ML20006D636

Discusses & Forwards Revised NRC Forms 396 & 398.All Applications for Licenses Should Be Submitted on Revised Forms No Later than 900201

ML20006D636
Person / Time
Site:	05000054, 07000687
Issue date:	01/05/1990
From:	Gallo R NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I)
To:	Mcgovern J CINTICHEM, INC.
References
NUDOCS 9002140148
Download: ML20006D636 (8)

Text

T i

JAN 5 1990 g

l-Docket No. 50-54

[

70-687 I

Cintichem, Inc.

ATTN: Mr. James'J. McGovern Plant-Manager e

P.= 0. Box 816 Tuxedo, New York 10987 Gentlemen:

SUBJECT:

REVISED NRC FORMS 396 AND 398 Enclosed is a copy of the revised NRC Form-398 (Enclosure 1), Personal Qualifications Statement - Licensee and revised NRC Form-396 (Enclosure 2),

-Certification of Medical Examination By Facility Licensee.

All changes.to the NRC Form-396 are detailed in Enclosure 3.

Changes to NRC Form-398 are detailed in Enclosure 4.

All applications for licenses are to be submitted on these revised forms no later than~ February 1, 1990.

The enclosed applications are for your use. Additional copies can be obtained by contacting.Beverly Martin, U.S. Nuclear Regulatory Commission, by telephone (301) 492-8138 or by writing to her, U.S. Nuclear Regulatory Commission, Information and Records Management Branch, Mail Stop NMBB 7714, Washington.

~D.C.

-20555.

If you have any questions regarding these forms,.please contact Richard J.

' Conte at (215) 337-5120 or Peter W. Eselgroth at (215) 337-5211.

Sincerely, eriginnt stemaa Mf' Robert M. Gallo, Chief Operations Branch Division of Reacter Safety

Enclosures:

As stated 4

0FFICIAL RECORD COPY 396 & 398 FORMS - 0057.0.0 12/14/89 900214014e 900105 F R-ADOCK 05000QQ4 00f, W

' Cintichem, Inc.

2 cc w/ encl:

T. Vaughn, Manager, Health Safety and Environmental Affairs M. D. Johnson, Reactor Supervisor L

D. D. Grogan,. Manager, Radiochemical Production I

W. G. Ruzicka, Nuclear Operations Manager Dr. William Vernetson, Director of Nuclear Facilities.

>i University of. Florida Public Document Room (PDR)

Nuclear Safety Information Center (NSIC)

State of New York bec w/o encl:

Region I Docket Room (with concurrences)

Management Assistant, DRMA (w/o encl) l W. Brown, NMSS (w/SGI and/or C0FI)

J. Roth,~ DRSS D. Haverkamp, DRP s'

P. Swetland, DRP i

L. Rossbach, SRI - Indian Point 2 N. Dudley, DRP t-OL Facility File t

1 DRS:RI Gallo/pb 01/02/90

()

yo f g4 P OFFICIAL RECORD COPY 396 & 398 FORMS - 0058.0.0 L

12/14/89 d.

.i

l DNBTRUCTSONS POR 00pLETHee benc PORM age J

PERGONAL QUALIPICATlON STAYEMEttf LICENBEE TO CEMAIN VALID,THIS FORM MUST NOT DE ALTEZED i

)

• 4/ TYPE OF APPLICAYlON 24 NEWi "X" IF YOU ARE A NEW APPLICANT. COMPLETE EACH CATEGORY OF THE FORM COMPLETELY, FOLLOWING THE l

t-INSTRUCTIONS BELOW. THIS 18 TO INCLUDE ALL EDUCATION, TRAINING AND EXPERIENCE THAT YOU HAVE i

RECElVED UP TO THE DATE OF THIS APPLICAT40N. NOTE: SEE ITEM #4 - THERE IS AN EXCEPTION. ALGO,THIS BLOCK IS TO BE MARKED IF PREVIOUS NEW APPLICATION WAS WITHDRAWN. PLEASE WRITE " WITHDREW" NEXT

(

TO "NEW."

4 th alwu 2.e - FOR 2h THRU 2.e, COMPLETE EACH CATEGORY COMPLETELY, BUT INDICATE ONLY THE EDUCATION, TRAINING, l

AND EXPERIENCE YOU HAVE RECElVED SINCE YOUR LAST APPLICATION. NCTE: SEE / TEM 14 - THERE IS AN I

EXCEPTION, j

i 2A RENEWAL "X"IF YOU ARE RENEWING CURRENT LICENSE.

