ML20205J431

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Matls Licensing Package for Amend 25 to License 50-14102-01 for State of Alaska,Dept of Transportation & Public Fac. Control:467026
ML20205J431
Person / Time
Site: 03007710
Issue date: 03/02/1999
From: Campbell V
NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION IV)
To:
References
467026, 50-14102-01, 50-14102-1, NUDOCS 9904120043
Download: ML20205J431 (15)


See also: IR 05000141/2002001

Text

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"U

u.s. NUCLEAR REGULATNtY CoMMlsSION

MATERIALS LICENSE

I

Pursuant to the Atornic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 ;r ublic Law 93-438), and Title 10.

2

Coda of Federal Regulations, Chapter I, Parts 30,31,32,33,34,35,36,39,40, and 70, and in relance on statements and

representations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess, and

trInsfer byproduct, source, and special nuclear material designated below; to use such rnaterial for tim purpose (s) and at the place (s)

designated below; to delives or transfer such material to persons authorized to receive it in accordance v/th the regulations of the

rpplicable Part(s). This license shall be deemed to contain the conditions specified in Section 183 of the Aemic Energy Act of 1954,

Es cmended, and is subject to all applicable rules, regulations, and orders of the Nuclear Regulatory Corenission r.9w or hereafter in

effect and to any conditions specified below.

Licensee

in accordance with letters dated

October 30,1998, and February 25,1999

1. State of Alaska

3. License number 50-14102-01 is amended in

Dept. of Transportation & Public Fac.

its entir s ./ to read as follows:

2. Headquarters Materials

.

4. Expiration date July 31,2001

5800 E. Tudor Road

5. Docket No.' 030-07710

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Anchorage, Alaska 99507-1225

Reference No.

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6. Byproduct, source, and/or special, J

7. Chemical and/or physical form

8. Maximum amount that licensee may

nuclear material

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possess at any one time under this

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license

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A.

Cesium-137

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SeRsource

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Not to exceed 10

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millicuries per source

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Americium-241

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a e neutron",

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Not to exceed 50

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'ources (T20Yler

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millicuries per source

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-102451

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h~'(Troxler'Dwgg

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Americium-241

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Not to exceed 330

millicuries per source

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No.

100337,

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D.

Americium-241

D.

Sea

so rces

D.

Not to exceed 100

(Troxler Dwg. No.A-

millicuries per source

100608)

E.

Cesium-137

E.

Sealed sources

E.

Not to exceed 10

(Campbell Pacific

millicuries per source

Nuclear Model CPN-

131)

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F.

Amcricium-241

F.

Sealed neutron

F.

Not to exceed 50

sources (Campbell

millicuries per source

Pacific Nuclear Model

CPN-131)

G.

Americium-241

G.

Sealed neutron

G.

Not to exceed 50

sources (Campbell

millicuries per source

Pacific Nuclear Model

],:aUSS

CPN-131)

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OmCIAL RECORD Gut 7

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NRc FORM 374A

u.S. NUCLEAR REGULATOR 7 COMM!sslON

PAGE 2

of 5

PAGEs

License Number

50-14102-01

,

'

MATERIALS LICENSE

o em r Reference Number

SUPPLEMENTARY SHEET

030-07710

Amendment No. 25

6. Byproduct, source, and/or special

7. Chemical and/or physical form

8. Maximum amount that keensee may

nuclear material

possess at any one time under this

license

H.

Cesium-137

H.

Sealed sources

H.

Not to exceed 11

Humboldt Scientific,

millicuries per source

in.c. Dwg.,No. 220064

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Americium-241

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Sealed sburc s

1.

Not to exceed 44

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Humboldt Scientific,

millicuries per source

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Inc. Dwg. No 220067

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Califomium-252

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Sealed neutron

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Not to exceed 66

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sources Troxler Dwp

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microcunes per source

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No.105560

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Not to exceed 100

K.

Californium-252.[

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souc'es (Troxle[Dwg.

