ML20006D700
| ML20006D700 | |
| Person / Time | |
|---|---|
| Site: | Ginna  |
| Issue date: | 01/05/1990 |
| From: | Gallo R NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | Mecredy R ROCHESTER GAS & ELECTRIC CORP. |
| References | |
| NUDOCS 9002140268 | |
| Download: ML20006D700 (8) | |
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JAN 5 1990 i
Docket No. 50-244 Rochester Gas and Electric Corporation I
ATTN: Mr. Robert C. Meeredy General Manager L
Nuclear Production i
49 East Avenue Rochester, New York 14649 Gentlemen:
$UBJECT:
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),
j 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, j
.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.
OTSELDR1 Signed Bya t
Robert M. Gallo, Chief Operations Branch Division of Reactor Safety
Enclosures:
As stated-b T
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9oo21 % Ik O. f FDR OFFICIAL RECORD COPY 396 & 398 FORMS - 0017.0.0 V
12/14/89
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Rochester Gas and Electric 2
Corporation 1
i cc w/o enCI:
Harry H. Voigt, Esquire R. Carroll, Training Manager (w/ enclosures) l Central Records (4 copies)
Director, Power Division State of New York, Department of Law t
Public Document Room (PDR)
L Local Public Document Room (LPDR) ll Nuclear Safety Information Center (NSIC)
NRC Resident-Inspector L
State of New York, SLO Designee
[J bec w/o enc 1:
Region I Docket Room (wit.h concurrences)
Management Assistant, DR'iA (w/o enc 1) i DRP Section Chief A. Johnson, PM -NRR J. Johnson,.DRP E. McCabe, DRP OL Facility File l
DRS:RI Gallo/pb 0 02/9p bY f f.5j q 0 4
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OFFICIAL RECORD COPY 396 & 398 FORMS - 0018.0.0 12/14/89 i
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INSTRUCTIONS POR COMPLETING NRC PORM 300 PE A50NAL OUALIFICATION STATEMENT-LlCENBEE TO FIEMAIN VALID,THD FOR3 MUST NOT DE ALTE7ED l
4.
. TYPE Of APPLICATION 2.s NEW
- X" IF YOU ARE A NEW APPLICANT, COMPLETE EACH CATEGORY OF THE FORM COMPLETELY, FOLLOWING THE INSTRUCTIONS DELOW. THIS IS TO INCLUDE ALL EDUCATION, TRAINING AND EXPERIElCE THAT YOU HAVE RECEIVED UP TO THE DATE OF THIS APPLICATJON. NOTE: SEE / TEM f 4 - THERE IS AN EXCEPTION ALSO,THIS BLOCK IS TO BE MARKED IF PREVIOUS NEW APPLICATION WAS WITHDRAWN, PLEASE WRITE " WITHDREW" NEXT TO "NEW."
2.b thru 2.e - 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 f4 - THERE IS AN EXCEPTION.
2.b RENEWAL "X"lF YOU ARE RENEWING CURRENT LICENSE.
2.s UPGRADE
2.sl MULTI. UNIT
- X" lF YOU CURRENTLY HOLD A LICENSE AT YOUR F ACILITY AND ARE APPLYING TO AMEND YOUR CUR.
MENT LICENSE TO ADD AN ADDITIONAL UNIT.
2.e REAPPLICATION "X"IF YOU HAVE PREVIOUSLY BEEN DENIED A LICENSE AND ARE REAPPLYING, 2.f WAIVER REQUESTED "X"THE. APPLICABLE WAlVER FIEQUESTED AND JUSTlFY IN COMMENTS SECTION llTEM 17).
2.s DATE PASSED GENERIC FUNDAMENTALS EXAMINATION SECTION (GFES).
THIS IS NOT APPLICABLE TO RESEARCH REACTORS. ENTER THE MONTH AND YEAR THE GENERIC FUNDAMENTALS EXAMINA.
TION BECTION OF THE WRITTEN EXAMINATION WAS PASSED IF THE GFESWAS 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 i
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 i
AREAIS) OF STUDY, INDICATE THE NUMBER OF YEARS SPENT IN EACH COLLEGE CURRICULUM AND THE HIGHEST DEGREE RECElVED, U$tNG THE DEGREE CODE PROVIDED. FOR VOCATIONAL / TECHNICAL EDUCATION. INCLUDE PROGRAMS SUCH AS NUCLEAR POWER SCHOOL, MILITARY TRAINING, AIR CONDITIONING / REFRIGERATION, DIESEL MECHANIC SCHOOL, ETC.
INDICATE THE NUMBER OF MONTHS IN EACH PROGRAM AND WHETHER A CERTIFICATE OR DEGREE WAS AWARDED, IF ADDI.
