ML20087L349
ML20087L349 | |
Person / Time | |
---|---|
Site: | South Texas |
Issue date: | 04/02/1992 |
From: | Hinson J HOUSTON LIGHTING & POWER CO. |
To: | |
Shared Package | |
ML20087L307 | List: |
References | |
FOIA-95-80 NUDOCS 9508250163 | |
Download: ML20087L349 (15) | |
Text
. _ _, _ _ _ _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ _ _ _ - _ _ _ _ _ _ - - _ _ _
' *i 9
AFFIDAVIT OF J.W. HINSON I, J.W. Hinson, being duly sworn, do hereby state as follows:
1.
I an employed by Houston Lighting and Power company (HL&P) as the Administrator-Investigations / Compliance Division at the South Texas Project Electrical Generating Station (STPEGS).
2.
On the morning of February 20, 1992, Mr. William J. Jump, HL&P's Manager cf Nuclear Licensing at STPEGS, called me to his office.
Mr. Jump provided me with a copy of a Department of Labor (DOL) decision involving ATI Career Training Center (ATI), Florida Power & Light Company (FPL), and Mr. Thomas J.
Saporito, Jr.
Mr. Jump asked that I review the decision to determine whether the information in it was consistent with Mr. Saporito's access authorization paperwork.
Mr. Jump requested that I follow the normal procedures applicable to cases in which new information becomes available concerning personnel who have been granted unescorted access to the STPEGS protected area. At this time, I was fakiliar with Mr. Saporito's name because his access authorization had been adjudicated and he had been granted unescorted access to STPEGS only a few days before.
However, I was unaware that he had filed a. petition pursuant to 10 CFR -
2.206 or otherwise raised concerns related to STPEGS, and Mr. Jump did not inform me of these facts.
3.
After leaving Mr. Jump's office, I obtained Mr. Saporito-
's " nuclear file," in which the paperwork supporting the granting of access authorization to Mr. Saporito was kept.
I informed my supervisor, Mr. Richard L.
- Balcom, that Mr. Jump had requested me to review litigation materials relating to Mr. Saporito.
I then proceeded to l
compare the facts recited in the DOL decision to those provided by Mr. Saporito on his access authorization paperwork.
I noted several apparent discrepancies, including:
In response to requests on the access authorization a.
data form to list all employers in the last five years, including reason for leaving, Mr. Saporito did not mention the fact that he had been employed by ATI and had been terminated for unsatisfactory performance.
9S08250163 950425 "
/;d~6 j 4-92-003 3
.ypygpy
ki
.n i~
b.
In response to a request on the access authoriza-
~
tion Screening Affidavit to provide
" complete details" on any case of being fired, discharged, or l
asked to resign, Mr. Saporito did not note that he had been terminated by ATI for unsatisfactory 4
,i performance.
In response to a section of the access authoriza-c.
l tioh data form requiring the individual to list i
"any litigation, legal dispute, or claim in which you have been involved," Mr. Saporito wrote "NONE,"
omitting Department of Iabor cases he had filed against ATI and Florida Power & Light.
4.
After this review, I brought these facts to the attention of Mr. Jump and Mr. Balcon, who was at that time the Access Program Director for STPEGS. Mr. Balcon and I :4et with Mr. Jump because he had asked me to review the file and report back to him.
Mr. Balcom and I agreed that these discrepancies warranted further investigation, and that an interview with Mr. Saporito was appropriate in order to give him a chance to explain the discrepancies.
Mr. Jump played no role in this decision.
At the Jime the decision to conduct the interview was made, I was unaware that Mr. Saporito had filed a petition with the i
NRC under 10 C.F.R. 2.206, or that he had otherwise raised any nuclear safety concerns related to STPEGS with HL&P or the NRC, and this was not discussed by us.
5.
At approximately 4:15 p.m.
on February 20, 1992, I met with Mr. Saporito in the Nuclear Security Department Investigations section to discuss the discrepancies _ in his access authorization paperwork.
