ML19250A766
| ML19250A766 | |
| Person / Time | |
|---|---|
| Issue date: | 10/08/1979 |
| From: | Davis A NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION III) |
| To: | Maliyuk J MESSMORE/TIMMERMAN SERVICES, INC. (FORMERLY MESSMORE |
| Shared Package | |
| ML19250A767 | List: |
| References | |
| NUDOCS 7910240542 | |
| Download: ML19250A766 (13) | |
Text
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'o UNITED STATES g
8 NUCLEAR REGULATORY COMMISSION o
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g r,I REG.ON 111 S
4 799 ROOSEVELT ROAD
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GLEN ELLVN. ILLINOls 60137
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hessmore Testing and Non L. ansee Supervision, Inc.
ATTN: John Maliyuk 265 East Market Street Akron, OH 44308 Gentlemen:
Subject:
Notice of Violation This refers to the telephone discussion between Mr. D. J. Sre:uawski of this office and you on September 25, 1979. From our discussion we learned that you possess material which requires a specific NF.C license; namely a Troxler gage containing 10 millicuries Cesium-137. Your possessu of that material without a valid, specific license is a violation of Section 30.3, 10 CFR Part 30.
Section 30.3 states:
30.3 Activities requiring license. Except for persons exempt as provided in this part and Part 150 of this chapter, no person shall manufacture, produce, transfer, receive, acquire, own, possess, use, import or export bp roduct material except as authorized in a specific or general license issued pursuant to the regulations of this chapter.
This Notice of Violation is sent to you under the provisions of Section 2.201 of the NRC's " Rules of Practice," Part 2, Title 10, Ccde of Federal Regulations. Section 2.201 requires you to submit to this office, within twenty (20) days of your receipt of this notice, a written statement or explanation in reply including:
(1) corrective steps which have been taken by you, and (2) corrective steps which will be taken to avoid this happening in the future.
In accordance with Section 2.790 of the NRC's "hules of Practice," Part 2, Title 10, Code of Federal Regulations, a copy of this letter and your reply will be placed in the Public Document Ro m.
In addition to your reply to this Notice of Violation, if you want to continue your program you must immediately submit the enclosed Form NRC-313, " Application for Byproduct Materials License" to the Regional Licensing Section, U.S. Nuclear Regulatory Commission, 799 Roosevelt Road, Glen Ellyn, Illinois 60137. A copy of the letter forwarding the appli' cation to the licensing section (but not the application) should be sent to Region III, U.S. Nuclear Regulatory Commission, same address as above, Attention:
A. B. Davis.
880 283 f 9,'a 7910240
Messmore Testing and C~
.J; Supervision, Inc.
Also you must immediately place the radioactive material on hand in secure storage until such time as you acquire a valid license. No other use of the material on hand or purchase of additional byproduct material is authorized.
Include a statement in your reply to this Notice of Violation confirming that you have taken this action and describing the controls that will be exercised over the stored material until sucu time that you obtain a valid license.
Your program will be subject to a license fee as required by Section 170.31 of 10 CFR Part 170; therefore, please submit the appropriate fee along with the application.
We request that you give prompt attention to these matters. Should you have any questions concerning them, we will be pleased to discuss them with you.
Sincerely, d % A. B. Davis, Chief
')
Fuel Facility and haterials Safety Branch
Enclosures:
1.
Form NRC-313 w/ Guide for Preparation 2.
10 CFR Part 170 cc w/o encls:
Central Files Reproduction Unit NRC 20b PDR NSIC Chief, Licensing Management Branch, h3SS 880 284
Form NRC-313 G)
(
)
)
Form Approved by GAO 10 30 INSTRUCTIONS FOR PREPARATION OF APPLICATION FOR BYPRODUCT MATERI AL LICENSE FORM NRC-313 (1)
GENERAL INFORMATION An appbcant for a "Byprutuct Material (Radioisotopes) Ucense,"
- 3. Broad Lbase (research and development) *Ucensmg Guale abouW complete Form NRC-313 G) in detaD and submit in duphcate for Type-A > icenses of Broad Scope for Research and Develop-to the U.S. Nuclear Regulatory Commission. The applicant should ment;"
endeavor to cover his entire radioistope program with one apphcation, if possible. However, separate apphcations shouM be submhted for
- 4. Licensms Guides for the performance of weu loggmg operations.
