ML20132F292

Request for OMB Review & Supporting Statements Re Collection of Info for NRC Form 398, Personal Qualifications Statement - Licensee. Estimated Respondent Burden Is 5,300 H

ML20132F292
Person / Time
Issue date:	07/10/1985
From:	Norry P NRC OFFICE OF ADMINISTRATION (ADM)
To:
Shared Package
ML20132F280	List: ML20132F277 ML20132F292
References
OMB-3150-0090, OMB-3150-90, NUDOCS 8507180378
Download: ML20132F292 (10)

Text

. .,

"" s 3 S'"""

(Rev Septemter 1983)

Request for OMB Review Important R,ad instructions before completing form. Do not use the same SF 83 Send three copies of this form, the material to be reviewed, and for t) request both an Executive Order 12291 review and approval under paperwork-three copies of the supporting statement, to:

the P perwork Reduction Act.

Answer a!! questions in Part 1. If this request is for review under E.O. Office of information and Regulatory Affairs 12291, complete Part 11 and sign the regulatory certification. If this Office of Management and Budget request is for approval under the Paperwork Reduction Act and 5 CFR Attention: Docket Library, Room 3201 1320, skip Part it, complete Part lit and sign the paperwork certification. Washington, DC 20503 PART l.-Complete This Part for All Requests.

1. Department / agency and Bureau /of f ece ongmating request 2. Agency code U.S. Nuclear Regulatory Commission Office of Nuclear Reactor Regulation Division of Human Factors Safety 3 1 5 0

,3. Name of person who can best answer questions regarding this request Telephone number Janet Lanning (301 )492-4577

4. Title of intormation collection or rulemaking NRC Form 398, " Personal Qualifications Statement ~ Licensee" _

$ Legat authonty for information collection or tule (cate United States Code. Publoc law. or Executwe Order) use .or The Atomic Energy Act of 1954, as amended _

6. Affected public (check allthat apply) 5 0 rederaiagenciesorempioyees 1 O individuaisorhousenoids 3 0 rarms s O Non-profitinstitutions 2 O stateoriocaigovernments 4 0 Businesses orother for. profit 7 0 smaiibusinessesororganizations PART ll.-Complete This Part Only if the Request is for OMB Review Under Executive Order 12291

7. Regulation identifier Number (RiN)

_ . _ _ _ _, or, None assigned O S. Type of submission (check one on eactr category) Type of review requested Classification Stage of development 1 O standard 1 O uajor i O eroposedordraft 2 O Pending 2 O Nonmajor ,

2 O rinaiorintenmfinai.withonorproposai 3 O Emergency 3 0 rinai or intenm finai. witnout enor proposai 4 0 statutoryoriudiciaidesdiine

9. CFa section affected CrR

10. Does this regulation contain reporting or recordkeeping requirements that require oMB approval under the Paperwork Reduction Act and 5 CrR 1320? * . O yes O No

11. If a maior rule. is there a regulatory impact analysis attached? .

1 O yes 2 O No It"No." did OMB waive the analysis? - 3 0 ves 4 0 no C:rtification for Regulatory submisslores in submitting this request for OMB review, the authorized reguiatory contact and the program of ficial certify that the requirements of E.O.12291 and any applicable policy directives have been cornplied with.

signature of program official Date 8507180378 850711 PDR ORG EUSDMB Signature of authonzed regulatory contact PDR-Date

12. (OMB use only)

Precous ed tnons obsosete NSP4 ?$40 00 6 M 4034 83 108 p$1((

MI6.'-Complit3This P rt Cnly if th2 Request is f r Apprivfl d t2 Coll 1cti:n of informitiin U;d:r th? Pcperwxrk RIductirn Act end 5 CFR 1320.

13. Abstract-Desenbe needs. uses and af fected public in 50 words or less NRC Form 398 is used to collect information from licensees / applicants seeking to obtain a n:w, reapplication or renewal license to operate a power plant.