TlONAL SPACE l$ NEEDED, CONTINUE UNDER COMMENTS (ITEM 17),
12, 1 RAINING - INDICATE THE TRAINING YOU HAVE RECElVED 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 ALD 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 SPElvT IN FULL. TIME TRAINING. TIMi IN TRAINING FOR THE LICENSE APPLIED FOR CANNOT BE DOUBLE COUNTED UNDER E XPE RIENCE (ITEM 13).
ALL REQUAllFICATION TRAINING TIME IS TO BE ACCOUNTED FOR IN THE REQUALIFICATION ITEM. PLEASE E'O NOT " DOUBLE LIST" THE TIME SPEN 1 IN REQUALIFICATION TRAlHING UNDER IT EM 12.6, REQUALIFICATION, EVEN THOUGH IT MAY INCLUDE i
CLASSROOM OR SIMULATOR TIME.
13.
EXPERIENCE - A MINIMUM OF 6 MONTHS AT THE SITE FOR WHICH THE LICENSE IS SOUGHT l$ REQUIRED FOR EACH POSITION HELD, COMPLETE ITEM 16. DO NOT DOUBLE COUNT TIME. IF YOU HAD OVERLAPPING DUTIES,THE MONTHS SHOULD REFLUCT THE PROPORTIONATE AMOUNT OF TIME YOU WE'1E AS$1GNED TO THOSE PARTICULAR DUTIES. IN NO CASE SFOULD THE NUMBER OF MONTHS REPORTED FOR A PAFITICULAR TIME PERIOD EXCEED THW NUMBER OF MONTHS THAT ARE IN THAT TIME PERIOD.
14, FACILITY OPERATOR TRAINING PROGRAM - INDICATE s. GRADUATE OF INPO ACCREDITED OPERATOR TRAINING PHOGRAM; AND tt CERTIFIED (ON NAC FODM C4) 09 MC MPROVED OlMULATION T ACILITY 15 USED IN THE OFERATOR TRAIN 6NG PHu.
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. NOTEl INPO ACCREDITED MEANS ACCREDITATION BY THE NATIONAL NUCLEAR ACCREDITING BOARD AND MEANS THAT AT LEAST THE MINIMUM REQUIREMENTS OF REGULATORY GUIDE 1.8, REV,2. ARE MET, 15 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, 16.
f.XPERIENCE DETAILS - INCLUDL POSITION TITLE, TIME PERIOD-FROM/TO, FACILITY, AND A BRIEF DESCRIPTION OF DUTIES PERFORMED WHILE SERVMG 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 CLARIFICATION FOR OTHER ITEMS ON THE APPL CATION FORM. IF THE SPACE PROVIDED IS NOT SUFFICIENT, YOU MAY ATTACH EXTRA INFORMATION WITH YOUR APPLICA.
TIDN.
18.
NRC FORM 396, CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE - MUST ACCOMPANY THIS APPLICATION.
19.
SIGNATURES - SIGN AND DATE ITEM 19.a. OBTAIN YOUR TRAINING COORDINATOR'S SIGNATURE AND THAT OF YOUR SENIO MANAGEMENT REPRESENTATIVE ON SITE.
DETACH THESE INSTRUCTIONS AND SUSMIT THE COMPLETED NRC FOP.MS 398 (ORIGINAL ANO TWO COPlES EACH) TO THE PRIATE REGIONAL ADMINISTRATOR.
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SiON. % ASHINGTON DC 2(MiM, AND TO THI PAPERWWOftet REDUCTION PRO >tCT 13t604:0801. OCf 0F MANAGE-TO REMAIN VALID,THt$ FORM MD67 NOT BE ALTE RED MENT AND SUDot 7, n AswitvoTON. DC 20603.
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- 3. EWS/PPWS OBSERVATION
- 4. E RS/CRW 3-OPE RATING PRACTICE
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1 ANY f ALSE st ATGMENT OR DattS$ TON IN THl$ DOCUMENT, INCLUDING ATT ActlMENTS. MAY BE SuiKCT TOglL AND CRIMIN AL $ANCTION$.
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440NATur.E-APP'JCANT DA14 1
CDtBOK APPLICABLE DOX
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I Re k i eenie, not she enen na,med tweveuei has suorensivuv somswims the es,entiv teremsen esammmem,s.to.en hrena.nt ei en owe.eer/se.nm.e oseem.e, pu eni to T I
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l senemy et perivev thei the ineprmeten in om oseumoni and enunmeme b erve emt somet 1'
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.-- f g Reeeet AL ONI.t = l sortify that the snow need andwmust meets the apsuewd regualitiesten pfegram iwifA estestbet seMW h from lh et fornuped by meten 60 64 h H of 10 CF R 60. and I.
that he she hm dierterged hes/het hcensed fossenelb6shese enmpetently ensi setely, I seso settity ender penelty et periory thei the informegen in the aucument end etterhrnentt l
48 tfue end oprvect.