When he arrived, he was accompanied by Mr. R.W. Cink. Mr. Saporito requested l
Mr. Cink to witness the interview, and Mr. Cink agreed to do so.
As of this time, I had not discussed anything rega ding Mr. Saporito with Mr. Cink.
At the commence-ment of the interview, Mr. Saporito was requested to sign a Preliminary Interview Form informing him of company policies involving investigatory interviews and-his responsibility to provide complete and truthful informa-i tion.
Mr. Saporito signed the form voluntarily, without i
i any pressure or duress from Mr. Cink or myself.
Mr.
Saporito requested that the interview not be videotaped, a request with which I complied.
Because the interview was not videotaped, I also requested Mr. Cink to witness the interview.
A copy of my notes of this interview are attached as Exhibit A to this Affidavit.
. } '].
I 4 003 J :, h_.,
,-)
r....
1
8 I
During the interview, I asked Mr. Saporito to review his 6.
access authorization data form and screening affidavit to determine if any of the requested information had been j
answered incompletely.
Following his review, he stated:
o He was not sure if he had provided the correct dates for his employment at RCA.
(data form)
)
not sure if he had been denlad access at o
He was He had been injured while repairing his house FPL.
and was prescribed a muscle relaxer.
Upon notify-i ing his supervisor of this fact, FPL had him remain in training for a while, during which his access may have been suspended or denied, but he was not sure.
(data form)
Prior to his listed previous address in_ Glendale, o
i Arizona, he had resided for about one month in Avondale, Arizona.
(data form)
He was not sure if he had answered Questions #2 and o
i
- 3 accurately in light of the information about the i
muscle relaxer.
I o
He was not sure if he had answered Question #6 correctly, but had indicated on Question f4 that he had been arrested and the charges were dismissed.
(affidavit) 4 provided the above information, Mr.
Saporito Having stated that those were the only areas on either of the two forms that were not answered completely.
i l
7.
Because Mr. Saporito failed to mention his employment v
with or termination from ATI, or his DOL claims against i
FPL and ATI, I asked Mr. Saporito to once again review i
l the data form and the screening affidavit, and he and I j
went through them block-by-block.
This time, Mr.
l Saporito acknowledged that:
a.
He had been employed with ATI for about three i
- months, and was terminated from that employment.
I b.
He was involved in litigation against FPL and ATI, which is still ongoing.
I He had been employed as a full-time Chief. Engineer i
c.
by the Double Tree Hotel in Miami, Florida in 1990 i
and had been terminated from that employment.
4 4....... C/1 eJ....
b Y'
.I 4 ~92 -0 03
=
d.
Ha hcd b2cn enploytd as a full-tima enginsar by the Jupiter Hilton Hotel in Jupiter, Florida in 1991, and was terminated from that position.
1 e.
He noted various other, less significant omissions 1
and possible inaccuracies in his access authoriza-tion paperwork.
Mr. Saporito stated that he did not list his employments with ATI and the two hotels because he considered them only temporary or part-time positions, even though he acknowledged that he worked 40 hours4.62963e-4 days <br />0.0111 hours <br />6.613757e-5 weeks <br />1.522e-5 months <br /> per week, and that he understood that the form requested that all jobs 1
within the last five years be listed.
He stated that he did not list the DOL and NRC proceedings he had initiated because he did not consider them to be " litigations" (earlier in the interview, however, he had described his claim against ATI as " litigation").
1 8.
At the conclusion of the interview, I informed Mr.
Saporito that the information he had provided would be given to the STPEGS Access Program Director, who would a-make a determination regarding the continuation of Mr.
Saporito's unescorted access.
9.
During this interview, neither Mr. Saporito no'r Mr. Cink informed me that Mr. Saporito had raised any safety i
concerns to the NRC or HL&P, or that any meeting between i
Mr. Saporito and the NRC had taken place, and I was not aware of those matters., During the interview, Mr.
