ML19095A475
| ML19095A475 | |
| Person / Time | |
|---|---|
| Site: | 07000371 |
| Issue date: | 03/01/2018 |
| From: | Cabrera Services |
| To: | NRC Region 1 |
| Shared Package | |
| ml051740240 | List:
|
| References | |
| Download: ML19095A475 (4) | |
Text
DOE/NRC FORM 7.ll (10-2014) Previous sditions are obsolete MANDATORY DATA COLLECTION AUTHORIZED BY 10 CFR 30,40, 50,70, 72,74,75, 150 Public Lffi 83-703,93-438, 9t91 U, S, DEPARTMENT OF ENERGY AND U, S. NUCLEAR REGULATORY COMMISSION NUCLEAR MATERIAL TRANSACTION REPORT APPROVEDBYOMB: NO.3150-0003 EXPIRES: 10131t2017 Estimaled budsn per rosponse to comply wilh lhis mandaiory collootion roquo6t: t hour and 15 minulos, This informalion is roquired,or lAEl accounling reports lhal 6how changes in invenlory of nuclar malorials. Snd comments regarding butdon gslimale lo lho FOIA, Privacy anc lnlolmalion Colloctions Branch (T-5 F53), U.S. Nuclear Regulalory Commis6ion, Washinglon, DC 20555-0001, or by inlrnot e{ail k lnbmllmto.Rwuro@nrc{ov, md to lhe Dsk Offs, Off@ of lnbmatio md Regulatsy Afiairs, NE0S10202, (3150{003), OffE o Mms.m.nl tnd R'dGt WzdihdtM m rnqnl I ' h6a.,'.d t^ ih^m6 a i^Idm.l;n dH;
/&.
-^t ri.^l-,
- ^.-,-^{-
--li" OMB @nlrol numbor, tlE NRC may not @nducl or sponsr, and a ptrson is rct required to respond lo, lh6 inbrmalion ooleolion, SHIPPi'SR6 2,NECEIVER'SRI6 3,TRANSACTIONNO, 4,COiRECTPNNO, S,PROCESSINGCOOE 6, ACTION CODE I
- 7. O@UM EiTATtOtr (On' ir documnt i..hdn.d 6Ec R ET)
ZBY ZBV
]UNCI707
..SH,PPERA
". srtopcn M
- b. RTCEMER i "^oa oF eAGEa con oF coDrEs 6ERIEg NAMEANOADDRE6S b.LtrENSE OFSHIPPER NO.
NAMEAND ADDNESS b, LICENAE OF RECNER NO,
- 10. NooFo^ra uNEs2 1 1, NATURE OF TRANEACTbN DIATRIBUTION OFCOPIES Cabrera Services Inc, 50 Founders Plaza ste 207 East Hartford Ct 06 I 08
' ^TrENrroN' Mike Plonski d.rErEFHoN: (860) 794-6915 brera Services Inc.
Founders PlazasteT rt Hartford Ct 06108
- c. ATTENTIoN Mike Plonski (860) 7e4-691s 2
5 14, TRANSFER AUTHORITY-CONTRACT, NM DRAFT, OR ORDEI NUMBER
- 15. EXPOFTOR IMPORIIFANSFERS LICENSE NO,
- 16. MATERIAL TYPE AND OESCRIPTION 17, UNE f,U[8ER OALEATbN 10.
