ML20118A022

Requests That Candidates Listed in Encl Be Registered for Reactor Operator & Senior Reactor Operator Licensing Exams Scheduled to Begin 920720.Certification That Training Completed Also Encl

ML20118A022
Person / Time
Site:	Sequoyah
Issue date:	07/02/1992
From:	Joshua Wilson TENNESSEE VALLEY AUTHORITY
To:	Ebneter S NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION II)
References
NUDOCS 9207090172
Download: ML20118A022 (21)

Text

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s an Tennessee varey be:ery, Axt Offce Bos N Sodoy Ca sv. Tennenee 37379 J.L wilson ve, eescent. secoyan wear eent July 2, 1992 Mr. S. D. Ebneter U.S. Nuclear Regulatory Commission Region II 101 Mariewta Street, NW, Suitt 2900 Atlanta, Georgia 30323 Attention: Mr. Tom Peebles Gentlemen:

In the Matter of

)

Docket Nos. 50-327 Tennessee Valley Authority

)

50-328 SEQUOYAH NUCLEAR PLANT (SQN) - CANDIDATES FOR THE REACTOR OPERATOR (RO)

AND SENIOR REACTOR OPERATOR (SRO) LICENSING EXAMINATIONS SQN requests that the etudidates listed in the enclosure be registered for the R0 and SR0 licensing examinations that are scheduled to begin July 20, 1992. Certification that all training has been completed is enclosed.

Because of the administrative 1y confidential nature of the enclosure, it is requested that the information contained in the enclosure be withheld f rom public disclosure in accordance with 10 CFR 2.790(a)(6).

If you have any questions concerning this submittal, please telephone Rick C. King at (615) 843-4173.

Sincavely, J

Wilson Enclosures cc:

See page 2

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l 9207090172 920702 7E'/-a i.

PDR ADOCK 05000327 A

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4 U.S. Nuclear Regulatory Commission Page 2.

i cca Mr. D. E. LaBarge, Project Manager

.f U.S. Nuclear Regulatory Commission j

One White Flint, North 11555 Rockville Pike l

Rockville, Maryland 20852 j

U.S. Nuclear _ Regulatory _Commis_sion Encicsures)

ATIN: Document Control Desk Washington, D.C. 20555 r

NRC Resident Inspector Sequoyah Nuclear Plant 2600 Igou Ferry Road Soddy Daisy, Tennessee 37379 Mr. B. A. Wilson, Project Chief l

U.S. Nuclear Regulatory Commission Region II 101 Marietta Street, NW, Suite 2900 Atlanta, Georgia 30323 i

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ENCLOSURE REACTOR OPERATOR (RO) AND SENIOR REACTOR OPERATOR (SRO)

PRELIMINARY CANDIDATES The nine candidates listed are the applicants for the R0 and SRO licensing exarinations.

Exam Previous 10 CFR 55 Hama IIRc Date_cf Birth License Numher Lannace William Coe, Jr.

R0 11/22/54 Jerry Arthur Deal R0 07/02/56 Calvin G. Fields SRO 10/26/53 Elwood Lee Hyden SRO 01/17/53 OP-20256-2 Lewis Westley Jones, Jr.

R0 02/28/59 John Edward Stinson R0 09/06/56 Norman Roland Thomas-SRO 12/02/57

' Anthony Lebron Tinsley R0 04/21/52 Judy Ruth Varner SRO 01/05/49 OP-20311-1 4

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1. NO RESTRICTIONS

2. CORRECTIVE LENSES SE WORN WHEN PERFORMING UCENSED DUTIES

3. H2ARING AID SE WORN WHEN PERFORMING UCENSED OUTIES

4. RESTRICTED UCENSE OR E xCEPTI9NJ hide dotads tetow and attacn supporting rnedical endence be NRC review.

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'01 Varieets Street. bite 3100 799 Rooseve<t Road iGng of Pmma. P A 19406 latanta.CA 33323 G4a Ellvn. IL 60137 Reconst Adametrator. Repon IV Pagone' Admanntreio*. RedenV Ddettar. Divetion of Lcensee Per*cumance ant $ Qusasty Evamation US Nuclear Requistory Comtnissarm US Nuclear Rawato*y Comm es; Atta: Operator Lcens.ng Brao 611 Ryan Piara Onve, Su<te 1CICO 1450 Marie ue. Lite 210 V 5 Nuc'es' Repawry Commisson Artirgton. TX 76011

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,1974 (Puebe Law 93 579). the fotnoerg statement is %mished to individuais wno ocas ageaev m the event the information ac:icates a voianon or potentiaa v.oiaten of law sucory mioimaten to tee U S. Nacasar Reguta'ory Commnsen an NRC Form 396, are in the owns the enformaton erwiscates a couton or pote%al coaston of law and en Tha inhemation,s me.nta.nact n a ivcem of records des gnated as NRC 16 and the course et an admmstrattve or ludic.ai oreceedmg in sad, tion : mis informaten may ee e*ceen es 65 pene n sism us7s taen 20.19m transferred to an approcrwte Federas. State. and locas agency to the extent relevant and AUTHORITY: Sectons 107 and 1611a of t%e Atomic Energy Act of if3F 4, as seressary n r n NRC oectsson acout you.

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CERTIFICATION OF MEDICAL EXAMINATION maw *w* = = an= "o **e=*mN Nucuu wwre.a,ieven ena.a en.r. m ut ue cono. waw BY FAClLiTY LICENSEE wu-e n.AM.<

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CFilC1 CF WA9QEW(NT aNO SUCYWT. WASHee3; M tK. 7:nc3 NAME QF APPUCAN T DEAL, h ery A FACluTY lF AC;UTY COCKE T NUMBE R SequOyah Nuclear Plant 50-327 & 50-328 A. MEDICAL EXAMINATION CERTIFICATION THl3 l$ TO CE RTIFY THAT THE ABOYE NAuED APPUCANT FOR AN OPERATOR /5EN OR OPE R ATOR UCENSE HAS BEEN EXAMINED SY A PHYsittAN PJilNTED NAME torpays,cien) l$ TATE AND UCF.NSA NU846ER l ERAMINATION DATk obe4 rr.W.

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BASED ON THE RESULTS OF THE EXAMINAYlON. INCLUCING INFORMAf TON FURNISHED B Y THE APPUCANT. THE PHY5tCIAN HA5 DETERMINED THAT THE APPUCANT*5 PHYSICAL CONDITION AND GENER AL HEALTH ARE NOT SUOH THAT IT MIGHT CAUSE OPER ATION AL E RRORS END ANGERING PUppC HE ALTH ANO SAFETY, i CERTIFY THAT IN RE ACHING THIS DETE RMIN ATON. THE GUiO ANCE CONT Af NED IN Me$l/AN1141983.0P ANst/ANS 15.41977 tN3801 WAS FOLLO*ED AND THAT DOCUMENTATON i$ AVAILABLE FOR REVIEW 8Y NRC ON THE SA$15 OF THE MMEN T10N Cf THE PHYSICIAN,i RECOMMEND THAT THE apt UCANT'S OPERATOR UCENSE 8E COf +> TIONED A5

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2. CORRECTIVE LENT:$ BE WORN WHEN PERFORMING UCENSED OUTIE3

2. HEARING AfD SE WORN WHEN PERFORUING UCENSED OUYlES

4. RESTRfCTED UCENSE OR EXCEPTION Provide deteels tmaa eruf setsch supsortmg medical evidence for Nnc rev ew.

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S. RESTRICTION CHANGE F ROM PREV 10US $1sBMITTAL how.de.re4sas beso e and setecn supporting mesicad evidence for NRC renew.

PROPOSED WORDIN'1 OF R ESTRfCTION (She 4 atevel RE LATlONSHsp OF RESTRICTION TO OtsOUAUFYING CONDITION ISreerir mescere how retreerten wed correct Ae esameterver concreas REMARES FCR RESTRfCTION CHANGE (Stock f socW/

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B. NONMEDICAL CER flFICAllON THIS CERTIFIES THAT TNE APPUCANT HA5 SEEN FOUND TO MEET THE SAFEGUAROS ANO FITNESS FCR DUTY REOutREMENTS OF THIS F ACIUTY FCR UCENSED OPERATOR $.

PtR. rum,SE STATEw1N T OR OMi%580N IN 7 Nil DOCUMENT, peCLUOeNG a rY ACHWENTS. W4v et eUBJtf*T to Civil AND CntastNAL SANr.;TbpNtw. CERTIF V IJNCtH PENALT Y QF

1. .N Y e a L THAT THE iNF0AMAT10N IN THIS DOCUWENT ANO ATT ACMMENTS !$ TRt/f AND COMRECT.

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Regicasi Administrator, Repon i Regenat Admerwrtretete, Regen il Regional Adm'nestrator. Region 111 U.S. Nuctest Requietary Comm ssaan U1 Nucieer Repmorv Con missen U.S. Nuc> ear Requietory Commissen 475 Allencate Road 101 Manefte Street Suite 3100 799 Roosevert Road f

illnq of hussia. P A 19406 Atlante. GA J0323 Glen Elfyn,IL CO137 Revenal Ademnetrator. Region IV Regioned Adrrunestretor. Regeon V Dim et Onnien of Ucensee Performenee and Quenty kverusten U.S. Nuefear Reptetory Coramissen U 5. Nucteer Repatory Comm. mon 811 Ryan P'ere Ortve. Arte 1000 1450 Mer* Lane. Suite 210

1. " 08'eator Ucenseg Sienen Arttngton. TX 76011 Wemut Creek, CA 94596 U 3. Nue:sar Rewetory Commesian Nesnington. CC 20555 PRIVACY ACT STATEMENT Pursuant to 6 U.S.C 55:em(31. enacted into low by section 3 of the Pn ecy Act of ROUTINE USES: The mformation met be enetoned to en soomoriete Feoeret. State, or 1974 (Pube c Law 93 579I the foitowing statement is *urno ert 'o irevidues was locos spacy in the owns the ineormcen wrecates a oisten or potentnet viotsten of law n

sucody mformation to the US Nucieer Regusatory Commesse=s on NRC Form 396.

and a the ewnt the mformaten inrtecern a veonaten or ;sotantial veoisten of law and in TNs info met on.e me.ptemed en a system of, cords des.gnated as NRC 18 and - the course of an edmemstrothe or judeel Droctoder*g. In F$drtion. t%8 mformstou may be ee.n.no a es wenn asemer um iA

. m, iones transfw.d.o en.co,corieve Foo. sece..ns inc.ai.pney io ice estent e.ent ena l

AUTHORITV Sectuns 107 and 18101 of the Atom.c Energy Act of 1954, es antNY 'or en 4RC oee+nn steut you.

amenised te2 0 5.C. 2137 end 220ttR wHETHER OtsCLOSURE l$ MANDATORY OR v0LUNTARY AND EFFECT ON INO1YiDUAL OF NOT PROYlDING INFORM ATON. Q>scioture as woruntary. If the PRINCIPAL PURPOSE (5): In8eresten enewed on this term o used to ae,e,m ne anetner the onysical conciten and pneral heefth of too spoi. cant e o sucn that thee requened +tormation <e not prow,deo. however. 'he epohcar.on tar a fechty oorretor s or swier opeestor s cenie mov be demed u

.41 not cause oceretensi errer, encongenne ounne meseta ena sarsty. TNs moorme taon mov de uses by the NRC ste f to dvermee if the moiv aust meets the reoune.

