ML20203E371

Matls Licensing Package for Amend 15 to License SNM-164 for Catholic University of America.Control:125019

ML20203E371
Person / Time
Site:	07000190
Issue date:	10/15/1997
From:	Henderson P NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I)
To:
References
125019, NUDOCS 9712170040
Download: ML20203E371 (14)

Text

utfW_NW AQadiQuasOKidsQu6iC Mtjii KKKii Kit KiQiDiGit -QEOiOeGaQsasoscWFe*3LWLW g

Il

%C FOnM 374 U.S. NUCLEA2 RCULATORY r')MMISslON f

Amendmen* No. 15 M ATERI ALS LICENSE wl a[ Pursvarit to the Atomic Energy Act of 1954, as amended, the Isergy Reorganitatio gl l Federal P egulations, Chapter I, Parts 30,31,32,33,34,35,36,39,40, and 70, and in reliance on statements and representations heretofore made g{ by the licensee, a license is hereby issued authorising the licensee to receive, acquire, possess, and transfer by product, source, and specia gl h rnaterial designated below; to use such material for the purpose's) and at the place (s) designated below; to deliver or transfer such material to f h persons authorised to receive it in at.cordance w ith the regulations of the applicable Part(s).This license shall be deemed to contair. the E'

H h specified in section 183 of the Atomic Energy Act of 1954, as amended, and is subject to all applicable rules, regulations, and or P

Nuclear Regulatory Commission now or hereaf ter in effect and to any conditions specified below.

VI d.

k k

Licensee In accordance with the letter dated EI September 17, 1997, El 1.

The Catholic University of America

3. License Number SNM-164 is amended in its entirety to read as follows:

4 E '

620 Michigan Avenue, N.E.

El 2.

Washington, D.C.

20064 El

.4. Expiration Date November 30, 2001

'j N

1 je7erNne' No..070-00190 c

6. Ilyproduct Source, ardor

7. Chemical and'or Physical

8. Maximum Amount that Licensee g

a Special Nuclear Material Form May Possess at Any One Time g

Under'Ihis License A. Uraniu.fi enriched to not A. Any A. 5 kilograms El 4

more than 2%

E i

B. Uranium enriched to not B. Any B. 10 kilograms E!

a more than 1%

E i hC. Plutonium 239 C. Sealed Pu-Be neutron C. 96 grams Ei N

sources E

4 D. Plutonium 239 D., Plated alpha 'sou.rces D.

I microgram E

E.s10 microcuries E

E. Any 4

<L

'. U

( E. Plutonium 238 s

• 4

/

F.*200 microcuries N

q F. Plutonium 239 F. Any yG. Plutonium 242 G.~Any G.-200 microcuries E[

k g,

/

F~Aillhorized use gj

~

)h g

A. through G.

To be used for research and' development as. defined in 10 CFR Part 70; Gl ll 2

animal studies; for source calibration; and for teaching and training of g

Q students.

g 0

Gl CDNDTTIDNS 4

A]j g

W 10.

Licensed material may be used only at the licensee's facilities at 620 Michigan gl Avenue, Washington, D.C.

g q

11.

A.

Licensed material shall be used by, or under the supervision of, individuals desigrated in writing by the Radiation Safety Committee, Aaron Barkatt,

(

4g Ph.D., Chairperson.

The licensee shall maintain records of individuals gl designated as users.

p f

B.

The Radiation Safety Officer for thi license is Donald l_uster, 12.

A.

Sealed sources and detector cells shall be tested for leakage and/or h

contamination at intertals not to exceed 6 months or at such other intervals isl h'

l as are specified by the certificate of registration referr d to in l

10 CFR 32.210, not to exceed 3 years.

[J \\ )Q g l

G

\\

E;

' st 7 7 r 3kl t

m ih.g.oI. 7{,

~,,

GI L.

' ) " V j ~.

R 3

• * * 's 9712170040 97101S tmmmmmmmmaurm$

l b

PDR ADOCK 07000190 ri arm m m m m m m m m.m...

C M

~-- - ------ ----------- ---- --- - -- - 6 G- @

= = = = = = = = * = = = = = =_=.

_ = = rL= M =.m =_ = = =L= = = !Lm._

.= = = =.= = =_= = = m m

• w = = ap 9,stC F oem 37' A U t. A m A^3 CE ULATORY COMMISS60N PAOL 7

or 3

Pacts I

(Jcense nurnber MATERIALS LICENSE

'~~

Docket o Rereience n a

SUPPLEMENTARY SHEET 1

Amendment.No. 15 l

l B.