Saporito did not indicate that he was hungry, tired, or thirsty, and did not request a break (near the end of the i
interview, Mr. Saporito was asked to go out to his car and get his driver's license, which he did).
s 5
10.
Following this interview, I briefed Mr. Balcom on the results.
Also present were Mr. Cink and Mr. Jump.
I advised Mr. Balcom that, based on the facts obtained during the interview with Mr. Saporito, revocation of Mr.
Saporito's access authorization would be appropriate.
Following this briefing, Mr. Balcom determined that Mr.
Saporito's access should be revoked, and directed me to begin processing the associated paperwork.
Mr. Jump and Mr. Cink played no role in this decision.
During this meeting, I do not recall any discussion of the fact that l
-4 8
b
'lI~
'i
~ "
~ '
4 003 l
O Mr. Saporito had filed a 10 CFR 2.206 petition or had otherwise expressed concerns regarding STPEGS to HL&P or the NRC.
I did not learn that Mr. Saporito had raised such concerns until the following day when informed of the results of an exit interview held with Mr. Saporito.
h.
e-(f.W. Hinson STATE OF TEXAS )
)
)
Subscribed and sworn to before me, a Notary Public in and for the State of Texas, this M ' day of Q, 1992 l
Mm
<f NNilE GONZALES N'o't'ary Publin in Sand Mr hm saw w rena, the State of Texas
% k m hans124,3 l.... _. C 4 003
~~6".] 6 '.
"~
' d ' *^ '" "
H-tston Lighting & Power Company
&4/4/M ve MidavN of i
OFFICE MEMORANDUM J. W NTH 50M 4
To NSD Fil
$92-1271 February 21, 1992, jl s
From J.
W. Hi R. W.
Cink j
Sm6/cct Adjudication: Thomas J. Saporito b
3 On February.20, 1992 an interview was conducted with Saporito by J. W. Hinson and witnessed by R. W.'Cink.
This interview commenced at about 1615 and concluded at about 1730.
The interview was conducted in the interview room of the Nuclear Security Department l
Investigations Section.
Prior to commencing the interview Hinson explained to Saporito. that the interview was part of'an adjudication investigation regarding his request for unescorted access to the STPEGS and that the interview would consist of questions concerning the information he i
had supplied on his data form and screening affidavit.
Saporito did sign a Preliminary Interview Form.
During the interview Saporito was provided the data form and screening af fidavit from his nuclear file and was asided to verify j
that they were the same forms as he submitted for unescort'd
)
e access.
After reviewing the two forms he stated that they were the same forms that he had submitted for unescorted access.
Saporito was asked to review both forms and determine if any of the requested information had not been answered completely.
After his review he stated:
o He was not sure if he had provided the correct dates for his employment at RCA.
(data form) o He was not sure if he had been denied access at FPL.
He had been injured while repairing his house and was prescribed a
muscle relaxer.
Upon notifying his supervisor FPL had him remain in training for awhile, during which his access may have been suspended or denied, but he was not sure. (data form) t o
Prior to his listed previous address in Glendale, Arizona he had resided for about one month in Avondale, Arizona.
(data form) 4 o
He was not sure if he had answered Questions #2 & 3 l
completely in light of his information about the muscle relaxer.
(a f fidavit) o He was not sure if he had answered Question #6 correctly, but had indicated on Question
- 4 that he had been arrested and the charges were dismissed. (a f fidavit) f Having provided the above information, Saporito stated those were the only areas on either of the two forms that were not answered completely.
.4 003 I " - --
b
. " " * " ^ " * "
F-iston Lighting & Power Company OFFICE MEMORANDUM To NSD File 192-1271 February 21, 1992 Page 2 from J.
W. Hinson/R.
W.
Cink Sub#ct Adjudication: Thomas,J. Saporito Hinson then interviewed Saporito over each specific area of the two forms.
