ML20011D286

Responds to Nonconformances Noted in Insp Rept 71-0192/89-06.Corrective Action:Radiographer Received Addl Training to Include Reconciliation of Info Between Film & Reader Sheet

ML20011D286
Person / Time
Site:	07100192
Issue date:	12/05/1989
From:	Temus C PACIFIC NUCLEAR SYSTEMS, INC.
To:	Macdonald C NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS)
References
26173, VKC-89-045, VKC-89-45, NUDOCS 8912260123
Download: ML20011D286 (12)

Text

{{#Wiki_filter:7/O/9h s D o t -- g p g L-p0* JUS kk g Q(,It g? USMIC usue 5 DEC141989 Y g,DEC141983 )"$ tyg[grg[h5e ms NU[ LEA 51 r WA S MAft stenus jj gyg7 Egg 0051 Cg q, po KET CLtRK v December 5, 1989 ru 'u VKC-89-045 U. S. Nuclear Regulatory Commission Office of Nuclear Materials Safety and Safeguards Division of Safeguards and Transportation Washington, D.C. 20555 Attention: C. E. MacDonald, Chief a Transportation Branch c' 7

SUBJECT:

NRC INSPECTION OF NUCLEAR PACKAGING, INC.'S q TRUPACT ASSEMBLY FACILITY - CARLSBAD, NM cu Gentlemen ,.J t o, the Enclosed are Nuclear Packaging, Inc.'s responses nonconformances identified by the NRC's audit team during the recent inspection of our TRUPACT Assembly Facility in Carlsbad, New Mexico. In addition to the responses, corrective actions for each nonconf ormance detailed in your report (710192/89-06) are addressed including scheduled dates for implementation of those items which are in-process. Copies of supporting documentation are attached as referenced in the body of these responses. Notations throughout these responses concerning NuPac*s Radiographer ref er to the Level II Radiographic Inspector on staf f at Nuclear Packaging's TRUPACT Assembly Facility in Carlsbad, New Mexico. Midland Inspection Services of Midland-Odessa, Texas performed the actual radiography prior to the NRC Inspection. Qualitex Testing (also of Midland, Texas) replaced the Midland contractor at the TAF on October 11, 1989, and continues to provide radiographic services to NuPac. The overview of radiography services at the TAF was performed by X-Ray, Inc. of Seattle, Washington, using the services of an ASNT certified Level III Radiographic Inspector. 10 CFR 71.119 requires that special NONCONFORMANCES #1 & # 2 processes be accomplished in accordance with qualified procedures and applicable codes. Welds on units S/N 102 and S/N 105 were f ound noncon1orming. EHOT EQURED g%,.k h 1 9912260123 891205 ADOCK0710g2 [ - DR= Bloi'13 Nuclear Packaging,inc. 1010 South 336th Street FederalWay, Washington 98003 (206)874 2235 Fax (206)B74 2401 Telex:152667 PNSI UD

t l . w I [,p & j C. E. MacDonald, Chief US NRC i Page 2 NuPac Response - Nuclear Packaging's radiographer has reviewed the area in question on weld # 10, unit S/N 102 and has determined that the indication was rejectable and was overlooked in the original review of the radiograph. The indication noted during the NRC's inspection of the film on S/N 105 was determined by NuPac to be an acceptable slag indication. To verify this determination, the doubler plate was removed from the area of the container allowing access to the subject weld area. Radiography of the seam in question was unable to detect the indication. The weld was previously radiographed in the as-welded condition. Prior to the installation of the doubler plate, the weld was ground flush with the parent metal. It is NuPac's opinion that the indication was removed during the grinding of the weld surface. Corrective Action - Nuclear Packaging contracted the services of an independent ASNT certified Level III Radiographic Interpreter to perform an overview of film on units S/N 101 - 5/N 112 during the period of 10/03/89 thru 10/22/89. The contractor applied a very conservative approach to his interpretation and as a result, NuPac made a-decision to re-review a number of indications with a more conservative interpretation. While working with these indications, the indication noted in unit S/N 102, weld # 10, area 17-18 was also repaired.. retested and found acceptable. NuPac has repaired approximately 28 of the 73 indications noted to date while continuing with new production as well. A copy of the indications list is attached ( Attachment A). The estimated completion date for the repairs is late January, 1990. In additnen to performing the overview of radiography, NuPac has taken the following measures to preclude reoccurrence: 1. Provided forty hours addition training for the NuPac Radiographer; copy of documentation attached (Attachment B). 2. Arranged for a dedicated viewing area to. isolate the + radiographer from the flow of production while performing interpretations. -3. Provided the NuPac radiographer with an optical device which will enhance viewing of small indications and aid in making finite measurements. 4. Allotted more time for the radiographer to perform reviews. S. Contracted new a radiography service, more experienced in ASME code work. 6. Increased monitoring of the radiography process by increasing internal audit frequency. E j

