ML20006D637

Forwards Revised NRC Forms 398 & 396 Re Personal Qualifications Statement & Certification of Medical Exam by Facility Licensee,Respectively.All Applications for Licenses to Be Submitted on Revised Forms by 900201

ML20006D637
Person / Time
Site:	Beaver Valley
Issue date:	01/05/1990
From:	Gallo R NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I)
To:	Sieber J DUQUESNE LIGHT CO.
References
NUDOCS 9002140149
Download: ML20006D637 (8)

Text

....... _ _ _

_q-JAN 51990

0ocket Nos. 50-334 50-412 Duquesne Light Company ATTN:

Mr. J. D. Sieber 4

Vice President

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Nuclear Group

' Post Office Box 4' L

Shippingport, Pennsylvania 15077 Gentlemen:

L

SUBJECT:

REVISED NRC FORMS 396 AND 398 Enclosed is a copy of the revised'NRC Form-398-(Enclosure 1), Personal Qualifications Statement - L'::ensee 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, i

Dr 18LDu1 S18ned Byt Robert M. Gallo, Chief Operations Branch Division of Reactor Safety

Enclosures:

As stated

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OFFICIAL RECORD COPY 396 & 398 FORMS - 0013.0.0 S

12/14/89 l9002140149 900105.ADOCK-0500gj4 P o (_1-E' '

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W Duquesne Light Company 2

l-cc w/o enc 1:

J. J. Carey, Executive Vice President, Operations J. O. Crockett, General Manager, Corporate Nuclear Services W. S. Lacey, General Manager, Nuclear Operations N. R. Tonet, Manager, Nuclear Engineering i

T. P. Noonan, General Manager Nuclear Operations S. C. Fenner. QA Manager K. D. Grada, Manager, Nuclear Safety H. R. Caldwell, General Superintendent, Nuclear Operations T. Burns, Director, Operations Training (w/ enclosures)

Public Document Room (PDR)

Local Public Document Room (LPDR)

Nuclear Safety Information Center (NSIC)

NRC Resident Inspector Commonwealth of Pennsylvania bec w/o enc 1:

Region I Docket Room (with concurrences)

Management Assistant, DRMA (w/o enci)

C. Cowgill, OkP P. Tam, NRR J. Dyer, EDO OL Facility File DRS:RI

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r 0FFICIAL RECORD COPY 396 & 398 FORMS - 0014.0.0 12/14/89 A

INSTRUCFlONS FOR ODMPLETING NRC PORM 3BB PERSONAL QUALIFICATlON STATEMENT-LICEMBEE TO REZAIN VALID,THis FORM MUST NOT BE ALTEZED i

4 TYPE CF APPLlCATION 2.'s NEW "X" lF YOU ARE A NEW APPLICANT, COMPLE14 EACH CATEGORY OF THE FORM COMPLETELY, FOLLOWING THE INirTRUCTIONS BELOW. THIS 18 TO INCLUDE ALL EDUCATION, TRAINING AND EXPERIENCE THAT YOU HAVE RECElVED UP TO THE DATE OF THIS APPLICAT40N. NOTE: SEE ITEM 74 - THERE 18 AN EXCEPTION. ALBO. THIS BLOCK 18 TO BE MARKED (F PREVIOUS NEW APPLICATION WAS WITHDRAWN, PLE ASE WRITE " WITHDREW" NEXT TO "NEW."

2.b thru 2.s-FOR 2.b THRU 2.e. COMPLETE EACH CATEGORY COMPLETELY, BUT INDICATE ONLY THE EDUCATION, TRAINING, AND EXPERIENCE YOU HAVE RECEIVED SINCE YOUR LAST APPLICATION, NOTE: SEE ITEM N - THERE 18 AN E XCEPTION.

2.b RENEWAL "X"IF YOU ARE RENEWING CURRENT LICENSE, 2.s UPGRADE

• X"lF YOU HOLD A RO LICENSE AND ARE NOW APPLYlNG TO UPGRADE YOUR LICENSE TO A SRO.

2.d MULTI. UNIT "X" lF YOU LURRENTLY HOLD A LICENSE AT YOUR FACILITY AND ARE APPLYlNG TO AMEND YOUR CUR.

RENT LICENSE TO ADD AN ADDITIONAL UNIT, 2.e RE APPLICATION "X"lF YOU HAVE PREVIOUSLY BEEN DENIED A LICENSE AND ARE REAPPLYING, 2.f WAlVER REQUESTED "X"THL&PPLICABLE WAIVER REQUESTED ANC JUSTIFY IN COMMENTS SECTION (ITEM 17).