Notwithstanding Paragraph A of this Condition, sealed sources designed to l

emit alpha particles shall be tested for leakage and/or contamination at p

l intervalt not to exceed 3 months.

p W

l C.

In the absence of a certificate from a transferor indicating that a test has W

been made within six m9nths prior to the transfer, a sealed source or I

detector cell received from another person shall not be put into use until l

tested, p

P Eachsealedsourcefabricatpdby-phelicenseeshallbeinspectedandtested D.

f transfer as a sealed, stu/c"e(.for construction defeqtsN a*kade, fan @cp p

v(

1. o E.

Sealed sources q' de ector cells need not b tested if:

2 p

(i) they contain only hydrogen 3; or

.,, p (ii) they nta n qi gas; or f

thbihlf-life 3 tye isdtde lis s or less pr (iiii I

th(y contajn not t

1

/

l

=k 1 V

4 4

(iv) 9 Wh6100 2 rbcu~ ries of beJa and/or gamma uh P

}ot10microcuries,ofalphaemitting(.

emitling ot more matWial;p{ ria[n%w

]

/,;'y :

p

, M ha pfticles y re in storage, and are

$y ts.

4 s

not bep g use SHow(evhg they$enoin tjgnf to (v) or i Y.

Ptiey' re removed >from storage for use R

l or trnn&sfer to' anot'he pd,td f nba

~

We not been tested within the k

aktestinArpp,pth'eysealed solirce-dr detector c@e tested b

[

bil b requir (e 4

l shall be stored for a transfer.

p q

q period of than10yearswithoutbehgtestedforleakageand/or 4

contamination.

J y

b k yh 4 g 4

Pi 4

l F.

The test shall be capable of'delecting the presence of 0.005 microcurie of l

4 radioactive material on the test sample.

Records of leak test results shall p

q be kept in units of microcuries and shall be maintained for inspection by p

q the Commission.

If the test reveals the presence of 0.005 microcurie or h

4 more of removable contamination, a report shall be filed with the U.S.

Nuclear Regulatory Commission and the source shall be removed from service f

d 8

4 and decontaminated, repaired, or disposed of in accordance with Commission k

regulations.

The report shall be filed within 5 days of the date the leak l

q test result is known with the U.S. Nuclear Regulatory Commission, Region I, p

a ATTN:

Chief, Nuclear Materials Safety Branch, 475 Allendale Road, King of M

Prussia, Pennsylvania 19406.

The report shall specify the source involved, the test results, and corrective action taken.

l l

G.

The licensee is authorized to collect leak test samples for analysis by the l

q licensee. Alternatively, tests for leakage and/or contamination may be p

performed by persons specifically licensed by the Commissinn or an Agreement k

i State to perform such services.

N I

p i

d kiiUskhids#22QMsamv&TW.:iiGMrYJMifazaravassV2CiGREv250id&Md.

U".L".N = = = =_" * * = * = = = =.

.PL",***======

d5=="**********"1 AAC F e.m 374 A U.17.-sAQ ZEGULATORY COMMISslON pggg 3

op 3

pgggg l

II W Lkenne cumber I

MATERIALS LICENSE oocket er Reference n SUPPLEMENTARY SHEET 070-00190 y

f Amendment No. 15 l

13.

Sealed sources or detector cells containing licensed material shall not be opened or sources removed from source holders or detector cells by the licensee.

p p

14.

The licensee shall conduct a physical inventory every six months, or at other F

interval approved by NRC, to account for all sealed sources and/or devices

[

received and possessed under the license, y

15.

Licen ed material shall not be used in or on human beings.

li F

The licensee shall not acqu{re li8nsk kit @ddpwith the U.S. Nuclear Regulato ip in a sealed source or device i

16.

I unless the source or device h'a d een register ssion pursuant t tFR 32.210 or equivalent lations of an Agreement 1

O n

17.

The licensee shallYot.use licensed material in field app:jcations where activity f

is releasea excepigas provi d otherwise by specific'cond' tion of this license.

F 18.