w. r i] .e 9 : (h t - C. E. MacDonald, Chief US NRC Page 3 r NQNCONFORMANCE # 3-10 CFR 71.119 requires special processes to l - be accomplished using qualified procedures in accordance with applicable codes. Penetrameters were not used on radiographs taken .after the repair of welds on unit S/N 102. The subject areas were re-radiographed to meet NuPac Resoonse - the density requirements not achieved in.the original repair film. l The radiography service which performed the original work had placed penetrameters in equal quadrants of the weld on the initial shot. The film being reshot happened to be areas other than those containing penetrameters originally. The contractor misinterpreted the. intent of ASME section V and reshot those areas again without penetrameters. Corrective Action - The subject welds have now been re-radiographed with proper penetrameters (per ASME Section III - NB SOOO, Table 5111-1) and found acceptable. The radiography service now being used by NuPac fully understands and will comply with the ASME t requirements for penetrameter placement. 10 CFR 71.119 requires special processes to -NONCONFORMANCE # 4 be accomplished using qualified procedures in accordance with applicable codes. Incorrect penetrameters were used on radiographs taken prior to August 23, 1989. NuPat Resoonse - The radiography service perf orming work f or NuPac at that time used the penetrameter chart f rom section V of the ASME code instead of the correct table contained in section III, NB - 5000. Corrective Action - During.the overview of radiography, the Level III Interpreter verified that although the correct penetrameter . was not used, adequate sensitivity was demonstrated to allow an interpreter to distinguish indications. This disposition is documented on NuPac Quality Discrepancy Report no.1271,( Attachment C).. The radiography service now being used by NuPac has incorporated the correct chart (table 5111-1) into their approved procedure.- NONCONFORMANCE # 5-10 CFR 71.135 requires that records must be maintained for three years after the GA holder last engages in the for which the program was developed. The original activity _ for drawing 2077-042, weld 10, view 17-18 was not radiograph available.

-- z [ 1 l C. E. MacDonald, Chief US NRC-Page 4 ( i 1 l NuPac Response - During the original welding process, it was noted that a=. surface indication existed in the weld which was caused by a start /stop of the welding process. Prior. to the initial i' radiography, the welder gouged the area. It was this gouge which i appeared in the original film. The film of the area in its as-welded state which the audit team believed to be the first repair was'actually the original film (dated 04/10/89). Corrective Action - During the overview of radiography by the Level l III Interpreter, no other deficiencies of a similar nature were l noted. This area will be specifically; addressed during future internal audits to preclude reoccurrence. NONCONFORMANCE # 6 - 10 CFR 71.123 requires that a test program be established which demonstrates that the package components will perf orm satisf actorily in service. The date indicated on one reader sheet was three days before the date on the radiograph. Midland X-Ray Inc.'s radiographer erroneously NuPac Response recorded the date on the subject reader sheet. He has since corrected the reader sheet and issued a letter stating that the date was in error (see Attachment D). Corrective ' Action --NuPac's radiographer has received additional training:.which included the reconciliation of information between the film and the reader sheet. NONCONFORMANCE #7 - 10 CFR 71.123 requires that a test program be . established which demonstrates that the package components will perform satisfactorily in service. Welds # 43 and # 44 on unit S/N 105 could not'be located on drawing 2077-042 and there was no documentation of the acceptability of weld # 44. NuPac Resconse - Welds # 43 and # 44 are not standard production welds. These welds were performed in accordance with the General Note #27 of the SAR which allows NuPac to make additional welds for the purpose of meeting dimensional requirements. Pertinent _information concerning these welds, such as weld location, welder identification, procedure, material traceability and inspection are documented on Quality Discrepancy Reports, Supplemental Weld Sheets and Shop Travelers in accordance with the NuPac QA Program. Weld _#-44.has been evaluated, found acceptable, and documented on j a film reader sheet. Corrective Action - Reader sheets for all welds were accounted for during the overview of film by the Level III contractor. NuPac 'will monitor continued compliance through perf ormance of regularly scheduled internal audits. i