SYSTEM MANAGERISI AND ADORES $- Ch.ef. Ope <stor Oceasm, B<eech. 0%ce of r

ments o* 10 CF P 55 to take en enemmaten or to be issued en ooerver's hcrase-Nuctew Rertor Regutesson U.S. %creer Roweto y Comrmwoe. warnneton DC 20555 r

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$1f suaf 5o gunot4 pea aaspowst to CouPLT *tiw 1kis g

tasFoeua ffom CCLLtCtsOm atoutiT 2 0 was popwamt' couutNf3 af GanDING Suncem Esf 4ua it to f at PERSON AL QUALIFICATION STATEMENT-l.lCENSEE 2',,g ",^,$"v Muc"t,c,o,a o,8, c"vMn'c*Wol c

m%sktNGTON JC W$t amo 70 TMS Partpwo8E mtDuc flON *aoJECT 0150atsoa 3F6 Ct 08 MANL?tMENT A40 t

TO ALMAIN VAllD, THit FORM MV37 NOT SE ALTERED 8vCCt '. **S"'*G '0" DC 30'803

1. APPLICANT *5 FUt f NAME / Lam. Arst, M, ewe / AND ADDR Ett Inschre /!P COW 1

4. TVPE OF APPLICATION ten e ane,.eese mesens h l wot l lcoLo X

l

' * ^ '" "' ou' 5" o Fields, Calvin G.

atNea*L

'*'"..d"r*v*t N,c,.e, y,

i..

2004 Battleground Circle

, y,c,, a u Soddy-Daisy. TN 37379 2 o*caat e c -

, outt,,a,,,,, m sht:tuOt ACOt* TONAL ttNIfi

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e 4 t APPOCA f ton 4. ut DICAL

2. CIT 12f NSHIP

2. SIRTH DATE I'"

l.0thtM A

a uw TtD tfaits uomTu Day ytan 5

g catt 4tio GANanc symeA.

((

utNint35mau 8 ' '"'" o tis wucut t,emateON s3C?cN DW i.

( orwin ix.e,4s 1j0 2} O 5 l3 3j S TVPE OF LICf NSE APPUED FOR

5. PAEVIOUS LICENSE (3) HE LO i

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a, DocattNuutta ao'sv k uctNstmuustm

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s. FaC1UTv ooCK ET NuuSEM 21660 l

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"*f ta sao ie r,, ~ o

. up L NAME AND ADDRESS (facArpel1# CadelOF APFLICANT'S EMPLOYER

10. CURRENT PO$1 TION AT FACILITY Tennessee Valley Authority J'**'"'""""*'

d @'#takW/rT."Nt Un.'r"l4"dUe"/Ns.

• ^55'"*""t^""u""'**"'

Pe0. Box 2000

' 5"'" 5* 8 "" "

Soddy-Daisy. TN 37379

]L wen rs W d stars ENoahren

$15 tant

e. 2nist tecwmcat movisomismat tNamten

8. saAus or ar*ucANT's eactutv lFacp.iry ooc.nar Nuutta

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Shift Secuoyah Nuclear Plant 50-327 e.usraucron Oparaeions

9. AooirtoN44 e Actu tv poca ETs sas.e,=r t

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m, muusta op g gs 4

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13. TRAINING (SINCE LAST APPLiCA TION - ZEE INSTRI.!CT10N51

13. E KPER sENCE [00 NO T 00UBLE COUNT-SEE INSTRUCTIONS)

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i NUCLEAR POWER PLANT FUNDAMENTALS moraf 1.RO I

2 = PLANT $YSTEMS 2. E00W/PPWO CLASSAOOM

- 3. EWS/P8WS l

OBSE RV ATION 4 ERS/CRW 5 OTHERts,.c,4s 3 OP#ATING PRACTICg CONTR(. ROOM CPERAflONS ON $HIFT SIMULATOR OPER ATING teaca czem e

possi(

];.ggg 6 0PERATOR A W dW"g E supe RvisoR S1MULATOR NAMES Sequoyah Unit 1 n ::#gy %z b.

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COMMERCtAL NUCLEAR tlasmeceay me unen/ Tant seareers 16 l

l e v 4 3RO 4NSTRUCTION

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10. REACTOR OPLRATOR /tmeawa#

5 d,*37e'gN$"vf,",'" ' '" 'U"' *G6 "GG" l

l 11 SENIOR CHA10R to.c a es j

[d*d f*f,"$[,c^j,** * * *"

12 SHIFT $' n'D -tSOR ito..ws 8.M E QU A UF ICATION 13 STAF8/SAIFT ENGINEER is.senwet 1.OTHER zseecures

14. AUX. EQUIP. CPE R ATOR INeance"***

f t. PLANT ST AF F l

18 OTHERyse.c,4s waC Fomu 296 (3.et*

s 2:

.I.lNRC PanM 396 U S. NUCLE AR REGULATORY COMMISSION ArraMD Sy OM5 NO 31SD0024 12 4 %

OtPe4E S. 14ea 1

{ 10 C7 R 94 33. SS 25.

}%S77.583'.St$7 (STmiaTED E80E4 8ER RESPON$E TO COMP (y wtN ?MS edQ%a TION COli1CTIC 8 REGLAST.

'S Met FCshv&RQ CEPT!iCATION OF MEDICAL EXAMINATION ce==en am^= meow'* art to 7"s wc**m4 ANO RECORDS 44ANAGEMENT SAANCH iMN88 17140. u S.

BY FACILITY LICENSEE quea aeouurOn Ce=Moson Aw~aTc= x un AND TO THE eaPEPwonn Af.JuC'10N P8CXCT l31SMQ24).

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OFrCE OF iA4NAGEMENT ANC BUDG(T..ASHINGTON CC 2 trial a - n i.i.,

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l F <1UTY DOCKET NUMBER FOCILITY SEOUOYAH HFJsLTH STATION k-327 6 50-328 A, MEDICAL EXAMIN ATION CERTIFICATION

.d[SY C.

V" f THE xdOv E NAMED APPUCANT FOR AN OPERATOR / SENIOR OPERATOR UCENSE HAS 8EEN EXAMINED BY A PHYSI'.; AN.

~'

^

'e en vy l STAT E Af40 UCENSE NUM8ER l EXAMsMTIOED ATE Tfd.

U737 OS O b.

t,AM Or EXAMINATION.NCLUDING INFORM 15dik FURNI RED BY THE APPLICANT. THE FHv$k.AN HAS DETEf?MINEO THAT THE APet,,.;<t

..ON AND GENERAL HEALTH ARE NOT SUCH THAT IT MIGHT CAUSE OPERATIONAL ERROP1 ENDANGE RINC PUSUC AEAe TH s*

N AEACHING THIS DETERMIN ATION. THE Gul0ANCE CONTAINED IN eNSUANS 3.41983.C, ANSUANS16.4-1977 (N3801 W As Mtp SAF P +

4 FQt *,0WER d4

.T J

- MTAT!ON IS AV AILABLE.QP W.VIEli BY NFC.

ON THE BAdt,OF '

JEN?AT'ON OF THG PHYSICIAN, t RECOMMEND THAT THE APPUCANT'S O*ERATOR UCENSE BE COTITmNED AS

cos,%, -

n

.I. NO P.

2. CORME..

' E WORN WHEN PERFORMING UCENSEO QUTIES

3. HEARIFE. alt) Es

. 4 WHFN PERFORMING UCENSEC OUTIEC

4. RESTiilt T*' LIC&K. j OR EXCEPTIONJrovide details ee6ow and attaca supporting medical evidence for NRC review.

4 W

5. REST'97lON CHANGE FROM PREVIOUS SU8MITTAL. Provide details be*ow end attach supoartmg medical eveence for NRC review.

PROPC NQ C'NG OF RESTR3CTION (8/cet 4 acow/

l t

E.ATIOMHIP OF RESTRICTON TO 0150U4 IFYING CONOfTION (Sneny moscre now nitreren wd correct rae caoussarymg conoirent REMARKS FOR RESTRICTION CHAIGE (P -

• e*

r 8 NONMEDICAL CERTIFICATION TH11 CERTIFIM THAT THE APPUCANT HAS BEEN FOUND '.O MEET THE SAFEGt.sARDS ANO FITNESS FOR DUT f REQUIREMENTS OF THIS

• ACIUTY FOR LICENSED OPf RATORS.

p-.

pMY F Ae 3E ST A Td 4h* 0d OMi15 TON im FMIS uCCUMENT. INCL.UO4NG ATT ACMMfN T3 t4AV St SUS %T TO Ch lL ANC-CPiMINA4. $ANCTIONS.1 CENT IF Y UNOLA PENALTY GF DERAJMY TMAT TM NORMATION IN THIS DOCUMEN' ANO ATTACHMENTS IS TRUE AND CCARECT.

PRINT NAME dhh SIGN U A E (semer uaneoernent peoresenratrw on &reJ TITLE DATE l

sm Gl3o 9L J/ L. Wilson SQN Site Vice President in accorr*sts with 10 CF H 55.3. Commumcatens this form snaet be u.cmtried to the NRC as fonews: SY Mali, ACORESSED TO:

Regional Admmerc woe. Region i Regened Admwistrator. Regen il Regiones Admmrttrator. Regton lil US. Nuciese Requistory Cornmissen U.S. Nuclear Revelatory Commenen U.S. Nuctor Regulator).ammesuon 47S Allendate Road 101 klanetta Street, hie 3100 799 Roosevelt Road King of Pruts a. PA 19406 AttanTa, GA 30323 Gien Ellyn. IL 60137 i

Director. Division of Ucensee vw. cance Regenal Aomenestrator. Regen !V R sp,nel Adm nistrator. !Npon V U1 Nucsear 4p atory Cammessen and Quasity Evaiuation r

U % Nucteer Regulatory Comm.ssea Artn: Operator Lcenseg Branen 6*

Ryan Pisaa Dnve. Susto 1000 1450 Marul Lane. Suite 210 Arlington TX 76011 Wamut Creen. LA 94596 U.S. Nuciar Requiatory Comm.suon l

Wasrungton. DC 20555 PRIVACY ACT STATEMENT RGdTINE USES. The m armaten may ee dructoud to an acorconste Feoeras. State. or Puriuant to 5 UAC. f 42aieH31. ene: tad mee law by section 3 of the Pnvecy Act of a

,1974 (Punhe Law 934795 the followmg state, ant is %medw, to indicduaes wno local agency en the evem the mformation encicates a notaten or potenties veaton of law succey information to.no US Nuclear Regusatory Comm ssen on NRC Form 390. are m tne event tte enformation mdicates a weaten or potenties vesaten of few and m This nformation e mamtamed m a system of avcortes cenynated rs NRC 18 and the course of an sormentrative or jueicias oracencing. In adrimon. tms informaten eney ee o.ac+ee et ss p ww nee ier 2397s iA.e,a 2o.199et par sterred to an sooroonate Federal State. and local agmcy to tne extent reievent ant, AUTHORITY: Sectens 107 and 161M of the Atomic Enargy Act of 1954. as necessary tor an NRC aecuan acout vou.

onended (42 U S.C. 2137 arsa 2201011.

WHETHER OtSt LOSURE 13 MANOATORY OR VOLUNTARY AND EFFEC' ON on this form is used to oevermee IN0tVIOUAL OF NOT PRovtDING INSORMATION. Descrosure is voluntary. if Yne I

PRINCIPAL PURPOSEiS): Information emerere w ermer the envocal conomon and general heretn of the aconcant are such enat they re*,esms m'ormation is not promoso, however, the acosication for a facility operator's n

vnll not cause operatenet urors endangennq ovonc hesitn and uferv. Yks m.orma-or sen'or oce'ator's heense may be demed.

tion may be used Dv ttw NRC staff *o outermme if the mdmduet meats tne require-SYSTEM MANAGE 7llSI AND ACORESS. CNe#

1. -star Licenwg Branen. Of6ce of i

memss.on. Wasnmqton, DC 20555.

j meats of 10 & R % to rate an saammeren or to be asued an ooerator's liceme.