2.s UPORADE

• X"lF YOU HOLD A RO LICENSE AND ARE NOW APPLYING TO UPGRADE YOUR LICENSE TO A SRO, 2.al MULTI. UNIT "X" lF YOU CURRENTLY HOLD A LICENSE AT YOUR FACILITY AND ARE APPLYlNG TO AMEND YOUR CUR.

MENT LICENSE TO ADD AN ADDITIONAL UNIT.

2.e REAPPLICATION "X"IF YOU HAVE PREVIOUSLY REEN DENIED A LICENSE AND ARE REAPPLYING.

2.f WAlVER REOUESTED "X"THS.4PPLICABLE WAIVER REQUESTED AND JUSTlFY IN COMMENTS SECTION (ITEM 17),

2.s DATE PASSED GENERIC FUNDAldENTALS EXAMINATION SECTION IGFE&l.

THis IS NOT APPLICABLE TO RESEARCH REACTOR $. ENTER THE MONTH AND YEAR THE GENERIC FUNDAMENTALS EXAMINA.

TlON SECTION OF THE WRITTEN EXAMINATION WAS PASSED, IF THE GFES WAS NOT TAKEN, YOU MUST HAVE PASSED AN NRC LICENSING EXAMINATION ON THE APPLICABLE REACTOR TYPE (PWR OR BWR) AFTER FEBRUARY 1,1982,WHICH LED TO THE ISSUANCE OF A LICENSE THIS DOES NOT INCLUDE INSTRUCTOR CERTIFICATION EXAMINATIONS OR REQUALIFICATION E XAMIN ATIONS, l

11.

EDUCATION - INDICATE BOTH ACADVM!C AND VOCATIONAL / TECHNICAL POST HIGH SCHOOL EDUCATION, FOR MAJOR AREA (S) OF STUDY, INDICATE THE NUMBER OF YEARS SPENT IN EACH COLLEGE CURRICULUM AND THE HIGHEST DEGREE RECElvED, USING THE DEGREE OODE PROVIDED. FOR VOCATIONAL / TECHNICAL EDUCATION, INCLUDE PROGRAMS SUCH AS NUCLEAR POWER BCHOOL, MILITARY TRAINING, AIR CONDITIONING / REFRIGERATION, OlESEL MECHANIC SCHOOL, ETC, INDICATE THE NUMBER OF MONTHS IN EACH PROGRAM AND WHETHER A CERTIFICATE OR DEGREE WAS AWARDED, IF ADDI.

TIONAL SPACE IS NEEDED, CONTINUE UADER COMMENTS (ITEM 17).

12.

TRAINING = INDICATE THE TRAINING YOU HAVE RECEIVED TO MEET THE REQUIREMENTS OF ANSI N18.1/ANS 3.1 THE BREAKDOWN OF TRAINING IN THIS CATEGORY PARALLELS THE ANS STANDARDS. REFER TO THE STANDARDS IF YOU NEED FURTHER CLARIFICATION. INCLUDE BOTH BEGINNING AND COMPLETION DATES AND THE TOTAL NUMBER OF WEEKS SPENT IN EACH TYPE OF TRAINING. THE NUMBER OF WEEKS IS PROVIDED, IN ADDITION TO BEGINNING AND COMPLETION DATES, TO ACCOUNT FOR INTERMITTENT TRAINING (FOR EXAMPLE,4 WEEKS OF CLASSROOM TRAINING SPREAD OVER A 2. MONTH PERIOD). THEREFORE. THE DATE COLUMNS MAY INDICATE A LARGER TIME SPAN THAN TM ACTUAL NUMBER OF WEEKS SPENT IN FULL. TIME TRAINING, TIME IN TRAINING FOR THE LICENSE APPLIED FOR CANNOT BE DOUSLE COUNTED UNDER EXPERIENCE (ITEM 13),

ALL REQUALIFICATION TRAINING TIME IS TO BE ACCOUNTED FOR IN THE REQUALIFICATION ITEM. PLEASE DO NOT " DOUBLE LIST" THE TIME SPENT IN REQUALIFICATION TRAINING UNDER ITEM 12.6, REQUAllFICATION, EVEN THOUGH IT MAY INCLUDE CLASSROOM OR SIMULATOR TIME.

13.