r,. (%]g C. E.-MacDonald, Chief US NRC Page 5 10 CFR 71.111 requires that instructions, NDNCONFORMANCE # 8 procedures and drawings _must be prescribed and must be followed. The instructions, procedures and drawings must include quantitative g_ and qualitative acceptance criteria. The annual visual acuity examination required by procedure GI-16.4 for a GA Inspector certified as a level II PT inspector expired on September 6, 1989. This inspector had performed PT examinations after the September l_ 6, 1989 expiration date. NuPat Response The subject inspector notified NuPac on 9/5/89 that she would be_ leaving the company on 9/22/89 3 her annual eye i exam which should have been renewed at that time was overlooked. ' Prior to her exit from the company, the Corrective Action inspector had her eyes examined by a local optometrist. Her vision was f ound to be normal and unchanged f rom her pervious examination. A copy of the examination results is attached (Attachment E). The Inspection Supervisor at the TRUPACT Assembly Facility will be responsible to monitor _ requirements for eye examinations in the future, notifying affected individuals by the first of the month in which they are due for re-examination. Should you require any additional information or clarification of the^information provided please contact the undersigned or V. K. Cannon, OA Manager at (206) 874-2235. Sincerely, NUCLEAR PACKAGING, INC. y Ob* / / C. J. Temus Technical Director GA Concurrence: 3;~ h V. K. Cannon OA Manager

y*K }g @v:dWO ' s;e d,, M E& M 4 "e i + A pus h>f m g u s d ;i mew s w a_M M 7.h P ;' R ' y: R + cg - + TN, ,M F

• n" s

u en'- " ab.. .s-i o N+h% (m ~d.d *

qf" d

'ATTACl!MENTsAf tPAGE 1,OP'2.- 'i a v ;

a-4 se 9g3

'G. Q 4 ?;;, A s T '[ i &%mwe,?Q ' b.3 ' V 4 4 + Mbbed. ' di M %x %, MM - + " T', s 4 . -. ~ - y c 7jl84T;NIMis U-ASSEsELY } 9'1)WGi: dd M*EAh! INDICAT10N il d,1.[. l.5 - j g ilS/N 101f[f!CV UPPERy bl. .I. 3l. .Ii 'l "o il051; 11(

l6-7 ; pL; HEAR IND(

'I 3 y ?!S/N101&10C4 UPPER 7 L1041: fl13) ?!$-61 liSHARP SUVi.' t ? M l$lS/N 10l lS/N"101f 10CV LOWER CUTER M 0 052? 12' 'l0-1: iIL'INEAR IWD 1; 2 g# l0LiL0ER OUTER e1 IM2l '(148 1: ~ 5 fyN!I j g}lj-10 1 R2?IPORDGITY ' j 21

I

< cli ' [I = .l. 2 M 16/N'102(10CAUPPERs !.lM1., 114 013-4, -ISLAG i! W*,IS/.N 102 S10CA UPPER 3 !!MI:, - 1,1..,zi5-6