14. Type of information collection (check only one)

Information collections not contained in rules 10 Regularsubmission 2 O Emergency submission (certsf cationattached)

I.; formation collections contained in rules 6 Final or intenm final without pnor NPRM 7. Enter date of expected or actual Federal 3 @ Existing regulation (no change proposed)

A O Regular submission Register pubhcation at this stage of rufemaking 4 O Notice of proposed ruiemakin <NPRM)

B O Emergency submission (cert,ricar,on attached) (month. der. rear >:

5 0 rinai. NPRu was previousiv pukhshed

15. Type of review requested (check only one) 4 0 Reinstatement of a previously approved collection for which approval 10 New coiiection has expired 2 @ Revision of a currently approved coffection 3 O Extension of the expiration date of a currentiv approved coiiection 5 O Existing collection in use without an oMB controt number without any change in the substance or in the method of collection

22. Purpose of information colIection (cneck as many as apply)

16. Agency report form number (s)(include standard / optional form number (s))

1 O Appiication for benefits NRC Form 398 2 O Program vaiustion 17 Annuai reporting or disclosure burden 3 0 ceneraipurposestatistics 0 4 Q Reguiatoryorcompiiance 1 Numberof respondents . .

1 5 O Prog am planningormanagement 2 Number of responses per respondent 3 Total annual responses (hne 2 times line 2) 2800 s O Research 4 Hours per response . Varies 7 O Audit S Totaf hours {hne 3 times hne 41 5300

23. Frequency of recordkeepmg or reporting (Check all that apply)

18. Annualrecordkeeping burden 1 Nur iber of recordkeepers 0 1 O Recordkeeping O neportina 2 Annual hours per recordkeeper. .. .

3 Totai recordkeeping hours (hne J times line 2) 0 2 G onoccasion 4 Recordkeepmg retention penod years 3 0 weekiy

19. Totalannual burden 4 O Montniy 1 Requested (hne 17-5 plus hne 28-3) .

5300 5 0 quarteriy 2 in current OMa inventory 1800 s O semrannuaiiy

+3500 7 O Annually 3 Difference (hne Iless hne 2)

Esplanation of difference 8 & Biennially 4 Program change + 100 9 0 other(desenbe):

5 Adiustment . +3400

24. Respondents

• obligation to comply (check the strongest obhgation that apphes)

20. Current (most recent) oMB control number or comment number 3150-0090 i g voiont,,,

21. Requested expiration date 2 O Required to obtam or retain a benefit 8-31-88 3 O Mandatory

25. Ar] the respondents pnmanly educational agencies or institutions or is the primary purpose of the collection related to Federal

26. Does the agency use samphng to select respondents or does the agency recommend or presenbe the use of samphng or statistical analysis. O ves @ No by respondents? .

27. Regulatory authority for the mformation collection 10 cFR 55 E 55.10, 55.12, ;o,55.33 rR  : or.other (specify>-

' aperwork P Certification in submitting this request for oMB approvat. the agency head, the senior official or an authonfed representative. Certifies that the requirements o Prrracy Act, statistical standards or directives. and any other apphcable information pohcy directives have been cornphed with Date signature of prcgram of ficial Date s.gnature st agency head, tne sen.or ott.cui or an autwrized representative 4Oa_ '

Patricia G. Norry, Director, Office of A inistration M IM/85

/

t SUPPORTING STATEMENT FOR NRC FORM 398, " PERSONAL QUALIFICATIONS STATEMENT - LICENSEE,"

10 CFR PART 55, 955.10, 55.12, and 55.33

1. JUSTIFICATION

a. Need for the Information Collection NRC Regulations 10 CFR Part 55, 555.10, 55.12, and 55.33, specifies

! the use of NRC Form 398 to collect information from licensee / applicants seeking to obtain. licenses to operate nuclear power plants. A proposed rule was published in the Federal Register (49 FR 46428) on November 26, 1984, that will change the sections to 10 CFR 55, 955.31, 55.35, and 55.56. The licensee / applicant is the only source for this information. Once received, the NRC Form 398 will be reviewed against the licensing criteria to ensure that a candidate meets all the requirements for taking the written examination or operating test; reapplying because of failure to pass the written examination or operating test, or both; or renewing a previous license.