During this review Saporito indicated:
Employment Area He was employed by ATI in Miami, Florida for about three months as a part time electronics instructor.
He could not remember the name of his supervisor.
He was terminated from ATI because they were concerned about becoming involved in the litigation he had initiated against FPL through the DOL and ASLB.
He was employed by the Doubletree Hotel in Miami, Florida from
'ime chief about January, 1990 to April, 1990 as a full c
engineer.
His supervisor was Tom Goodwin, General Manager.
He was terminated from the hotel because he offered an opiriion regarding the location of a pool shower.
No specific reason was given to him as to why he was being terminated."
He was employed by the Jupiter Hilton Hotel in Jupiter, Florida for about three months in 1991 as a full time engineer.
He reported to the ch'ief engineer, but could not remember his name.
He was terminated because he could not work a day shift.
He stated the reason he did not provide the above employers on the data form was because these jobs were not full time, even though he did put in forty hours per week.
He indicated he did not accept the jobs with the idea of remaining at them forever.
He stated when he was completing the data form he copied from his resume, which did not list these jobs.
He stated he understood the data form was requesting all jobs for the past five years.
General Information - Litication. Lecal Dispute. Claim Area He stated he was a complainant in a DOL proceeding against FPL and ATI, which is still pending appeal.
He stated his understanding was this proceeding was not a lawsuit, but an Administrative Law Hearing.
He stated he filed a complaint against FPL in 1989 or 1990 with the ASLB regarding their license to operate the Turkey Point Nuclear Plant.
He stated he is not sure of the status of this complaint.
He stated he was involved in a divorce in 1991.
E 4 003
. " " ". " ^ ' " "
U~iston Lighting & Power Company OFFICE MEMOR ANDUM To NSD File #92-1271 February 21, 1992 Page 3 from J.
W. Hinson/R.
W.
Cink Subject Adjudication: Thomas J. Saporito He stated his, daughter was injured at a neighbors house and, while he did retain an attorney, he was not sure if a lawsuit was actually filed.
He indicated he received a sett?.ement.
He stated he did not indicate the above information on the data form, because he did not believe they were litigations.
General Information - Unescorted Access Suspension / Denial Area He stated while employed at Turkey Point he began to experience chest pains.
He was examined by three physicians who diagnosed his condition as severe gastritis.
He was prescribed Zantex, a stomach medication.
He stated upon reporting this to his FPL supervisor he,was sent to a company physician, Dr. Dolsey, for examAnation. 'He stated he requested an IBEW steward accompany him during the exam.
He stated Dolsey became upset during the exam and reported to FPL that he was not cooperating.
He was returned to the plant where he was questioned for three days regarding information he had provided to the NRC.
He stated he was told that security had pulled his badge, but he does not know if they suspended / denied his access.
He was told that he could not go into the plant, but not because of a FFD violation.
He did not indicate this information because he was not sure it was a FFD issue.
Orcranization Membership Area He indicated he was a board member of the Nuclear Energy Accountability Project for about one year.
He stated he did not provide information for this area because he missed it.
He did state that he is not sure if the project organization was a social,
- civic, fraternal, or honorary organization.
Previous Address Area He stated for bout one month in Se tember, 1991 he resided at Saporito stated the only areas on the screening affidavit he did not answer completely were those areas also addressed by the information he provided regarding the data form.
c..
4 003
" " " ~ " ' " "
F"iston Lighting & Power Company OFFICE MEMOR ANDUM To NSD File #92-1271 February 21, 1992 Page 4 from J.
W. Hinson/R.
W. Cink Sub/cci Adjudication: Thomas J. Saporito At the conclusion of the interview Saporito was informed that the information he provided would be given to the Access Program Director, who would make a decision regarding the continuation of his unescorted access.
