ML20023B247
| ML20023B247 | |
| Person / Time | |
|---|---|
| Site: | North Anna  |
| Issue date: | 12/10/2019 |
| From: | Lane N, Simmons G Dominion Virginia Power |
| To: | Office of Nuclear Material Safety and Safeguards |
| References | |
| GL-700115-25 | |
| Download: ML20023B247 (8) | |
Text
Dominion Energy V1rgin1a North Anna Power Station 1022 Haley Drrve, Mineral, VA 23117 D0m1n1onEnergy com December 11, 2019 Director, Office of Nuclear Material Safety and Sl!f ads ATIN:
- II C.,
U. S.
uc ear Regulatory Commission Washington, DC 20555-0001 ft Dominion j a,, EnergyQt Serial No.19-482 NAPS/DPM Docket Nos. 50-338/339 License Nos. NPF-4/7 VIRGINIA ELECTRIC AND POWER COMPANY (DOMINION)
NORTH ANNA POWER STATION UNITS 1 AND 2 ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICES In accordance with 10 CFR 31.5, enclosed is NRC Form 664, General License Registration, for registration of generally licensed devices maintained at North Anna
- Power Station.
If you have any questions, please contact Mr. G. R. Simmons at (540) 894-21 O?:
Sincerely, f'\\.e ~
N. Larry1ane Site Vice President Enclosure Commitments made in this letter: None.
cc:
U.S. Nuclear Regulatory Commission ATIN: Document Control Desk Washington, DC 20555-0001 U. S. Nuclear Regulatory Commission Region II Marquis One Tower 245 Peachtree Center Ave., NE Suite 1200 Atlanta Georgia 30303-1257 NRC Senior Resident Inspector North Anna Power Station
\\'---....-
":)1 I IIIIIII IIIIII II llllll lllll lllll lllll lllll lllll llll 1111111111111111111 I llllllll llll lllll llll 111111111111111111 GL-700115-25 11/05/2019 SECTION 1 PAGE 1 of 2 NRC FORM 664 (04 - 2019) 10CFR315 U.S. NUCLEAR REGULATORY COMMISSION GENERAL LICENSEE REGISTRATION APPROVED BY 0MB: NO. 3150--0198 0MB EXPIRATION DATE: 04/30/2019 Estimated burden per response to comply wrth this mandatory collec!ion request 20 minutes NRC will use this informabonto track general licencees and their devices to ensure a higher level of device accountab1lrty Send comments regarding burden esbmate to the FOJA, Pnvacy, and lnforma!Jon Col/ect1on Branch (T-6A 1 OM), U S Nuclear Regulatory ComlTllssion, Washin1;1ton, DC 205555-0001, or by internet e-mail to lnfocollects Resource@nrc gov, and to the DeskOfflcer, Office of lnforma!Jon and Regulatory Affrurs, NEOB-10202, (3150-0198), Office of Management and Budget, VvashinQton, DC 20503 If a means used to impose an 1nformat1on collec!ion does not display a currently valid 0MB control number, the NRC may not conduct or sponsor, and a perscn 1s not required to respond to, the inforrnabon collec!Jon Complete all six sections of this registration form. If any of the preprinted infonnatlon Is Incorrect, provide the changes In the applicable boxes. USE CAPITAL LETTERS.
General License Registration Number SECTION 1 - GENERAL LICENSEE INFORMATION c..[1.,_:1001,15:25:_.:.i Enter the company name and the street address for the physical location of use for your devlce(s). For portable devices, specify the primary storage location. Do not use P.O. Boxes.
Company Name*
DOMINION VIRGINIA POWER I I I I I I I I I I l I I I I I I I I I I I Department:
NORTH ANNA POWER STATIO I I I I I I I I I I I I I I I I I I I I I I Address Line 1.