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microcuries per source

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Authorized use

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For use in Troxler Mod,el 45

640 to

.. . roperties of materials.

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A. and B. For use in Troxler Model 3400 eri

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sity gauges to measure properti-

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construction materials'

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C.

For use in Troxler Model 2226 or 3241' gauges to rn'easure asphalt content of construction materials.

D.

For use in Troxler Model 3241 Series gauges to measure asphalt content of construction materials.

E. and F. For use in Campbell Pacific Nuclear Model MC Series gauges to measure properties of

construction materials.

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G.

For use in Campbell Pacific Nuclear Model AC-2 gauges to measure properties of construction

materials.

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H. and I. For use in Humboldt Scientific, Inc. Model 5001 series gauges to measure properties of

construction materials.

J.

For use in Troxler Model 3400 series gauges to measure the properties of materials.

K.

For use in Troxler Model 3242 asphalt content gauges to measure properties of construction

materials.

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NRC FbRM 374A

U S. NUCLEAR REGULATORY COMMISSION

PAGE

3

Of 5

PAGEs

Ucense Wmber

50-14102-01

l

.

MATERIALS LICENSE

Dociet or Reference Number

SUPPLEMENTARY SHEET

030-07710

Amendment No. 25

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CONDITIONS

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10. Licensed material may be used at the licensee's facilities located at 5800 East Tudor Road, Anchorage,

Alaska; 2301 Peger Road, Fairbanks, Alaska; Mile 7 Old Glacier Highway, Juneau, Alaska; and may be

used at temporary job sites of the licensee anywhere in the United States where the U.S. Nuclear

Regulatory Commission maintains jurisdiction for regulating the use of licensed material.

11. A.

Licensed material shall only be used by, or under the supervision of and in the physical presence of,

Patrick H. Harmon, Maureen Lee, Howard J. Jerue, or individuals who have received the training

described in letters dated February 15,1991, May 31,1991, June 10,1991, and February 25,1999,

have received copies of, and training in, the licensee's operating and emergency procedures, and

th_e Radiation Safety Officer.

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have been designated by\\ \\

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B.

The Radiation Safety Office

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Sealed sources and detector ciills'shbe>tIsted forkakage and/or contamination at intervals not

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12. A.

to exceed 6 months or at such5thebiManAIM enecified-by.the certifi6 ate of registration referred to

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in 10 CFR 32.210:

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Notwithstanding Paragrap

.aled s ,

s designed to emit alpha particles

shall be tested for leakage at,

ag go atioD,atant

not to exceed 3 months.

rari'sfeIror'in}dicati'ng that a ieak test has been m

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C.

In the absence of a certificate from

6 months prior to the trarder, a sealed soufedt or detector cell received from another person shall

not be put into use until tested. yL

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D.

Sealed sources need not be leak tested if:

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(i)

they contain only hydrogen-3; or

(ii)

they contain only a radioactive gas; or

(iii) the half-life of the isotope is 30 days or less; or

(iv) they contain not more than 100 microcuries of beta and/or gamma emitting material or not

more than 10 microcuries of alpha emitting material; or

b)

they are not dasigned to emit alpha particles, are in storage, and are not being used.

However, when they are removed from storage for use or transferred to another person, and

have not been tested within the required leak test interval, they shall be tested before use or

transfer. No sealed source or detector cell shall be stored for a period of more than 10 years

without being tested for leakage and/or contamination.

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' NRC FORM 374A

u.S. NUCLEAR REGULATORY CoMMISsloN

PAGE

4

of 5

PAGEs

License Nuraber

50-14102-01

.

' MATERIALS LICENSE

D cm a Rdece Nune

SUPPLEMENTARY SHEET

030-07710

Amendment No. 25

E.