b. Practical Utility 1

Minor modifications are proposed to the NRC Form 398 to provide clarification for the applicant. The Institute of Nuclear Power Operations (INPO) accreditation has been added to assist the agency reviewer in determining the applicant's eligibility to apply or reapply for or renew an operator's license. A waiver section for NRC's completion has been added to record waivers that have been granted to an applicant when the applicant has passed either the written or the operating test. .These proposed modifications will i

have no significant impact on the estimated burden to the

licensee / applicant or the NRC-reviewer.

The information provided on the NRC Form 398 is extracted by the Regional Offices and keyed into the Operator Licensing Tracking System (0LTS) data bank for tracking operator licenses and can be I

used for generating statistical data and reports on licensing actions.

It takes approximately three months from submittal of an NRC Form 398 to the issuance of a license or denial letter. Renewals take from one to two months, because candidates are not required to take i

an examination, rather they're only required to submit updates

! to the NRC 398.

i-

c. Duplication with other Collections of Information This information does not duplicate nor overlap other information collections required by the NRC.

d. Consultations Outside the NRC There have been no consultations with other Federal, State or local government agencies since the last OMB submittal. However, several utilities have been contacted to provide the NRC with a better estimate of form completion time for new applications, reapplications, and renewal applications.

2. Description of the Information Collection

a. Number and Type of Respondents All new, renewals and reapplications for an operator's license must be submitted on NRC Form 398. There are approximately 1300 new and 1300 renewal licenses issued annually and approximately 200 reapplications annually, and the previous renewal estimate was 500 fewer than our current estimate and is being adjusted upward based on data available from the Operator Licensing Tracking System. An operator's license currently expires two years after issuance whereby an applicant must file for renewal. The proposed amendment to Part 55 would extend this renewal period to five years thereby reducing the number of renewal applications to approximately 520 annually,

b. Reasonableness of the Schedule for Collecting Information Information has to be collected and reviewed as necessary to determine if the individual meets the requirements 1) to be given a written examination or operating test, or both, to obtain a new operator's license; 2) to reapply for a license, or 3) to renew an existing license.

c. Method of Collecting the Information The NRC Form 398 has been designed to standardize the essential information needed to apply or reapply for or to renew an operator's license. This form represents the best method of data collection at this time. The information received is placed in a data base for easy access and retrieval by NRC headquarters and regional offices.

d. Record Retention Period Records are not required to be retained by the licensees / applicants.

e. Reporting Period NRC Form 398, applications for new licenses, are to be submitted in total one time only and there is no prespecified reporting period.

l l

l l

I First reapplications are to be filed at least two months after the date of the denial letter. Second reapplications are to be filed six months after the date of the second deni'al letter. Third reapplications are to be filed two years after the date of the third

' denial lctter and the applicant may file successive reapplications two years after the date of each prior application.

Renewal applications are to be submitted no fewer than thirty days prior to the expiration of the existing license. Currently this is every two years, but under the proposed amendment to Part 55, it will be every five years.

f. Copies Required to be Submitted NRC Form 398 is required to be submitted in triplicate to the appropritte Regional Office.

3. Estimate of Burden

a. Estimated Hours Required to Respond to the Collection The estimated burden to complete the NRC Form 393 is 3 hours3.472222e-5 days <br />8.333333e-4 hours <br />4.960317e-6 weeks <br />1.1415e-6 months <br /> per initial application, .50 hours5.787037e-4 days <br />0.0139 hours <br />8.267196e-5 weeks <br />1.9025e-5 months <br /> per reapplication, and I hour per renewal application.

