ML18022A175

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Surveying Solutions, Inc., License Renewal Application. Dated 01/11/2018
ML18022A175
Person / Time
Site: 03037659
Issue date: 01/11/2018
From: Ball A R
Surveying Solutions
To:
NRC/RGN-III/DNMS/MLB
References
602167
Download: ML18022A175 (3)
v • d • e


Text

January 11th, 2018 Materials Licensing Branch U.S. Nuclear Regulatory Commission, Region III 2443 Warrenville Road, Suite 210 Lisle, Illinois 60532-4352 RE: NRC Material License No. 21-32687-01 Renewal Application NRC Form 313 To whom it may concern: SURVEYING

  • ENGINEERING
  • CONSTRUCTION SERVICES residential
  • commercial
  • design
  • construction
  • GPS I just noticed that I did not sign NRC Form 313 in the NRC License Renewal Package that was sent earlier today. Please add the attached signed form 313 to that package. If you have any questions, please feel free to give me a call at (989) 846-6601.

Sincerely, SURVEYING SOLUTIONS, INC. ~. Adam R. Ball, P .E. Radiation Safety Officer/ Project Engineer aball@ssi-mi.com RECEIVED JAN 2 2* 2018 surveying FOR TODAY... solutions FOR THE FUTURE ... 4471 M-61, Standish, Michiqan 48658

  • tel 989-846-6601
  • fax 989-846-6607
  • www.ssi-mi.com NRC FORM 313 (10-2017) 10 CFR 30, 32, 33, 34, 35, 36, 37, 39, and 40 U.S. NUCLEAR REGULATORY COMMISSION APPLICATION FOR MATERIALS LICENSE APPROVED BY 0MB: NO. 3150-0120 EXPIRES: 06/30/2019 Estimated burden per response to comply with this mandatory collection request 4.3 hours3.472222e-5 days <br />8.333333e-4 hours <br />4.960317e-6 weeks <br />1.1415e-6 months <br />. Submittal of the application is necessary to determine that the applicant is qualified and that adequate procedures exist to protect the public health and safety. Send commen1s regarding burden estimate to the Information Seivices Branch (T -2 F43), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to lnfocollec1s.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150--0120), 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.

INSTRUCTIONS:

SEE THE CURRENT VOLUMES OF THE NUREG-1556 TECHNICAL REPORT SERIES ("CONSOLIDATED GUIDANCE ABOUT MATERIALS LICENSES")

FOR DETAILED INSTRUCTIONS FOR COMPLETING THIS FORM: h!tj1:lfwm,,,nrc,ggv/readln_g-m1/<loc-c-0llections/nure..9.s/stafJjJ![1§56/.

SEND TWO COPIES OF THE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW. APPLICATION FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH: MATERIALS SAFETY LICENSING BRANCH DIVISION OF MATERIAL SAFETY, STATE, TRIBAL AND RULEMAKING PROGRAMS OFFICE OF NUCLEAR MATERIALS SAFETY AND SAFEGUARDS U.S. NUCLEAR REGULATORY COMMISSION WASHINGTON, DC 20555-0001 ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS: IF YOU ARE LOCATED IN: ALABAMA, CONNECTICUT, DELAWARE, DISTRICT OF COLUMBIA, FLORIDA, GEORGIA, KENTUCKY, MAINE, MARYLAND, MASSACHUSETIS, NEW HAMPSHIRE, NEW JERSEY, NEW YORK, NORTH CAROLINA, PENNSYLVANIA, PUERTO RICO, RHODE ISLAND, SOUTH CAROLINA, TENNESSEE, VERMONT, VIRGINIA, VIRGIN ISLANDS, OR WEST VIRGINIA, SEND APPLICATIONS TO: LICENSING ASSISTANCE TEAM DIVISION OF NUCLEAR MATERIALS SAFETY U.S. NUCLEAR REGULATORY COMMISSION, REGION I 2100 RENAISSANCE BOULEVARD, SUITE 100 KING OF PRUSSIA, PA 19406-2713 IF YOU ARE LOCATED IN: ILLINOIS, INDIANA, IOWA, MICHIGAN, MINNESOTA, MISSOURI, OHIO, OR WISCONSIN, SEND APPLICATIONS TO: MATERIALS LICENSING BRANCH U.S. NUCLEAR REGULATORY COMMISSION, REGION Ill 2443 WARRENVILLE ROAD, SUITE 210 LISLE, IL 60532-4352 IF YOU ARE LOCATED IN: ALASKA, ARIZONA, ARKANSAS, CALIFORNIA, COLORADO, HAWAII, IDAHO, KANSAS, LOUISIANA, MISSISSIPPI, MONTANA, NEBRASKA, NEVADA, NEW MEXICO, NORTH DAKOTA, OKLAHOMA, OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, TEXAS, UTAH, WASHINGTON, OR WYOMING, SEND APPLICATIONS TO: NUCLEAR MATERIALS LICENSING BRANCH U.S. NUCLEAR REGULATORY COMMISSION, REGION IV 1600 E. LAMAR BOULEVARD ARLINGTON, TX 76011-4511 PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION JURISDICTIONS.