Experimental a 1s, or roducts, rom ex '

e tal an 1s, that have been administered 1 sed mate

) hall 3t' bf Ofor human' onsumption.

p

(

\\

A Thelicenseeis[ authorized 7.t

(

t a sport 4ipe\\

g daterial in-ccordance with the 19.

lis f Radioactive E

provisions of 1 CFR

'. 71 kagins. aidy,portation 3

Material."

vg 20.

Exceptasspecif$ ally'pr (detItt(rk ho thyMicenserthelicenseeshall h

conduct its program in a) fdgneeTiti the 4 'atements, representations, and li e

b procedures containqd in the documentMiincludgifany enrJosures, listed below, The Nu: lear Regulatory, Commission"sfegyldtidnsdshall gov ~ern unless the l

e correspondence are more r strictive than the regulap(ceitsee's application a statements, representgti ns and procedures in the 1 h

g

lons, n

i Application dated Octob r 30r 1990 g M A.

^

d B.

Letter dated August 13, 19 #

l C.

Letter dated September 10, 1991 excluding enclosure (2) l D.

Letter dated July 19, 1996 y

q W

E.

Letter deted October 25, 1996 p;

d F.

Letter dated October 15, 1997 including enclosure 1 b;

4 p.

d F.

4 k;

y' 4

);

)

$4 g{d 4

l I

d For the U.S. Nuclear Regulatory Commission il l

OCT I 51997 OriginalSigrwd By:

f Pamela J. Henderson Q

! Date By RUclear Materials. fety Branch h

Region i p

W King of Prussia, Pennsylvania 19406 P,

M Ma NuiQiGQi35MKfdHMMaQr2iGiDibr vaus:mramr.massmGaChras2DiFsDii.f

./

O-O OCT l5 997 Sr. Rosemary Donley, S.C.

Executive Vice President The Catholic University of America 620 Michigan Avenue, NE Washington, D.C. 20064

Dear Sr. Donley:

This refers to your license amendment request. Enclosed with this letter is the amended license.

Please review the enclosed document carefully and be sure that you understand and fully implement all the conditions incorporated into the amended license, if there are any errors or questions, please notify the U.S. Nuclear Regulatory Commission, Region 1 Office, Licensing Assistance Team, (610) 337 5093 or 5239, so that we can provide appropriate corrections and answers.

Thank you for your cooperation.

Sincerely, MM% '

PamelaJ.Hondemon Pamela J. Henderson Division of Nuclear Materials Safety License No SNM-164 Docket No. 070-00190 Control No. 125019

Enclosure:

Amendment No.15 cc:

Donald R. Luster Radiation Safety Officer OFFICIAL RECORD COPY Ml10

O-O s..

2-r t

t 3

i a :-

i t

DOCUMENT NAME: R:\\WFSiMLTR\\LSNM-164 -

T.

.i...,v.: w. e icann mi e. n..:

c - copy wi.etacht...ci

- copy wi.it.ch/.nci

= - wo copy OFFICE DNMS/RQ]jp N DNMS/RI l

l NAME-PHendersorU DATE 10/15/97 10/ /97 10/ /97 10/ /97 OFFICIAL RECORD COPY

10-15-1997 W44fft FTC^5ACJLITIES PLAN!MPA TO 7 " p25516103375324 P.02 h

W. -

r Q.

(,)

l ai

+',

2 i

j!

CUA

~

l ffcS/d l K-7 L.

i

'IME CNIMOIJC UNIVERSTIT OF! AMERICA'.

C, e

i r ;

p; 3

I Radladon Safety ODke i

i I Wa.hingm D.C. 20M4

\\

' 2024194206 FAL* 202419-4446 !

October 15,1997

y l'

,e l:' :!

t U.S. Nuclear Regulatgry Commission Region I Nuclear Materials Section B

hl l

i J!

475 Allendale Road '

King of Prussia, PA 19406 '

j

Subject:

Request for lxense Amendment -

, Docket No. 070-00190 l

CUA mjuestslicenshy action to amend its special nuclear mathrials license as follows:

f. -

1. Increase:the plutonium 239 possession limit from its citrrent 10 microcuries to 200 i

microcuries.

j t

p

2. Add plutoniutp 242 at'a possession limit of 200 mi:roccies and "any" chemical and/or

!!I physical fomd l

i Also, in order to meet the unity rule as defined in 10 CFR 70.25; we request a reduction in our current approved U 235 possession limits [ license section 6A,7A, and 8A] and a new possession limit for uranium as fo'lows:

1

3. [ Reduction]

