boxes. USE CAPITAL LETTERS.
General License SECTION 1 - GENERAL LICENSEE INFORMATION Registration Number GL-700115-20 Enter the company name and the street address/physical location of use for your device(s). For portable devices, specify the primary storage location. Do not use a P.O. Box address.
Company Name: DOMINION VIRGINIA POWER Department: NORTH ANNA POWER STATIC Address Line 1: 1022 HALEY DRIVE Address Line 2: END OF ROUTE 700 City: MINERAL State: VA Zip Code: 23117 - 0402 For (Do NRC Use Only; not write here) category::* y:* i A A
t III 1111111111111 IIII III 1111 ll III111n III l 1111 III 11III1 IIII 1III IIIIIIIII IIII 1111 11M11 III IIIIII GL-700115-20 SECTION 1 10/30/2015 PAGE 2 of 2 SECTION 1 - GENERAL LICENSEE INFORMATION (Continued)
Enter the name, teleiphone number and title of the person who is the responsible individual for the device(s).
Last Name: EVANS First Name: ROBERT Middle Initial: B Telephone: (540) 894-2107 Extension:
WEZZIIEWE WI
Title:
CURRENT SAFETY OFFICER Enter the mailing address where correspondence regarding your devicels) should be sent.
This address should be specific to the use or storage location of your device(s).
Department: NORTH ANNA POWER STATION Address Line 1: 1022 HALEY DRIVE Address Line 2: END OF ROUTE 700 City: MINERAL Stte V Z Coep 31 00 - EII I A A
GL-7001 15-20 10/30/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION IuIIII SEC*,TION 2 Our records indicate that you have these devices. Please update the information as necessary. PAG El1 of 1 NRC Device Key 595514 (Internal Control Number)
Distributor/Distributed By: OXFORD INSTRUMENTS ANALYTICAL Distributor License Number: 29-30342-02G Manufacturer Name: METOREX, INC Device Model (Not Source Model): DOPS Device Serial Number: 128018 Transfer Date (Receipt Date): 08/12/1 999 I I* II~*Not _Jl D]
inpossession of device (Also complete Section 4.)
MM DD YYYY Isotope (e.g. AM241 ) Activity (e.g. 100) Unit (e.g. mCi) 1 AM241 30.000000000 mCi 2
EW 3
EW 4
EW 5
WE 6
WE WE A A
111111II II~III GL-7001 15-20 IIHiII 11111 IIII Ii11 111IIIII 11III 11II IIIIII II1111 II IIIIIII111 II I1IIII IIIII IIII 10/30/2015 SECTION 3 SECTION 3 - ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1 Provide information about other devices you have that are subject to registration. Do not report specifically licensed devices.
Manufacturer Name Initial Transferor Name I
Initial Transferor License Number (if known)
I Device Model Number (Not Source Model)
Device Serial Number I
0 Manufacturer/initial Transferor listed above How acquired and date (e.g.,I' jj jj J l
from a distributor/manufacturer, 0 Other General Licensee Date Transferred: jj* I I other licensee, other source)? -
UJ Other Source (Received) MM DD Y YY Y Isotope (eg. AM241) Activity (eg. 100) Unit (e.g. mCi) 1.
II III il II WE 2.
III II 3.
DWZZ* hb II WE 4.
Ir II WE 5.
fl I I I II I I 4 I WE 6.
II I I I II I t I f LW 7.
II W I I II WE 8.
r l I I I II I i I I WE 10.
WE A A
/ I lIII1I11 GL-0/0/1201 11II I 11 HIIIill I1I1 111111 HIill11111 111111il1l11II1 Il111I11 I11111111 SECTION 4 - NOT IN POSSESSION OF DEVICE IIII i i IIII I11III Il SECTION 4 Provide information about devices listed in Section 2 or 6, but no longer in your possession. PAGE 1 of 1 Part 1 Transfer Date:
NRC Device Key: * ** _ L - J (from Section 2 or 6)
MM DD YYYY Location of the Device:
o Whereabouts Unknown (complete Part 1 only) 0 Transferred to another general licensee (complete Parts 2 and 3) o Never Possessed the Device (complete Part 1 only) 0 Transferred to a Specific Licensee (Not the manufacturer) o Returned to Manufacturer (complete Part 1 only) (complete Part 2)
Part 2 License Number of Recipient (if transferred to a specific licensee):
Company Name:
Department:
Address Line 1:
Address Line 2:
City:
Part 3 Enter the name of the individual responsible for this device:
Last Name:
First Name: Middle Initial:
Title:
1K K A A
I111IIII11111I11I11IIIII11ii 1I1ii1I1111 III 011I1111 IIIIMIlIII IIII IMII111 IIII IIIIIIIIIIIII GL-7001 15-20 SECTION 5 - CERTIFICATION SECTION 5 10/30/2015 PAGE 1 of 1 I hereby certify that:
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. Ilam aware of the requirements of the general license, provided in 10 CFR 31.5.
(Copies of applicable regulations may be viewed at the NRC website at:
http:llww.nrc. gov/reading-rm/doc-collections/cfr)
SIGNATURE - RESPONSIBLE INDIVIDUAL (Listed in Section 1) DATE WARNING: FALSE STATEMENTS MAY BE SUBJECT TO CIVILAND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIALASPECTS. 18 U.S.C. SECTION 1001 MAKES ITACRIMINAL OFFENSE TO MAKEAWILLFULLY WRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER IN ITS JURISDICTION.
A A
/ l~III II~III GL-700115-20 III11111 III111 II~IlIIII I IlI 1111!1 IIII lIiiIIIll IIIIIIIIIIIII IIIII IIIIIIIIIIII 10/30/2015.. . .= . . .. . . . ..
................... .q FI*.TI N kl R PAGE 1 of 1 NRC Device Key: 825331 Manufacturer License No: 12-04933-04G Manufacturer Name: PERKINELMER LIFE SCIENCES Model Number: B31 0000 Serial #: DG08129527 Transfer Date: 07/20/2012 Isotope: BA133 Activity: 0.020000000 Unit: uCi NRC Device Key: 689428 Manufacture r License No: 20-15525-04G Manufacturer Name: GE ION TRACK Model Number: ITEMISER Ill Serial #: 09-8424 Transfer Date: 06/30/2003 Isotope: NI63 Activity: 10.000000000 Unit: mCi NRC Device Key: 707159 Manufacturer License No: 455-01G Manufacturer Name: METOREX, INC.
Model Number: 880 Serial #: 128018 Transfer Date: 02/27/2002 Isotope: CD109 Activity: 10.0'00000000 Unit: mCi NRC Device Key: 547351 Manufactt urer License No: MD-31-076-01 Manufacturer Name: CONCO SERVICES CORP.
Model Number: 101 Serial #: N596 Transfer Date: 02/1 5/1 994 Isotope: NI63 Activity: 5.000000000 Unit: mCi