2.g DATE PABBED GENERIC FUNDAMENTALS EXAMINATION SECTION (GFES).

THIS IS NOT APPLICABLE TO RESEARCH REACTORS. ENTER THE MONTH AND YEAR THE GENFRIC FUNDAMENTALS EXAMINA.

TlON SECTION OF THE WRITTEN EXAMIN ATION 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 EXAMINATIONS, 11.

EDUCATION - INDICATE BOTH ACADEMIC AND VOCATIONAL / TECHNICAL POST HIGH SCHOOL EDUCATION. FOR MAJOR AREAtS) OF STUDY, INDICATE THE NUMBER OF YEARS SPENT IN EACH COLLEGE CURRICULUM AND THE HIGHEST DEGREE RECElVED, USING THE DEGREE CODE PROVIDED, FOR VOCATIONAL / TECHNICAL EDUCATION, INCLUDE PROGRAMS SUCH AS NUCLEAR POWER SCHOOL, MILilARY 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 ADDl-TIONAL SPACE IS NEEDED, CONTINUE UNDER 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 THE ACTUAL NUMBER OF WEEKS SPENT IN FULL. TIME TRAINING. TIMG IN TRAINING FOR THE LICENSE APPLIED FOR CANNOT BE DOUBLE COUNTED U EXPE RIENCE (ITEM 13),

ALL REQUALIFICATION TR AINING TIME IS TO BE ACCOUNTED FOR IN THE REQUAllFICATION ITEM, Pl.E ASE DO NOT

• DOUBLE LIST" THE TIME SPEN 1 IN REQUAL;FIC#, TION TRAINING UNDER ITEM 12.0, REQUALIFICATION, EVEN THWGH iT MAY INCLUDE CLASSROOM OR SIMULATOR TIME, 13.

EXPERIENCE - A MINIMUM OF 6 MONTHS AT THE SITE FOR WHICH THE LICENSE l$ 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 i

TIME PERIOD, 14, FAClEITY Of FMATOft TMINING PROGRAM - INDICATE e. GRADUATE OF INPO ACCREDITED OPERATOR TRAINING PROGRAM; AND k CEtWWlED 10N NHC FOOM 474) OR NRC APPROVED CIMULAT!ON rACILITY 13 USED IN THE OPERATOR TRAINING GR AM, IF "YEr IS CHECKEU IN BOTH ITEMS 14.s AND 14.b, THEN ITEMS 11 (EDUCATION),12 (TRAINING),13 (EXPERIENCE),

AND 16 (EXPERIENCE DETAILS) DO NQT NAVE TO BE DOCUMENTED, NEW APPLICATIONS MUST STILL INCLUDE THE NUMBER OF BIGNIFICANT CONTROL MANIPUd.ATISNS UNDER ITEM 12.3, NOTE: INPO ACCREDITED MEANS ACCREDITATION BY THE NATIONAL NUCLEAR ACCREDITING BOARD AND MEANS THAT AT LEAST THE MINIMUM REQUIREMENTS OF REGULATOR OUICE 1.B.REV 2. ARE MET, 4.

FUR RENEWALS ONLY - (1) ENTER THI APPROXIMATE NUMBER OF HOURS SINCE PRLVIOUS RENEWAL OR ISSUAN LICENSL IF F!RST RENEWAL. (2) ENTER DATE.AND RESULT OF MOST RECENT NRC ADMINISTERED REQUAllFICATIO

NATION, l

16, EXPERIENCE DETAILS -INCLUDE POSITION TiliE, TIME PERIOD-FROM/TO, FACILITY, AND A BRIEF DESCRIPTION OF DUTsES PF.RFORMED WH!LE SERVING IN THAT POSITt04, IF MORE SPACE 18 NEEDED, USE COMMENTS (ITEM 17), OR IF NECESSARY, A'T ACH ADDITf0NAL INFORMATION.

t th COMMENTS - USE THl3 SPACE TO INCL 4SE ANY EXTRA INFORMATION OR ULARIFICATION FOR OTHER ITEMS ON T CATION FORM. IF THE MPACE PRDVIOCO IS NOT SUFFICIENT, YOU MAY ATTACH EXTRA INFORMATION WITH YOUR APPLICA.

TION.