3 hours3.472222e-5 days <br />8.333333e-4 hours <br />4.960317e-6 weeks <br />1.1415e-6 months <br /> X 1300 New Applications = 3,900 Hours

.50 Hour X 200 Reapplications = 100 Hours 1 Hour X 1300 Renewal Applications = 1,300 Hours (Proposed rule would reduce number of renewals and burden hours to approximately 520 for a total of 4,520 burden hoursannually.)

l Total Annual Burden Hours = 5,300 l

The previous submittal to OMB stated that there were 1300 new and i 500 renewal applications requiring 1 hour1.157407e-5 days <br />2.777778e-4 hours <br />1.653439e-6 weeks <br />3.805e-7 months <br /> for completion of NRC Form 398, and proposed a new category "reapplications" to begin upon receipt of OMB approval. The data and the number of reapplications has averaged 200 annually.

The estimated burden hours for new applications and reapplications have been recomputed based on the respondent's actual time to complete the NRC Form 398. New applications take longer to complete because all information must be listed. After the initial application, the reapplications and renewals just update specific relevant items.

4

b. Estimated Cost Required to Respond to the Collection New applications, 3900 hours0.0451 days <br />1.083 hours <br />0.00645 weeks <br />0.00148 months <br /> annually X $60/ hour = $234,000 annually ,

Reapplications, 100 hours0.00116 days <br />0.0278 hours <br />1.653439e-4 weeks <br />3.805e-5 months <br /> annually X $60/ hour = $6000 annually Renewal applications, 1300 hours0.015 days <br />0.361 hours <br />0.00215 weeks <br />4.9465e-4 months <br /> annually X $60/ hour = $78,000 (Proposed rule, 520 renewal applications annually X $60/ hour =

$31,200 for a total annual cost of $271,200.)

Total Annual Cost = $318,000 The estimated cost required to respond to the collection has increased from that previously reported to DMB. The cost changes are based on the increase of time required to complete the entire NRC Form 398 for a new application, the addition of reapplications, and the increased number of renewals,

c. Source of Burden Data and Method for Estimating Burden The burden data are ascertained through contact with several utilities. The burden increase is due to the fact that when original contact was made with the utilities concerning the time it took the applicant to complete the NRC Form 398, the form was not actually being used and it was an estimate on the part of the utilities as to the time involved. Now that the NRC Form 398 has been used for the past three years, the experience of the utilities has been reflected on the burden estimate.

The number of NRC Form 398's received annually for new, reapplications and renewals is based on the data now available from the Operator Licensing Tracking System.

4. Estimate of the Cost to the Federal Government The estimated burden required to process the NRC Form 398 is .75 hours8.680556e-4 days <br />0.0208 hours <br />1.240079e-4 weeks <br />2.85375e-5 months <br /> per new application and .50 hours5.787037e-4 days <br />0.0139 hours <br />8.267196e-5 weeks <br />1.9025e-5 months <br /> for each reapplication and renewal.

The NRC Form 398 processing includes data input, files maintenance and forms review regarding the eligibility criteria. Data input takes longer for new applications because all data must be entered initially, whereas for reapplications and renewals, the data base need only be updated.

1,300 new applications X .75 hours8.680556e-4 days <br />0.0208 hours <br />1.240079e-4 weeks <br />2.85375e-5 months <br /> X $60/ hour = $58,500 annually 1,500 reapplications and renewals X .50 hours5.787037e-4 days <br />0.0139 hours <br />8.267196e-5 weeks <br />1.9025e-5 months <br /> X $60/ hour = $45,000 Annually (Proposed rule would reduce the annual number of reapplications and renewals to 980 for a total cost of $29,400; 980 X .50 X $60.)

i Cost for Operator Licensing Tracking System = $80,000 Annually Total annual cost to the Federal Government is $183,500 (Proposed rule would reduce the Federal Government's total annual

. cost to $167,900.)

Enclosures:

1. NRC Form 398, revised

2. Current NRC 10 CFR Part 55

3. Proposed NRC 10 CFR Part 55 ,

M 9

b e

I i

, -< . _ _ - - - . . _ _ . . _ , , . . . . , _ , . _ _ -.-, . ~ ~ , _ _ _ _ _ _ _ _ , , , , y..._-__,_.,..,__. __-..,, . ,,,, _._ , - _~ - _ m.-.