Nuclear Reactor Re9,lation. U.S. Nuclear Regusatc.a 1

rr NRC POpas 3sq Iseig

(n.

e, N;.C PORM 398

- u.L NUCLE AR REGVF STORY COMutsseose

<T..O A T E R E C $l.y E D.C, mm ap, roved.S,YOMS No 3150 0090

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Off,",',,'$d' -

EsT,MATEo suaoEN PER REs*oNst to CoMPtv wita T-s INFORMATCN CCLLECTCN REOutsT 2 o wRs FORWARO COMME NTS R E GA ROtNG sum 0EN EST fM AT E TO THE PERSONAL QUALIFICATION STATEMENT-LICETJSE E

• Poa*AfeN A=o RECoRos MANAoEMENr eR ANCu IMNSS 77147. U S. NUCLE AR REGULATORY COMMI55 TON.

WASHINGTON. OC 20455 ANO TO THE PAPERwoM Rf DUC-T10m PROJECf 121504090s. OFFICE OF MANAGEMENT AND TO REMAIN VALID,THIS FORM MUST NOT BE ALTERED aUocET.

• AsMiscTON, DC 20 sos,

1. APPLICANT'S FULL NAME (last, fint,MWel AND ADORESS t',c*weIJP Coorf

4. TYPE OF APFLICAflON (Clwce apPaceae sonmJ h l HOT l l COLD l

aAivER REOutu

<&ne e. a-, f o Hyden, ElwOOd Lee

• ^'

i..RiTTE N,C,,e,.,y, 2330 Crescent Club Drive

• UP' *85 1

X HixsOn, TN 37343

2. OPE R A tmq gg,,g,yj d MULYl. UNIT 1AMFNO TO itJCLUDE ADDITrQhAL S/ NIT) e R E APPLICA f ton 3 EuGiaiuTv

' #'I

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4. MEDICAL

2. CtT12ENSHIP

3. 86RTH DATE s.oTHER UNITED ETATES MONTH DAY vtAR NO

_X 3 I

l_ s. DATE P As3ED CENERiC SUNDA" N MM vvi

)

MENTALs EnumarioN sECTc s, ro,no i m oTwER rs,=+i 0 11 11 7 5l 3

"'4"teca st r>

t

5. TYPE OF LICENSE APPLIED FOR

8. PREVIOUS LICENSE (5) HELD 4 OPERATOR

4. DOCKET NUMSER RQ SRO k UCENSE NUMBER

[f[

d. F ACiUTY DOCK ET Nt/ 9 ER

,,g

[

h SENcR OPERATOR I

I I

ss. 20515 X

OP-20256-2 1l 2 1 11 9I4 so.

327 & 328

a. UMuitD SRO le A. Fuer Nants *t, s

p p

7. NAME AND ADORESS (fricluce E **sstJ OF APPLICANT'S EMPLOYER

10. CURRENT 'OSITION AT F ACILITY a PLANT SUPERINTENDENT L AuxsuaRY UNeT OPER.

Tennessee-Valley Authority AS$1ETANT PLANT SUPERINTENDENT

,0,1 E,Q

^7o"'"^****"'**

A h $HIFT SUPERyt3CR TO OFW Ws Soddy-Daisy, TN-37379-

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] orNeR c,se.N,

4. sTArPENeiNEER

8. NAME T. APPUCANT*5 P AduClear Plant I F ACIUTY OOCK ET NUMBER g $NtFT TECHNIC #i ADytSOR/5HIFT ENG4NEER IUTV equoyah 50-327 f.

INSTRUCTOR 9, AcontioNAL F ACauty coCitETs(Mesa.aer t==es s sEmioM CO, Rot amou OPERArom 50-328 Y

IL CONTROL ROOM OPER ATOR

11. EDUCATION

& MiGNSCHOOL

e. MAJOR AREAISI OP STUOy

,,'ff, O"'

OEGREE CODES

d. v0CATcNAEGwe r4L lIyf" %"c",*,$$

(Te me went Air I

caAouaTE

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" "yng o.NONE TVA Nuclear Operator 18 X

GEO EQUlv ALENCY

1. CERTIFICATE 0""

3

2. Associate Training Program NO-Art 2

0

3. ACwEtOR g sygggno{ "

4 MASTER

. vgAgs OP 3

5,00CTORAL

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12. TRA5NtNG (SINCE LAST A?9LIC.4 TION - SEE INSTRUCTIONS) 11 EXPERIENCE (DO NO TCOUBLE COUNT-SEE INSTRUCTJONSI

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• acu to

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• NAVY

• aou

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• 1-NUCLEAR POWER PLANT FUNDAMENTALS,oa =s 1 RO 2 PLANT SYSTEMS 2. EOOW/PPWO Cl ASSROOM -

3. EWS/PPWS OSSERVATION 4. E RS/CRW 3-OPERA'.NG PRACTICE

5. OTHER issee,4s CONTROL ROOM OPERATIONS ON SHIFT SIMULATOR OPERATING tracAnMeC:sawooms poss:L WWW*

6. OPER ATOR w e ~ w% 3Mgx ' @,}

SIMULATOR NAMES

n. Sequoyah-Unit 1 MfpMp%

7. SUPE *MSO R 38-h 8 - Pt.5i45STAF F

~ N I'Or'o U tsYvo l l YE5 l l NO TNhh fh 9 - OTHE R (sosewi 9.h.h4p gp w wee. o. asacnv.tv w.~- m. arm =3 f gggggy{

w sw m b4dAtMfMW COMMERCIAL NVCLEAR #acasding RemweWren Asaws l

4 -SRO INSTRUCTION

10. REACTOR OPERATOR ttwwces g agr4*fsyg= = smei m com aos noow g i, SENIOR OPERATOR (tcenmer t

- s. 7,'M"f,"Cyva aim aowna l

12 SHIFT SUPERVISOR it,cenmas 6 REQUALIPICATION l

13 - STAFF / SHIFT ENGINEER ireamet 7 -OTHER tsese*#

14 AUX./EOUIP. OPER ATOR INenacennwi 15 - PLANT STAFF 16 - OTHE R (seecWs i

NRC PORM 398 (2-m

,----g v

-r-rm - - -

NXC 70PM 398 U S. NUCLE AR REGULATOR Y COMMI53lON APPROVED BY OM8 sc 3tSocQH b CH Od"8E1 1,70e*

to CFR S$ 23.15 k SS 2739.31 il 67 ESThaTED SUfEEN PER AESPONSE TQ cm" wrTW T54fg wcewnO= ccmeTok ReCu m is u=

wuio CER TIFICATION OF MEDICAL EXAMINATION ma"ac*com"enaama f'u'owS'='t to w = SN e 5 aNo s==A.auEw mu.CN

-.a

r.... u t BY FACILITY LICENSEE Nuctua aeoutece cOu== son. aasNecTcet oc am Ase0 TO THE P&PERwORK REDLTTION PROACT Q150eJet.

ORICE Ok anaNAGEMENT M*'3 BuCGET. W ASHNGTON. DC 30501 NAME OF APPUCAPsT HYDEN, Elwood L.

lF ACsuTY OOCKET NUMBER FACluTY FequOyah Health Station A. MEDICAL EXAMINATION CEhTIFICATION THIS IS TO CERTITY T' TAT THE ABOVE NAMED APPUCANT FOR AN OPERATOR / SENIOR OPERATOR UCENSE MAS BEEN EXAMINED SY A PHYS.CIAs PRINTED NAME (o/phrs'cen) l STATE ANO UCENSE NUMSER j EXAnalNATlON DA TL Robert H. Cofer, M.J.

MD-02737 92-04-06 SASED ON THE RESULTS OF THE EXAMINATrGN. INCLUDING INFORMATION FURNIS D SY THE APPUCANT. T[

4YSICIAN HAS DETERMtNED THAT THE APPUCANT'S PHYSICAL CONDfTON AND GENER AL HEALTH A RE NOT SUCH TH AT IT M*GWT CAUSE OPERATtON RCRS ENDANGERING PUR IC HE ALTH AND SAFETY. I CERTIFY THAT IN REACHING TH15 DETERMINATON. THE GutOANCE CONE UNED IN ANSUANS 3 4 OR ANSUANS15.4-1977 (N3% M*

FOLLOWED AN') THAT DOCUME38TATON IS AV AILABLE FOR REvtEW SY NRC, ON THE BAS!$ OF THE RECOMMENDATION OF THE PHYSICIAN. I RECOMMEND THAT THE APPUCANT'S OPER ATOR UCENSE BE CONDITONED AS FOLLOWS;

1. NO RESTRtCTIONS

2. CORRECTIVE LENSES BE WORN WHEN PERFORMING UCENSED OUTiES 3, HF AF"NG AIO SE WORN WHEN PIRFORMING UCENSED DU RIES

4. RESTRICTED UCENSE OR EXCEPTON Proeide dets9s below are are ecmyting momead evidence for NRC revww.

5. RESTRICTON CHANGE FROM PREVOUS SUSMITTA; Jrre oe details beinw and attaen supportmg maidecal evidence for NRC review.

PROPOSED WORDING OF RESTRICTION iB!act 4 aboves RE LATION'.hlP OF RE':TRICTON TO DISQUAUFYlNG CONDITION (armnv macare how restreren awd comiiT.the esqueh?ver conturent REMARKS FOR RESTRICTION CHANGE (8ber 5 aooan B. NONMEOtCAL CER TIFiCATlON THIS CERTIFIES THAT THE APPLICANT HAS 8EEN FOUND TO MEET THE SAFEGUAROS AND FITic 'S FOR DUTY REQUIREMENTS OF THIS F ACluTY FOR UCENSED OPERATORS.

ANv F ALSE STATEMENT OR OMIS5ON IN Tius OOCUMENT WeCLuCING ATTACNMEN r$. MAY en SUeJECT IQ CIVIL AND CRIMINAL 5ANCTmiL3. CtRTe v UNotN PtNALiv QF FEAJtJMy THAT THE 4NPORMATION IN THIS DOCUMENT ANO ATTACHMENTL IS I4UE AND CORRECT.