gamma irradiators. Appbcations for medical uses abould be submitted on Form NRC-313 (M) and appbcations for use of sealed sources in
- 5. Ucensing guide foi the use of scaled sources in portable and semi.
radiography shouM be submitted on Form NRC-313R. Supplemental portable gaugms devices.
sheets may be appened when nemasary to provide complete infor-mation. Item 18 must be completed on s# epphertions. Submirsson The Commission charges fees for fihng of appbcatens for bcenses as of an hcomplete appbcation wf# often result in e delay in issuance of specified in Section 170.12, Title 10, Code of Federal Regulations, the bcense because of the correspondence necessary to obtain infor.
Part 170. The apphcant abould refer to Section 17031,5chedule of motion requested on the appucation.
fees for matenals beenies, to determine what fee should accompany the appbcation. No action can be taken on apphcations until fees are NOTE. -When the appbcation includes one v the special uses Ested.
paid. Checks or money orders should be made payable to the U.S.
below, the appbcant should request the appropuate pamphlet which Nuclear Regulatory Commissaon.
grovMes additsonal instructions:
Two copies of the completed Form NRC-313 0) and two copies of 1 Industnal Radaography "Ucensmg Requirements for Industrial each attachment there'o, should be sent to the Division of Fuel Cycle Radiography" (use apphcation Form NRC-313R for Radi-and Material Safety OJace of Nuclear Matenal Safety aid Safeguards, ography);
U.S. Nuclear Regulator) Commission, Washmgton, D.C. 20555. One copy should be retained for Ge apphcant's file. Appbcations may 2 Labernory and Industrial Uses of Smau Quantities *T;uide for also be filed in person at the Commission's ofnce at 1717 H Street, Preparatior. of Appbcations for Laboratory and ladustrial N.W., Washington, D.C. or at 7915 Eastern Avenue, Silver Sprms.
Uses of Smau Quantities of Byproduct Material."
EXPLANATION OF FORM NRC-313 (I)
Form NRC-313 G) is designed for use in supplying information 5.
The actual sites of use should be Ested as indicated. Per-on programs of varymg complexity. The appbcant should provide manent facilitien such as field offices for portable gauges or complete aformation on his proposed progresn For the possession devices should be identined in Item 5 by Street, Address, and use of bcensed material For those items that do not apply, indicate City and State. Temporary field locations of use should as N.A. (not apphcable).
be specined as "temperary job sites of the appbcant" and hst the States throughout which the temporary job sites wiu Item No.
be located. Attach additional properly keyed sheet if mors space is needed.
1.
Self-explanatory 2.
The "apphcant" is the organization or persons lesaDy res-ponsible for possession and use of the Ecensed matenals specafied in the appbcation.
7.
The " Radiation Protection Ornces"is the named individual who is expected to coordmate the safe use of the licensed 3.
Self-explanatory matenal spedned in the appbcation and who will ensure compliance with the appbcable parts of Title 10, Code of 4.
Self-expleatory Federal Regulations.
880 285
98E 088 8.
13st by name each radioisotope to be po==ad and used Attach additbnal property keyed sheets if more space le under the licenw. Exarnple:
needed.
t.E State the use of each licensed material listed in 8.A. B, C.
A B
and D.
(1) todine-131 (1) todide' (2) lodine-131 (2) todinated Human 9.
Desmption of containers and/or devices in which sealed Secura Atumin sources listed in Item 8 will be stored or used. Example:
(3) Krypton-85 (3) Gas (4) Cesium-137 (4) Scaled Source A
B e
(1) #4 - Source houang Iso. Corp C
D (1) Not Applicable (1) 10 minicuries C
(2) N. A.
(2) I miDicurie Model Z-278 (3) N. A.