INSTRUCTIONS FOR COMPLETION OF NRC FORM 398. FIR 50NAL QUALIFICATIONS STATIMENT - LICENSEE NEW, REN[WAL, UPGRADED. MULTI-UNIT. AND REAPPLICATION APPt! CANTS. COMPLET[ [ ACH CATEGORY OF THE FORM COMPLETELY. FOLLOWING THE INSTRUCTIONS BELOW. THIS 15 TO INCLUDE ALL EDUCATION. TRAINING AND EXFiRIENCE THAT YOU HAVE RECT!VED UP TO THE DATE Or THIS APPt ICAT ION.

e SPECIFIC INSTRUCTIONS FOR ITIMS !! - 17:

11 - EDUCATION: INDICATI BOTH ACADEMIC AND VOCATIONAL / TECHNICAL POST HIGH SCHOOL EDUCATION. FOR MAJOR AREA (5) 0F STUDY.

THE NUMBER OF YEAR $ SPENT IN [ACH COLLEGE CURRICULUM AND THE HIGHEST DIGREE RECE!VED. USING THE DIGREE CODE PROVIDED. FOR YO TECHNICAL EDUCATION, INCLUDE PROGRAMS $UCH AS NUCLEAR POWER SCHOOL, MILITARY TRAINING. AIR CONDITIONING /REIRIGERATION. DIE 5[L MECHANIC SCHOOL. ETC. INDICATE THE N'.NBER OF MON 1HS IN EACH PROGRAM AND WHETHER A CERTIFICATE OR DEGREE WAS AWARDED. IF ADDIT NEEDED. CONTINUE UNDER ITEM 15.

THE BR[AKDOWN 12 - TRAINING: IN THIS ITEM INDICAT2 THE TRAINING YOU HAVE RECEIVtD TO MEET THE RtQUIREMENTS OF ANSI N18.1/ANS 3.1.

OF TRAINING IN THl5 CATEGORY PARAILELS THE ANS STANDARD 5: PLEASE REFER TO THE STANDARDS IF YOU NEED FURTyrR CLARIFICATION. INCLUDE BOTH BEGINNING AND COMPLETION DATES AND THE TOTAL NUMBER OF WEEKS $ PENT IN EACH TYPE OF TRAINING. NUMBER OF WEEKS 15 PROVID ADDITION TO BEGINNING AND COMPLETION DAT[5, TO ACCOUNT FOR INTIRMITTENT TRAINING (FOR EXAMPLE. FOUR WEEKS OF CLASSROOM TRAINING SPREAD OVER A TWO MONTH PIR100). THEREFORE. THE DATE COLUMNS MAY INDICATE A LARGER TIME SPAN THAN THE ACTUAL NUMBER OF WEEKS TIMI TRAINING. TIME IN TRAINING FOR THE LICENS[ APPLIED FOR CANNOT BE DOUBLE COUNTED UNDER EXPERIENCE. ITEN 13.

ALL REQUALIFICATION TRAINING TIME 15 TO BE ACCOUNTED FOR IN THE REQUALIFICATION ITEM. PLEASE AVOID "000Ett LIST]NG" RECORDING AL TIME SPENT IN R[ QUALIFICATION TRAINING UNDER ITEM 12.6. REQUALIFICATION EVEN THOUGH IT MAY INCLUDE (LA55R00M OR $!MULATOR INDICATE IF OPERATOR TRAINING PROGRAM 15 INPO ACCREDITED.

FOR RENEWAL AND REAPPLICATION APPLICANTS: ALSO INDICATE JUST THE TRAINING YOU HAVE RECE'lVED $1NCE YOUR LAST APPLICATION IN C ITEM 15.

13 - [IPERIENCE: FOR EACH P05tTION HELD. COMPLETE ITEM 14. DO NOT DOUBLE COUNT TIME. IF YOU HAD OVERLAPPING DUTIES. THE MONTHS SHOULD REFLECT THE PROPORTIONATE AMOUNT OF TIME YOU WERE ASSIGNWTO THOSE PARTICULAR DUT!IS. IN NO CASE SHOULD THE NUMBE REPORT [0 FOR A PARTICULAR TIME PERIOD EXCIID TH[ NUMBER OF NONTHS THAT ARE IN THAT TIME PERIOD.