1. THIS IS AN APPLICATION FOR (Check appropriate item) D A. NEW LICENSE D 8. AMENDMENT TO LICENSE NUMBER [Z] C. RENEWAL OF LICENSE NUMBER 21-32687-01
2. NAME AND MAILING ADDRESS OF APPLICANT (Include zip code) Surveying Solutions, Inc. 4471 M-61 Standish, Ml 48658 3. ADDRESS WHERE LICENSED MATERIALS WILL BE USED OR POSSESSED
4. NAME OF PERSON TO BE CONTACTED ABOUT THIS APPLICATION Adam R. Ball 4471 M-61 Standish, Ml 48658 and 1000 s. US-27, St. Johns, Ml 48879 and BUSINESS TELEPHONE NUMBER BUSINESS CELLULAR TELEPHONE NUMBER 989-846-6601 989-484-0358 Anywhere Surveying Solutions, Inc. maintains jurisdiction 1-------------...._------------t for regulating the use of radioactive materials.

BUSINESS E-MAIL ADDRESS aball@ssi-mi.com SUBMIT ITEMS 5 THROUGH 11 ON 8-1/2 X 11" PAPER. THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED IN THE LICENSE APPLICATION GUIDE. 5. RADIOACTIVE MATERIAL 6. PURPOSE(S)

FOR WHICH LICENSED MATERIAL WILL BE USED. a. Element and mass number; b. chemical and/or physical form; and c. maximum amount 7. INDIVIDUAL(S)

RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR TRAINING AND which will be possessed at any one time. EXPERIENCE.

8. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS. 9. FACILITIES AND EQUIPMENT.
10. RADIATION SAFETY PROGRAM. 11. WASTE MANAGEMENT. (See 10 CFR 170 and Section 170.31) CA-iE~~RY
12. LICENSE FEES (Fees required only for new applications, with few exceptions*)

I *Amendments/Renewals that Increase the scope of the existing llcense to a new or higher fee category will require a fee. I AMOUNT $1 ENCLOSED PER THE DEBT COLLECTION IMPROVEMENT ACT OF 1996 (PUBLIC LAW 104-134), YOU ARE REQUIRED TO PROVIDE YOUR TAXPAYER IDENTIFICATION NUMBER. PROVIDE THIS INFORMATION BY COMPLETING NRC FORM 531: h!!p~~/www,nn:.,go\llrnffd.lng,.rm/dQ!:.,!;QIJ!!!;tlQ1l$/fQ!'.!1:llilnr~Ulnfp,html.

13. CERTIFICATION. (Must be completed by applicant)

THE APPLICANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENTATIONS MADE IN THIS APPL/CATION ARE BINDING UPON THE APPLICANT.

THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEHALF OF THE APPLICANT, NAMED IN ITEM 2, CERTIFY THAT THIS APPLICATION IS PREPARED IN CONFORMITY WITH TITLE 10, CODE OF FEDERAL REGULATIONS, PARTS 30, 32, 33, 34, 35, 36, 37, 39, AND 40, AND THAT ALL INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF. WARNING: 18 U.S.C. SECTION 1001 ACT OF JUNE 25, 1948 62 STAT. 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.

CERTIFYING OFFICER -TYPED/PRINTED NAME AND TITLE Adam R. Ball, Radiation Safety Officer NRC FORM 313 (10-2017)

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