I 18, NRC FORM 388, CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE - MUST ACCOMPANY THl$ APPLICATION,

19. - ElGNATURES - SIGN AND DATE ' TEM 19.e, OBTAIN YOUR TRAINING COORDINATOR'S SIGNATURE AND THAT OF YOUR SENIOR MANAGEMENT REPRESENTATIVE N SITE,

' DETACH THESE INSTRUCTIONS AND SUBMIT THE COMPLETED NRC FORMS 398 (ORIGINAL AND TWO COPIES EAC PRIATE REGIONAL ADMINISTRATOR,

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THis CERTIFitS THAT THE APPilCANT HAS g(EN FOUND TO ME ET THE SAF EGUARD$' REOUIREMENTS OF THIS F ACILITY FOR LICENSID OPE R ATORS. AND 1 HAVE NO KNOWLEDGE OF THE APPLICANT E XCE EDINO THE CUTOF F Lt VE LS FOR ALCOHOL OR CONTROLLED SUBST ANCES AS (ST ABLISHED PURSUANT TO 10 CF R 20 l

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PRiv ACi ACT ST AltMENT l

Pursuant to 8 U $LC $52ateH31. enarten mio ian by weten 3 of the Pnvacy Act of ROUTINE USES The information mov be disclowd to en soproorisie Federal. ' tate. or 1974 (Pubiec Lee 93 5791. the follamme statement is turn.shed to inoividuais who iocai agency m the event tee m'ormaien indicates a e ossten or potenties vioiaien of is, topo4v informai on to the U S %cisar Regulatory Commissen on NRC Form 396 and in the evditt the m'ormatqn indicates a veteten or mmntiai veisten of low and m This informaten et maintained m e setem of recoros nes:gnend as NRC 16 and the couru cf an sammentrative or audicisa proceedmg in aJoition erns informaten may tw described at St Federal Reginer 3318' (Segnemtst 10.19861 tramiterred to an sopropriate Federat. State. and locai agency to the enwnt resevent end AUTHORffY: Sectens 107 and 16114 of the A:omic Energy Act of 1954. as necenary for en NRC oecision suout you.

amenomJ I42 V S C 2137 and 2201tu WHETHE R DISCLOSURE is M ANDATORY OR VOLUNT ARY AND EFFECT ON PRINCIPAL PURPOSti$l intormaton entered on tNs form is used to deteemme INDIVIDUAL OF NOT PROVIDING INFORMAitON D%.osure 4 voluntary. If the j

whether the pnygocai cond ten and generai besith M the appiecant are such that they 'equested mtormation es not provioed. however. the appncsten for a facitety eterator i l

will not cauw opersional errors e-oangenng public health and istetv. This mtorme or ionior operator iincerise may be cen.co ten may be used by the NRC statt to oeurmine if the md<vidual meets the reawre SYSTEM MANAGERIS) ANO ADDF tSS CNet Orwrator Licensmo Branch Omce of ments et 10 CF R 65 to teme an easmmeten or to be issued an operator a license

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Medical Examination Certification Added block "Bestriction Omse Frte i

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Non-Nedical Certification Omsed nonw i=1 certification statament to: Power anactors-This certifies that the applicant has been found to meet the safeguards' and fitnnes for chrty reguirements of this this facility for licensed operstors.

Nonpower-this certifian that the applicant has been fami to meet the safeguards' requiremarrta of this facility for licensed operators and I have no knowledge of the applicant

==naading the autoff levels for alanhol or aant m iled subu+manam as es+=h14=had pursaant to 10 CFR 26.

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SuttWW OF CfWUE5 '!O NRC FOR( 396 Itas 4.d Addad clarifying statmount to indicate this is to be 1

checked only if application is to===nd license to 1

add a&iitional unit (s),

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Item 4.f Added "(Catasory)" to operating.

i Added "NHaal".

Item 4.s Added a new item "Date Passed Generic Ftawasantals Examination Section".

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

Item 12.5 Chansed wortiing to " Extra Persen CN Shift In Control Room (13-week minin a)" for clarification.

Item 12.5a Added a nos item " Tina on Shift Above 205 Peoer (6-week minima)".

Item 14.a Added the wortis "That Is Based Upon A Systems Approach to Tr=4aia=" for clarification.

Item 15 Added "Date and Result of Most Roosnt NRC Administered pequalification Enemination".

Item 19.a Added the wortiing "I Aarther certify that I have notified ur current employer of: (1) all prwious coployerst (2) anr instance where I have been tested by a Health and Human r

Services (HRB) Certified Drw Testing IAboratory or a Licensee's testing facility for alochol or a controlled i

substance, and the test resulta ava==4=d the cutoff levels established pursuant to 10 CFR Part 26: (3) any instance where I have been artisted for the sale, use or possession of a controlled substanos described in 10 CFR Part 26: and (4) any reemans for rgmoval or twvocation of unescorted access at a rnaclear 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 Manneement Representative On Site.

POR HRC USE thder waiver category added " Medical".

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