Saporito was told to report to work according to his normal schedule him of any further actions.
and his management would inform JWH/jwh t
ree*e eem 9
J s_....:
4 003
r PRELIMINARY INTERVIEV FORM SOUTH TEXAS PROJECT The Houston Lighting & Power Company (HihP) desires to incerview you relacLve to an official Investigacion it is conducting. In chat regard, HIhP expects your full and complace cooperacion in the investigation.
Any refusal or EsL1ure by you co cooperate fully in the invescLgacion any resuic in your discharge from be the employ of KlhP.
Failure to cooperace on your parc any include but not limited co:
1)
- Your not answering truthfully any question asked of you.
2)
Your not ceiling the complete truth.
3)
Your withholding any facts ascerial co this invescigation.
4)
If a subsequent appointment'is scheduled for Eucure Interview, your failure to keep that appointmenc.
5)
Your Ecklure co respond cxvchfully to a polygraph exandnation conducced in accordance with the Employee Polygraph Protecclon Act of 1988.
6)
.Your discussing this interview with other employees.
Nothing herein is in any way incended to rescricc you from presenting informacion or concerns regarding nuclear quality or safety to che HRC or any other regulatory authority, SPEAKOUT, or any other person.
I have read and I underscand the above.
,L v7Z- -
~
Signa e
01 - 2o -9L Date O.
lh e.ss
- /- -
...... Q i......_zo_..: 15.....
4 o o 3
~. _ ~
i i'
i I
'i tle 246A (06/90)
I CONTRAC TOR /. VENDOR / UTILITY j
DATA FORM (For Unescorted Access Authorization)
YOU MUST COMPLETE THIS FORM CAREFULLY.
COMPLETELY. IN YOUR OWN llANOWRITING. AND 6
IN BLACK INK.
Pleo:.. do NOT obiveviote.
{
Foilure to do so moy result in o deloy or possible re jection.
PERSONAL:
NAME LAST FIRST usDDLE SOOAL SECURITY NUMBER i
A 'O OR. I f n snA S Y
allASES OR OTHER NAuCS PREvtOUSLY UsED.(ExAuPLC MAsDEN N AME).ALONC wtTH DATES USCO. -- l SEX I
j l@
g PRESO4T ADDRESS Cf TY STATE ZIP i
i TELLPHONE NUuDER ARE YOU A CITIZEl-8>t ITED STATES?
HO IF NO. PLEASE Lt SN SA TYPE NUuGER COuts TR Y i
R/U ADDRESS
$t4su /M NIC. A Q 7 7 Z $ f /1 S kMMYtfCo kc C
i
$'t /2 l/ / LP S M %S/hA
//'i e 's n D)9 Yl a
~
l
/71R. )<tc/, 9s le sJA BAR D40 A TE PLACE Or BIRTH I
EXPIRATIOtd DATE DRIVEfrS LICENSE NUMBER f
l PERSONAL
REFERENCES:
l LIST FOUR PERSONS WHO WILL VOUCH FOR YOUR CH AR ACTER AND %HO H AVE KNOWN YOU WELL FOR AT{
DO NOT INCLUDE RELADVES OR FORMER EuPLOYERS. ALL REFERENCES USTED uuST COVER die PRECEOtt4G F l
PERIOO.
l NAME ADDRESS I
OCCUPA llON PHOf4E N*"/6 as c n/L
' " '" ' * ' 5 % { f,.')
y,zc.,
.De /// btu.DB BfL1d,9,da 3c333 Cc *D n'dA-y^l,.pga;,,,,
)J,) % r [,,a g
/c.i E. C e // 0 s e. / w e p.g c n.
AP/ hic ~. air TH//
u,, ;u,
\\
Ah.