Uranlum enriched to not Any i

. $ kilograms -

h; more than 2%

i' I4 L

[New]

Uranium enriched to not Anyj 10 kilograms I' :

more than 1%

i j

hi In accordance with 10,CFR 70.34, we have provided the grounds for this amendment in enclosure one to this letter, The imhersity has received contract authorizition to pr d

research activities from GTS Duratek/BNF1 the prime contractor to DOE's Idaho National e

Engineering Lab for LIAs particular project. We respectfully req {k these amendment requ'sts in o' der to meet already established

,'l e

r work phare before tidend of this year. Should you have any questions or should you require l

additionalinformation, please call me.

j Sincerely, i

f' 4

i f.

l I

Donald R. Luster, RS

(

cc. J. Beres, Director:

/25c/7,'

Env. Health & Safejy l

OCT I 5 1997 ^

NN O'FFICIALN00FID00PY ML 10L L

10-15-19W 1124541 FCluTIES PLAWrAUPA TO mr$25516103375324 P.

{j li [il.? j l l _.

[l

I j.

fg i

<i.

.L q -

i

' Enclosure 1 i

ll i

y 1

Grounds for Amendment i

yi

'1!.

i

?

I Q'

l. Background Infotmation j

i.

l For mo' e than fiftekn years Ihe Vitreous State Laboratory, apart o'f the P'hysics Department at!

I r

Catholic nlversity, iri associado'n with GTS Duratek, has been performing research for the f~

developnEnt of glass as a stabic form for the long term disposition of radioactive was complex of high temperature furnaces and associated process a'nd analytica1 equipment is i

8 dedicated to this effort The work has involved both simulated : waste streams and real waste streams received from a number of DOE sites in the form of treatability studies. The radionuclid. i inventory in these sarrlpics lprimarily depleted uranium at$d thorium oxide]fas able to be

-[>

accommodated by out current Byproduct, SNM and/or SUD license possession limits.

2. Change and Expansion of DOE Priorities In a new approach o more cost-effecthe cleanups of cenal DOE sites, a congress mandate privatization approact has been huplemented for cleanup of th$ cold war legacy. CUA has been.

y b

asked to apply its waste stream characterization experience to the Idaho National Engineering.

I ahoratory waste rei$cdiation program. This willinvolve the investigation of potential plutoniuln[

concentration mechan,Istns, development of plutonium waste stream stimulants, and glass lf formulation and testing.

h,

3. histification for the Increase in Pu 239 and Addition of Puf42 at the Requested Possession ]

Limits' n

i i

q The mechanics of this research have been done many times hefore and CUA is well experienced j not suflident to prcpire the amount of glass needed for testing an in glass formulation, llowever, the current license possession limit for Pu 239 at 10 microcuries only about one gram df glass, an insufDeient quantity to study ihe properties previously discussell! ;

in paragraph two. Sinho higher c,oncentrations (in weight rather than activity) are required, the ' ji j I

isotopes of plutonium having the lowest specific activity are tis isotopes ofinterest. This would be Pu-239 at 6.2E-2 rnCi/mg or Pu-242 at 3.96E-3 mci /mg. liicreasing the possession limit of Pad. I 239 to 200 microcurids would yield ~3.2 mg of Pu-239 and ad' ding Pu-242 at a possession limit bfi 200 microcuries woul' yield ~50 mg of Pu 242. These weights would be sufficient to prepare d

some Pu doped glasseIs for observation by scanning electron microscopy in order to identify any h; plutonium phases which could theoretically be formed in interaction with the glass metter refractory material.

l0i t

{

4. Safety; The proposed work essentiallh involves the fabrication of a 11 amount of glass in an oven which will be located inside a glove box equipped with filtration and monitoring systems. Such a l

)

proecss is routine for %is laboratory, having been done many times over the years. Sa,mples of tlie '

glass am then pmpare' for electron microscopy examination. nionitoring and oversits is provided d

through the radiation pfety office according to procedures and policy in the approved radiation !

l safety manual.

I i

i i

i l

1 t

e

---

t 10-15-1997 11:46ft1 : FCcfCILITIES PLAINITEPA TO

?!-7 25516103375324

'P.04-I U'

q q p 4,

4 ' p. U id i 3 l;.o l if 1: 4' q

9 ;., ;

e 4

4 P

i.

t p

5. Disposition of Simtlant Material, Treatability Samples and Associated Treatability hiaterials d e i

.r.1

. Following completbn of the research and acceptability of tid final report, the glass!treatabilitju '

,1 <

samplea, associated tdatability materials, and simulant materials will be dispositioned hither to a i:l:

~

licensed burialfacility or returned to the DOE, depending on how the contracts are w0rded.