FOR RENEWALS ONLY: ENTER THE APPROXIMATE NUMBER OF HOURS 51NCE PREVIOUS RENEWAL OR ISSUANCE OF LICENSE IF FIRST RENEWAL.

14 - EXPERIENCE DETAILS: INCLUGE POSITION TITLE. TIME P[RIOD - FROM/10. FACILITY, AND A BRl[F DESCRIPTION F0 DUTIES PERFORMED WHILE SERVING IN THAT POSITION. IF MORE SPACE 15 NEEDED. USE ITEM 15. OR IF NECESSARY ATTATCH ADDITIONAL INFORMATION.

15 - COPMENTS: USE TH15 SPACE TO INCLUDE ANY EXTRA INFORMATION OR CLARIFICATION FOR OTHER ITEMS ON THE APPLICATION FORM.

$ PACE PROVIDED 15 NOT $UFF]Cl[NT, YOU MAY ATTATCH EXTRA INf 0RMAT10N WITH YOUR APPLICATION.

16 - NRC FORM 396. CERTIFICATION OF MEDICAL EXAMINATION: INCLUDE A COMPLETED NRC FORM 396 WITH [ACH APPLICATION DELAYS IN ISSUING LICENSES. IF THIS IS NOT POSSIBLE, PLACE AN "X" IN ITEM 16b. AND FORWARD THE FORM AS 500N AS POSSIBLE: MAKE SURE ALL ITEMS ARE COMPLETED.

Ih-SIGNATURE 5: SIGN AND DATE ITEM 17a. OBTAIN YOUR TRAINING COOPDINATOR'S SIGNATURE AND THAT OF YOUR HIGHEST LEVEL OF CORPOR

. MANAGEMENT FOR PLANT OPERATIONS.

DETACH THESE INSTRUCTIONS AND SUBMIT THE COMPLETED NRC FORMS 398. IN TRIPLICATE AND 396 TO THE APPROPRIATE REGIONAL ADMI ,

PRIVACY ACT STATEMENT Pursuant to U.S.C. 552alel(3), enacted mto law by Section 3 of the Prevacy Act of 1974 IPublic Law 93 5791 the f ollowing is furneshed to individuals who supply information to the U.S. Nuclear Hegulatory Commission on NRC Form 398. This information is maintained in a system of records dessenated as NRC 16 and described at 46 Federal Register 46717 (September 21.1981).

1. AUTHORITY. Section 107 and 161(e) of the Atomic Energy Act of 1954. es amended (42 U S.C. 2137 and 2201(ii).

2. PRINCIPAL PURPOSES. The information well be collected and evaluated for determining licensing eligibelity and to generate statisticat data and reporte on licensing actions.

3. C'OUTINE USES. Informet.on entered on this form may be used to. (a) determme et the indivedual meets the requerements of 10 CF R Part 55 to be issued an operatorja license; (b) provide researchers with information for statist + cal evaluations related to selection, traineng. and esamination Cf f acility operators; (cl provide facility management with suf ficient information to enroll the mdividuals m the fecensed operator requalification program;(dl provide for enammateon and testing material and obtain results from contractors 4.WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION-Disclosure is voluntary However. if the enformation requested is not proveded. NRC wiH not be able to evaluate whether the appl cant meets the requirements of 10 CF R Part $$ ,

5. 5YSTEMS MANAGE RS AND ADDRESSES:

Regional Administrator, Region i fiegional Ad":ini5trator. Region II U S. Nucteer Regulatory Commess.on U.S. Nuclear Regulatory Corr:iStion 631 Park Avenue 101 Marietta street. Sutte 2900 Kmg of Pruss.e, P A 19406 Atlanta, GA 30323 Hegional Administrator. Hegion til Hegonal Adminestrator. Hegeon GV Hegional Adm.nistrator, Heg on V U S Nuclear Hegulatory Commession U S Nuclear Hegulatory Commession U S Nuclear Hegulatoe y Comm aon 799 Hoosevett Hoad 611 Hvan Plata Drive. Suite 1000 1450 varia Lane. Suite 210 Glene El.vn. IL 6013 7 Aelengton. T x 76011 Ninut Crees, C A 94596

NaC P ame us seuCLE Aa as cut ATOa* COuwe5siON A- ai ova oAve alctivt0 nr .

t til 3400090 e, abaC# e A A:

twa ss io, E.