The leak test shall be capable of detecting the presence of 0.005 microcurie of radioactive material

on the test sample. If the test reveals the presence of 0.005 microcurie or more of removable

contamination, a report shall be filed with the U.S. Nuclear Regulatory Commission in accordance

with 10 CFR 30.50(b)(2), and the source shall be removed immediately from service and

decontaminated, repaired, or disposed of in accordance with Commission regulations. The report

shall be filed within 5 days of the date the leak test result is known with the U.S. Nuclear Regulatory

Commission, Region IV 611 Ryan Plaza Drive, Suite 400, Arlington, Texas 76011, ATTN: Director,

Division of Nuclear Materials Safety. The report shall specify the source involved, the test results,

and corrective action taken.' v ~

The licensee is authorizeb to ollect leak test samples for analysis by Troxler Electronics Laboratory

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or Microtec Services,, Altematively, tests for leakage and/or contamination may be performed by

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persons specifically licensed by the Commission or an Agreement State to perform such services.

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13. Sealed sources or detector cells 'contaliiing licensed materfaf shall not be opened or sources removed

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from source holders bype license }

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sic *afinverstgr$8WhiD d' I/M 95onths to,accountgr all so

14. The licensee shall conduct a p

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received and possesse'd' unde

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15. Each portable gauge stiallihav

'or o ler locked;

tain

esigned t6 prevent unauthorized or

accidental removal of th' Teale

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n. The gau' ge or its container must be

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locked when in transport,Ttorage,

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sun /eilla'nce of an authorized user.

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16. Except for maintaining labeling as required by O'C#R Part 20 or 7.1, the licensee shall obtain

authorization from NRC before making any changes in the,_ sealed source, device, or source-device

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combination that would alter the description or specific 5tions'as indicated in the respective Certificates of

Registration issued either by the Commission purs'uant to 10 CFR 32.210 or by an Agreement State.

17. The licensee may remove the source rod from portable gauges for the purposes of cleaning,

maintenance, or repair of the gauge (s)in accordance with procedures outlined in letter dated February

15,1991.

18. The licensee is authorized to transport licensed material only in accordance with the provisions of 10 CFR Part 71," Packaging and Transportation of Radioactive Material."

19. The licensee shall not use sealed sources or probes containing sealed sources at depths exceeding 3

feet below the surface.

20. In addition to the possession limits in item 8, the licensee shall further restrict the possession of licensed

material to quantities below the minimum limit specified in 10 CFR 30.35(d) for establishing

decommissioning financial assurance.

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-

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.

NRC FORM 374A

U.s. NUCLEAR REGULATORY cOMMisSloN

PAGE

5

of 5

t' AGES

'

Ucense Number

50-14102-01

.

MATERIALS LICENSE

D cw r Reference Number

SUPPLEMENTARY SHEET

030-07710

Amendment No. 25

21. Except as specifically provided otherwise in this license, the licensee shall conduct its program in

accordance with the statements, representations, and procedures contained in the documents, including

any enclosures, listed below. The Nuclear Regulatory Commission's regulations shall govem unless the

statements, representations, and procedures in the licensee's application and correspondence are more

restrictive than the regulations.

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A.

Letter dated February 15,1991 5m

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B.

Letter dated May 31,1991 c M '

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Letter dated June 10,199.1f

D.

Letter dated October 5fi992

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Letter dated May 28,.1997

Letter dated Septenit@r 18

F.

Letter dated Octobei,30, M 1997

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Letter dated February 25,1999. .&

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FOR THE U.S NUCLEAR REGULATORY COMMISSION

Date

By

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VivIa'n H. Campbell, Senior Rad 4 tion Specialist

Nuclear Materials Licensing Branch

Region IV

Arlington, Texas 76011

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UNITED STATES

NUCLEAR REGULATORY COMMISSION

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REGloN IV

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611 RYAN PLAZA DRIVE, sulTE 400

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ARUNGTON, TEXAS 76011-8064

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March 2,1999

State of Alaska

Department of Transportation and Public Facilities

ATTN: Robert L. Farmer

Radiation Safety Officer

5800 E. Tudor Road

Anchorage, Alaska 99507-1225

SUBJECT: LICENSE AMENDMENT

Please find enclosed License No. 50-14102-01. You should review this license carefully and be

- sure that you understand all conditions. If you have any questions, you may contact the

reviewer who signed your license at (817)860-8143.