EXPERIENCE - A MINIMUM OF 6 MONTHS AT THE SITE FOR WHICH THE LICENSE IS SOUGHT IS REQUIRED, FOR EACH POSITION HELD, COMPLETE ITEM 16. DO NOT DOUBLE COUNT TIME, IF YOU HAD OVERLAPPING DUTIES, THE MONTHS SHOULD REFLECT THE PROPORTIONATE AMOUNT OF TIME YOU WERE ASSIGNED TO THOSE PARTICULAR DUTIES. IN NO CASE SHOULD THE NUMBER OF MONTHS REPORTED FOR A PARTICULAR TIME PERIOD EXCEED THE NUMBER OF MONTHS THAT ARE IN THAT TIME PERIOD, 14, FACILITY OPERATOR TRAINING PROGRAM - INDICATE e. GRADUATE OF INPO ACCREDITED OPERATOR TRAINING PROGRAM:

AND h. CERTIFIED F *C FCN". CC CN NNC APPNOVED SlMULATi3 FACILITY ik v5EO m int Ur CNA40H IHAlNING PRO.

GRAM. IF "YES" IS CHECKED IN BOTH ITEMS 144 AND 14.b, THEN ITEMS 11 (EDUCATION),12 (TRAINING),13 (EXPERIENCE),

AND 16 (EXPERIENCE DETAILS) DO NOT HAVE TO BE DOCUMENTED, NEW APPLICATIONS MUST STILL INCLUDE THE NUMBER OF SIGNIFICANT CONTROL MANIPULATIONS UNDER ITEM 12.3, NOTE: INPO ACCREDITED MEANS ACCREDITATION SY THE NATIONAL NUCLEAR ACCREDITING BOARD AND MEANS THAT AT LEAST THE MINIMUM REQUIREMENTS OF REGULATORY GUIDE 1,B, REV,2, ARE MET, 16, FOR RENEWALS ONLY - (1) ENTER THE APPROXIMATE NUMBER OF HOURS SINCE PREVIOUS RENEWAL OR ISSUANCE OF LICENSE IF FIRST RENEWAL, (2) ENTER DATE AND RESULT OF MOST RECENT NRC ADMINISTERED REQUALIFICATION EXAMI.

NATION.

18, EXPERIENCE DETAILS - INCLUDE POslTION TITLE, TIME PERIOD-FROM/TO, FACILITY, AND A BRIEF DESCRIPTION OF DUTIES PERFORMED WHILE SERVING IN THAT POSITION, IF MORE SPACE IS NEEDED, USE COMMENTS (ITEM 17), OR IF NECESSARY, ATTACH ADDITIONAL INFORMATION.

17.

COMMENTS - USE THIS SPACE TO INCLUDE ANY EXTRA INFORMATION OR CLARlFICATION FOR OTHER ITEMS ON THE APPLt.

CATION FORM, IF THE SPACE PROVIDED IS NOT SUFFICIENT, YOU MAY ATTACH EXTRA INFORMATION WITH YOUR APPLICA.

TION, 18, NRC FORM 398, CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE - MUST ACCOMPANY THIS APPLICATION, it.

SIONATURES - SIGN AND DATE ITEM 192. OBTAIN YOUR TRAINING COORDINATOR'S SIGNATURE AND THAT OF YOUrt SENIOR MANAGEMENT REPRESENTATIVE ON SITE,

' OETACH THESE INSTRUCTIONS AND SUBMIT THE COMPLETED NRC FORMS 398 (ORIGINAL AND TWO COPIES EACH) TO THE APPRO PRIATE REGIONAL ADMINISTRATOR.

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BIO 4ATUH5-APPLICAsfl DATE OH00K APPLICARLE 80K I E l sonwy shes the ensue named pusainssi he auseousun, somseeied the eneung seenesse mouwenome se to heensed a en Deereiertsenter ossesor pwevent so Tais to, coes of enewel neovinsens.