Es. s s, geno PFRSONAL QUALIFICATIONS STATEMENT-LICENSEE

, iAs.

• TvP Ce A*PuC ATiO= e s . ., . s . a .

i (PPuC ANTI e uL t = Ave sine. e.,.e.

l

. ..  ; , .t APPuC ai .0- r e

. - 'va a ai uva s'i o IJwsf.fr e.e sewer I

&OOm 65 On Rf D Nuween eact I MOT 4 0 inst

- i-en-s 1 - OR M 7-COLD 2 SICD40 _t was17t h FC.teye.,

Cit y i Aos e at% nA6 lstattiAti rip Coot iAs s 3 v .a0

( ,,2 sivut ai va

< UPcaam N- u,G, w w 3 SIRIM OAll 4AO q ese ggt g ygig '-

3. Ctfilt94M6P GAG) ~

MONTM OAV vtAR e UNITED STATES t CTMER (3,.cd47 l l l

. Tv,f OP uCE E A,Puto ,0. (A , . Patv.OU.L.Ct ui ,MtLOiu, l

. Ort.ATO. . OOC 8Yavou - y . L.Ct ~n =uon. ,; ,'; g , - lll, . . AC ui, oc,Ca t , .u..t.

l

b. SENIOM OrtRATOn 66 l l l

s. LIMITED SRO fe# Fe.# Neame,A l l l

d sNSTRUCTOa CEmTissCATION l l l 7 8;.AME 08 APPuCANY1 tuPLOvim 4 Ant to cuantNT POSIYtON AT F ACILITY 4A51 l e PL ANT $UPtmess?ENOthi e , uhet OPE enaTOR

- Aussteam,1unsthi TR AshE E SusLDINGr ADOntl5 4Att b AS5sSI ANT PLANT SUPimeNTINOE NT touseptN1 ope # ATOR

- INONLICEN540 096nA Tons s SM'81 EUPtavison

~

Cliv taw STaftANI ter Coot iAOI d STAf f thGiht en a OTMe m ($,.c,91 e e $Mes t TECMhlCAL advisor'5Msti (NGa%E t a

0. ELAut Of APPLICANT 1 p ACitrTV (API f INSTavCTOn lF ACILITY OOCast ~

gS NIOm CONTmOL mOOw

_ OPE R A TCR 9 A0011 TONAL f ACluTV OOCalT5 fMete.4ta.r treas.es IAmi si CONTROLstOOu OPEmATom II. EDuCAf toss (AT) l e MiGM SCHOOL e MAJOR APCA(S) 08 STUDY o",",",.'", "o','c$,$ l f,Iy, ,CO

, gS DEG t - 0 wo*u a5C E mEC C GRADUATg thGiht RehG traMar, tuore e .s .ea aed f T vPt OF TR AsheNG 45 *eo GED EQuiv ALENCy 0-NONE t-Ct at ssiC A T E OTHER 2- A550Cea T E b NUMetROPvtARS 3-SACMcLOm OFCOLLEGE 4 -M AST E R 5-DOCTOMAL

12. TRAGN18sG 4Aul 13. ERPERitNCE (Avg l

s l e MONTM ANOvtan le hues GtR le MONTM AND vt AR O* lteNuusta l l enow } vo lOf mtEKS , y ,,,, ,, i i NAVV I 1 a t-NUC.s,E so. L AR .; PontR PLA847 Fue#0AMENTAL$ j 1 RO l l l 3 PLANTSv8Ttus l l l l l Ce u.OO. l l l l 2-tOOntPPWO