20. OALBTED ELilENTrereHT I For Enrth.d UDnlom Or{y 22, ACTIO! OATE lDO) l l b.coNcrsE NoIEATTAGHEO L ] c.uKFEPoRTB!E? ll "." f l ". b.SHIPPER'S CORNECTION 04 26 2017
- d. RrcEMERS M*URESNI
.. f ECEMER'S CORRECTION 21, TOTAL6ROSStrtGHt
- 25. iolAL votUME (W.tt Tr.n.t B OnM F
cl !,c IIJIo.-o REFENENCE LINE NO, (TEM/BATOH NAME) IIEUg t. d. cooE xry MEAg.IOENI, oRossffitGHt t. NETtrIGHI ELEMENI EIEMENT LIMIT OF ERROR ISOTOPE MEBT j 2 I GFLU1483 I z0 776 l5 15 59 13 3FLU2t98 I z0 776
- 6 8.1 1 llo f f f 2r,. s*tpy
- I:<?KuffirHoRrzEoo,^""rErF2;y t )
.1,.1, 02Ts.RECETVER.SDATA SIGNATUREoFAUTHoRIZEDoFFIoIALNDDA',iEEiENED F cta&ul Luo UJtilN WARNING: FALSE STATEMENTS IN 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 WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION. oogNRc FoRM 741 (10-2014) 1 3 6 7 I l l 3 I I I I I tl I l l tt I I I I i tt i I I ttl I I I tl I I I tl tl I tl I I I tttti I I
DOE/NRC FORM 74{ (10-2014) Previous sditions are obsoleta MANDATORY DATA COLLECTION AUTHORIZED BY 10 CFR 30, 40,50, 70, 72,74,75,150 U. S. DEPARTMENTOF ENERGY AND U. S. NUCLEAR REGULATORY COTIIIISSION PubricLawss3-703'e3'438'ss-el NUCLEAR MATERIAL TRANSAcfloN REpoRT APPROVEDBYOMB: NO.3150{003 EXPIRES: 1013112017 Eslimald buden ps rspon66 lo cmply with tis mildatory @ll6lis rqu6t t h@r and 15 minutes. This informalim i8 required lor IAEA lnlormalion Coileclions Branch (T-5 t53), U.S. Nuclear Regulatory Commission, Washinglon, DC 20555{001, or by jnbnot o-mail to lnlocollets,Re6ource@nrc,gov, and to the Desk oflicr, Offce of lnformation and Regulalory Affairs, NEOB-10202, (3150-0003), Ofice of Managomonl and Budg6t, Washinglon, DC 20503, ll a manE used lo impos an informalion ooll@lion doo8 noi display a currently valid OMB conkol numbr, lho NRC may nol conducl or sponsor, and a porsm is nol required to roEpond lo, the intormalion colleclion. IE 3, TRANEACTDN NO, 4, CORRECTIO( NO, i
- 5. PROCESSINGCODE r.sdtpptRS {S
- 2. RECENEi'E i ZBY ZBV lUNCl709 I
l' sHrPPEiA ',iECENEi .. sHrppEi M I o. n..em" i,ree
- o.
"*." l "o* oF c@6 SERIES 3.r. SME AID ADoiE6a Cabrera Services I ffi
- a...xArEAf,DADDREss lb,trcEx8E io.
I oFRECEMR l*: IO, NO OF OATA LINES 2
- 11. NATUROFTRANSACTTON DETiEUIION OFCOPIES Cabrera Services Inc.
50 Founders Plaza sle 2O7 East Hartford Ct 06108 ..ArElroil: Mike Plonski d.rELEPHotrE: (860) 794-6915 [: 50 Founders Plaza sle 2O7 East Hartford Ct 06108 '^"'ntou'Mike Plonski d.rELEpHoNE: (860) 794-6915 2 5 6
- 14. TRANSFER AUTHORITY-CONTRACT NM DRAFT OR ORDER NUMBER EXTiTOR TMPORT TRANSFERSi IICENSE NO 16 MATERIAL TYPE AND DESCRIPTION 17, LINE NU[8ER 16.