(3) I nullicurie (4) Iso. Corp (4) 2 source of l50 10-18 Self-explanatory. (For those items that do not apply, Model Z-78 minicuries each indiste as N.A. (not applicable).
PRIVACY ACTSTATEMENT Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by section 3 of the Prwacy Act of 1974 (Public Law 93-579), the following statement is furnished to moividuals who supply information to the Nuclear Regulatory Commisson on Forms NRC-313M, NRC-313a, NRC-3131, or NRC-313R. His mformation is maintained is a system of records designated as NRC-3 and described at 40 Federal Register 45334 (October 1,1975).
- 1. AUTHORITY Sections 81 and 16t(b)of the Atomic Energy Act of 1954, as smended (42 UIC. 2111 and 2201(b)).
- 2. PRINCIPAL PURPOSE (S) The informatbn is evaluated by the NRC staff pursuant to the criteria set forth in 10 CFR Parts 30-36 to determine whether the appliation meets the requirements of the Atomic Energy Act of 1954, as amended, and the Commission's regulations, for the issuance of a byproduct materiallicense or amendment thereof.
- 3. ROl> TINE USES The information may be used: (a) to provide records to State health departments for their information and use;and (b) to provide mformation to Federal, State, and loal health officials and other persons in the event of incident of exposure, for their informataon, investigation, and protection of the public health and safety. The information may also be disclosed to appropriate Federal, State and loal agencies in the event that the mformation indicates a violation or potential violation of law and in the course of an administrative or judicial proceeding. In addition, this information may be transferred to an appropriate Federal, State, or local agency to the extent relevant and necessary for a NRC decinon or to an approprute Federal agency to the extent relevant and necessary for that agency's decision about you. A copy of the license issued miU routinely be placed in the NRC's Public Document Room,1717 H Street, N. W., Washmgton, D.C.
- 4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION Disclosure of the requested information is voluntary. If the request information is not furrushed, however, the application for byproduct material hcense, or amendment thereof, will not be processed.
- 5. SYSTE M M ANAGER(S) AND ADDRESS Director, Division of Fuel Cycle and Material Safety, Office of Nuclear Material Safety and Safeguards, U S. Nuclear Regulatory Commisuon,%shmston, D.C. 20555.
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)
FoRu NRC 3131 U.S. NUCLEAR REGULATORY COMMISSION
- 1. APPLICATION FOR:
(1 19)
(Check and/or compkt* as appropriate) 10 CF R 30 APPLICATION FOR BYPRODUCT MATERIAL LICENSE INDUSTRIAL
- s. NEW LICENSE See attached instructions for details.
- b. AMENDMENT TO:
UCENSE NUMBER Completed applications are filed in duplicate with the Division of Fuel Cycle and Material Safety, Office of Nuclear Material Safety, and Safeguards, U.S. Nuclear Regulatory Commission,
,_ pgugW,L 97 Washington, DC 205SS or applications may be filed in person at the Commission's office at uggngg nuuaga 1717 H Street, NW, Washington, D. C. or 7915 Eastern Avenue, Siler Spring, Maryland.
- 2. APPLICANT'S NAME (Institution, firm, person, arc.)
- 3. NAME OF PERSON TO BE CONTACTED REGARDING THIS APPLICATION TELEPHONE NUMBER; ARE A CODE - NUMBER EXTENSION TELEPHONE NUMBER: ARE A CODE - NUMBER EXTENSION
- 4. APPLICANT'S MAILING ADDRESS (include Zip Codel
- 5. STREET ADDRESS WHERE LICENSED MATERIAL WILL BE USED (include Zip Code)
(IF MORE SPACE IS NEEDED FOR ANY ITEM, USE ADDITIONAL PROPERLY KEYED PAGES.)
- 6. INDIVIDUAL (S) WHO WILL USE OR DIRECTLY SUPERVISE THE USE OF LICENSED MATERIAL (See items 16 and 17 for required training and experience of each indirnfuelnamed bekw)
FULL N AME TITLE a.
b.
e c.
- 1. RAD 1ATION PROTECT'lDN OFFICER A ttach a resume of person's training and experience as outtmed in items 16 and 17 and describe his responsbilities under item 15.