=19JG m,

s ~ c ~,JjiS/Nl102?.10CA LOWERt 11042 ' M110 [117-18/ICRACK ~l= Nis $!b M [if y~. - Lt _. -Il El - 11-l> d &li 1 I Il 'I f + QR : f MM2 ! 9h@WIS/N'103110CALDWER? ~

- 19A J Til-2' 'ILINEAR INDE "1

N ' "{ 7ty y jl3 ft( 7 ft r 1 i 1 f ~ [IS/N 104 fl0CV UPPER DUTER *;Llt041'

t3A L

10-1 R1 !!NC.' FUSION

'I. @s i(S/N,iO4 Ti!CV LDER * : 11052 ? 112$ E13-4 (LINEAR I C +; hh)d/N n I $.. Si r.. .l. l' j I K((if tS/N;105110CV'LDER OUTER 6t11042' ' i 90 (0-1,1-2tPOROSITY; 1 i LIG/N 105510CA LOWER DUTER #l 11042, '!9B 14-5 IPORDSITY1 I-

e d

fMIS/W 10$il0CV LOER INNER *6 11042 : 14 > 10-1 q! LINEAR IM) y jMGl( < ' gl{ ' 17 1 }). t ,t. O i LIS/N 106TIICV L0ER c1052 Fili ;12-3 IPORDSITY-- I ] fc A jlS/N 106[llCV LDWER: ,1052 '13-4 'ICRATER CRACK.31' q Ud 9tS/N 10WilCV LDERI - j1052i, -Ils !5-6! :! POROSITY l ~ l @lS/N 106$11CV l.0WERf l1052' (11 116e7' IPOROSITY : I-d J ? StS/N :106Vl!CT LOER ;

1052 1,

-II 112-13?!$ LAG-I h p I M S/W iW S ICV LOWERI

1052, Lil

!!3-14.ISLAG. I. n .. c 10525 '!!6-17 ISLAG 'l ' u e. TIS /N 106 <!!CV LOWERi

[ USli106 OllCV LOWER M Q lg

[ --1052 l II - !!7-1B ISLAG l-N

!}

}i) 'l' 'l' ' V EIS/N;107 ft0CA UPPER. t!Mit >ll: 1114-15 ' SLAG IS/M.107?IOCAUPPERb l1041 ' il ' l5-16R2lSLl6 I. d h;E i lS/N107$10CAUDP6 !MI' 11 .116-17 ISLAG' I 7 9 11S/N 107 il0CA OPPER; -1041: . Il ~120-2tR2: SLAG /POR. I< ' J llS/N 107 il0CA UPPERJ '1041-11. il23-24R2tSLAG1 I. j -[d ! M E,; ig.. - - 11 11-

(

.l.- sw-m a m g j $15/N 107 Wl004 LOWER v f1042 12A ': 2 ICRACX l, . If ?!S/N'107 610CA LOWERS -IM2 - 'l3B - 10 ICRACK' 1 I $YW[$lS/hi107EIOCAUPPERf S/N107f!!CVLOWERl 1052 12 '10-1= .IPOROSITY

1 1 gl fl041

. ll3 ' 10-1 (CRACK- .I ~l = hlS/N!!0N 10CA UPPER - 1041 !!3 : 16 ISLAG-I U i jS/N$107 [10CA upper) 1041: 113'. !7 ICAACK l-N ,, 4 jlS/N ;107n!DCA UPPER ; 1041 113 18-9 R1'ISLAG I % f ld S/N 107 1: lf 3SP ___..,.. I ~l; I I l i' 0CA LOWERY 1042 . 111. !!!-12 (CRACK l ., N lS/N(107kl0CA LDERi IM2 til' l12-13 -ICMCK I. a + (IS/M 107 TiDCA LOWER ' =1042' 110 !!6-17 ISLAG I i dlS/N'107411CV DPPER1 1051 ' 11 16-7 (CECK ' i 1 fIS/N107E10CVUPPEROUTERe. 1041~ 12A 10-1,1-2tSLk I ~ > f :iS/N 1081 !!CV LOWER- /'S 'l l i I I 1 ll 7 1052 13 15-6 IPORDSITY I M A Y lS/W 108 110CA UPPER 1041 !!2- !!6-17 ISLAG/ POL I N hhS/NL106fl0GI LDER. 1042 118 !2 ISLAG I ~e & 2 tS/N 108 4 0CA LOWER- '1042 L 118 i3-4 R2 ISLAG I DRQlgjg1106h!DCVUPPERDUTER*:~1041: !2B li-L '! LINEAR I hkdW &;'W L ' Nl

