ML20137H066
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UNITEb STATES j'.. :.
. ;., NUCLEAR REGULATORY COMMISSION A
. $ 7.,""f ,,-
k REGION IV S 2, 611 RYAN PLAZA DRIVE, SUITE 1000 k * ._ #
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D. E. Van Farowe, P.E., Chief Division of Radiological Health 3R&oJ Y Michigan Department of Public Health
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7 3500 North Logan St. ort &os Fuh P. O. Box 30035 Lansing, Michigan 48909 g
Gentlemen:
Enclosed for your information and records is a copy of Form NRC-241 dated March 16, 1981, showing activities by Graver Tank and Manufacturing Company, Inc., in Michigan, a location where NRC has jurisdiction.
Sincerely, h /k n D. Brown, Chief Technical Inspection Branch
Enclosures:
- 1. Form NRC-241 i
- 2. Texas Radioactive Material License No. 11-2176 l
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8508280141 850712 b* \
g;N8;ois6 eon APR 17188r
Form Atc.ss: Farm Anorno.l.
- gs'th. bo . U.S. ATOMIC ENERGY CoMMISStoN s RefCRT OF PnOPOSED ACT!Vl?!ES
. IN NON-AGRsEMENT STATES itectlen 150.20 of 10 CFR 150 catablishes a Cenern) !!rs'nse authoriz!nft any person who holds n specine lleense from art " Agreement State" ea state with wh!rh the U.S. Atomic Energy Commission hns entered into on effcettve acrec-ment under sutisection 274b of the Atomic Energy Ae:t UI 10548 where the licensee maintains c.n oince for directin::
the !!cen.wd activity and nt which radlation safety records are normally maintained, to conduct the same activity in "Non-Agrectnent States"if the specific liccuse issued by the Agreement State does not ilmit the authoriced actit f ty to speciRed irlstallatietss or locations.
INsTRUCTIo'NS Submit this Form and the Agreement State specinc license If the Licensee, af ter filing this report. Proposes to ennduct in quadruplicate at least 3 days prior to engaging in each activitics in non-Agreement statca not spectacd in this report.
- - activity permitted under the oenern! License established by an amended Form AEC-241 (Revised) should be flied with Sec.150.20 of 10 CPR 150. Send to: the Commis, ion.
Director of the Atomic Energy Commission Regional Com-pil.*Jscc Ocice listed in Appendu: D of Part 20 of this ch.tpter NOTE: Activrrt::s coNWctEs IN IfOtt*ACAEtME.W STATE 3 ITNDE t for the region.in which the Agreement State that issued THE cENERAL LICENSE ARE LIMITED TO A TOTA!. OF 180 the specific license it located. DAYS IN ANY CALENDAR YEAR.
- 9. N AME OF LICENME 2. ADOr4ESS OF LICENSEE -
(Pereen er horn proposing to conduct the esti.ities described belo e} ' thfailing address or other facetion erhere licensee mer be leseted)
Graver Tank & Mfg. Co. , IIic. '
P. O. Box 1764 ,
(Graver Southwest) Houston, Texas 77001 ELGraver DESCRIPTION Tank willOF ACTIVITIES TO DE CONQUCTED be performing, oth X-ray IN NON.AbREa tube anc MENT Ir STATES um UNCER THE G[NERAMf radiographing. Graver will be operating under our Texas Liscense No. 11-2176 as ammended. We will be using two radiographers, both will be safety trained _in Texas Regulations.
& LOCATIONS AT WHfCH THE*.E ACTivtTIES WILL BE CONOUCTED. AND DATES SOMEDULED.
(aire en cornptete an addreee en possible >
"TREET AND NUMBER (or other location) CITY AND STATE From- To-- DAYS
...The Dow Chemical'Co. Midland, Michigan 48640 April 13, 1981 Michigan. Division 3 to 175 dr October 5, 1981
- 9. UST SEALCD SOUnCES. OR DEVICES CONTAINING SEALED SOURCES. WHICH WILL SE POSSCSSEO.USED. lNSTALLEO. SEMvlCEO OR TESTED BN NON.AGRECM CNT STATES. ,
+
(freelude deseription el type and enantity elradienctiee material conta;.~*d in each eested source er device.}
- 1. Iridium 192 - Gulf Nuclear G13-20V camerk, 100 CI or less
- 2. naltospat 200 KV X-rav' tube..
C. NUMBER OF SPECIFIC LICENSE AND NAME OF STATE ISSUING SUCH SPECfF8C LICENSE WHICH AUTHORIZES THE UNDERstCNEO TO CONOUCT ACTlvlTICS WH4CH ARE THE SAME. EXCEPT FOR LOCATION OF L'3E. AS THOSE SPECIF6ED aN STEM 3 ABOVE. FOUR COPIES OF THE Sr*ECIFIC,8.ICENSE MUST ACCOMPANY THIS FORM. ,
Texas Liscense #11-2176 Graver Tank & Mfg.eCo., In.c.* .
as mmmended.
.P. O. box 1764, Houston, TX 77001 ,
CERTIFICATE 7.1. THE UNDERSIGNED. HEREDY CERTIF"Y THAT: .
- c. Allinformation in this tcport is true and comp!cte.
- b. I have read and understand the provisions of the generallicense 10 CFR 150.20 reprinted below and on the reverse side of this form: and I understand that I am required to comply with these provisions as to all byproduct, source, or special nuclear material which I possess and use in non agreement States under the oeneral License for which this report is Sled with the U.S. Atomic Energy Comminion.
' e. I inaderstand that activitica conducted in non Agreement States under oeneral License 10 CFR 150.20 ste limited to a total of 150 days In any calendar year.
OATE: TYPE OR PRINT NAME OF LICENSEEt 3/16/81 Graver Tank & tifg. Co. ,Inc. (Graver Southwt PLEASE ..
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EARNING 18 U.S.C. Section 2001: Act of June 2~,,1988: G2 StatIMKin'aGIt a crirnin'ai d5nseM/ma(c $ *lllfully falac state.
. snemt or representation to any department er agency of the United States as to any riatter'within its jurisdiction. l t
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