I
- 8. LICENSED MATERIAL L
ELEMENT CHEMICAL NAME OF MANUF ACTURER MAXlMUM NUMBER OF 1
AND AND/OR AND MILLICURIES AND/OR SEALED N
MASS NUMBER PHYSICAL FORM MODEL NUMBER SOURCES AND MAXIMUM ACTI-E (if Ses/ed Source)
VITY PER SOURCE WHICH WILL BE POSSESSED AT ANY ONE TIME NO.
A B
C D
(1)
(2)
(3)
(4) w:..-
DESCRIBE USE OF LICENSED MATERIAL g
(1)
(2) im (4)
FORM NRC-313 I (179)
[
- 9. STORAGE OF SEALED SOURCES NAME OF MANUFACTURER MODEL NUMBER I
CONTAINER AND/OR DEVICE IN WNICH EACH SEALED SOURCE Wlit BE STORED OR USED.
C.
N 8.
A.
NO.
(1)
(2)
(3)
(4) 10, RADIATION DETECTION INSTRUMENTS TYPE M ANU F ACTU RER'S MODEL NUMBER RADIATION SENSITIVITY
{
OF NAME NUM8ER AVAILASLE DETECTED RANGP.
(alpha, beta, (milliroentoens/ hour N
Ihe?RUME*:T gamma, neutron) or counts /minutel n a, B
C D
E F
E A
(1)
(2)
(3)
(4)
- 11. CAllBRATION OF INSTRUMENTS LISTED IN ITEM 10 Ob. CALIBRATED BY APPLICANT On. CALIBRATED BY SERVICE COMPANY A ttach a separate sheet descrbing method, frequency and standards N AME, ADORESS, AND FREQUENCY used for calibrating instruments.
12, PERSONNEL MONITORING DEVICES SUPPLIER EXCHANGE FREQUENCY TYPE (Chack and/or complete as appropnate)
(Service Company) g B
A O MONTHLY O tti FILM BADGE O QUARTERLY O (2) THE RMOLUMINESC:
'I OO$lMETER (TLD)
O OTHER (Specdy1:
O(31 OTHER (Speedyl:
- 13. F ACILITIES AND EQUIPMENT (Check were appropriate and attach annotated sketch (es) and description (s O a. LABOR ATORY FACILITIES, PLANT F ACILITIES, FUME HOODS (IncAde filtration, ef anyl, ETC.
O b. STOR AGE F ACILITIES. CONTAINE RS, SPECIAL SHIELDING (fixed and/or temporary /, ETC.
O c. REMOTE H ANDLING TOOLS OR EQUIPMENT, ETC.
O d. RESPIRATORY PROTECTIVE EQUIPMENT, ETC.
- 14. WASTE DISPOSAL
- a. NAME OF COMMERCIAL WASTE DISPOSAL SERVICE EMPLOYED b.lF COMMERCIAL WASTE DISPOSAL SERVICE IS NOT EMPLOYED, SUBMIT A DETAILED DESCRIPTION OF M BE USED FOR 0:SPOSING OF R AOBOACTt'/E WASTES AND ESTIMATE E
880 288 r e - ~ n c., a l i,.
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INFORMATION REQUIRED FOR ITEMS 15,16 AND 17 Begin each item on a escriba in detail the information required for items 15,16 and 17.
Deparate page and key to the application as follows:
s Oescribe the radiation protection program as appropriate for Radiation Protection Officer, RADIATION PROTECTION PROGRAM.
the material to be used including the duties and responsibilities 15.
be followed, f leak testing will iae etc. If the application is for sealed source's also submit Ibk testing procedures, or i l k test kit.
performed using a leak test kit, specify manufacturer and model number of the ea Attach a resume for each individual named in FORMAL TRAINING IN RADIATION SAFETY. Describe individual's formal trai Include 16.
items 6 and 7.
the name of person or institution providing the training, duration o received, etc.
- a. Principles and practims of radiation protection.
- b. Radioactivity measurement standardization and monitoring techniques and instruments.