1022 HALEY DRIVE I I I I I I I I I I I I I I I I Address Line 2*
END OF ROUTE 700 I I I I I I I I I I I I I I I I I I I I I I I City:
MINERAL I I I I I I I I I I I I I t I I I I I I I 1*
1*
State VA IT]
Zip Code 231174527 I I I I I I - I I I I I
\\..,1 I IIIIIII IIIIII II llllll lllll lllll lllll lllll lllll llll 1111111111111111111 I llllllll llll lllll llll 111111111111111111 GL-700115-25 11/05/2019 SECTION 1 - GENERAL LICENSEE INFORMATION (Continued)
SECTION 1 PAGE 2 of 2 Enter the name, telephone number and title of the person who Is the responsible Individual for the devlce(s).
Last Name: SIMMONS I I I I I I I I I I t I I I I I I I I I I I I I First Name: GEORGE Middle Initial* R I I I I I I r I I I I I r
~
D Business Telephone Number:
(540) 894-2107 Extension*
I I
I 11 I
I 11 I
I I
I I I I I I - I
Title:
RAD PROTECTION MANAGER I I I I I I I I I I I
- I I I I t I t I I I I I I Enter the mailing address where correspondence regarding your device(~) should be sent.
Department' NORTH ANNA POWER STATION I I -*I I I I I I I I I I I I I I I I I I I I I I Address Line 1:
1022 HALEY DRIVE I I
- 1 I l I I I I I I I I I I I I I l I I I I I Address Line 2:
END OF ROUTE 700 I I I I I I I I I I I I I I I I I I I I I t I I City:
MINERAL I I I I I I I I I I I I I I I I I I I I I I I I state* VA [D Zip Code: 231174527 j
j j
j I -I -
J I I I I
-11m1111111111111111111111111111111111111111111111111111111111111111 I llllllll llll 11111111111111111 GL-700115-25 11/05/2019 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 Our records indicate that you have these devices. Please updtae the information as necessary.
PAGE 1 of 1 NRC Device Key 595514 (Internal Control Number)
D1stnbutor/Dustnbuted By:
Metorex Incorporated I I I I I I I I I I I I I I I I I I I I I I I I Distributor License Number:
29-30342-02G I I I I I I I I I I I I I I Manufacturer name.
METOREX, INC I I I I I I I I I I I I I I I I I I I I I I I I Device Model (Not Source Model)
OOPS I I I I I I I I I I I I I I I I I I I I I I I I Device Senal Number 128018 I I I I I I I I I I I I I I I I I I I I I I I I Transfer Date.
08/12/1999 ITJITJI I I I I D Not In possession of device (Also complete Section 4.)
MM DD YYYY Isotope (e g. AM241)
Act1v1ty (e g. 1005)
Unit (e g mCi) 1 AM241 30 mCi 111111 1111111111111
~11~11 2
CD109 10 mCi 111111 1111111111111
~11~11 3
l~l~I ~I ~I I I I I I I I I I I I I I I I I I I 4
I I I I I I I I I I I I I I I I I I I I I I I 5
~I l~I ~I ~I I I I I I I I I I I I I I I I I I I 6
I I I I I I I I I I I I I I I I I I I I I I I
\\J I IIIIIII IIIIII II llllll lllll lllll lllll lllll lllll llll 1111111111111111111 GL-700115-25 11/05/2019 I llllllll llll 11111111111111111 SECTION 3 - ADDITIONAL DEVJCES SUBJECT TO REGISTRATION SECTION 3 PAGE 1 of 1 Provide Information about other devices you have that are subject t6 registration. Do not report specifically licensed devices.
Manufacturer Name I I I I I I I I I f I I I I I I I I f I I I I I I I I Initial Transferor Name I 1 I I I I I I I I l I I I I I t I I I I I I I I I I Initial Transferor License Number (if known)
I I I I I I I I I I I I I Device Model Number (Not Source Model)
I I I I I I t I I I I I I I I I I I I I I I I I I I I Device Serial Number I I I I I I I I I I I I I I I I I. I I I I I I I I I How acquired and date (e g.,
0 Manufacturer/Initial Transferor listed above from a_ distributor/manufacturer, 0 Other General Licensee Date Transferred: [I] [I] I I I I I other licensee, other source)?
- 1.
- 2.
- 3.
- 4.
- 5.
- 6.
- 7.
- 8.
- 9.