T',

..s 4

f

'g I,5 4

t 9

i ili

, ; }-

1:it i

l 1

.j,i I

s j

h'

, - i.

i I, ' !. '

3-n s

h l$)

i 4,

"s.

i 6

P,4

[. 8'

?

i I:

'. !,. A f

l II'F.

e l.

a

[

lp r.

i t

4 4

L l

ll l

+

. I-

}I!

i a

i f i-il i

i i

i e

s g j'

?

4

.i i: !

R j'e

=

h l. !

t i

I 8

.1 J-i i

j 1

[

f

-t g

a t

1,.

t-

[

j i

i I

e i

j s

t t

i

'l 4

TOTAL P.04

v v

TELEPHONE CONVERSATION RECORD Conversation Date: Octobei 6,1997 Mail Control No.: 125019 License No.:

Docket No.:

SNM 164 070-00190 Person Called: Donald Luster Organization:

Telephone 3/7.50.0C)

Number:C2d t Radiation Safety Officer Catholic University Person Calling: Pamela J. Henderson

Subject:

Amendment Request Summary:

1 informed the RSO that their request to include Pu 242 on their byproduct material license thould have been requested for their SNM license.

I also looked at the current possession limits on the SNM license and told the RSO that their current limit for 2% enriched uranium (20 kg) along with the increase and addition of Pu 239 and Pu-242 respectively would put them over the limit for $750,000.00 FA and would necessitate their submitting a DFP.

We discussed various options to reduce possession limit activities such that they could add / increase the Pu and still be within the activities for $750,000.00.

The RSO stated that he would probably request to decrease the amoint of enriched uranium so that he could obtain the Pu originally requested.

Action Requhed]Taken: File MS-15. Await response.

Signatuhe:x

, s f @ /f2np Date: October 6,1997 0FFl0lAL REC 0fiD COPY ML10 l

1 l

. ~. -.

O-

~

4 1

This is to acknowledge the receipt of your letter / application dated

[

, and to inform you that the iritial processing which includes an administrative review has been performed. pg gp po,7 swn-Ny There were no administrative omissions. Your application was assigned to a technical reviewer. Please note that the technical review may identify additional omissions or require additionalinformation.

Please provide to this off:ce within 30 days of your receipt of this card A copy of your action has been forwarded to our LI::ense Fee & Accounts Receivable Branch, viho will contact you separately if there is a fee issue involved.

125018 Your action has been assigned Mail Control Number When calling to inquire about this action, please refer to this control number.

You may call us on (610) 337 5398, or 337 5260.

125019 ac rew su mi Sincerely, see Licensing Assistance Team Leader f

f

-.e n

o.~

CUA O

h THE CATilOLIC UNIVERSrIY OF AMERICA Radiation Safety Office Washingtm D.C. 20064 202J194206 FAX: 202 319-4446 September 17,1997 U.S. Nuclear Regulatory Commission Region I - Nuclear Materials Section B 475 Allendale Road King of Prussia, PA 19406 c

Subject:

Request for License Amendments of -o 2c75-o 9 m License No.-OiMM9tr, Docket No. 030-00638 License No. SNM 36tr, Docket No. 070-(X)190

/4 w CUA requests licensing action to amend its special nuclear materials license and its byproduct materials license as follows:

For the SNM license: Increase the plutonium 239 possession limit from its current 10 microcuries to 200 microcuries, [Section 8.E.]

For the Byproduct Materials License: Add plutonium 242 at a possession limit of 200 microcuries, {Section 6.]