- c. Mathematics and calculations basic to the use and measurement of radioactivity.
- d. Biological effects of radiation.
Describe individual's Attach a resume for each individual named in items 6 and 7.
Work experience or on-work experience with radiation, including where experience was obtained. Include list of radio EXPERIENCE.
17.
the-job training should be commensurate with the proposed use.
maximum activity of each used.
- 18. CERTIFICATE (This item must be cornalernd by applicent) 2, The applicent and any official executing this critificate on behalf of the applicent nam f Federal Regulations, certify that this application is prepared in conformity with Title 10, Code o Part 30, and that all information contained herein, including any supplements attac and correct to the best of our knowerdge and belief.
i l ff e to make a wiltfully falso statement or 25,1948; 62 Stat.749; nukes it a crim na o ens WARNING.-18 USE., Section 1001: Act of Junerepresentation to any department or ege i hin its jurisdiction,
- b. CEPTIFYING OFFICI AL (Signaturel
- s. LluENSE FEE REQUIRED (See Section 170.31,10 CFR 170)
- c. NAME (Type or printi
- d. TITLE 111 LICENSE FEE CATEGORY:
e.DATE
- 12) LICENSE FEE ENCLOSED: $
FORM NRC4t3 I (179) 880 289
i 1
FORM NRC 3131 U.S. NUCLEAR REGULATORY COMMIS$10N
- 1. " APPLICATION FOR:
(1-19)
~
(Check and/or compbete as approproate) 10 C F R 30 APPLICATION FOR BYPRODUCT MATERIAL LICENSE
- a. NEW LICENSE INDUSTRIAL
- b. AMENDMENT TO-Soe sttached onstructions for dsteilt LICENSE NUMBER Completed applications are filed in duplicate with the Divis%n of Fuel Cycle and Material Safety.
~
Office of Nuclear Material Safety, and Safeguards. U.S. Nuc; car Regu'atory Commission.
R OF -
Washington DC 20SSS or applications may be filed in person at the Commission's office at g,ggugguvuegg 1717 H Street. NW. Washington. D. C. or 1915 Eastern Avenue. Silar Spring. Maryland.
- 2. APPLICANT 1 NAME (Institution, firm, person, etc.)
- 3. NAME OF PERSON TO BE CCNTACTED REGARDING THIS APPLICATION TE LEPHONE NUMBER; ARE A CODE - NUMBER EXTENSION TELEPHONE NUMBER: ARE A CODE - NUMBE R EXTENSION
- 4. APPLICANT'S MAILING ADDRESS (Inchedelip Codel
- 5. STREET ADDRESS WHERE LICENSED MATERIAL WILL BE USED (Include Zip Code)
(IF MORE SPACE IS NEEDED FOR ANY ITEM. USE ADDITIONAL PROPERLY KEYED PAGES.)
- 6. INDIVIDUAL (S) WHO WILL USE OR DIRECTLY SUPERVISE THE USE OF LICENSED MATERIAL (See items 16 and 17 for required training and experoence of each individual named below)
FULL NAME TITLE a.
b.
C.
- 7. RAD 1ATION PROTECTION OFFICER A ttach a resume of person's training and experience as outioned on Items l 16 and 17 and describe his responsabilities under item 15.
l
- 8. LICENSED MATERIAL L
ELEMENT CHEMICAL NAME OF MANUFACTURER MAXIMUM NUMBER OF i
AND AND/OR AND MILLICURIES AND/OR SEALED N
MASS NUMBER PHYSICAL FORM MODEL NUMBER SOURCES AND MAXIMUM ACTI-(If Sealed Source)
VITY PER SOURCE WHICH WILL E
BE POSSESSED AT ANY ONE TIME NO.
A B
C D
(1)
(2)
(3)
(4)
DESCRIBE USE OF LICENSED MATERIAL E
(1)
(2)
/
ls G
(4)
FORM N RC.313 8 (179) 880 290
- 9. STORAGE OF SEALED SOURCES NAME OF MANUFACTURER MODEL NUMBER I
CONTAINER AND/OR DEVICE IN WHICH EACH SEALED SOURCE WILL BE STORED OR USED.