O6LgTED ELEUEMEEHT 21. OBTEAIEO ISOTOPE rE,T For Eilbd UEdh ody E (oD) S!IPME[T t.colceercrrarn"n.o f_,. ] c.uKREPoRrAsLE? [ l *. E b,AHIFPEfi'S CORNECNON 05 01 z017
- d. iECE&ER'6 M*UREMENT
.. REcEMER'scoiREcnON 2' TOTALOROSSWIGHT
- 25. lOI AL voLuME (w..b f t ntuB OnU F
cl lhd uJecIo e; N BACK HEFERENCE NUMBER uilE OTEM/BATCH NAME) ITEMA N!MBER t. 9. CODE co0E KEY j. t. NETffiIGHT ELEMENI WEEHT ELEMENT BOrcPE EOTOPE El6ffT I BASIS 2 3 EERUO226 l0 t76 l3 l5 BFLUOOT4 l0 t76 \\4 73 t t f ,a_ s^PPERsDNru",,'^,^n?,1,"^7, ) .t +.1, 27s, RECEIVER.S DATA slGNAruRE oF AUTHoRIZED oFFlclAL AND DArE SIGNED F o 9'Eul Itro UIt NN Z--/ I I i WARNTNG: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCUMTE IN ALL MATERIAL RESPECTS. 18 U.S.C. SECTION 1 OO1 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 WTHIN ITS JURISDICTION. DOE/NRC FORM 741 (10-2014)
DOE'NRC FORiI 74I (10-20'14) PEvious editions are obsolete MANDATORY DATA COLLECTION AUTHORIZED BY 10 CFR 30,40, 50,70, 72,-t4,75, 150 Public Laws 83-703, 93-438, 95-91 iWi NUCLEAR U. S. DEPARTIENTOF EtrtERGy
- u. s. ilucLEAR *rdillro*"
"otrrrssror{ MATERIAL TRANSACTION REPORT APPROVEDBYOilB: NO.31S0{003 EXplRES: 10t3112017 Eslimalod burden por responoe lo conply wilh this mmdatory @llslim roquest: I hou aM 15 minules. Thi6 informalion is roquired hr IAEA e@unilng ropods lhal show changes in inventdy of nudoar mateilals. Send Mmflls regarding burden slimale lo tro FOti, *ir."i.na Inbrmalim collecliore Branch (T-5 F53), U.s-Nuolear Regulatory commission, wahiiglon, DC 20s5s{001, or by intorml mail to lnhmlbcts Resource@nrc.gov, and to lhe Desk olficer, offm ol lnbrmalion aa negulato'ry Affairu, Neoglozoz, tliso{g63j, brf.l "j Mamgmsnl and Budget, Wa8hinoton' Dc 20503, ll a means used to impom an infirmation collelion dos not aiElay a curiendy vdia oMB conlrcl numbel, tha NRC may nol conducl or sponsor, and a person is notrequired lo rg8pood lo, lhe inlormalion oolloction, r.*rrenrs ] _2.nEcErvER'eRrs r.,*"roruo@*sr*cooE lqv lzav pr.rcrzl I E*,",-A b,FFCEVER ,A,STIPDTRM b,FECEIVER DAGE OF PA{'S CCP\\ .F CCPII! SERIES "- 6;EiAEEi"-',*' i Cabrera Services Inr 50 Founders Plaza s ] oFREcEIvER ] NO, ..,_t L ro. loor olta LNes I 11, NATURE OF TRANSACTION otsIf,taunoN oF coPtEs 207 LaDrera servlces lnc. 50 Founders Plaza sE 207 East Hartfbrd Ct 06108 c.ArErrcr: Mike Plonski d.ErpHoNE: (860) 794-6915 b, Rt6 East Hartford Ct 06 108 "^"tntF*Mike Plonski d.rELEprcNE: (860) 7944915 5 14, TRANSFER AUTHORIry - CONTRACT, NM DRAFI, OR ORDER NUMBER i5. EXrcFtOi UrciT TiMERS: WmE No. 16, MATERIAL TYPE AND DESCRIPTION 1a. 20, OBLbATD ELEMENTWErcHT 21. OELIGATED ISOTOPE For Eh.th6d Urantumoht 6 22, ACIION DATE lDD) .,6AIPMENT t.coisExorEAnrcHE" [- .u(iErcir^B*? ["e" Iuo h-AHPFER'S CONRECTION .. RECEIPT d,iEOSVEiS MreUREME{T 05 II 20t7 .. RrcEMiScoRREcnox
- 24. TOTALGflOSS @6HI
- 25. tol AL lotuue lw..b ft ntu Onltt F