NRC expects licensees to conduct their programs with meticulous attention to detail and a high

standard of compliance. Because of the serious consequences to employees and the public

which can result from failure to comply with NRC requirements, you must conduct your program

involving radioactive materials in accordance with the conditions of your NRC license,

representations made in your license application, and NRC regulations. In particular, note that

you must:

1.

Operate in accordance with NRC regulations 10 CFR Part 19, " Notices, Instructions and

Reports to Workers: Inspection and Investigations," 10 CFR Part 20, " Standards for

Protection Against Radiation," and other applicable regulations.

2.

Possess radioactive material only in the quantity and form indicated in your license.

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3.

Use radioactive material only for the purpose (s) indicated in your license.

4.

Notify NRC in writirt of any change in mailing address (no fee required if the location of

radioactive mak

semains the same).

5.

Request a"

obtain written NRC consent before transferring your license or any right

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thereunder, either voluntarily or involuntarily, directly or indirectly, through transfer of

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control of your license to any person or entity. A transfer of control of your license

includes not only a total change of ownership, but also a change in the controlling

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interest in your company whether it is a corporation, partnership, or other entity. In

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addition, appropriate license amendments must be requested and obtained for any other

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planned changes in your facility or program that are contrary to your license or contrary

to representations made in your license application, as well as supplemental

correspondence thereto, which are incorporated into your license. A license fee may be

charged for the amendments if you are not in a ee-exempt category.

6.

Maintain in a single document decommissioning records that have been certified for

completeness and accuracy listing all the following items app l';able to the license:

Onsite areas designated or formerly designated as restricted areas as defined in

10 CFR 20.3(a)(14) or 20.1003.

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State of Alaska

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Onsite areas, other than restricted areas, where radioactive materials in

quantities greater than amounts listed in Appendix C to 10 CFR 20.1001-20.2401

have been used, possessed, or stored.

Onsite areas, other than restricted areas, where spills or other unusual

occurrences involving the spread of contamination in and around the facility,

I

equipment, or site have occurred that required reporting pursuant to 10 CFR

l

30.50(b)(1) or (b)(4), including areas where subsequent cleanup procedures

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have removed the contamination.

Specific locations and radionuclide contents of previous and current burial areas

within the site, excluding radioactive material with half-lives of 10 days or less,

depleted uranium used only for shielding or as penetrators in unused munitions,

or sealed sources authorized for use at temporary job sites.

Location and description of all contaminated equipment involved in licensed

operations that is to remain onsite after license termination.

7.

Submit a complete renewal application, or termination request at least 30 days before

the expiration date on your license. You will receive a reminder notice approximately

90 days before the expiration date. Possession of radioactive material after your license

expires is a violation of NRC regulations.

8.

Request termination of your license if you plan to permanently discontinue activities

involving radioactive material.

You will be periodically inspected by NRC. Failure to conduct your program in accordance with

NRC regulations, license conditions, and representations made in your license application and

supplemental correspondence with NRC will result in enforcement action against you. This

could include issuance of a notice of violation; imposition of a civil penalty; or an order

suspending, modifying, or revoking your license as specified in the " General Statement of

Policy and Procedure for NRC Enforcement Actions" (Enforcement Policy), NUREG 1600, Rev.

1.

Thank you for your cooperation.

Sin erely,

h.