N l8.
C.
A.
NO.
f til (2)
(3)
(4)
- 10. RADIATION DETECTION INSTRUMENTS TYPE M ANU F ACTU R E R'S MODEL NUMBER RADIATION SENSITIVITY I
OF NAME NUMBER AVAILABLE DETECTED RANGE (alpha, beta, (mittiroen tgens/ hour N
INSTRUMENT gamma, neutron) or Counts / minute)
A 8
C D
E F
(1)
(2)
(3)
(4)
- 11. CAllBRATION OF INSTRUMENTS LISTED IN ITEM 10 Ob. Call 8 RATED BY APPLICANT 0 a. Call 8 RATED BY SERVICE COMPANY Attach a separate sheet describong method, frequency and standartts N AME, ADDRESS, AND FRECUENCY used for calibrating irrstruments.
- 12. PERSONNEL MONITORING DEVICES SUPPLIER EXCHANGE FREQUENCY TYPE (Check and/or complete as approperate.)
(Service Company) g 8
A O MONTHLY O(1) FILM BADGE O QUARTERLY O (2) THE RMOLUMINESCENCE DOSIMETER (TLD)
O OTHER (Specify):
O (31 OTHER (Specoty):
- 13. FACILITIES AND EQUIPMENT (Check were appropriate and attach annotated sketch (es) and description (s).
O a. LABOR ATORY F ACILITIES, PLANT F ACILITIES, FUME HOODS (Inchede filtration, af any), ETC.
O u. STO R AGE F ACILITIES, CONTAINE RS, SPECI AL SHIE LDING (fixed and/or temporary), ETC.
O c. REMOTE H ANDLING TOOLS OP. EQUIPMENT, ETC.
Od RESPIR ATORY PROTECTIVE EQUIPMENT. ETC.
- 14. WASTE DISPOSAL
- b. IF COMMERCI AL WASTE OtSPOSAL SERVICE IS NOT EMPLOYED, SUBMIT A DETABLED DESCRIPTION OF METHODS WHICH WILL BE USED FOR DISPOSING OF R ADIOACTIVE WASTES AND ESTIMATES OF THE TYPE AND AMOUNT OF A THE APPLICATION IS FOR SEALED SOURCES AND DEVICES AND THEY WILL BE RETURNED TO THE MANUFACTURER,SO STAT n
q - c.,,,n.m, 880 291 t
t
)
INFORMATION REQUIRED FOR ITEMS 15,16 AND 17 Describe in detail the information required for iteras 15,16 and 17. Begin each item on a separate page and key to the application as follows:
15.
RADIATION PROTECTION PROGRAM. Describe the radiation protection program as appropriate for the material to be used including the duties and responsibilities of the Radiation Protection Officer, control measures, bioassay ptocedures (If needed), day-to day general safety instruction to be followed, etc. If the application is for scaled source's also submit leak testing procedures, or if leak testing will be performed using a leak test kit, specify manufacturer and model number of the leak test kit.
- 16. FORMAL TRAINING IN RADIATION SAFETY. Attach a resume for each individual named in items 6 and 7.
Describe individual's formal training in the following areas where applicable. Include the name of person or institution providing the training, duration of training, when training was received, etc.
- a. Principles and practices of radiation protection.
- b. Radioactivity measurement standardization and monitoring techniques and instruments.
- c. Mathematics and calculations basic to the use and measurement of radioactivity,
- d. Biological effects of radiation.
17.
EXPERIENCE. Attach a resume for each individual named in items 6 and 7.
Describe individual's work experience with radiation, including where experience was obtained. Work experience or on-the-job training should be commensurate with the proposed use, include list of radioisotopes and maximum activity of each used, i.2
- 18. CERTIFICATE (Thss item must be completed by applicent)
The applicent and any official executmg this certificate on behalf of the applicant named in item 2, certify that this application as prepared in conformity with Totle 10. Code of Federal Regulations, Part 30, and that all information contained hereon, nncluding any suppMments artsdred herwto, is true and correct to the best of our knowkdge and belief.