AME ANO SIGNATURE ISener Management Bearramtsrae en S,res l TITLE PRINTED DATE

(* ? o

/

sa.

yb J

Wilson SON Site Vice Presidenc Yn accorpe wim 10 CF R 55,5. Commun.catem, this ' form snatt be suomitted to sne NMC as foslows: 8Y MAIL AC'3RESSED TO:

l-Regional Admm strator. Regmn i Regonal Admmestrator. Regen il Regional Admmistrator. Ragen ite U.S. Nucteer Regulatory Conusession U.S. Nuctear Regmatory Camtmssen U.S. Nuclear Regusatory C>mmesson l

475 AHendste Acsd 101 Mar erts Street. Sune 3100 799 Roosevest Road l

King of Prussia. PA 194'36 Atlanta GA 30323 Glen Ellyn. IL 60137 I

Regional Admi Trator, Regson IV Regional Admmestrator. Regen V Gactor. Dim *on of Leemee Performance U.S. Nuctear Repatory Commessen U.S. Nuclear Repatory Camtmsnion and Quahty Evamaturt I

611 Ryan Ptata Onve. Suite 1000 1450 Mare Lane. Sune 710 Attn: Operator ucensmg Banen i

Atmt, ton. TX 75011 Wamut Case. CA 94596 U.S. Nuclear Repatory Cor>' mission Wasnmoton. DC 20555 j-P91V ACY ACT STATEMENT Pwsuant to 5 U.S.C. 552ateH3L enacted imo inn by secten 3 of the Pnvecy Act of ROUTINE USES. The informaten mov be ducioned to an accroariate Feoeras. S:are. or

, t974 (f% enc Law 93 519L ene Milowing statement is iurmned to andmduais wno local agency m the event the msormaten mdicates a veosation or potencias violation of law moty mformaten to the US Nocteer Reguutory Cammassorion NRC Form 396. and m the event the m8ormaten arvmcates a violation or setential veoiation of law and in Tbs mformaten is mamtamed m a svttem of records desegnated as NRC-18 anc the course of an admmistratre or audcal procieomg. In addman, tnis mformation may be seecr**e et SS Feee w Regeper 13978 i Augwn20.19909 transferred an aporopriate Federt State, and local agency to the extent reevant and a t of 1954. as necessaer ~r s. NRC decision acout pou.

AUTHORITY: Setions 107 and 161W 64 the Atomic Energy c

amenessa t42 0.1C. 2137 and 220f fii).

WHETHER OtSCLOSURE 15 MANDATORY OR VOLUNTARY ANO EFFECT ON PRINCIPAL PURPOSE (S): Information emered on mis form is used to determme INulvlDUAL OF NOT PROVIDING INFORMATON. Disciosure is voiuntary, if the wnether the onysicat conomon and generat heastn of tr e appocaat are suen inar eney mtmeswa entonnaten s not onmoed however, the sooncation for a facary operator's mii not cause operetenas errors emsangermg punuc heattn and safety. Thu mierma-or tener ooerator's iscer>

may be dmd.

tion may he used by the NRC statt to determere of tne mdmoua6 meets Ine require-SYSTEM MANAGER (S) -.3 ADORESS. CNef. Opentor Licammq Bancn. Office of ments of 10 CFR 55 to taas an esammaren or to be esmed an operator's 6 cense Nuclear Reactor Regutaoort, U.S, Nuciear Regulatory Cornmisuon. Wasnegron, OC 20555.

Nnc #fsana 39e 489 i

l l

l

D.

j 6'

m l

N AG FORM 3'J8 U.1 NUCLE AR REGUL ATORY CUMu@CN AppHOv fD BV Out NO 3thuN0 Ire be swnetems'ke knC)

D*IE "ECE VED (t;*n E x PsRE E. 12,21 94 g

ESTIMATED SURDEN *ER kEaPONSE TO COMPLY WITN TMIS INFORMATION CC LLECTION REQUE ET 2 0 M5:5 FORW ARD COMMEN TS R E GARD tNQ SVROEN E$7tM A T E TO THE PERSON AL QUA LIFICATION STATEMENT-LICENSEE

• • 'oa ** T *N

'No "E mao * *^ *^ c E *E *T Ea^Nc" (MNB8 T7 5 41 U S. NUCLE AR NEGULATORY COMMiS5 TON.

W ASMtNGToN. DC 705H. AND TO THE P APERWOPE MEDUC-TION PROJECT L31M40901.OFFlCE OF MANAGEu(NT ANQ TO REMAIN VAL 10. THIS FORM MMST NOT BE ALTERED SUDGE T. WA&MaNCTON. QC 20$03.

1. APPLICANT'S FULL NAME (l.asr. T&se M>ad/el ANO ADDRESS (include El# Cod,J 4, TYPE OF APPLICATION /Chus acae.c aee an.eu lX l Moi l l COLD Jones, Lewis Westley, Jr, withdrew I

X 4 NEa

• • 'vER REoVEsno

"*7, *r'((C,,,,,,,

,, RENwAL 2472 North Brier Circle u,oR,a Chattanooga, TN 37406

., MutTi UNa i-Evo ro

'c"**'

tNCLyCI AC0tTIONAL UMT) e R E APPLICATICN ELsGaest Tv 3

4. ME QlC AL

N""

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2 CIT 12ENSHIP

3. BIRTH DATE 2 EECOND g.orwgR a UNITED ITATES MONTM OAV l YEAR

~

2*'"

X X

a DATE PASSED GENERIC FUNDA.

MENTALS ERAMINATION SECTION orwER ise 0l3 2 I815 I9

"' '"ea st r>

TITT

5. TYPE OF LICENSE APPLIED FOR

6. PREVIOUS LICE NSE($) HELD 1

a, OPERATOR

a. DOCKET NUMBER

%O SRO k UCENSE NVMsER

d. F ACIUTv DOCK ET NUM8ER h SENSOR OPER AroR 1

I i

ss.-

21567 I

i i

33 e.

UMITED SRO le s.. Fue# Naaeder) i i

1. NAEE AND ADDRESS //nclurie Elp Codef OF APPLICANT'S EMPLO VE R 10 CURRENT POSITION AT FACluTY U]L AUXILIARY UNai CPtiR.

a. PLANT $UPERINTENDENT Tennessee Valley Authority AS3!$T ANT PLANT SUPERINTENDENT SUILDfNG/EQUtPMENT A f oa<TaAiNE Errua =>NE k

P.O. box 2000 oPEa4TOa <Ncw vCivs-so OrtaA rcas e.

sH,FT supervisor Soddy-Daisy, TN 37379

4. STAF8 ENGINEER

j. OTHER /3 sees &#

8. NAME 08 APPUCANT'1 F AC1UTV a F ACILITY DOCKET NUM8ER

a. SHIFT TEf.;HNtCAL ADVISOR / SHIFT ENGINEER 8

Sequoyah Nuclear Plant 50-327 t,NstRuCToR

9. Acom sNAL

• ACiuTv ooexETs (A#e e La o 5 sEN oM CoNTRot Room OPERA oR 50-328 IL CONTROL ROOM OPER A TOR

11. ED UCATION a ricN school

e. MAJOR AREAtsi oF stuoy i yttf. j ;;;'*;.'

DEGREE CODES

d. v0CATiONALITECHNicAt.

"7

((,%@

tre se e w X

cRAcuATE ENGs"EER'~o *ELos!

wGuesroccast es ear "n v ~m

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nn

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Mechanical Ener Tech 2

2 a.NeNE TVA Nuclear OperatO:

18 X

vlO EQUIVALENCY

1. CE RTIF ICA T E

^

Training Program 3

OTHER 2.AssOCart NO 3.sACwtLOR k NUM8EROF

4. M AST ER t.cocroRAL Yeas op o

entt W L

12. TnAINtNG (SINCE LAST APPUCA '10 - SEE INSTRUCTIONS)

11. EXPERIENCE (DO NO T OQU8LE COUNT-SEE INSTRUCTIONS) n,-. -..

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naou to a.-.

NAyy saow to

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i 1-NUCLEAR POWER PLANT FUNOAMENTALS rooms i.RO 1

l 2 PLANT SYSTEa45

2. EDOW/PPWO l

CLASSROOM 3. EWS.PPWS l

OS"E RV A TtON

4. E ASICRW l

h-OFERATING PRACTICE 5 OTHER(3,=47 CONTROL ROOM OPER ATIONS ON SHIFT l

i SIMULATOR OPERATING tineAae c;.we *'

FOSM SIMULATOR NAMES 3

y:

6. OPE R ATO R 7. SUPE RviSO R

(

SequOyah Unit 1 3

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wue e a. me.ce.v.rv w.~

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PS COMMERCIAL NUCLEAR nwn.wia, n rsvrm R,xrors f

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4 -SRO INSTRUCTION

10. REACTOR OPERATOR (Lwa nii 5 m*ly' jfg& fey" ' '" " ** **"

11. SEN10R OPERATCR (LuenndI

a. lj.",8,$" gyp A 2n cowsa 12 SHIFT GUPERVtSOR (L,ceneet 6 -R EQUAllFICATION l

13 - STAFF / SHIFT ENGINEER ILeva t!

l 7 -OTHE9 rs,m+i t4. AUX./EOutr. OPER ATOR Avoweennst l

l t'. PLANT STAF F l

l 16 OTHER tsom&s NRC FORM 398 G.it)

NHC Otu 396 U 3. NUCLE AR REGULATORY COMMIS$10N A8PROWII By OMS. *C 3%me peu EXPIRES. f.3148 10 Ce se $5 M 15 25, i

65 27. 56 31. S$ S F gsmeATED SURCCN PER DESC6 f0 COMPLY WefH NS e#C64MTIUN COL 1MnON nEOuEsT 75 nmN.

70AMAD CERTIFICATION OF MEDICAL EXAMINATION cc=,w',***'"'aumN esmAw w enauArcN BY FACILITY LICENSEE Nuca4mouuma,cwur s.wo yNe rn.. u.s.

A~C ece os==

CC-sm uwNon oc rom ue to w we=C= acouc,om m Omca cr.mowsNr uc euOc.rT. ans ueer amame.

ca x mm NAME OF APPUCANT JONES, JR.,

LEWIS W.

j F ACILITY DOCILET NUMSER FAC1UTY SEQUOYAH HEALTH STATION 50-327 & 50-328 A. MEDICAL EXAMINATION CERTIFICATION THIS 15 TO CERTIFY THAT THE AROVE NAMED APPUCANT FOR AN OPERATOR / SENIOR OPERATOR UCENSE HAS BEEN EXAMINED BY A PHYSJCIAN.

PRINT ED N AME io/ Anyscaenf j STATE AN

-[ CENSE NUMBER l EXAMINATlON DATE MARY A. DU m, M.D.

"D T 7376%

Th. mn 92 03 30

'8ASED ON THE RESULTS OF THE EXAMINATION. INCLUDING.NFORMATION FURNISHED SY THE APPUCANT. THE PHYSICIAN HAS DETERuiNED THAT THE APPUCANT*$ PsOSICAL CONDITION AND GENERAL HEALTH ARE NOT SUCH THAT IT MIGHT CAUSE OPE RAT'ON AL E RRORS END ANGERING PUBUC HE ALTH AND SAF ETY. I CERTIFY THAT IN RE ACHING THis DETERMINATlON. THE GUiO ANCE CONTAINED IN ANSI /ANS 3.4-1983. OR ANSI /ANS 15.a-1977 (N380$ WAS FOLLOWED Af40 THAT DOCUMENTATION 13 AVAILABLE FOR REVIEW BY NRC, ON THE BASIS OF THE RECOMMENOATION OF THE PHYSICle.N I REL10MMEND THAT THE APPUCANT*$ OPERATOR LICENSE SE CONDITIONED AS FOLLOWS:

g 1. NO RESTRICTIONS

2. CORRECTIVE LENSES BE WORN WHEN PERFORMING UCENSED DUTIES 3, HEARING A!O BE WORN WHEN PERFORMING UCENSED DUTIES

4. RESTRICTED UCENSE OR EXCEPTION Provide details bcow anr1 attaen supporteg medical evidence for s'RC <ewww.

5. RESTRICTION CHANGE F ROM PREVIOUS SUBMITTAL Provide details beew and attacn supportmg medme ev dence for NRC review, PROPOSED WORDING OF RES e'RICTION 18:ock 4 abowel RELATIONSHIP OF A ES'T RICTION TO O!SOUAut YING CONO# TION I8nenv atacare now resrmten w II conect 4rie siscusa *rme conerenf REMARKS FOR RESTRICTION CHANGE (skock S aco**)

8. NONMEDICAL CERT ARCATION THIS CE1TIFIES THAT THE AFPUCANT HAS 8EEN FOUND TO MEET THE SAFEGUAFOS AND FITNESS F081 OUTY RECUIREMENTS OF THIS FAC:UTY FOR LICENSED OPERATOR 1 ANV 7 AL3E STA.Eutast UN CM*S3tose eN 4 Na3 DOCUMENT. INCLUQiNs3 ATTACMaieENTS. wa v RE SuaJECT TO CivtL ANo caiuvNAt aANcTIONs a cte r s71 uMotn PENALT v &

PERIU81V THAT YHE INFORMA710N IN THit DOCUMfNT AND ATTACHMENT 113 TRuf AND CORRECT.