TRAINING COORDINATOR SENIOR MANAGERRENT RIPRESENT ATIVE ON SITE PRINTeo OR Tvrto hAut PRtNTED OR TYPau haut l
lDATE seONaTURL l Daft 5tOhATURt 1
1 FOR NRC USE WAtVER / Check or cturipsere drems.es amplicande/
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CERTIFICATION OF MEDICAL EXAMINATION W'o,,c,til,',y,g, ",5,Aao;gg,yng p
l BY FACluTY LICENSEE
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filDheCTION e#0 JECT 43tto4102ai 088 04 QF W&44G4 Uthf AND SUDQ41, Wha $MehGTO4 DC 7otoa NAMt OS APPLICANT i
FACILsTv f ACILITY Doct,ET NUNDER A. MEDICAL E XAMINATION CERTIFICATION THIS IS TO CE RTIF Y THAT THE AB0vt itAMED APPLICANT FOR AN OPER AT0R'SEN10m OPL R ATOR LICENSE HAS 61EN t AAMINED BY A PHv51CIAN PRINT ED N AML tof anysecsans lST Att AND LICEN$t NUMBER E R AMIN Atl0N D ATL BASED ON THE RESULTS OF THE E R AMIN Af t0N INCLUDING INFORM 8 T10N FURNISHE D By THE APPLICANT. THE PHv5lCI AN HAS DLTiltMINtD THAT THE APPLICANT'S PHYSICAL CONDITION AND GINLR At HE ALTH AR( NG( SUCH THAT IT MIGHT CAUSE OPE R ATION AL t RRORS ENDANGERING PUOLIC HE ALTH AND SAF(TV I CtkTif Y THAT IN Rt ACHING THIS Of TERMINAtl0N THE GUID ANCE CONT AINED IN ANSI /ANS 3 419R3 OR ANSI /ANS 16 419n tN3eolw As FOLLO*ED AND THAT DOCVUtNT ATION 15 AVAILABLE FOR RtVIEW BY NRC.
ON THE GASIS OP THE RECOMMENDATl")N OF T.tMMYSICisN I RECOMMEND THAT THE APPLICANT'$ 0PER ATOR LittN$t St CONDifl0NED AS FOLLOWS:
- 1. NO RESTRICTIONS
- 2. CORRICTIVE LENSES DE AORN WHEN PERFORMING LICENSED 00715
- 3. HEARING AfD St WORN WHtN PERFORMING LICEN5fD Dutil5 4 RtSTRICTED LICE NSE OR titCE PTION Provide asiaan teiow and attech supportme medicas evidence for NRC review S Rt STRICtl0N CHANGE 8 ROM PRt Vf0VS SUBMITT AL +Provee netaisi tein* and ettoch susormme medecai eveent.e for NRC revew AOP0 BED WORDING 05 RESTRICTION (8saca d eteves at LAtl0NSHIP 0F REST RICTION TO DISOUALIFYING CONDtil0N taretty emascere ar>w resrncton wist correct ene osaquatWmy comurens 75 MARK $ FOR RtSTRICT10N CHANGE (Noct 8 apoiel
- 8. NGNMLDICAL CLRilFICATION POWE R RE ACTORS.
THIS CERTIFIES THAT THE APPLICANT HAS SitN FOUND TO Mt ET THE SAF EGUARDS~ AND FITNESS FOR DUTY Ft0VIR(MENTS OF THis F ACiLITY FOR LICENSED 0PE R ATORS NON PowtR RE ACTDRS.
THIS CtRTif tES THAT THE APPLICANT HAS BEEN F0VND TO MtET THE SAFIGUARDS' Rf 0UIRE MENTS OF THis F ACILITY FOR LICENSED OPER ATORS. AND t HAVE NO KNOWLEDGE OF THE APPLICANT t XCECD:NG THE CUTOFF LEVELS FOR AtCOHOL OR CONTROLLED SUBST ANCES AS EST ABLISHED PURSUANT TO 10 CF R 26 f we e atsg siaiawewe on owiuium in emis c>ucvvent inuupimu at iacavamt> ua v et av.atct tu civis amp 6miwimas un61 sus a. i tawi a e v%veh etna 6 ri ut PtflJURv IHAT THS ihtoPWAtlON th THIS DOCUMENT AND ADeCHMENTS 18 TRut AND CORRECT.
J RINT ED N AME AND SIGN ATURE (Setter Haneeement nearesenteme on S, ret flT LE DATE 1
in accoroance enn 10 CF R 55 5. Communications. tait form snail De suomitted to the NRC as follows. SY MAIL ADDFitSSED 10.