WARNING.-18 USr., Section 1001: Act of June 25,1948; 62 Stat. 749; rnekes it a criminal offense to make a willfully falso statement or representation to any department or egency of the United States es to any metter within its jurisdiction.
- a. Lit;ENSE FEE REQUIRED
- b. CERTIFYING OFFICIAL (Strature) tsee section 170.31,10 CFR 170)
- c. NAME (Type or pront)
(1) LICENSE FEE CATEGORY:
(2) LICENSE FEE ENCLOSED: $
FORM N RC-3t3 I (179) 880 292
- 9. STORAGE OF SEALED SOURCES k
CONTAINER AND/OR DEVICE IN WHICH EACH SEALED NAME OF MANUFACTURER MODEL NUMBER M
SOURCE WILL BE STORED OR USED.
E.
C.
NO.
A.
(1)
(2)
(3)
(4)
- 10. RADIATION OETECTION INSTRUMENTS
~
TYPE M ANU F ACTU R E R'S MODEL NUMBER RADIATION SENSITIVITY I
OF NAME NUMBER AVAILABLE DETECTED RANGE (alpha, bots, (molliroentgens/ hour N
INSTRUMENT 9"* ***"*"U*"I
- ' C*""l* *""'*E A
8 C
D E
F N O.
(1)
(2)
(3)
(4)
- 11. CALIBRATION OF INSTRUMENTS LISTED IN ITEM 10 O a. CALIBRATED BY SERVICE COMPANY Ob. CALIBRATED BY APPLICANT Attach a separate sheet describong method, frequency and standards N AME, ADDRESS, AND FREQUENCY used for calibrating instruments.
- 12. PERSONNEL MONITORING DEVICES (Check and/or compi$te as appropriate.)
(Serv Co panyl A
8 O MONTHLY O(1) FILM BADGE O QUARTERLY C 12) TH E RMOLUMINESCENCE OOSIMETER (TLD1 O OTHER (Specify):
O f 3) OTHE R (Specity):
- 13. FACILITIES AND EQUIPMENT (Check were appropriate and attach annotated sketch (es) and description (s).
Oe LA8OR ATORY FACILITIES, PLANT F ACILITIES, FUME HOODS (include filtration, of any). ETC.
O o. STOR AGE F ACILITIES. CONTAINE RS, SPECIAL SHIELDING (fixed and/or temporary), ETC.
O c. REMOTE H ANDLtNG TOOLS OP. EQUIPMENT, ETC.
Od RESPIR ATORY PROTECTIVE EQUIPMENT, ETC.
- 14. WASTE DISPOSAL a N AME OF COMMERCI AL WASTE DISPOSAL SERVICE EMPLOYED
- b. IF COMMERCI AL WASTE DISPOSAL SERVICE IS NOT EMPLOYED, SUBMIT A DETAILED DESCRIPTION OF METHODS WHICH WILL BE USED FOR DISPOSING OF RADIOACTIVE WASTES AND ESTIMATES OF THE TYPE AND AMOUNT OF ACTIVITY INVOLVED.lF THE APPLICATION IS FOR SE ALED SOURCES AND DEVICES AND THEY WILL BE RETURNED TO THE MANUFACTURER,SO STATE.
I j
Fomu NRc 313 I (179) 880 293
I FORM NRC 313 I U.S. NUCLEAR REGULATORY COMMISSION
- 1. APPLICATION FOR:
(1 79)
(Check and/or compkte as appropriate]
10 CF R 30 APPLICATION FOR BYPRODUCT MATERIAL LICENSE
- a. NEW LICENSE INDUSTRIAL See attached instructions for detailL b AMENDMENTTO:
LICENSE NUMBE R Completed applications are filed in duplicate with the Division of Fuel Cycle and Material Safety.
Office of Nuclear Material Safety, and Safeguards. U.S. Nuclear Regulatory Commission' R
OF-Washington, DC 20SS5 or applications may be filed in person at the Commission's office at g,gguggnuyega 1717 H Street, NW, Washington, D. C. or 1915 Eastern Avenue, Silar Spring. Maryland.