'D S GT3ATURE (Samor Manes apr depresenreve on T. ret l TITLE lDATE PRINTED NAME S WA b 3d Q J. L, 11 son SQN Site Vice President I

in accordance witNj CF R 55.5. Communicatens, tnis form sna6 be mometted to tne NRC as Wlows: SY MAIL ADORESSED TO:

Regenas Administrator, Region i Regioeal Admenntrator. Region il Regional Adminsstrator. Region ill U 1 Nucrear Regulatory Ciammissen U.S. Nuclear Rewatory Comminion u.1 Nucisar Reguistory Camtmsson r

[

4T5 Allendste Road 101 Manef*a Street. Suste 3100 799 Rooseve,t Road King of Prussia PA 19406 Atlanta. 9A J0323 Gien Ellyn. IL 60137 Regeonad Adramistrator, Region IV Regionae Admmistrator, Region V Director, Division of Uciesee Puformanes arid Cussity Evsiusten U.1 Nuclear Remiatory Cammitsion US Nuclear Reguaatory Commissen 611 Ryan P!aza Drive. Suste 1000 1450 Mens Lane Suite 210 Attn:Cowater Ucenseg 5-ench Arimston. TX 76011 Wamut Creen. CA 946G6 11S. Nucrear Regusatory Caramission WasnerNton. OC 20555 l

e

=

PRIVACY ACT STATEMENT

[

Pvrluant to 5 UIC 557ateit31. enacted imo law by secten 3 of the Pnveev Act of ROUTINE USES: The miormanon me ' e discsowd to an acoroonate Federat. State, or

,1974 (Public Law 93579), the followmq itatemem es *urnished to individuan wne local agency m toe event tfse mvormaten md cates a veosation or moremies violaren of law suociy information to the U1 Nucteer Regusatory Cornmineun on NRC Form 396 ano m the event tfu enforrmanon irocatas a viotaten or potennaa sioisten of law ar'd m the course o an accrunntrattve or puoicial proceedsng. In addeten Ws informaten may be r

TN inforrre e is meintamed in a systern of re<mros designated as NRC 16 and l

transtened to an accroonste Federai. State, and locat aaency to the entent retevent and seurite.e as h eeree me,w jas7e (Augus 20.199o1 i

l AUTHORITY: Sec sons 107 ano 161Q af tne Atomic Energy Act of 1964, as necessary ter an NRC aecision aoout vou.

I amencied f42 UAC. 2 tJ7 and ;701(dL WHETHER CISCLOSURE IS MANCATORY OR VOLUNTARY AND EF8ECT ON

(

PRINCIPAL PURPOSEfSI: Informaten entered on tnis form is used to determii e INOlVfDUAL OF NOT PRO'/tOING INFORMATION. Disctosi.r

.s vosumary. If tne w ether the i:%vsical condition anri generas hearth of i aco6 cant are sucn ertat they requested mfonnaren is not provided. %meever, tne agonicanon 'or a facility operator's l

e will not cause oceratonal errors endanqennq publ6C hesita and safety, Tbs snk.rma.

of seC3r operator's Iscense may og demed.

ten may be used av the NRC staff to oevermme if the individual meets ene mouire-SYSTEM MANAGEFtIS) AND ADDRESS; CNef Ocierator Ucenseg Brant Orfice of erwnts of 10 CF 4 55 to taae an esammaten or to be iuuad an opef ator :licenw.

Nuclear Reactor Regulaten, U 1 Nuclear Regulatory Commmen. Wasnmgren, DC 20555 Netc eOne 39e San l

. - ~ - -

-I e NHC,softM 398 u.s NUCLE AR msGULATony CommisseoN Apeggyge gy oug No 3,goog3g

- Dare ancasyto in ea) e Piacs is.n.n f re n ce--w: ' *ci ns Cra u ss:n ss' 63.47. ens S6 $7 ESTIMATED sumoEN PER RESPONSE To COMPtv nsTM Twis IN#onuaTioN CCLLECTCN Pfouts? 2 0 MRS Fomw AHo CouutNTs AEGamomG auro 64 (STIMA T E To Twt PERSONAL QUALIFICATION STATtiMENT-LICENSEE

• • cawarom Amo asCoaos =ANacevu=f saANCa fuNue 77tes. u s. NUCLI AA AEGULAfomy Cormss oN.

wasMsNGTON oC 20556 Aho To THE # APEpwopK mieuC.

TON PmogCT 43igacogos, OFFICE op MANAGEu(NT ANo TO REMAIN VALIO.THIS FORM MUST NOT BE ALTERED evoctT. wasumGTom. oc 2osaa

1. APPLICANT'S FULL NAME

., firsr. Ai,dviel AND ADOR ESS (me!ude lip Coaef

4. TYPE OF APPLICATION sca.cn eswee.e an ess h l wof l lCOLo X

a Ntw l

wAlvam atoutsT Im n-, ED f.

-Stinson. John cdvard

' ' * " ' " 'c'='

Route 5,' Box 5026

• "**^**

-DayconTN 37321 E#'****'***

~

e MULitssNs1(AMEAr0 ro INCLVOC ACOstr0NAL UNIT 1

3. EUGa stLa t y

. asA> uCAfioN

.. weoiCAL

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~

2. CITIZE N5HtP 181R TH O ATE 2.stcoNo 5.orata al a usesTto sTAfts woNTw o4T vgAn a DATE

• Assto GENEmeC PUNoA.

MENTALs f uAMWAfloN SECT @N 3 Tw o

m. ofusa is.-+,

0 19 016 5 i6

~i Ae uCA nt <>

3 oi

5. TYPE OF LICENSE APPtlED FOR

6. PREVIOUS LICENSEI5) uf LD

[

E a oPEMAfoR a oCCKEThuwSEA AC 3Ro k UCENSE NuM9tR

,,\\ "

',,g

d. F AC2UTV o0CF.(T NuMGER i

3 I'

e6 stNonortmAfom 1748 8

8 1

so.

55 A uniTas sao <, A.,,

[NAME AND ADDRESS (trickde EIP Coder OF APPLICANT'S EMPLOYEli

10. CURRENT POSITION AT F AC3LITY ME'Ea"AaYsNOs Tennessee Valley authority assistant PLANT suPtAINTENDENy oPi A ron,oulPMEN,T SulLDING/E k

NoN uC us.

P.O. Box 2000 susFT suPERWison EO ost#A roms t

Soddy-busy. TN 37379 a stas * <Namsin L ofwen is e,47-

. sw.af T:CwN. CAL AovisaarsmeT sNomssa

a. NAus o= Ae.uCANT s e AC:uTv j e ACiuTv ooCx 7 Nu-sea SoNoovah Nuclear Plant 50-M7 L msTauCTom

9. AoomoNAL 7 AcruTv ooCKaTa tu.a L.a.=s

. uNen CoNinoL aoou opt = Atom

~

50-328

% CONT ot.co.o,..ATo.

11. EDUCATION s-NU a muw sCHoot

e. mA.aon Antarss os sTuoy l,? f;;, j = l OEGRE E CODES

d. VOCATIONAL /T(CwMfCAL j[C"s's Mayo 5 cast esa es uoNms

""3*'***,2 y,

,o

~~

X caAouAft aNGmaanima spistoss Chemical 1:.ngr 1

0 TVA Nuclear OoeraCor 18 X

~

Gro ecuivALsNCv

,Diology/ Chemistry 4

3 i:'AET'o Training Progra2 n

No -

A. = A stra t-

. Nu.... o,

. Mech Engr Tech 2

2

5. wcron AL 7.,tno,'

7 l

1L TRAtNING iSINCE LAST APPLICA TION - SEE INSTRUCTIONS) 11 EXPEREENCE (00 NO T DOUBLE COUN T-SEE JNSTRUCTIONSI wo= r. o n..

. wo = r

.=o e a NAyy

..o a

ro

==a"

• =ow to

==u.

gea 1 - NUCLEAR POWER Pt, ANT FUND,.MENTALS momi 1 RO l

2 -Pt. ANT SYSTEMS

2. EOOWIPPWO

~ CLASSROOM 3 EWSsPPWS 08SERVATION 4 ERJCRW 5 OTHERtseaN, 3-OPER ATING PR ACTICg

' CONTROL ROOM OPERATIONS ON SHIFT SIMULATOR OPERATING (snenwee Ct.ssrooms FOSSIL a+gyamuniY c f9_& PMD tf.

6. OPE R ATO R SIMULATOR NAMES SequoySh Unit 1

$ 7_.W S O* f *T C D

7. SUPE RVISO R l

?UQfif '.

fk Qt Myf gg 8 PLANT STAFF l

i k 'y Q ; h D h N

' u.

h 9 0THER tse.chs No$'. e eYao l lYES f f NO g< w Chr A,-ggra

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yrk.%,

COMMERCIAL NUCLEAR reaeme w a re tr s, n com

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4 -SRO INSTRUCTION -

10. REAC'OR OPERATOR tc es S -f,"y%'[.*[,$"j,7,.**"* * '" * * * ***

Ii. SEN60R OPERATOR (ter. awes

)

4. N*gygMQ'u'f' M *"

12 SHIFT SUPERVISOP tier sos l

6 REQUALIFICATION.

13. STAFFiSHIFT ENGINEER et.re wi j

7 -OThER tse.e.m -

t4. AUX.;EQUtP, OPERATOR INo wennes l

15. PLANT STAFF l

l 16 0THER iso.ews l

NRC Fonu 3M (2 921

U,$. NUCLE AR REGULATOR Y COMMISSION APMsOWD SY OM8: NO.Uso4De N.R.C, FonM 396 etPers.

-n =

10 Ce R 15 23 59 25, 51.27. 56 3t iS SF (F1 MATT 3 8UiW N PTR RESPONst TO comet y w?H Tves edonn4AT10N Coll.fCT10N RFQUETT.

11 MIN.

PopwAAO CERTlFICATION OF MEDICAL EXAMINATION mM'ei =o^=a=="'M^t"m iarc~ aron ANo ACCORDS MANAG(MENT BRANCN (MN88 TF14b, W$

BY FACILITY LICENSEE NUCMo w eAre=NO. ascoM AR NOUuTORy @MMaWON, WANNOTON. DC MSS.

ANo r e rCT ms OFFICE C# MANAGEMENT ANC 9U00(7, e A NNGTON DC phi i

NAME OF APPUCANT STINSON, JOHN E.

l8 ACIUTY OOCKET NUM8ER F ACT U TY SEQUOYAH HEALTH STATION 50-327 & 50-328 A. MEDICAL EXAMINATION CE ATIFICATION THl3 IS TO CERTIFY THAT THE A80VE NAMED APPUCANT FOR AN OPER ATOR! SENIOR OPERATOR UCENSE HAS 8EEN EXAMINED BY A PHYSICIAN.