o ?t IIJo. o. ro ci REF'NENCE LINE IOE!TIFICATION IIEMS NUMBER 7. cooE t. iWGHT L NETGGHT ELEMENT ELEMENT lsotoFE WE6HT J, BASIS I GFLt)2002 I z0 776 t3 15.07 ll tf f z6s.sHrPPER'sDA*ry O.1, O 27s'REcErvER'sDArA F oIt UJ IJJo IJJv. NN ( ) w^iilllrc: FALSE SIATEMENTS lN THls CERTIFICATEITAY gE ltlBJE BE coMPtEIE aND accUMTE lN au rvlArERlAL REsPEciIs. 18 U.sc. sEcTloN lml MAxes ne cnttrner orresl ro ueie r wuEiii-rriii EiiiE[-i* o" REPRESENTATION TO ANY OEPARTUENT OR AGENCY OF THE UNITED SIATES AS TO AI.IV UATTEN VIfrIiI rS IUNlsOrcIOI, DOE/NRC FORM 741 (10-2014)
DOE/NRC FORM 741 U. S. DEPARTMENTOF ENERGY 1to-20t41 Previous editions ere obsolele g \\.,z/"a AND i,a4lorioiy orrr coLLEcloN i {ffifi i U. S. NUGLEAR REGULATORY COl,lMlSSlON AUTHORTZED By 10 cFR 30,40,50,70, g"I(5tfJ' 72,74,75,',t50 PubricLa\\ns83703'e3-438's$e'r NUGLEAR MATERIAL TRANSAciloN REpoRT APPROVED BY OMB: NO. 3150-0003 EXPIRES: '101311201f
- slimaled burden per rosponso lo comply wilh this mandalory coll4tion roquosl t hour and 15 minutes. This informatis iE required for IAEA tcoounling reports thal show changes in inventory ol nucloar matarials. Send comm6nts rogarding burden estimat lo lh6 FOIA, Privacy and ntormalion Colloctions Branch (T-5 F53), U.S. Nuola Rogulatory Commision, Washirgton, DC 20555{001, or by inl6rn6t s-mail lo nlocolecls.R*utc@ntc.gov, and to itE Desk otfcer, Off@ of lnfomalion sd Rgulatoy Alfairs, NEO&10202, (3150{003), Off@ of Uanagmml and Budgot, Washington, DC 20503. ll a mans us6d lo impoEo an infomation collelion doe8 nol display a cutrendy valid IMB @nlrol numbI, th NRC may not mf,duct or sponsor, and a person is nol rsquited lo rospond lo, lheinfomalion colloclion.
shtFpER'BRts 2,ReCENER'6R16 3.TnAN6ACTIONNO, 4,6OfiRECTIONNO. S.PROCESSINGCOOE ACTDN CODE
- 7. D@UMEITATlON (Onf td.cumnl ri cti..fi.d SECRE' ZBV ZBV UNC 1704
..SHTPPERA b, RECEMEi ..sHlppERM lo.aa"a"a* paGE oF p&Es cofr oF "o",a"] SEFIES a...il&EANDrcoFEss I ot SHIPPER I Cabrera Services Inr LICENSE 9...NAMEAtrDADORESS b.LtsENSE NO, OF RECEVEi NO. ro. No oF DArA LlNE62 11, NATURE OF Ti NSACIFT mmBuTbtr oF coPtEs Cabrera Services Inc. 50 Founders Plaza sle 207 East Hartford Ct 06108 q.ArENrEri Mike Plonski d.rElEPHoilE, (860) 794-6915 50 F'ounders Plaza sre lu t East Hartford Ct 06108 c.arENrEN: Mike Plonski d.rELEPrc{E: (t60) 79+6915 3
- 14. TRANSFER AUTHORITY - CONTRACT, NM DRAFT OR ORDER NUMBER 15, EXPORTOR IMPORT TiANSFERS: LICENSE NO.
T
- 16. MATERIAL ryPE AND DESCRIPTION LItrE NUMEER 16.
1t. 20. OELIGATEO ELEMENTMIGXI
- 71. T 6
For nrichod UnnllmOat B {oo) b.CONC16E NOTEANAChEO c.uKREPoRraBLE? [] tr. fl
- o b,SHIPPEF6CORFECTION 03 t7 2017 d, f, ECENi'S MASUREMEtrT
., REcENEi'sCoiRECTION 24, TOTALOSOSS WEEHI 25, IAIAL VoLUME (w.st. Tr.hsl.6 aD19 F o .!1e UJ o-G Io @N LINE NO, IDENTI'ICATION ITEMS t. I oo0E (EY j. GROSgWEIOHI t. NE'WEGNT ELEMENT WEIGHT ELEME{T EOTOPE ISOTOPE ERROR h. gAsls 2
- }FLI 12I20
)0 t76 5 24 3FLU2008 l0 776 l3 +.43 2 f f t 265. sH'ppER'sDArA """/ry4re;ry:'*^\\ r, z 1t z .la.1,.l/ 27s. RECEIVER'S DATA SIGNATURE oF AUTHoRIZED oFFlclAL AND DArE SIGNED F o ? d, u.l ulo tuE FN (_ WARNING: FALSE STATEMENTS lN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSTONS 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 WITHIN ITS JURISDICTION. DOSNRC FORM 741 (1O-2O14)}}