ML19095A466

Appendix E, 741 - NRC Form 741_AA_ZBV_VDM_Transaction_4

ML19095A466
Person / Time
Site:	07000371
Issue date:	03/01/2018
From:	Cabrera Services
To:	NRC Region 1
Shared Package
ml051740240	List: ML19095A013 ML19095A014 ML19095A016 ML19095A017 ML19095A018 ML19095A019 ML19095A020 ML19095A021 ML19095A022 ML19095A023 ML19095A024 ML19095A025 ML19095A030 ML19095A034 ML19095A035 ML19095A036 ML19095A037 ML19095A038 ML19095A040 ML19095A042 ML19095A043 ML19095A045 ML19095A046 ML19095A048 ML19095A049 ML19095A051 ML19095A052 ML19095A055 ML19095A056 ML19095A060 ML19095A061 ML19095A063 ML19095A064 ML19095A067 ML19095A069 ML19095A198 ML19095A200 ML19095A201 ML19095A204 ML19095A205 ML19095A206 ML19095A268 ML19095A269 ML19095A319 ML19095A321 ML19095A322 ML19095A324 ML19095A325 ML19095A326 ML19095A328 ... further results
References
Download: ML19095A466 (1)

Text

DOE/NRC FORl,l 74i

..,.'"'"c,.^

U. S. DEPARTMENTOF ENERGY (10-2014) Previous editions are obsolete -r'h..,r/l, AND Mnlroaiony orr.q coLLEcTtoN

*{$#..3 U. S, NUCLEAR REGULATORY COMMISSION AUTHoRIZED BY 10 CFR 30 40. s0. 70, T(lil$l{tr*'

72,74,75, 150 PubricLawss3-703'e3-438'e5-e1 NUCLEAR MATERIAL TRANSACIoN REpoRT APPROVEDBYOMB: NO,3150-0003 EXPIRES: 1013112017 Estimalod burden per rcsponse to comply wilh lhis m.ndalory @lloclion requesl: t hou and 15 minulss. this information is required fot IAEA accounting reporlG thal 6how chango8 in lnvenlory ol nucloar materials. Send commonls rogardlng burdon slimate lo the F0lA, Privacy ad lnlormalion Colloclions Branch {T-5 F53), U.S, Nuclear Rogulalory Commis6ion Washington, DC 205554001, ot by inlernet email to (3150-0003),

Moagemenl and BudgI, Washing{s, DC m503. ll a mans wd lo impN an infomallr cdlclim d6s rcl display a ouronlly vdid OMB @nlrcl number, lh6 NRC may nol oonduol q sponsor, and a person is notrequiEd lo r6po[d to, lho infomstion colleclion, Regulatory 1-sHtpERai6l2.RrcEUEiEitsl!,ti^x6rcTpNNo.

zBY lvott F

S..NAMEANDAOOREgS b-LICENSE OF SHIPPER

{O-Cabrera Services Inc.

50 Founders Plaza stez$7 East Hartford Ct 06108

" o't"*"'Mike Plonski s.r, NAME AND AooFEss : b, LICENSE oFREcEIvER No.

ENERGY SOI,IITIONS

]cllvs paclrlrv 423 WEST 3OO SOUTH, SUITE 2OO SALT LAKE CITY, UT 84IOI I

I c.ArENrEN JIISTIN LEE I

• I*..***

i' I

G. Uk REPoiIABE? I l.j"*T 1s6017_?t!els _F::tlt_!.8_0lt 64e:2I9

4. TRANSFER AUTHORITY-CONTRACT.

NM DRAtr. OR ORDER NUMBER

-GJ,IATERIAL T.1PE AND o 6

,3a. t,llscELt (NEOUS

]

YEs iZ*

DAra LINES 6 tu F6F7666IirToTT-

b. Rrs t-s.ffi m

,,". I couf,rEY oF I u^rr*,*

NuMsEFl o6rcaToN i Ef ----T---

ET

--_T_r-l-_

11, NATUREOFIRANBACTEN I3;Sf,FFEmAddd-m--

f--'

b. Rt6 t'

zo.

2' I"

,,..#,1!",lEL-,::'"':,.fl.{tf,::::, l,

l--

l,,,o,.n, I o "*,"o."r"o""r"r,on l' "*'o' l ",,.,:.".-"-,",.

2s. ro rrL voLUMt r&16 rr*t.^ o.ry'47 25 DETREUTIO{ OF COflES

-Emfui I vwi I {MD I (oq I frY.n

-fsT-1ror?

-t--1--t--

-f-r tll*lll.lI mK lrlNElryPE neen:rce I No. loFNv.

ruxBER l

l cHANoE

.1".1".

l2l

_l3l 141 t5J t5l tl FT ol-lt-dlU.tL o-l! l._

I]oldi*f f

J MATE-coMP/

I nm eecm l-*i-*l r,.

2o Vta I lzo itto I w:tu{)

lro ltlt)

Po ?rc1 lzo fie I T--" f-t

]

IOEHTIFEArctr I

rtwurcnwa l.

IERRU03t2 ltufr{Fr]2362 lcrluzros lbFLUlo32 lrsnuoro lcruuzrrz r---

rc.or I PRoJEcr trus l

truMBER CODE i.

ISOTOPE fff 2cr.sHlPPERs

?;:r[p{ru,""

ANU UAI E SIGNED 6/ zt 1 r ?

lr0 +

27s.REGEMER'S DATA Fof u,tu>i lt(.)T l!E!-

r:

Ni-m z-I

--- - -l-r

--l

]r E

-t-T*+

l--T-+

T--1--

tr I

F-:

T----r----

t:

t--]--

WARNING: FALSE STATEMENTS lN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C. SECTION 1OO1 MAKES IT A CRIMINAL OFFENSE TO MAKE A WLLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WTHIN ITS JURISDICTION.

DOE/NRC FORlVI 74'.1 110-2014)

GROSSWEEH' hE'ffiIGF I ELEMENI ELEMEN' WEGHT%

ISOTOPE wErGF' tlffi' rsoroPE I MEqr