PRINTED N AME totoo sreisnt l STATE ANO LICENSE NUM8ER l EXAMINATION DATE r

C0FERs ROBERT HARRISON, M.D.

MD-02737 97/03/23 8ASED ON THE RESULTS OF THE EXAMINATION. INCLUDI 4G INFORMATION FURNISHED SY THE APPUCANT. THE PHYSICIAN HAS DETERMINE 0 THAT THE APPUCANT*3 PHYSICAL CONDITION AND GENER AL HEALTH ARE NOT SUCH THAT IT MIGHT CAUSE OPERATIONAL ERRORS ENDANGERING PUSUC HEALTH AND SAF ETY, i CERTIF Y THAT IN RE ACHING THt$ DETERMINATION, THE CulO ANCE CONTAINED IN ANSUANS 3.41983. OR ANSUANS 1$.41977 (N3801 W AS FOLLOWED ANO THAT DOCUMENTATION IS AVAILAOLE FOR REVIEW SY NRC ON THE BASIS OF THE RECOMMENDATION OF THE PHYSICIAN, I RECOMMENO THAT THE APPUCANT*5 OPER ATOR UCENSd BE CONDITIONED AS FO LLOWS;

]' t, NO RESTRICTIONS

2. CORRECTIVE LENSES 8E WORN WHEN PERFORMING UCENSED OUTIES

3. HEARING AlO SE WORN WHEN PERFOf. MING UCENSED DUTIES 4 RESTRICTED UCTNSE OR EXCEPTir N P ovide details below ered attaen su-portmq medical evidence for NRC review.

4 S. RESTRICTION CHANGE F90M P.dV10US SU8MITTALJrorde de's.3s be4ow end attacn succorting medics # evidence for NRC review.

PPOPOSED WORDING OF RESTRICTSN (Sicc# 4 adowel R E LATIONSHIP OF RESTRICTION TO CtSQUAUFYtNG CONDITION (Snefly mitscare how rettncTen mil correct f/is descuels/ rent condgenf t

3 MARK 3 FOR RESTRICTION CHANGE (#4c4 S aoovel B. NONM EDir.L CER IIFICATION THIS CERTIFIES THAT THE APPUCANT HAS 8EEN FOUND TO MEET THE SAFEGUARDS ANO FITNESS FOR DUTY REQUIREMENTS OF TNIS 7 ACILITY FOR UCENSED OPERATORS.

ANY P ALSE ST ATEMENT 04 OMis540N IN tN11 DOCUMENT. ANCLUOtNG A TTACMMENT3. MAY 35 $UsJECT TO CJVIL AND CMIMENAL SANCTIQNi s CtATlFY umotn FEN 4LT v QF FtJiJURv ' AAT THE INFORMATON IN THIS DOCUMENT AND ATTACHMENT 3 is TRUE AND CORRECT.

PR. i ED ME AND SIGNATURE (Saner 4fanegement /teerssentsreve on Ste) TITLE DATE (LD

.s n~

%, y2--

J.

L. Wilson SQN Site Vice President in accorda eth 10 CFR 55.S. Communications. this form seed be supmitteet to the NRC as hilows: SY Mall ADDRESSED TO:

Regenat Adamstrator Region f Regional Aden.stestor. Revon il Regwai Adnunnerstar. Revon ill s guistory Comm1seon U.1 Nucteer Requistory Commesson U.S. Nocteerap,9usatory Commmen U.S. Nuctur e

101 he rietta Strut. Suite 3100 799 Roowvet Road 47f Allenoa8-Reed a

King of Prussia, PA 19406 Attants. GA 30323 Glen Eliyn,IL 60137 Director 0.vmon of tJeernee Performence R)gional Admen strutor. Regon IV Regenas Admmmretor, Regeon V e

and Custery Entuaten U.S. Nucteer Regu. story Commission U.S. Nucteer Regulatory Commmen Artn Cowetor uaensing Brenen 811 Ryan Ptare Onw. Suite 1000 1450 Meia Lane. Suite 210 U S. Nuciar Regusetory Commess on Astingeon, TX 76011 Walnut Crees. CA 94596 Wasamqton. OC 20555 PRIV ACY ACT STATEMENT Pursuant to S U.1C 552stell31, enacted into inw by eecesan 3 of tu Pnvecy Act of ROUTINE USES: The chemenon mov be descrosed to an ecornpriate Federas. State. or 1974 (Pubuc Law 935791 the followeng statement.e ' urn

• shoo to srvsmdus4s wne inczi egency in ene event the enformation entrecotes a vioteren or potent ei violaten of law suonty efometion to tfie U.1 Nucteer Regulatory Commmen on NRC Form 396.

sad in tN event the enformation mdicates a vootation or potentist v+oleren of few end in This informenon s n emtemed m e evitem of reconts dengnered as NRC 18 and. ene coune of an edemamratrwe or gudest proceerting. In adomon, this informet on me, ce seweeee si As 8 w meseveer 23s?e IAw.e 20. tesol trenstweed to en sooroariste Feowed. State. cnet loca6 agency to the enveat feevent ead

[

AUTHOR $TY! Sectens 107 and 1810) of t% Atemec Energy Act of t954 es neceuery %c en NRC decisson accut you.

I emeresed 141 U.S.C. 2137 end 2201(ill.

WHETHER DISCLOSURE 75 MANDATORY OR VOLUNTARY AND EF8ECT ON iNOlvtOUAL OF NOT PROVIDING INFORMATION Onesosure is voluntarv. If tN PRINCIPAL PURPOSE (St: Irdnmanon enreed.on tfus %rm n used to ae,ermme reme5ted *menon is not orceded, nc* wever, the aposication for a facility oterstor a whetner ene onysecas conditen eno peeral health of the ecosscant are suen test spey wat not cause onweriene ereori endangenne puooc meetta ano niety. This m'ome-or wn'or noe'e'o' s 6cenee mov t's 8*n'ed teon mov be used by TM NRC neff to overmme of the md.widue mens tM recurre-SYSTEM MANAGERIS) AND AOORESS. Chief. Operefor L.cermng Branen, Offics of monts of 10 CFR 55 to tenie an seemmeeson or to be mued an occator's ticonse Nuctew Rueror Regulation. U.S. Nucteer Heruterary Commmion. Weengeon DC 2C555.

NnC 7084s 19e Get)

a.

C C 7054 39s u.s NUCLE An macuu Toav Commission

,,moy,o,, og, go pgn,,3 oatt atCEevEa

' h 8' '**''d *

• C1 (2 90 t RFIRE S 13.M - te (sTI SATED SURCEN Pim mEspoN33 TO COMPtv *1TM TM'1 gg 3 eNFORMATiON CCilfCTiCN MEOut3T 2 0 >#$ 50mwam0 CO*4MENTS R E G AMC iNG SURDEN EsTIM A T E TO THE PERSON AL QUALIFICATION STATEMENT-UCENSEE

'~'oa=Aro"

^ao atCcac. MANAct uE NT saANCn MNBS 7714 b. U S NuCLian REGuiaTony COMuiss SON.

WAsMiNGTON DC 20555 AA.O TO TME PargewomK REDUC TiCN P54oJECT iU504 amice. OF 8tCE Of MANAGEMENT ANO TO REMAIN VAUD. THl3 FORM MUST Nr)7 OE AtTERED SuoGET. W A3MmGTON. OC 20$03.

1. APPUCANTS FULL N AME (last, first, Af, curet AND AOORESS (bemoe E!P Coor)

4. TYPE OF APPUCATiON tchece answerees acaese f

l l COLD HOT l

.Aivta aaavisteo x

New a

' * * * * * ~

Tho2as, Norman Roland

e. MENfWAL g, ga g77g g gg,,,,,,yj 7515 Woodland bay Drive u uPGa 8 DE Harrison, TN 37341

, o r,,,,,,,,,,o y 2. ore a A r >NG rC-,

sNCLVOt ADOttlCNAL VNITl

e. R E APPuCATION 3. E LeGitiu ty 4. MEDICAL

~

2. CITIZE N SHIP

3. GtRTM D ATE F NO I

E QATE P. ! 40G%EntC8VNOA.

i g.oTeg X

& UNtTIQ ITATES MONTH QAY VEAR 8'"'"'

L3 t u gyI yy L

MENTAucA,AM,WAftON sECTCN s aTuanis

• s 1 12 012 5l7

"'A" 6s u;oi

5. TYPE CF L CEP'3E APPUED FOR

6. PREVIOUS UCE NSEts) HELD CMMATom m DOCKET NuMSER Ro sAO h UCENSE NuMef R

[^

4 F ACluTV DOCKET NuMBEm g,

i i

i X

6 ssNon orenAToa ss. 21750 i

t i

so.

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v

7. EAME AND ADOR ESS (inchior 21P Cooel OF APPUCANTS CMPLO YER

10. CURRENT POslTIOP' AT F ACIUTY 6 AumeuANY uNat O*ER.

& PUNT suPtMmTENDENT 5"o"c u'i2E Nr

Tennessee Valley Authority

,,33,,,,,,,

NT sunaiiNTooENT e

" * c '*8-

'o o"r'e"" A ro'*n, P*O* Box 2000 smn sunnvisoa Soddy-Daisy. TN 37379

Tar, eNcmasa x, oT e. rsm,+,..

(

Shife

. smn TECxNiCAL Aovisoarsm,T Ncmera j a ACrutv ooCarT NuMsEn

,y7,,uc7c,

a. NeTa,se Arrucf[Tsu$urvear Plant e

50-327 Technical qttoya t

Advisor

9. AooiTioNAL

• ACiuty coCxrTa twwN,.a a t-==s

. ssNica Co"Taot acou o*tmArom 50-328

h. content mocM ortm ATOR

11. EDUCAT10N MSU g*A',gy s man scwoot a uA.aon Amtmst or sTuov i. 7.;, }=0 ar,,e,a,,

COOES DEGREE

4. voCATmNAuTscwNiCAL 1uoNr~s

~n v -

~~a g-sNa.unnneNa arretoss esr oga,au y

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13 TV1 Shift Technical 6

Xl oss eouivAtamCY gNa d Associate Advisor (SQN) l l

~

.C 3 0ACHELOR

__g MUM 6EM OP k

5. M A STER 4

vtAngos OOCTORAL

~n tros

12. TR:.tNING iSINCE LAST APPLICA TION - SEE INSTRUCTIONSI

13. EXPERIENCE (00 NO T DOUBLE COUNT-SEE iNSTRUC?lONS) wo~r-.

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1 - NUCLEAR POWER PLANT FUNOAMENTALS roams 1 RO I

2 JL/.NT SYSTEMS 2. EOOW/PPWO CLASSROOM J, FWS/PPWS OBSERVATION 4 - ERS/C.81W l

s -0THER tscoe &s l

3-OPERATING PRACTICE CONTROL, ROOM OPERATIONS ON SHi"T f,

SIMULATOR OPER ATING /Jaesusa C.asweemd l

poggy, x

6. OPE R ATO R SIMULATOR NAMES t.

Sequoyah Unit 1

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7. SUPE RvisO R I

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3 11 l

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COMMERCIAL NUCLE AR umen,m,-, me evr.,, aunen 4 -Sn0 INSTRUCTION

}

l

10. REACTO R OPERATOR rtments

,9,(u ra A ee aso= un s,..e r = co= r a% aco'"

l 11 SENIOR OPER ATOR fLeewJ l

f J wf f e WmArvur 0+ (

(

di' y

s ReOUAusiCATiON ia STArsisHieT ENGINEER,t.e i

7 -OTHER ts e 4A 14. AUX.iEOUIP. OPE R ATOR INome-es l

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1

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16 - 0THE n ts e,4, i

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NRC FORM 396 U S NUCLEAR HEGULATORY COMNilSSION aPeWD gy Owa. NO. 31%N4 (bes)

C#mES, 5-7 se 10 cf R 95 23. 58 2$.