- 2. APPLICANT *5 NAME (Institurson, firm, person, etc.)
- 3. NAME OF PERSON TO BE CONTACTED REGARDING THIS APPLICATION TELEPHONE NUMBER: ARE A CODE - NUM8E R EXTENSION TELEPHONE NUMBER: ARE A CODE - NUMBE R EXTENSION
- 4. APPLICANT *S MAILING ADDRESS (laciude Zop Codel
- 5. STREET ADDRESS WHERE LICENSED MATERIAL WILL BE USED (include Zip Code)
(IF 7.' ORE SPACE IS NEEDED FOR ANY ITEM USE ADDITIONAL PROPERLY KEYED PAGES.)
- 6. INDIVIDUAL (S) WHO WILL USE OR DIRECTLY SUPERVISE THE USE OF LICENSED MATERIAL (See items 16 and 17 for required training and emperoence of each indavutosinamed below)
FULL NAME TITLE a.
b.
c.
- 1. RADIATION PROTECTION OFFICER VA ttach a resume of person's traoning and esperrence as outtoned in items l 16 and 17 and describe his responsibilottes under item 15.
I
- 8. LICENSED MATERIAL L
ELEMENT CHEMICAL NAME OF MANUFACTURER MAXIMUM NUMBER OF 1
- *10 AND/OR AND MILLICURIES ANDIOR SEALED N
MASS NUMBER PHYSICAL FORM MODEL NUMBER SOURCES AND MAXIMUM ACTI-E (if Sealed Source)
VITY PER SOURCE WHICH WILL BE POSSESSED AT ANY ONE TIME NO.
A B
C D
(1)
(2)
(3)
(4)
DESCRIBE USE OF LICENSED MATERIAL E
(1)
(2)
(3)
(4)
FORM NRC-3131 (1 N)
^O 880
i i g
INFORMATION REQUIRED FOR ITEMS 15,16 AND 17 Describe in detail the information required for items 15,16 and 17. Begin each item on a separate page and key to the application as follows:
RADIATION PROTECTION PROGRAM. Describe the radiation protection program as appropriate for 15.
the material to be used including the duties and responsibilities of the Radiation Protection Officer, control measures, bioassay procedures (If needed1, day today generaf safety instruction to be followed, etc. If the application is for sealed source's also submit leak testing procedures, or if leak testing will be performed using a leak test kit, specify manufacturer and model number of the leak test kit.
- 16. FORMAL TRAINING IN RADIATION SAFETY. Attach a resume for each individual named in Include items 6 and 7.
Describe individual's format training in the following areas where applicable.
the name of person or institution providing the training, duration of training, when training was received, etc.
- a. Principles and practices of radiation protection.
- b. Radioactivity measurement standardization and monitoring techniques and instruments.
- c. Mathematics and calculations basic to the use and measurement of radioactivity.
- d. Biological effects of radiation.
17.
EXPERIENCE. Attach a reume for each individual named in items 6 and 7.
Describe individual's work experience with radiation, including where experience was obtai ted. Work experience or on-the-job training should be commensurate with the proposed use. Include list of radioisotopes and maximum activity of each used.
- 18. CERTIFICATE (This item must be completed by applicent)
The applicent and any offocial executing this certifieste on behalf of the applicent named in item 2, certify that this appliestion is prepared in conformity with Totle 10 Code of Federal Regulations, Part 30, and that all information contained herein, includong any supplements attached hereto, is true and correct to the best of our knowardpe and belief.
WARNING.-18 U.Sc., Section 1001: Act of June 25,1944; 62 Stat.749; makes it a criminal offense to rrake a willfully falso statement or representation to any departnwns or egency of the United States as to any metter within its kariediction.
i
- b. CERTIFYING OFFICIAL (Signaturel
- s. LICENSE FEE REQUIRED (See Sectron 170.31,10 CFR 170)
- c. NAME (Type or printi 111 LICENSE FEE CATEGORY:
(2) LICENSE FEE ENCLOSED: S 880 295 FORM NRC413 1 !179)
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