II F

"t-1-

by %g. %QW b . Rf 5W ny. ? .w s ~ .a w n:

%=p cw c

n s-x; g@g y, .d s g&g g:p ' g,- ~ c .t o m y -,' +r g y> : my, tuf c h_% N - gjh v - i + e r. !ATTAC11HENT A> PAGC 2 OF.2.z % d;!Qp g& sq, = t m, y 'm , ~,., n y, v c -a- ~ jp!'M4ec49 4:. 3 r :- ] ^_, ;y'l .T s .l} ~ l h 1 l@lCAT!DN ' i N y VltMITNO.f i SL8499E*0LYl [t DW6T8ilWELD #1 AREA 1 t 1: - l~ ~ I-1 If 1, I R JitS/N 19 ~ 11CV LDER f "10520 i 13 - !2 3 ' :!PORDSITY I e U 4 i !S/Njl09 $11CV' LOWER 3. ^ < 1052 =: 13 ' 17 4 '.lCMCK. -- E h,*JISJ:'109(llCVLOWERi 1052: ,12.. 110-1 ISLAB' li

J!

~ $i pWIS/W,109l 10CA LDERE, '.1042 ) 2127! '16-7 4 llSLA6 ~l E! 5 4 Ed[!G'N 109 (IDCV LOWER DUTER * : 1042 ?

1191.10-1 ISLAG-

1

+ RWI c e el.;; -g-

g.

s h4 lS/N-!!0E!DIRLOWERi IM2" 1 110L !!!2 i3' !LIEAR IND 'l k fI RjglS/W 110110CA UPPER : _ IMIK -.112 (3-4? ILIM IND .I d ?1041 ' "11 ' !!9 ILIEAR IND 'I W 719/N;110$:10CAUPPER. hhp hts /N'110?.l0CA LOER; ' IM2 - 126, !!!-12 (LIM 11@ = Ji- [fdn;;MS/N'!!01 1CV LOWER ?

-1052

. !! ? 11-2' ! LINEAR IND 1_ 1 h f!S/N lt0(!0CV LDER OUTER's,IM2L llAf 1R1lLINEAR1ND:- i. SIS!N,110?10CVUPPEADUTER*"1!041 129 -.11-2 R2 ISLAG 'l' i; gD( l {l4 ll' ( g; g . g.' g) - g ] 4 HIS/N111M10CALDWER; IM2: 1127 'lo-l' 'lLI M IND-l' lji [1S/(1111.1)l0CA LDER il042- !!!- l10-1 ilL M AR IND .I ~ ~ 1042 'l10; I14-5 'lLI M IND i' 1 4,. y JS/W 111 1 004 LOWER - EIS/K:111 HIDCA LOWERi 10421 Ll10 : 119-10;.ILI M IND-Li 1042i .-110

116-17-{ ILINEAR IND l

9 fl *, jB/N[111 (10Cet LDER 1 ~ i 042 T118 1119-20R2iLI M IND .I % ?" flS/N !!! 010CA UPDER-[IS/W;111]l0CAlLOWERf' 1 f* 3 ' d!S/N.111[10CAUPPERi _IMI.. ( 11 [17-8 : (INC. FUSION 1