95 27.55 31,15 57 Etructo gunNN PF.R RESPONSE r0 COMP (T Wmd TWtg N

esostaaAT1ces CT12.EC'ON AEOufST:

iS WM FO6&rAAD CERTIFICATION OF MEDICAL EXAMINATION c=MmT5 amam eva=$=t = '**^mN ado AECJADS s4ANAGEMENT SAANCs. IMNB8 m4L US BY FACILITY LICENSEE NuCuAa aeou,uroav c.=cMMissoN. wAs-rOn oc ass AND10 me Anm.c aEaucm~ aanCT mssom.

CFFiCE CF MANAGEMENr A*C 8VO0ET. *ASHNGTON. OC 30503 NAME OF APPUCANT THOMAS, NORMAN R SEQUOYAH HEALTH STATION, l F ActuTY 00CKET NUM8ER F ACIUTY 50-327 & 50-328 A. MEDICAL EXAMIN ATION CERTIFICATION THl3 IS TO CERTIFY THAT THE A80VE NAME0 APPur' ANT FOR AN OPERATOR / SENIOR OPERATOR UCENSE HAS BEEN EXAMINE 0 SY A P*tYSICIAN.

PRINTED NAME frf anyme,ani l STATE AND UCENSE NUM8ER EXAMINATION DATE Robert H. Cofer, M.D.

MD=02737 Tennessee 4/13/92 8ASED ON THE RESULTS OF THE EXAMINATION. INCLUDING INFORMATION FURNISHED SY T AE APPUCANT. THE PHYSICIAN HAS DETERMINED THAT THE APPUCANT*$ PHYSICAL CON 0tTION AND GENERAL HEt LTH ARE NOT SUCH THAT IT MIGHT CAUSE OPERATIONAL ERRORS ENDANGERING PUBUC HEALTH AND SAFETY. I CERTIFY THAT IN REACHING THIS DETERMINATtON. THE CUl0ANCE CONTAINED IN ANSI /ANS 3 41983, OR AN$1/ANS 15.41977 (N3801 WAS FOLLOWED AND THAI DOCUMENTATION 15 AVAILABLE FOR REVIEW BY NRC ON THE SAS:S OF THE RECOMMENDATION OF THE PHYSICIAN. I RECOMMEND THAT THE APPUCANT'S OPER ATOR UCENSE BE CON 06TIONEC AS FOLLOWS

1. NO RESTRICTIONS

2. CORRECTIVE LENSES SE WORN WHEN PERFORMING UCENSED OUTIES

3. HEARING AfD SE WORN WHEN PERFORMING UCENSED OUTIES

4. RESTRICTED LICENSE OR DCEPTION Provide ostads twow an2 c~fi-ems medical evidence br NRC renew.

5. RE$7RICTICN CHANGE FROM PREVIOUS SU8MITTAL Prowde aetam beeow and attach supportmg nedicas evidence for NPC review.

PROPOSED WOR 0 LNG Ol' RESTRICTION (8/ocs 4 aco**/

RELATtONSHtP CF RESTRICTIO.N TG 0tSQUAUFYtNG CONDITICN (ane//r endscare now resrncren we# comer the draoussefying condirenf REMARKS FOR RESTRtCTION t HANGE (Broct 5 aoovel B. NONM EDtCAL CER Tir4 CATION THIS CERTIFIES THAT THE APPUCANT HAS BEEN FOUNO TO MEET THE SAFEGUAROS AND FITNESS FOR DUTY RECUf REMENTS OF TH13 F ACIUTY FOR UCENSED OPERATORS.

4NY 7.LL3 i STArEMENT OR OM4553ON IN tnt 3 DC 'UMENT. INCLuOaNG ATr AChadENTS. MAY SE sueJECT TO CWIL ANO CRIMINAL SANCTIONS, a GERilFV uMQkA PENALTV OF PER.'URY THAT TM( BNSCRmTiON IN THr3 DOCUMENT ANO ATTACNMENTS as TRUE A40 COMMECT.

kNTED ', O SIGNAT E (Senor Menevement Ancremprartwo on S,re; l TITLE DATE s

b$

4 bb

[L. Wilson SQN Site Vice President m Mzord4 Ee with 10 CF R 55.5. Cammunicatens. this form sned be sucmetted *o the NRC as follows: 8 Y Mall ADDRESSED TO.

0

- Regenal Adrmnestrator. Regen i Regonal Admmistrator. Regen 11 Regional Admmistrator. Reipon ill i

US Nuctest Requistory Commission us. Nuciear Regutatory Commmen

45. Nue: ear Requimary Commiss.on 4/5 Allendale Road 101 Manetta Street Suite 3100 799 Roosentt Road King of Prussaa. P A 19406 Atlanta. GA In2J G;en E!!yn. IL 60137 Regenas Adrmmstrator. Region IV Reg.onae Aonsistrator. Region V Cirector, Omsson of Lacer see Performarc.

and Quauty Eva4uanon U.S. Nuceer Regutatory Commiseen U S Nuciear Regulatory Cammission Artn:Ooerator L,ceawg Seanen 61I Ryan Plaza Onw. Suite 1000 1e50 Meria Lane. Suite 210 V S. Neear Requtatory Caramisvon Artmgton TX 76011 Walnut Creet, CA 94596 Wasemqton. OC 20555 PRIV A CY ACT STATEMENT Pursuant to 5 U.S.C. 552ateH3L ~ wted erna aw by sectice 3 of the Prmcy Act of ROUTINE USES: The mformation may be discosed to an soproonate Federat. State. or 1974 (Puche Law 83 579). the fonowing statement is Nrnrsned to mdmduas wne local agency in the ownt the mformation mdscam a violation or potential vesaten of law suopy mformation to the U S Nuclear Requistory Commessen on NRC Form 396, and in tne ownt tne eformation moscates a viosanon or potentiad weisten of law and m l

TNs informaten is maintemed m a system of records desrgnated as NRC 16 and the course of an adnumstratrve or audicat proceedmg. In ado ton, this.n%rmaton may be teseees et 16 Fewee Reeneer 13978 IAveser 20.199tR transfe* red to art.orpocriate Federal State. and bcat aguncy to tr't estent mwvant and AUTHORITY-Sections 107 ed 16Hil of the Atom 4 Energy Act of 1954. as necessary for an NRC oecision about yr A amorced (42 U S.C. 2137 and 2201til).

WHETHER OISCLOSURE IS MANDATORY OR VOLUNTARY AND EF#ECT ON IN0lvl0UAL OF NOT PROVlotNG INFORMATION Disclosure is voiuntary. If tm PRINC1 PAL PURPOSElS1: Information emered on tru form is used to determme requested dormeon is not prowded. however, the aophcaten for a fachty operator's weietner the pnysscal conditen and generai haseth of tne appucant are such inat they

=di not cause operatense ertori encangenne puoiic heneth and safety. This miorma-or sener oper8(cs heense may be dea'ed-ten may be used by the NRC staff to oetermme if the md'v+aimeets the requere-SYSTEM MANAGER (S) AND A00RESS: Chiet. Doerator Licenwg Brinch Offke of ments of 10 CF R 55 to tame an saammaten or to be issu+ an coerator's license.

Nuc! ear Reactor Regutaten, Ul Nuctear Re9uistory Cornmiss on, Waeington. CC 20555.

w.

NMC FONM 394 Mt]

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. Anaovf D sy ous No 31soacso DAf a ascanvao (I-TI) '

E ap4M(3.12 33 34 I8 M CeaWefeJ 4F NICl to CFR St.31.58 JS.

EstruAf t0 eLROEN Pfm mESPCkst 70 c0MPLv wsfw THis 66 47, eae Sg gy msomuaTioN CCLLECT$N Rfou(57: 2 0 MRS FO*WARO CoMMEhfS PE GARose+G SUROIN E.17tM A f f r0 THE

- FESONAL QUALIFICATION STATEMENT-LICENSEE

• • oaw A r eN Ana a Coaos wANActue=r ea ANC-IMN83 77tes, u$ NUCLE AR RFGULATORY COMWSSiON.

wa$w'NGTON. OC 20516. AND To ThG #APERwomK mgone f10N PROJECf 13tS0 004L OF8'CE OF MANAG&WINT ANQ

- TO REMAIN VALID. TMS FORM MUST NOT BE ALTERED suoG tT.w A&MwGTON. DC 20503.

t APPLICANT'S FULL N AME /Last, first, Medcr!al AND ADORESS (irve/ugel/P Carfel

4. TYPE OP APPLICATION #Cnece asen.se soms lX l war l lcoLo l

' * ^ " ' ' " " ' * " "

• X

a. ara Tinsley,-Anthony Lebron

,,n AL

"'";';'k"CL 4608 Ricky Drive

,,c,Ao.

Chattanooga, TN 37411-1225

, outt,uN,T,,,,No ro 2 * <aArao =

mcLvot AOosnoNaL VNors 3 8uGeesurv e_ REAPPuCATCN 4, MEDICAL

~

2. CITIZE NSHfP

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3. 81RTH DATE

-3 No S.ofwem

& UNITED $TAfts

'WONTM CAT V ".AR l

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.uc S. TYPE OF LICENSE APPL'ED FOR

5. PREVIOUS LIFENSEts) HELD E

. oPfm ATon

8. DOCKET NUM4EM Ro SMO it UCENE$88UM6tR

's

• ACluTV DOCK.ET NuweER k $5Nfon 0PERAT04 0

3 I

ss. 21751 8-I 8

so.

a UMITtw smo re a. pues eveasers s

7. NAME AND ADORESS (inclucre IJP Coo *J OF APPLICANT'S EMPLflYER

10. CURRENT PoslTION AT FACILITY

$U#a"A2[<Es

' ^ ^ " * ' " * " " * ' "

-Tennessee Valley Authority-

' ' ' " * ' ' " " ' ^ " * ' " * " " ' " '

eat!N5"'Es'=s.

Peo box 2000

" ~ ~ '

Soddy-Daisy, TN 37379 asTAn Ncmua

} of sa,sm,rr.

a. NAus o AM uCANT*1 F AciuTv F ACIUTV DOCKET NUM9EM g $H5FT.TgCHNsCAL AQv1JCmigMeFT (NQWESM

~

SeauOvah Nuclear PlanC 50-327 e, msTnuCTea

9. AcomoNAL F AciuTv occxETs <As-baa==s s sawsom coNrnoL moou oes=ArCn

_50.-328 CoNTaot.oo on. Aro.