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TRAINING COORDINATOR SENIOR MANAGEMENT REPRESENTATIVE ON StTt PRINT 90 0R TYP90 OEAML PM4N1 ED OR T ve'60 Naut SIOfeATUstl lDATE teGNATURE lDATE FOR NRC USE WAIVER tcheck or ConwJere #eme as ansWireble) luttisRtoUimtutNTs l j oots wot utst REQUiMEMENT$ lisown toewi o.i.hv. o.,

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F ACILif Y l F ACILITY DOC 8tf T NUteDE R A. MEDICAL EXAMINATION CERTIFICATION THIS il TO CE milF v THAT THE ABOVE Nauf D APPLICANT FOR AN OPERATOR / SENIOR OPE R ATOR LICEN3E HAS BEEN ixAMINED $Y A PHYSICIAN PRINT ED N AMt for phrarrwans lST ATE AND LICENSE NUMBER l E KAMIN ATION D Aff g ASE D ON THE RE SULTS Of THE E x AMINATION. INCLUDING INFORMAtlON F URNISHED BY THE APPLICANT. THE PHYliCI AN HAS DETERMINED THAT THE APPLICANT'S PHYSICAL CONDlTION AND GENE R AL Hi ALTH ARE NOT SUCH THAT ff MIGHT CAUSE OPER AtlON AL E RRORS (NDANGE RING PUOLic HE ALTN AND GAF ETY. I CE RTIF Y THAT IN Rf ACHING THIS DETE RMINAflON THE GUIDANCE ODNT AlNE D IN ANSUANS 3 41983. DR ANSDANS 15 4-1977 iN3eol W AS FOLLOWED AND THAT DOCUMENTATION IS AVAILABLE FOR RtviEW 8Y NRt ON THE BASIS OF THE RECOMMENDATION OF TdfHYSICIAN. I RECOMMEND THAT THE APPLICANT'S OPERATOR L-CENSE BE CONDITIONED AS l

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l. NO RtSTRICTIONS J

2. CORRECTIVE LENSES BE WORN WHEN PERFORMING LICENSED DUTIES

3. HE ARING AfD 8t WORN WHEN PE RFORMING LICENSED DUTIES

4. RE St RICTED LICE NSE OR E xCt PTION.Proude estaa emo. and ettach supportmg medical evidence for NRC review n

6 RE ST RiCTtoN CHANGE F ROM PRE VIOUS SUBMITT AL -Provide detads twoon and attach supportmo medical oversence for NRC review

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AE LATIONSHIP OF R E St RICTION TO DISOUALIF YING r;ONDITION (8refry sturrere how scarreren we# correct the WeagusMy#ng conoirent LEMARKS FOR RtSTRICTION CHANGE 8Acca 6 shovel B. twCNMLD' CAL CE R11F ICAl(ON POWE R RE ACTOR $.

TH15 CE RTIFIES THAT THE APPitCANT HAS BEEN FOUND TO ME ET THE SAF EGUARDS' AND FITNESS FOR DUTY REQUIREMENTS OF THis F ACILITY FOR LICENSED OPER ATORS NON POWE R RE ACTORS THIS CERfiflES THAT THE APPLICANT HAS BEEN FOUND TO MEET THE SA. 6 GUARDS' REOUIREMENTS OF THl$ F ACILITY FOR LICENSED OPER ATORS ANO l HAVE NO KNOWLEDGE OF THE APPLICANT EXCEEDING THE CUTOF F LEVELS FOR ALCOHOL OR CONTROLLE D SUBST ANCES AS EST ABLISHE D PURSUANT TO 10 CF R 26 f== e atst stat ewant on owissiom e= rais oucuuen t esctuoimu..t t arautwis was et susanc t to civn amu cnewiha6 pNct euws. a ctati+ = vmutH F6Nativ 06 4 ERJURV THAT THE iNPOMMAfiON IN THIS DOCUMENT AND Aft &CHMEhflit tMUE AND COnmEC1.

r RINT E D NAME AND SIGNATURE (Senor aasnagemeter stepresenterr e on 3,res TITLE Daft in accorcance witn 10 CF A 66.6. Commumcaters. this form shall be submitted to the NRC as losiows. 8Y MAIL ADDRESSED iO.

Regional Admmistrator. Regen i Regenet Admmistrator. Region il Regionai Admemstrator Region til U S. Nuclear Regulatory Commissen U S % clear Regulatory Commnsen U S Nuclear Regulatory Commessen 475 Alsendaie Road 101 Marietta Street. Sune 3100 799 Rooseveit Road song of Prussia. PA 19406 Atlanta. G A 30323 Gion Ellyn. IL 60137 Regenal Adminstrator. Region av Regenal Admimstrater, Reg'on V U S %cisar Regulatory Commmen U S Nuclear Regulatory Commmion 611 Ryan Ptasa Drive. Suite 1000 1450 Mria Lane. Sune 210 Arimgton. T X 7601i Wamut Cseek CA 94596 PHiv ACY ACT STAiEMENT Pursuant to 6 U twC 652aleH31. enacted mio saa ev wetion 3 of the Privacy Act of ROUTINE USES. The mtormaten n.sv de disclosed to en sopropriate Feoeral. State, or the %Iloweg statement is umished to moeviduais eno local agency in the event the information irviecates a veoisten or potential vetation of laa 1974 (Public Laa 93 6791.