Vivian H. Campbell

Senior Radiation Specialist

Nuclear Materials Licensing Branch

Docket: 030-07710

License: 50-14102-01

Control: 467026

.-

Enclosures: As stated

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State of Alaska

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DOCUMENT NAME: P:\\ -

To receive copy of document, Indicato in box: *C' = Copy without enclosures *E" = Copy with enclosures "N" = No co)y

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OFFICIAL RECORD COPY

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DEPARTMENT OF TRANSPORTATION AND PU8UC FACIUTIES

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se00 Tucon RoAo

sTA TEnGW D6NGW & BVQnEB9NG BBMCES DMSDM

ANCHORAGL ALASKA 99607-UM

NEADOUARTB98 ACATBliALS

1907) 26S 6230 IFAX 26042311

Colleen Murnahan

U.S. Nuclear Regulatory Commission, Region IV

Ilarris Tower,611 Ryan Plaza Drive, Suite 400

Arlington, TX 76011-8064

February 25,1999

i

Re:

Amendment to License 50-14102-01

Dear Ms. Murnahan

Attached is a copy of the State of Alaska Amendment to License 50-14102-01, letter

mailed January 15,1999 and a follow up letter with corrections mailed later. Apparently I

mistakenly did not date these letters.

Also attached is the State of Alaska Warrant Detail Inquiry which describes payments

made through the Warrant system. It states that the $340.00 fee was paid December 23,

1998 to:

U.S. Nuclear Regulatory Commission

License Fee & Debt Collect Branch

i

P.O. Box 95414

l

St. Louis, MO 63195-4514

Should any of these statements be incorrect, please contact me at 907-269-6246 and I will

correct them.

Sincerely,

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Robert L. Farmer, P.L.S.

State of Alaska, Department of Transportation /Public Facilities

Statewide Radiation Safety Officer

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DEPARTMENT OF TRANSPORTATION AND PUBLIC FACILITIES

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sva remor oesoen a swonernaa senwces omsson

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AncuanAos atAsKA 90607-12H

NEADQUARTERs MA TERIALs

(907)269-6230 (FAX 269-6231)

United States Nuclear Regulatory Commission

Region IV

Harris Tower

611 Ryan plaza Drive, Suite 400

Arlington, TX 76011-8064

Attn: Charles Cain

Branch Chief-Licensing

Re:

Amendment to license 50-14102-01

Dear Mr. Cain:

January 15,1999 an application to renew license 50-14102-01 was forwarded to your

office, the intent being to renew NRC License 50-14102-01 based upon NUREG 1556.

,

Vol.1. However, as a result of a telephone conversation with you Friday, January 29

1999, application is not due until renewal July 31,2001. Please void that material.

NUREG form 313, Application for Material License, was forwarded January 15,1999 in

(above stated) application as an amendment and renewal request of the licenses. Please

process that form. Additionally, in response to your request of January 29,1999 attached

is a completed US NRC FORM 577.

There have been some changes in personnel at the State of Alaska DOT /PF as outlined

below:

Mr, Howard Jerue, State of Alaska Radiation Safety Officer retired November 1,1998

'

and Mr. Russ Sirian replaced Mr. Jerue as State of Alaska Radiation Safety Officer (see

attached letter dated October 30,1998).

Mr. Robert L. Farmer was licensed as a Radiation Safety Officer by Troxler November

20,1998 (see three attached Troxler documents). However, I can not train Gauge

operators as I have not completed the required 40 hour4.62963e-4 days <br />0.0111 hours <br />6.613757e-5 weeks <br />1.522e-5 months <br /> Radiation Safety Officer course,

plus 8 hour9.259259e-5 days <br />0.00222 hours <br />1.322751e-5 weeks <br />3.044e-6 months <br /> RSO course and 30 hours3.472222e-4 days <br />0.00833 hours <br />4.960317e-5 weeks <br />1.1415e-5 months <br /> onsite training that is required.

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A retired State of Alaska Radiation Safety Officer, Mr. Jerry Roach shall conduct NRC

required training classes for State of Alaska Gauge operators in Southcentral region in

1999 (see attached NRC letter dated April 24,1990).

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Regrettably, Mr. Russ Sirian died December 4,1998. As of this date, please remove Mr.

'

Sirian as acting Statewide Radiation Safety Officer.