]t>/uge
$a IIN s
/W E-T"
L,... I,:.. 7 p C
{
..._.Y
^
4 003 l
l L
STP 'N60 (06/90)
EDUC A TION: YOU uuSI UST EWRY HaQ4 SCHOOL. TRADE SCHOOL. DUsiHESS SOsOOL COLLEGE At40 Olli INS TITU DONS. UST ONLY DECREES ACTUALLY RECEIVED AND CRADES SUCCESSFULLY CouPLC School NAME ANO LOCAYsON
- r., M"%0,t,, $,$ 7co,7 MAIN SuaJEcts OF STUDY
^
CRADE
/ p/Jm -#W[8h, ///
/9cf
/Jt@
HICH bg/) JQ} - jp,j,Yfff;,, f}q jgg y j 9 *7)
/). yt$
pf,4p. yog, i
BUSINESS J
TRADC hw %). ))y,QJanyl. Ps)
JCOJ
/9'23
.1 169 Sl<sfaw/C f i
OTHER C C O cour m twev)
YES NO WHEN WHERE j
caen so xx.
COLLEGE LEVEL INFORMATION ONLY LEVEL HAME AND LOC ATION rn [ 9 o OEGREE REC *O AND MAJOR f
vts on no f[
UNDER j
CRAOUATE f //#
(cssoc, emov.atos.)
/;' (
l*
/ / //
I CRADU A TE 2
IF YOU HAVE 00TA!NED HOURS OR CREDITS TOWARD A DECREE NOT YET COMPLETED. PLEASE CrvE T FOLLOWING INFORM AllON:
NUMBER OF HOURS /CRE0lTS COMPLETED
/,
NUuGER OF HOURS REOUIRED TOR DEGREE -/
EMPLOYMENT: YOU uuST UST EWRY JOB FOR THE P AST MVE YEMtS. START WD4 YOUR PRESENT OR uOST RE PLEASE INDICATE ALL PERT 005 OF UNEMPLOYMENT. IF NECESSARY. ATTACH ADO nONAL SHEETS OF P AND NOTE THAT YOU HAVE DOHE S0.
A00sDONAL SHEET (S) ARE ATTACHE 0.
HAME At40 COMPLETE ADORESS OF CouPANY LIST:
1 E SON FOR LE AVING u0 n
wo YR
.jffm a/),
$ n es i D - s i/ 1 r'
/2bs. Ev.n nh
' INSYQastwi-C ofhl /%
$$l /2 -9l _As n FA* ///) n T13 - PA/c 14 a rn L ::cleArt Av P ul a lov /*L. A. > t -t i
e A /D f/<..., > K.> ci*ir c. t' enD - i 3 e > Sd. > x S l' nits /tv=1r n N knfen
\\
' iu.x1 o/;i,,. t u <.. n.
1 - 89 9-9/
A a.;i.,,a_. ri a u f/r.n *nn L.a >> J /*1e (~o - smLil. f/cInn
' _71. d u,.,1 f, h r/ 5 c A l
2,Gisw..A 77u>,ilwMs S~8L l--89
~
~~
'?a /m L Ar l< knkhs t ' h ~/ auraff CuYerl* EbrfE1 $<;
R (. f)
(rn,pr.n n Y i r.
l~ 77 3-22
%;r>n M%x -Gh
~\\
21Z, sa 9 7.<,,
r' A Ynew -irLfalLL L n & Luan/
l-9YTmt SirP M ~- K i d t o w i s 7 %
m in & ~
e 4
i 2
MILIT ARY EXPERIENCE:
OR Af JCH Or SCRvlCE A/
D A TES OF SCRVICE. FROu...
. 10 HCASON FOR OtSCH ARCC
__ OiSCilARGC TYPC
._ _. _.__. LAS1 fu t W.