..tw, - 5 i i i i O.u .va f.O., .-E S C l l l l l l l l 2.O,8a A1.NG P ACT.CE ,

l l

.-C T M t . ,3, i i i i l CONinOL aoOu Octa ATiO=s osi sa r l l ,,,,,, l l

sivutaTOn OrtaATioNs tsar o ,e s s-ortnavon l siuutAToa hautisi T-sutt a vison 14 l l l l B-PL ANT ST AF F l l l l vs. NO .-0 T Mi a ,s, ,

l l l l

" *^*"

u'Q') - COuut,aciAL aa Nuctsam te cava.a, a

=a/r.,

10.mE ACTOM OrtRATOR U c a, sed}

s- smO INSTRUCTION 11-5thsOR OPEm ATOR (*.s t us- l l l l

.- E T A Pt..O , ON .M., T l l l l i,- M . T .urt v, O. u,.. ,.,m l l l l x EOuatification l l l l > >-if A. .,sM . Y t ~G ~t E u +.. .s> l l l l

,-0,Mt., , i i i i .. Au ,t OU.P ,NON4,C,Nuu, Ort. A TO.

i  ; i i l l l l ..-PLANT sia.. l l l l

..-OYME ,w.~,

l l l l l l l l l l l l l l l l l l 1 I I I I I

_ _. 4. u_m._ . m. u_ =_m

-~ ~. -

. t. ,

._. e . .> .m , . m ..

e.

, ,, . I. _r. _ _u______..._

. % ..,xy - ..__...__. _ _ _

iu - A.onsty p e,..,,s ve9e.,.,C y; f f a,l$ ATAC64ED b bM NA M IG. OfftC fores see. CERTieeCATE 08 astDecat Exame86AT90E0 (AM)

,,,s e ., e - z.en, ,. _ _- = - .e.,e - ..

. . e.. ~, e - , . . ..e e e e .e ,,,e - , .n o.,e. . ..e. r.ee e ,,C ,e M%

03 6 N A W hk.

• Af*f*b4 MNT

_ :en, en. ..e ,_, ,~,

o. .so.ne. .e

.e , _ e. _ ee e ~ ,.ne.,e-- . .e e e _e ~ e.n dv M .he feed , e.u te snede evease,pe 8.e emernenes.en m . .. . ~. ~ .

M M Ee88'e8 ReTweeteenk Per

, $$. and ,het ,ete end wseuse hee e s. sed for en Oeg.esest5ename 0.oreeer sacense e. per. ore,i ei.ther sorgnee e,,ses

• T C N NWAIDEC +Dfgle(lad (44* sL Chl ef AD E D bIYh* .c -- _ ace see' s.t Ae.1 e Pc i arioe/

econ oe eessess,se,sen gre.n (e*M *** 'f*..s *Wase spuas d) se essee.ed .v sec.assa to 64u-01 8 10 Cf R to. ens ,het s/he sies e=e*

4 A GIWEWWAL Oesty e eer..e, ,he, ,me eteve sio. nee sne.weshase,,hesee ~~

ehenged 8bs./her tegenord remaeg e u,pe.on,69 end ende ey 8 e

f I M7g

~

~

" s s(,M T6M t. H8Aeed5Y kvft-O ICO.RPOM41%

Mah;Mh tAL.N T F O R PL A se1' c o-T 1 W e 4J

' ~~

d^

Elfs N ATVKE * 'T mat 6JtN&_ @hDA'llR FOR e c.wsc-wr,ve.n. tcd er s. we Mm. a. amGA/c)

OtM6fIEle hY DEJ4)C.b OV MCr."I E MEL Avi AE M k 64T E CA 5. l** 4 k%W L t i,4 0 4 (( *

• KCh Iid D O C. fm NOT Mt.LT kG ue,r E" MG. 04 9-t_ _ ,

E u.v i t w s k.

-~

l DiMU W k l C o.ori 4Tv Af __