11. EDUCATION a mow sCwoot -

s uAaon AsaAm or sTuor

.~. ;"., { =';

DEGREE COOES

& VOCATIONAUTECHNICAL j

Y[g"E sWO

1. '#,J#oicR,,

ee,,,,,,

~ n ce ~ ~ ~.~o uoNras X

oaAouATs

=umummo <r,4(asi j-u Mechanical Engr Tech 2

f_ 2 cio sousvALsNCy o,. Nome 18 X

TVA Nuclear CoeraCor

. CsaTmCAn l

2. AssociAn Training Progra:n NO 3.sacHELom 5. MASTER e

a Nvuean op i

OoCTQRAL Y'4Ams op

-9 l

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d-I

13. ThlNING (SINCE LATT APPL.tCA TION - SEE thSTRUCTIONS) 115XPERlENCE (00 NOTDCUBLE COUNY-SE!INSTRUC* ONS)

. e r

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."a*

NAVY

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'o gg, 1-NUCLEAR POWER PLANT FUNDAMENTALS mami 1 RO l

'1 i

2 Pt. ANT SYSTEMS 2. ECOw/P8WO l

3 E'*SiPPWS l

. CLASSROOM -

ORSERVATION

4. ERS/CRW j

5 OTHERts,.eAs 3-OPERATING PRACTICE..

. CONTROL ROOM QPERATIONS ON SHIFT SIMULATOR OPERATING tsarnsJee Cw possit 6 OPERATOR L gh"WS.iggt(g.flMi'2 SIMULATOR NAMES D

L Sequoyah Unit 1-7 susERvisOR I

N h

b.

S.Pt ANT STAFF l

[mQN EQTHER Isenews

$ ((m$'w [e'$I[eYvo _'

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- -:16-l 4 -SRO INSTRUCTION

'I l

10 REACTOR OPERATOR it.ce==vs 5 -l,y,fe'[/M,'J'?"'" '" """ *"

I~

11 - bdNION OPE RATOR tLeennes l

i

4. Ug N E $ ddf * * ***

12 - SHIFT SUPCRVtSOR ILA ewes l

6 REQUALIFICATION 13 STAFF /5HtFT ENGINEER ILas=was l

l 7 -0THER isesees

14. AUX.iEQUIP. OPERATOR avrime ss l

15. PLANT STAFF 16 OTHER rseec*s j

(

NaCFo==aseca.eu

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m F

NRC Fonu 396 U 3. NUCLE AR REGULATORY COMM133 CN APP 840VED BY OMe; NO. 3%I24 pen EsPu%5-i.abes to Cf R 503,45 25, SE 27.$6 3t.15 M ESTsaartrO suroDs eEst stESPONSE TO COMPLY arm + nits esFosmaaticne COLLIC'IO*e 8tECLAST 19 wet sonwano CERTIFICATION OF MEDICAL EXAMINATION cc=e'ccaos M-atwur 'naANcHimaao'~o ma 5*^rs 'm.'a'm.

a oa ama wo ae Ao.a BY FACILITY LICENSEE Nucana aeoutArw c =sm,m **=rce( oc ams.

aNo To rHe nPErwePn arouC e= eaoact missao.

omer or uu.eotur.ur me suoort. As ncx oc aom NAME OF APPUCANT TINSLEYs ANTHONY L.

lF ACIUTY DOCKET NUMBER TAClWTY SEOUOYAH HEALTH STATION 50-327 6 50-328 A. MEDICAL EXAMIN ATION CERTIFICATION THIS 13 TO CERTIFY THAT THE A80VE NAMED APPUCANT FOR AN OPERATOR / SENIOR OFE R ATOR UCENSE HAS GEEN EXAMINED 8Y A PHYSICIAN.

ISTATE AND UCENSE NUMBER I E X AMIN ATION D ATE PRINTED NAME sorsnys,ceans 92/03/30 DUFFY, MARY A. L J.

c.m -. se i

'T'fu. m 2q e-cwo@e 8ASED ON THE RESULTS OF THE EXAMINATON. If4CLUDING INFORaAATiON FURNISHED BY THE APPUCANT. THE PHYSK.;!AN HAS DETERMINED THAT THE APPUCANT*S PHYSICAL CONDITON AND GENERAL HEALTH ARE NOT SUCN THAT IT MIGHT CAUSE OPERATIONAL ERRORS ENDANGERING PUBUC HE ALTH AND SAFETY. t CERTIFY THAT IN REACHING THIS DETERMINATION. THE GUfDANCE CONTAINED IN ANSI /ANS 3A1983 OR ANSUANS 15.41977 (N3801 WAS FOLLOWED AND THAT DOCUMENTAh0N is AV AILABLE FOR REVIEW BY NRC.

ON 1HE BASl3 OF THE RECOMMENDATION OF THE PHYSICIAN. I RECOMMEND THAT THE APPUCANT*S OPERATOR UCENSE BE CONDtTIONED AS FOLLOWS:

/

1. NO reb 7RICTIONS

2. CORRECTI.E LENSES BE WORN WHEN PERFORMfNG UCENSED OUTIES

3. HEARING AfD 8E WORN wHEN PERFORMING UCENSED DUTIES

4. RESTRICTED LICENSE OR EXCEP'lON Provice detadt be4aw and attach supporting n'seca# evidence br NRC review.

1, RE3TMCT'ON CHANGE FROM P8lEvCUS SUBMITTAL Aovide dotads beiow ed attach succortmo medicas evioence for NRC review.

PRDrOSE3 WORDING OF RESTRICTION IBloct t abowel s

RELATONSHIP OF RESTRICTICN TO OtSQUAur:YING CONotTION (8nenr md care how resrecten

,# corrwT the d,aouentwrig co,mrsorU REMARKS FOR RESTRICTION CHANGE ta/ocs 5 ace.el B. NONMEDICAL CERTIFICATION THIS CERTIFIES THAT THE APPUCANT HAS 8EEN FOUND TO MEET THE SAFEGUARDS ANO FITNESS FOR DUTY REQUIREMENTS OF THiS FAC:UTY FOR UCENSEO 9 SRATORS, ANY F AL3d lT ATEMENT OR OMI55PON iN T4*iS DOCWEN r. sasu.uou C A fwie 4TE

+

F1MNRY TLAf THE INPuRMATICM IN This 00CUMENT. AhO ATTACMasL7 e 4 (RL E

• a.MAY SE sueJECT TO i

GCORRECT.

PRINTto NAuE ANo S GNATURE ISemor Maugemwir Aeomsmermr on S,res, TITLE DATE klpv J D '.s n 6

Jj L. Wilson W Site ViCe President i

in acccercanc.srwith 10 CF R 55.5. Communicatens, ttus form sfiel be r mitted o tne NRC as feelows: SY VAll ADORESSEO TO:

j Reo anas Aammistrator Region 3 Regionai Adm nostrator. e gion il Regonal Admmestrator. Reepon ill re U S Nuclose RequLstory Coremission U.S. N.sc3eer Requistory Commmeon U.S Nucient Regulatory C3mmewon 475 AJtenosie Road 101 Marietta Sceet. Smte 3100 799 Rooseve!t Road King of Pru ta a. P A f 9406 Ariants. GA.X1323 G;en Eityn. IL 60137 9egional Admanestrator. Regen IV Regenas Adammstrator. Repon V T4reer.or. Divnaon of tacensee Performance U.S. Nuctor Regulatory Commmen U.S. Nucioar Regutatory Commission and Quasny Evatuanor Attn: Operator Licens ng Branen 811 Ryan Pls.a Onve. Suite 1000 1450 uvia Lane. Lee 210 U.S. Nuctear Requiatory Commiusan Athrgton. TX 76rt11 Wamut Creev, CA 94596 Wesnmgron DC 20555 PRfVACY ACT STATEMENT Punuent to 5 U.S.C. 552auM31. enacted invo ia ey section J of the Pr.vacy Act of ROUTINE USES: 'he information may be disciosed to an approonste Fedwas. S6 ate, or 1974 (Puotic Law 93 6791. the 'oilowmg stseement is Nmisned to moividuais wna locae agency m tne erent the information moscates a violation o. potential vio.aren o' law

, wacay in%rmation to tne U.S. Nuclear AmPdatory Commessen on NRC Form 396.

an.d c tne event the informanon mdcates a victaten or potential vto84 ten of law F4 m This mforman is vamtamed n a svitem of 'ecords designated as NRC 16 and tea course of an adtrunntranve or judscial proceedsng. In additton, tms ne*crmsten may 1:e owne>=s se ss *=seese me see,11s re ( Aw.e 20 te90L transferred to an approonate Feowal. State. and locat agency to the utent revevant and AUTHOktTW Sect >ons t07 and 16101 of tm, Atomic Enugy Act of 1954, as necessary Mr en NRC decmon acout you.

amended f42 V S.C 2137 and 22011at WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON PRINCIPAL PURPOSEiSP Informaten entered on tms 8erm 's used to dewmme INDIV10UAL OF NOT PROV10iNG INFORMATON Disclosure is.oduntary. If the eneiner ins prwucal cono,ren and generse netn of itse anoticant are sucn that teey mysested inmnnanon is net provided, iioweve, the soph anon for a faciistv operator's will not Cause nVitr2tional effors endarH;ent*g pubjec heef tn arid safety. This mforma.

or satfwor operator's asCeme may he demed.

ten may tie used av tee NRC staff ta detwfmne if the marvaduat meets tfie require-SYSTEM MANAGERS AND A00RESS: Ch.ef. Operator Licenseg Branen. Of+ ice of l

ments of 10 CF R 55 to tue an amarnmaren or to oe muod an orwrator's ficense.

Nuclear Ructor Regulaten, U.S. NucieF begu'atory Commmeon, Wasnington. GC 20555 l

l MRC FOnM 398 4 45)

LCpoRM398 ul Nuctc AR ReoutATORY CouMissiom APPROVE 0 ev oms No 3150 0090 DATE REctivf D t^*'"55 u-22 "

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F ACrUry p AcuTv OOctEr NUweE A Seemvah Nucien Pimp 50-327 & 50-328 A. MEDICAL E XWINATION CERTIFICATION THt1($ TO CERTIFY THAT THE ASOvf NAMEO APPUCANT FOft AN

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UcJ, rub in o n 22. 3 T l-10-91 BASEO ON THE RESutTS OP !wt EXAMINA TION, JNCLUDING INFORMAFON FURNf5HEO SY THE AP'UCANT. THE Ptev3 SCAN WA3 OETERMINEO THAT THE APPUCANT'S PHYSICAL (DNOITIOef AND GENER A( HE ALTH ARE NOT $UQ4 THAY JT MIGHT CAUSE OPE R ATION AL E RROR$ ENee NGERING PUSUC HEALTH ANO SAF ETY. I CERTIFY THA T IN RE ACHING THis OETERMINATION. THE GUsOANCE CONTAINEO IN ANSI /AN11 A-ISR3. OR AN31/ANS 19.4.177 * !N340) w AS FOLLOwED ANO TNAT COCUMENTATION IS AVArtA8LE FOR REvtEw tv eenc ON THE 9Ast$ OF THE OOuMENDAflON OF THE PHYSICIAN. I RECOMMENO THAT THE AP'UCANT'S OPER ATOR UCENSE BE CONDITtONEC AS FOt,LCwS:

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8. NONMECICAL CER14 S.CA T ION PCrwf R 4* CORS:

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THIS CERl1FIE$ THAT THE APPUCANT HAS SE EN FOUNf' TO MEET THE 1AFEGUA ROS' REQUIREMENTS OF THr$ F ACluTY FOR UCENSEO ONRATORS ANO f M AVE NO iCNOWLEDGE OF TNE APPUCANT EXCSEDING THE CUTOFF LEVELS FOR ALCOHOL OR ;nNTROLLEO SuesTANCES AS ESTASUSHf 0 PJRTUANT TO 10 C79 29.

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/ft Assmeareerner, Regean i Papened Aetnew=serecer, Regen 17 Ampew=e6 Athemningemy, Repna Ill Muesene Reouiseer, Canna==ca u s. Nurseer Reestovery Con mmen U 1 'eier$es, Re s swe<v Cs,nm e.

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