10411

'il - 15 4 11 C FUSIDH - I h ., 7tS/N 111f l0CA UPPER l c10415 Li!3J 1 114 lLIEAR IND 1 T .y k 'dllB/Njll_1[10CA UPPER' ' IM1: f13A ?ll FILM ILINEAR.IND .I- ' N' iIS/N 111N IDCV LOWER DUTER

• T LLO42 ' -.124 ? : 13-4-5 ill,I M IND' I

.lM1 129' .10-1-2 ISLAG i-lj (5,}lS/N!!!kl000liPPERQUTERi K ilS/N 111 110CV UPPER OUTER,e '~1041- - 12 '10-1 _~~lLINEAR f 'I, 4 y.- h" h I-N., + [: l' 'I'- l' il/ l W i IS/Nl112 LIDCA LOWER i+ 1042 J 11 A ' 10-1 'IPORDSITY I i 7 k AS/W !!2 fi!CV LOWER (

1052 il2h L10l.

! LINEAR IND I 4 J0421 12A= 'l4-5. TILINEAR IND I-hlS/N_112MDCVLOWERDUTER* 1 m{, $1L X i' f 'I ; 't, t l ,l. a p y/ tlQ y .l' l-t i t-7. y: e l .}._- N: ,' ? t. $s e '. 4,4 W: s.

• f I

,-s f I i ( i cy y [y, %7 %~: n ~ ~. \\ b t g $1 i, 0,. l i t W -,f, Di>

• s

7 T. ATTACID!ENT B 5 n MEMCMANDUM Cctober 30, 1989 Tes V. K. Cannon - NuPse 04 Manager From J. W. Waddileve - X-Ray, Inc. Asst. Lab Suev. This memo is intended to deaumont eadiegraphie intercretation training which provided to Chusk CarDenter of Nuclear Deckaging, Inc. This tYaining was geovided during the radiography overview performee at the Trusaet Assembly Facility in Carlsbee, New Meutes by myself during the perted of Deteter 3, itas through Detober Al, 1989. The performance of my review required a substantial (almost .censtant) interfaes with Me. Careenter. During this period I l revtewed work perfmemed by Chuck, both east and current. In soing so, I had an opportunity to discuss mode interpretations, fanite L measurements, optical enhancement, and film euality with hirn. As a personal observation, the cuality of Mr. Carpenter's *ilm review technique increased markedly during this review. It is iny opinion that his enhanced technique een be partially attrisuted to this period of en the-Jeb traieing. As evidenced by

myself, Me. Carpenter's film review teennique is new totally adecuate to detect all reJeetable indleations.

L This

training, a dedicated viewing facility and an increasse l

amount of time to perform redsegraphic interpretations will benefit both Chuck and Nuclear Paekaging. c O-u sign.di____ s ~> J. W. Weddileve Level !!! Swaminee ASNT Cert. No. MS-733 l l

1. 665-292 902 Aed-X 62:51 68, OE DO

L_1 - INSPECTION .f 1.. ' d RECORD ouAuryomonsemovQ,Qir)Y =4 ac i o %dn0410P, NK N $M h0Lt5$ /p -& 89 ThhkT.5 Wt\\OS l MadL.71eer

• • /*
• m7 7.".',,,

~ " * ~ *

• t ygg

_, e u t;* %bes seeee!.s .n. -.s. e~ g-n=. w esos mm ... o n ~, og ~ ' " " " Jlrglmp% ye 7' tu - m _,, l ndhet'Sebk Mit asi L e. .e. I taall-Al % eltosehrs v.& on Radoo-AbctPr Asrs: %ed ea rev,eas of \\ atuAv af We TRoPAC.T17 radnearesLs ba 3 x tu.d,W e. Leelnr <,~Ill cricr a 8-LE-91 Raduk ra'.cku k-2Ay Tut 05/'twa%. I ulere 1/J ac c.o tdd #ce, mrR a r a D O / m L A h m M sl.* A w s d,fe Ke c.s o,rews cF esmE %k && mi,t', A k 3ECTufr'e v Atitcle 2 ToL e 69erso dos releno+i.sh a +> bas r-M > d heu of '4.sdE Herehre -hCe M.ed-radoca ce M E S k!Ce) lb ~ blY).siba T LSEdQYn ~ dit^^*-b U A Ta;ole-mB ' ///- /, S