III AINING RCCCIVED At40 OUitCS PCRf0Ruto witti.C tu IHC uiu r ARY SER v1CC _.._.___
AllC YOU HOW A MCMOCR OF THC AC livC liCSCRVCS dR H A DON AL GU ARD?.._.. ~_. ' '.1".}., _
URANCll Of StRv6C[
OAl[5 Of SERVICC,
!O 4 - 9 2 - 0+3 l
Sie 246t. (U6/901 ORGA14tIATION MEMBERSHIP:
fM0fCATE wuC1HER YOU ARE A PAST OR PRCSENT LIST SOO AL. OVIC. FR ATERNAL, AND HONORARY ORCANIZADONS.(YOU NEEO NOT INCLUDE ANY ORCAN1ZAT WEuGCR. LENCTH OF utuBERSHiP. AND ANY OFFICE HELO.
OTHER OIRECTLY OR OY suPUCADON IN0iCATE YOUR RACE. REUGON. NADON AL ORiC8N OR 1
CONVICTION RECORD:
HAVE YOU EWR SCEN CONWCTED. PLED CutLTY. RECOVED DEFERRED ADJUO4CAftON. OR H TRAFFIC OR PARKINC)? ff VES.
A CRiutNAL uATTER (tHCLUDING OWI OR TRAFFIC OFFENSE OTHER THAN NON-it4 JURY EXPLA3N ALL 0,CCURRENCES IN DETAIL:
.Ala k
GENER AL INFORMATION:
HAVE YOU EWR DEEN REFUSED A BONO OR HAD ONE CANCELLE0? _ _I/O LIST ANY UDCADON. LEG AL OfSPUTE OR CLAtu sN WHICH YOU st AVE DEEN INVOLvCD (LAWSUITS PERSON OR CORPORADON) AND OtSPOSITION OF SAut:
i
/A%W L o$
HAVE YOU EVER DEEtt DISCHARCEO OR ASKE0 TO RES3CN OY A F4tEVIOUS EMPLOYER?
r A'
A
~/ / ** # Ie lI b0 -
I IF 30. UST EMPLOYER. DATE AND ORCUuSTANCES. -
a oS ma ~Pmfic lLehra s'iv n l! @ u &+s%$A$'..
i f.1-XT -RP ~ % Ann $ Adv) be rAate-M '
of rzran<s P-4iG IIAtt YOU EVER DEEN SUBJECT TO A PLAN FOR TREA TING SUO$1 ANCC AGOSC (EXCt.UDES SO.F-RF.FERR;,i l a dt H AD 2O UNESCORTED ACCESS SUSPENDED OR 0[NIED FOR MOLATION OF A FITNESS FOR OUTY POUCY?
c IF SO. PROVIDE COMPLETE DETAILS.
.m 4
i PLE ASE PROVIDE THE FOLLOWING INFORu ADON ABOUT ALL PL ACES YOU H AVE RESIDE 0 FOR THE P AST FIVE idtNG WITH YOUR PRESENT ADDRESS. ALL PERIOOS OF TiuE uuST BE ACCOUNTED FOR. AND ALL MULTIP E RESiOE L
uuST BE USTED.
l STATE /ZtPl FROM - TO STREET ADORESS COUNTY CITY 14=PM
/+ iA I
l l
l CER TIFY IH A T ALL INFORu A HON PROviOED ON THIS D A t I, FORu 15 CORREC T. AND I Ut3DDISTAND to A1 Au r MISST AIEMLHl. MISR[PR[${til AllOlJ Oil OuissiDis u A Y CouSritulE CAUSE FOR / OlI .S DENI AL p
ge g'&
- H gc..
16 _
,u
_.c/ -oR-s;L acN Aiom. _3 L uAiE
~~
4 003
STP 61: (01/90) 500..t TEXAS PROJECT ELECTRIC GENERATING STAllON DAll SCREENING AFFIDAVIT 3Si N AME ( TYPE OR PRINI)
FIRSI MID0t.E M Af 0LN HOME PHONE O Soinatso do-a
.r EMPLOYER D A TE OF 81R TH SOCIAL SECURITY NO.
ORIVERS LIC NO S T ATE & EXPIR A TION D A TE r
I 1.