- 10.
sotope (e.g. AM241)
£.*.*
0 Other Sources MM DD YYYY Activity (e.g. 100)
Unit (e.g mCi)
I 1
-111ffi11111111 llllilll 11111 lllll lllll 111111111111111111111111111111111 111111111111111111 IIII 11111111 GL-700115-25 11/05/2019 SECTION 4 - NOT IN POSSESSION OF DEVICE SECTION 4 Provide lnfonnation about devices listed In Section 2 or 6, but no longer in your possession.
PAGE 1 of 1 MM DD YYYY Location of the Device:
0 Whereabouts Unknown (Complete Part 1 only) 0 Transferred to another general licensee (Complete Parts 2 and 3) 0 Never Possessed the Device (Complete Part 1 only) 0 Transferred to a Specrtic Licensee (Not the manufacturer) 0 Returned to Manufacturer (Complete Part 1 only)
(Complete Part 2)
Part 2 License Number of Rec1p1ent (1f transferred to a specific licensee)*
I I I I I I I I I I I I I I Company Name*
I I I I I I I I I I I I I I I I I I I I I I I I I I I Department:
I I I I I I I I I I I I I I I I I I I I I I I I I I I Address Line 1
- I I I I I I I I I I I I I I I I I I I I I I I I I I I Address Line 2.
I I I I I I I I I I I I I I I I I I I I I I I I I I I City*
I I I I I I I I I I I I I I I I I I I I I I I I I I I State. [TI Zip Code* I I I I I I - I I I I I Part 3 Enter the name of the individual responsibe for this device:
Last name.
I I I I I I I I I I I I I I I I I I I I I I I I I I I I First name*
Middle Initial.
111111111 I I 11 I D
~~~~~~~ Telephone J
I J
11 I I I J I I I J
Extension* l~l~l~l~l~I Title.
I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
- 1111111111111111111111111111111111111111111111111111111111111111111111 GL-700115-25 11/05/2019 I hereby certify that: -
SECTION 5 - CERTIFICATION 1111111111111.11111 IIII IIII IIII SECTION 5 PAGE 1 of 1 A.
All information contained in this registration Is true and complete to the best of my knowledge and belief.
B.
A physical inventory of the devices subject to registration has been completed, and the device Information on this form has been checked against the device labeling.
C.
I am aware of the requirements of the general license, provided in 10 CFR 31.5.
(Copied of applicable regulations may be Viewed at the NRC website at' rm/doc-collections/cff)
SIGNATURE - RESPONSIBLE INDIVIDUAL (Listed In Section 1)
DATE WARNING: FALSE STATEMENTS MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL ASPECTS. 10 U.S.C SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY WRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER IN ITS JURISDICTION.
m111m111111111111111111111111111111111111111111111111111111111111 I IIIIIIII IIII IIIII IIII IIII IIII GL-700115-25 11/05/2019 SECTION 6 - DEVICE NOT SUBJECT TO REGISTRATION SECTION 6 PAGE 1 of 1 NRC Device Key:
547351 Manufacturer License No*
MD-31-076-01 Manufacturer Name: CONGO SERVICES CORP.
Model Number: 101 Isotope: Nl63 NRC Device Key:
689428 Manufacturer Name: GE ION TRACK Model Number. ITEMISER Ill Isotope. Nl63 NRC Device Key:
707159 Manufacturer Name: METOREX, ~NC.
Model Number: 880 Isotope: CD109 NRC Device Key:
825331 Serial #
N596 Activity: 5 Transfer Date:
02/15/1994 Unit:
mCi Manufacturer License No:
20-15525-04G Serial #:
09-8424 Activity: 10 Manufacturer License No:
Serial #:
128018 Activity: 10 Transfer Date*
06/30/2003 Unit:
mCi Transfer Date.
02/27/2002 Unit:
mCi Manufacturer License No:
12-04933-04G Manufacturer Name: PERKINELMER LIFE SCIENCES Model Number: 9310000 Isotope: BA133 Serial #:
DG08129527 Activity: 20 Transfer Date.
07/20/2012 Unit uCi