In accordance with 10 CFR 70.34, we have provided the grounds for these amendments in enclosure 1 to this letter. The university has received contract authorization to proceed with the described research activitics from GTS Duratek/BNFL, prime contractor to DOE's Idaho National Engineering Lab for this particular project. We respectfully request your prompt consideration of these amendment requests in order to meet already established schedules for completion of this work phase before the end of this year. Should you have any questions or should you require additionalinformation, please call me, Sincerely, mY / o Donald R. Luster, RSO cc. J. Beres, Director 125010 Env. Heahh & Safety 0FFICIAL RECORD COP /R 10 SEP 2 21997

(

~

(}

v w

Grounds For Amendments

1. Background Information For over fifteen years the Vitreous State Laboratory, a part of the Physics Department at Catholic University, and in association with GTS Duratek, has been performing research for the developmerd of glass as a stable form for the long term disposition of radioactive waste. A unique complex of high temperature furnaces and associated process and analytical equipment is dedicated to this effort. The work has involved both simulated waste streams and real waste streams received from a number of DOE sites in the form of treatability studies. The radionuclide inventory in these samples [primarily depleted uranium and thorium oxide] was able to be accomodated by our current byproduct, SNM and/or SUD license possession limits.

2. Change and Expansion of DOE Priorities in a new approach to more cost-effective cleanup of certain DOE sites, a congress mandated privati7ation approach has been implemented for cleanup of the cold war legacy. CL A has been asked to apply its waste stream characterization experience to the Idaho National Engineering Laboratory waste remediation program. This willinvolve the investigation of potential plutonium concentration mechanisms, development of plutonium waste stream stimulants, and glass formulation and testing.

3. Justification for the Increase in Pu-239 and Addition of Pu 242 at the Requested Possession Limits The mechanics of this research have been done many times before and CU A is well experienced in glass formulation. Ilowever, the current license possession limit for Pu-239 at 10 microcuries is not sufficient to prepare the amount of glass needed for testing and evaluation. It would result in only about one gram of glass, an insufficient quantity to study the properties previously discussed in 2. Since higher concentrations (in weight rather than activity) are required, the isotopes of plutonium having the lowest specific activity are the isotopes of interest.

This would be Pu-239 at 6.2E-2 mci /mg or Pu242 at 3.96E-3 mci /mg. Increasing the possession limit of Pu-239 to 200 microcuries would yield ~3.2 mg of Pu-239 and adding Pu-242 at a possession limit of 200 microcuries would yield ~50 mg of Pu-242. These weigt ts would be sullicient to preparc some Pu doped glasses for observation by scanning electron microscopy in order to identify any plutonium phases which could theoretically be formed in interaction with the glass melter refractory material.

4. Safety The proposed work essentially involves the fabrication of a small amount of glass in an oven which will be located inside a glove box equipped with filtration and monitoring systems. Such a process is routine for this laboratory, having been done many times over the years. Samples of the glass are then prepared for electron microscopy examination. Monitoring and oversite is orovided through the radiation safety office according to procedures and policy in the approved radiation safety manual.

o.-

o

5. Disposition of Simulant Material, Treatability Samples and Associated Treatability Materials -

1 Following completion of the research and acceptability of the final report, the glass treatability

- samples, associated treatability materials, and simulant materials will be dispositioned either to a licensed burial facility or returned to the DOE, depending on how the contracts are worded.

r i

i l

t'~~1F OR L F M S U S E )

f-

0 I C RMATION FROM LTS BETWEEN:

Program Code: 22110 License Fee Management Branch. ARM and Status Code: 0 Fee Category: EX ID Regional Licensing Sections Exp. Date: 20011130 Fee Comments: 170.11(A)(4)

Decom Fin Assur Reqd: Y LICENSE FEE TRANSMITTAL A.

REGION I

1.

APPLICATION ATTACHED Applicant / Licensee:

CA1HOLIC UNIVERSITY OF AMERICA, THE Received Date:

970922 Docket No:

7000190 Control No.:

125019 License No.-

SNM-164 Tction Type:

Amendment 2.

FEE ATTACHED Amount:

Check No.:

3.

COMMENTS Signed ____

_'_ _h oate

_________7 k_ _Zt7________

m i l e s t o p(**t!3' iT }frip. fe d.I-( _ _y/ )

B.

LICENSE FEE MANAGEMENT BRANCH (Check when r

[,..

\\t,,

.~

1.

Fee Category and Amount: _

__d_______,

U /ht_(

hfk___

2.

Correct Fee Paid.

Application may be processed for:

Amendment

__________,_ C _

Renewal License 3.

OTHER Signed

__________(__________________g_

Date

____________L_____________y__

a q

l

'O RECENEDDY L W 1

~~ z, gg w.1,Of ff-g-p?

b

/

pss/

u.a _$/

.f..-

e, y ou oc.n.x/o & 7- _ -

t b

$1+ 09 % /6/ l19 3

hi

/ ( W[)

.s/