r suppiv informaten to the U S Nuctear Regulatory Commmen on NRC Form 396-and m the event the mtormaten mthcates a velaten or catential veisten of law and m This m'ormation es maimamed m a system of recoros designated as NRC 14 and the courw of an admmistrative or ludiciai procecome in auditen. th.s mtormaten may tw described at 61 Feoerai Register 33167 (Septemtwe 18.19866 transferred to an appropriate Feoerai. State, and locas agency to the entent relevant and AUTHORITY Sectens 107 and 661M of it e Atomic Evgv Act of 1954. as recessary for an NRC decision sbout you.

amended 142 U S C. 2137 and 220ttill WHETHE R DISCLOSURf 15 VANDATOR v On VOL.UNT ARY AND EFF E'T ON PRINCIPAL PURPOSE (Sh leformaton entered on this form 6 uwd to determme INDivtDUAL OF NOT PROviDING INFORMATION Daciosure is voiuntary, if the ehether the physical conditen and generas heart' of the applicant are such that they Mauetud inbrmaten is not previoed however. the appocaten for a facihty operator s will not cauw osweetonal errors ennengerms subut health and matetv. This informa or sener op*'ator a heente may tw denied ten may be used bv the NRC siaH to determme af trw mdevidual meets the require-SYSTEM MANAGE Rt$l AND ADDRESS Chief. Operator Licensme Branch Ottice el meets of 10 CF R 65 to tame en enammaten or to be issued an opecator s beenw Nacivee Reactor Reguisten. U S. Nuciese Reguistorv Commusion. Washacion. DC 20555 Nec enav 'rea onliv

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SCPtERY OF QUNES M HIIC F000( 398 l

i Medical Examination Certification Added block "!Instriction Change Fms Prwious Sukaittal" plus Remarts sectica.

I Han-Hodical Certification Changed nonendical certification statement to: Poser Snactore-This certifies that the applicant has been found to meet the safeguards' and i

fitmens for chaty requirementa of this i

this facility for licensed operators.

Hanpower-lhis certifies that the applicant has been found to meet the safeguards' requirementa of this i

facility for liW operatore and i

I have no knculedge of the applicant t

w iry the cutoff levels for alochol 4

or omntrol. lad substances as es+=hliM pursuant to 10 CFR 26.

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Item 4.d Added clarifying statmount to indiosto this is to be i

checked caly if applicattan is to amend liannee to add additional unit (s).

j

~ Item 4.f Added "(Catasory)" to Operating.

1 Added "te diani".

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1 Item 4.s Added a new item "Date Pommed Generic Fundamentals t===4 nation Section".

J Item 12.3 Changed wording to " Certified Startup Program Completed" for clarification.

Item 12.5 Qansed wording to " Extra Person Qa Shift In Control Room (13-week mininas)" for clarifiestian.

Item 12.5a Added a new item " Time on Stift Above 205 Peeer (6-week l

minima)".

Item 14.a Added the words "'! hat Is Bened Upon A Systems Approach to Tr=4a4a=" for clarification, i

-Item 15 Added "Date and Result of Most Rosent Nic Ahred Degualificatica E===4aaticut.

I Item 19.a Added % wording "I further certify that I have notified.

er ce< wit employer oft (1) all prWFlous employerW; (2) enr.

I instance where I have been tested br a Health and ihnen Servious (155) Certified Ikiar Testing Imboratory or a Licensee's testing facility for alochol or a centrolled substanos, and the test results M the autoff: levels

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established sursuant to 10 CFR Part 26; (3) any instance where I have been arrested for the sale, une or possession of a controlled substamos described in 10 CFR Part 26; and i

(4) any twesens for removal or revocation of unescorted access at a nuclear facility".

Item 19.b and Item 19.c Moved 19.b and 19.c tesother. Applicable box aust now be checked. Also added block for typed name of Training Coordinator and Senior Manny===nt aspresentative On Site.

70R Nic OBE Ooder univer estagory added "tendina)".

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