Hove you ever been gronted unescorted occess to ony other nucleor focility*
yes no
- 2. ' Hove you ever had o security clearance denied or revoked?
yes
- no 3.
Hove you ever been subject to o plon for treoting substonce obuse (excludes self-referrol) or hod' unescorted occess y
5 suspended or denied for violation of a fitness for duty policy ps
. no 4
Have you ever been orrested, indicted, or chorged for violating g_ny low, regulation or ordinance?
yes no S
Are pu currently chorged with, under indictme it or pending triot on any matter?
yes no 0.
Hove you ever been co1victed, pied guilty, recci.ved deferred
/j odpdicotion, or hod a conviction set aside in any motter?
yes no 7.
Hove you ever been charged with Driving While intoxicoted or Driving Under the influence?
yes o
do 6
Hove you ever been refused a bond or had one concelled?
yes 9.
Hove you ever been fired, dischorged or osked to resign by a previous employer?
yes no 10 Hove you ever been o defendant in a court mortial do proceeding while in the military service?
yes 11.
Have you ever. in the post, tested positive for drugs or use
~p of alcohol resulting in nn-duty impairment?
yes no i
12.
Hove pu ever received treotment for olcohol obuse?
yes o
do 13 Hove you ever Aceived treotment for drug abuse?
yes 14 H ove you ever been treated for men t ot, emotional or do odpstment problems?
yes i
15 Hove you ever been associated with any organization or combinotion of persons which you knew odvocoted the overthrow of ony government?
yes no 16 Hove you ever committed or ottempted to commit, or wilhngly oided or obetted onother who cymitted or ottempted to commit octs of violent or unlowful protest ogoins t the use of nucleor energy by pubhc utilities
_____ yes no 17 Hove you e ver porticipated in the pubhcotion of written mo t erial encouroging others to violently or unlo w f ully protest the use of nucleor energy for peccelui purposes
yes no 16 Is there anything in your bockground not mentioned obove which may of fect your obihty to be granted occess to o nuclear plan t or anything which snoy require fur t her c. plon o t ion
yes no if YOU ANSWERED ~ YES~ 10 AN Y OF THESC OUf STIONS. PLE ASE RI.f t:14 Ut i TH[ yQQf_S lj NUun[R AND PROVIDE COMPLEll DE T AILS ON IH[ RE V[RS[ SID[
. l11 I/
. g[_
.f D
...,. )
i..
4 003
]
}
south TEXAS PROJECT ELECTRIC CENERM.
S T A DON i
Ouestion 1 Complete Details i
O AJLt AE Q W AJt*.A A si]9 $ 19Ys s. A)
C -t* N/
b5 V
4
[c t". / W -
A)L/ r AS N ff AJ Y WMD.
f
~
n t
e
~
\\
~
k
/N '+ d o tA) N
)}ts r. Ah
- b/A AsY ~ /)f/19Af t i f/
p 9.
ExpA,,,,x wl H JgG;aA P m J/,;h - b L x,'a 1
rj
,A L
A*/Y
& Jy7 A-h 19$
A Er i
- rb NXu O
NYA a
i A
Al. ? 0
/ tJerYteA $ Xx.
t~1 S
,br$ e i,EM l < L v
SAlm
- 01. A) b A/WC fA_AL k
? AAlb
+
<-~4 i'
I understond that any messtotement, misrepresentation, or omission on any documentotion used to process unescorted occess will constitute couse for deniol of occess 0t ony time.
O/-/3-fL Applicon t noture / Date informed opphcont to report oil orrests by low enforcement ogencies, including Owl or of fenses other than n on -in jur y t ro f fic or porking to the tJucleor Security Department within 72 hours8.333333e-4 days <br />0.02 hours <br />1.190476e-4 weeks <br />2.7396e-5 months <br /> of the orrest Sec.urit y Representativo -/Mk 4 003
....jp _.
J.D.
..., :)
-