1. l&N l lO'I$? U A WAV (J ht'!C Y

/ ,,, / X"7//44JA/gr 'il"B.L iI:.o TTE"~ ~L s /ohN7 ~ '~ W, Yhla }M.SW.'s.a 3j, 'l? ,g g .,j, m e. %e of a.pceper cefecesace %Ie its *F e -e.s-er, ydaa [,,,,,p m,,og e g QuIonechoH N5S000 T win be ned for Pede+elde 108 5Iil-)+1o raneb r selec 9 E #! E00N DIdI0Yd 48t0L99909 ! W:t ! MHl! @ # IU **d #

- o + _ 4 ATTACHMENT D .e,teeher n. ion f, l TO WHOM IT MAY CONCsRNt 1 Rtchard C. Hager, Level !!! for Midland Inspection authoriae L Charles Cattenter to change the date on'a repair radiograph taken on 2-1-89. The date on the radiograph is 1-38-89, the date should be 2-1-89. The item in geestion to 3077-084-0-8-005 N-t repair 3.. The reason for this change is the repair radiograph was dated as the same day as -the original radiograph. This sistake ens made by-myostf when I was called to Nuolear Paekaging to correct eene internation on eene radiographs taken by a radiographer employed by Wieland Inspecties. . This authorisation is for t'io ites ea17 a ( N ) 4 e.rd e, nas.r',' If 6 9 8 9

,o,

.wj.~.. ATTACHMENT E ., y VISUAL ACUlTY RECORD The CW1 and CAW 1 are required to pass an eye examination, with or without corrective lenses, to prove (1) near vision acuity on Snellin English, or equivalent, at 12 inches; and (2) far vision acuity of 20/40, or better. Shall also take a color perception test for red / green and blue /ycIlow differentiation. This form is to be completed by the eye examiner I l-and is subject to the following conditions: E The eye examiner must be either an Optometrist, a Medical Doctor, a Registered Nurse, or a Certified Physician's . Assistant and must indicate his or her title in the space provided below.

• The date of the eye exam must not be more than 7 months prior to the date of the welding inspector exam.

L NOTE: Visual acuity records which do not comply with the above will not be accepted. SuJ: Lwat-Applicant's Name Cenificate No.' Social Security No. ~ L Date & City of your CW1 test eseets without ' Meets with TESTS. '~ eye correction eye correction Does not meet ~

1. Far vision

-/ L 20'40 or better U) O. O

2. Near Vision g

l-Snellen English at a distance of 12 inches O O Color Perception Meets Does not meet Pseudoisochromatic plates Ishihara plates" / i

3. - Red' green differentiation f)/..

O

4. Blue' yellow differentiation G-O I certify that I, f>n a O

administered an eye exam PRINTED NAME OF EYE EXAMINER 1

to 4 N ., on which demonstrated PRINTED NAME OF APPLICANT MO. DAY YEAR the vision capaollities indicated above. Check one of the following titles you hold: L (if you do not hold one of '.he below titles have your supervisor sign below.) .j @ Optometrist O Medical Doctor L1 Registe. ed Nurse O Certified Physician's Assistant l ~ StateL.I nse k ' 4/ db Y0 k W d slGNATURF 'F EYE FXAMINER PROFESSIONAL ADDRESS bM, AMtA ff 2 23 Tel. No. (_EOI ) N f 70-W l certify that the above-named eye examiner works under my supervision. I am a(n): / Check one of thefollowing: 1 1-0 Optometrist O Medical Doctor O Registered Nurse O Certified Physician's Assistant PRINTED NAME OF SUPERvlSOR SIGNATURE OF SUPERVISOR l

====_____. L l: 1 $}}