Regenal Admemitrator, Regen i Reemaal Administrator Region 11 Regenal Admmistrator, Region ill U L Nuclear fleguistory Commissen U S Nucitar Regulatory Committen U $ Nuclear Requistory Commessen 475 Allendate Road 101 Marietta Street Suite 3100 799 Raoseveit Road King of Pruties. P A 19406 Ananta. GA 30323 Gen Ellvn. IL 60137 Regenas Administrator Region IV Regenal Admmistrator. Region V U.S. Nucear Requiatory Committen U.S Nucmar Rm usatory Commmien 611 Ryan Plate Drive Sune 1000 150 Maria Lane. Suite 210 Arhngton. TX 76011 Walnut CreeA CA 94596 PHav ACY ACT ST A'kME NT Pursuant to 6 U.S.C $$2aleH3L enaned mio saw t y secten 3 of the Privaev Act of ROUTl86E USES The mtormaten may be disclosed to an appropriate Federal. State. or r tnahed to individuals who local agency m the event the informaten mdicates a vioiation or potential vetalen of law 1974 (Public Law 935791 the followme sistement 4: u supply mtormation to the U S Nuclear Regulatory Commision on NRC Form 396 and in the event the mformation moscates a veisten of potentiai vioisten of Law and m This mio manon is mamtamed m a avstem of recerat aesinated at NRC 16 and the course of an administrative or suoicisi proce.ome in sodden. th.i mtoreisten may tw cescribed at 61 Feueral Regater 33157 (Septemtier 18.1986L transferred to en appropriate Fede'a1. State. and soce agency to the entent reevant and AUTHORITY: Sectent 107 and 16101 of the Atomic Ene ov Act of 1954. as aecessary for an NRC oecision atest you amenced (42 V S C. 2137 and ?201 tin
%HETHER DISCLOSURE IS MANDATORY OR VOLUNT ARY AND EFFECT ON PRINCIPAL PURPOSitSL Insormanon entered on this term 4 uwd to oeiermme INDIVIDUAL OF NOT eROVIDING tNFORMATION Daciosure is vosuntary. If the whether the physcas conditen are generas health et the opphcant s'e such that they emunted information 4 not prov ued however. the opptcaten for a facihty operator's will not count olieratonal erfort endangermg pup' g health and safety Th4 mtorma or gener operator i iscente enev be cen%s ten me, tw useo ey the NRC siaH to oetermer, d the morvidua6 meni the equire SYSTEM MANActRts) AND ADDRE$$ Ch.et Oterator Licensmo eranch. Othee of ments of 10 CF R $$ to tame an enemmaten or to be usued an operator i licenw Nuclear Reactor Reguution. U.S Nucwar Requestory Comminion. Washington, DC 20555 Nec emy we onaei
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StatWJT OF QUH2ES M Hic PORT 396 Medical Examination Certification Added bloch " Restriction Qanse Fron Pawicus autanittal" plus Remarks j
emotion.
i Non-Medical Certificatica Changed non-endical certification statement to: Power Reactors-This l
oertifies that the applicant has been found to mort the safeguartis' and fitmens for cksty requirementa of this L
this facility for licensed operators.
Nonpower-This certifies that the applicant has been food to meet the
==far=4' requirements of this facility for licensed operators and I have no knowledge of the applicent emooeding the cutoff levels for minnhal or controlled substances as es+=huahad pursuant to 10 CFR 26.
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i SuttERY OF CintG510 IWC FotW 396 i
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Added clarifying statmount to indicate this is % be I
Item 4.d checked only if application is to amend license to add additional unit (s).
Itan 4.f Added "(Category)" to Operating, j
Added "tenMani".
Item 4 s Added a new item "Date Passed Generic Fundamentals Izanination Section".
Item 12.3 Chansed wording to "Cartified Startup Pregram casoleted" for clarification.
L Item 12.5 Chansed weciing to " Extra Person (km Shift In Centrol lioom (13-week minimus)" for clarification, i
Item 12.5a Added a new ites " Time On Shift Above 20E Power (6-week minimum)".
. 1 Item 14.a Added the words "That Is Based Upon A Systems Approach to Training" for clarification.
Itan 15 Added "Date and Result of Host Roosnt HNC Administered Requalification h=miantion".
Itse 19.a Added the wording "I further certify that I have notified.
er current esplayer of t (1) all pewious esplayers: (2) any instance where I have been tested by a Health and &anan Servioso (HRB) Certified Drug Testing Leeri or a Licensee's testing facility for alcohol or a controlled substanoe, and the test results ah.the autoff levels
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established pursuant to 10 CFR Part 26 (3) any instance where I have been artisted for the sale, use or possession of a ocntrolled substanos described in 10 CFR Part 26: and (4) any reaanras for removal or revoontion of unescorted aooems at a nuclear facility".
Item 19.b and Itam 19.c Moved 19.b and 19.c together. Applicable box aust now be checked. Also added block for typed name of Training Coordinator and Senior Management Representative On Site.
FWt NRC USE Under waiver category added "te Mna)",
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