Per application submitted January 15,1999 Mr. Robert L. Farmer is appying for the State

Radiation Safety Officer and (Central Region) Radiation Safety Officer. Additionally,

,

Mr. Jerry Roach shall be training new and renewal of Gauge Operators tests this summer

through fall of 1999. Mr. Robert L. Farmer shall attend classes in order to meet NRC

standards for teaching Gauge Operators fall of 1999.

,

Should you have any questions, or comments please contact me at 907-269-6246.

Sincerely,

!

Robert L. Farmer, R.L.S.

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State of Alaska, Department of Transportation /Public Facilities

State Radiation Safety Officer

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INQ-WD: WARRANT DETAIL INQUIRY

02/01/1999

WARRANT CLASS GN - GENERAL

m vsidNUf98EKG259541837

ROUTING CODE ' MAIL

STATUS AW

DATE LAST ACTIVITY 12/23/1998

SCHED PRINT DATE 12/08/1998

WRT PRINT _ AMOUNT

340.00

WRT PRINT __DATE__12/R 4}jjj

__ACCUM LIAB AMOUNT

REDEEMED Dg M 24R]41pjb

RE TC NCl T DATE 12/23/1998

5

ADDRESS NAME: U.S. NUCLEAR REGULATORY COMMISSION

L1: LICENSE FEE & DEBT COLLECT BRANCH

L2: P.O. B0X 954514

CITY / STATE: ST. LOUIS

M0 63195 - 4514

................................ BANK DATA *********************************

BANK NUMBER 050

ACCOUNT NUMBER 2070729001

CASHED AMOUNT

340.00

REDEEMED DATE 12/23/1998

MICROFILM NUMBER 122398257075

INQ-WD: WARRANT DETAIL INQUIRY - REMIT ADVICE

02/01/1999

g ANT NUMBER 25954183_

IINE

--

T--------------


MESSAGE -------------------------------------

1 ATINLALIM5JJ3 301-415-6e67

gjuoAggI0g

2

U.S. NUCLEAR REGULATORY COMMISSION

3 ILICENSE FEE & ACCOUNTS RECEIVABLE BRANCH

4 RE: STATE OF ALASKA DEPT OF TRANSPORTATION & PUBLIC FACILITIES

LICENSE NUMBER 50-14102-01_

FEE CATEGORY 3P AMENDMENT

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INQ-WD: WARRANT DETAIL INQUIRY - REF LINES

02/01/1999

WARRANT NUMBER 25954183

OVERFLOW YES

REF TYPE

NUMBER

AMOUNT

DATE

COMMENT (TRUNCATED)

1 PVN NRC91205

US NUCLEAR REGULATOR

2 STM 501410201

340.00 11/18/r998 DOT &PF D&ES HQ MATLS

3 IND 1_1J31SS)-

11/18/.1998 USNRC LICENSE /INTERI

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17 SRD 25137

12/15/1998

18 OD AA12328500015

12/15/1998

Enter-PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10--PF11--PF12---

CONT QUIT

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BASE FINS REFS REMTS PFKYS

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October 30,1998

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RE:

Docket No.

0307710

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License No.

50-14102-01

Control No.

571699

U. S. Nuclear Regulatory Commission

l

1450 Maria Lane

Wahiut Creek, CA 94596-5368

!

Attn: Beth A. Prange

Sr. Health Physicist (licensing)

'

Dear Mrs. Prange:

l

I am retiring November 1,1998 and Mr. Robert L. Farmer has been selected as my

l

replacement. Mr. Farmer will send his resume after he has attended the RSO class

l

offered by Troxler Electronics on November 19,1998.

!

Please amend the Department of Transportation and Public Facilities license to indicate

'

the following:

Mr. Robert L. Farmer will be the Statewide Radiation Safety Officer for the State

'

of Alaska, DOT &PF.

Remove Howard J. Jerue as the Statewide Radiation Safety Officer.

Mr. Russ Surian, Radiation Safety Officer for the Central Region, will act as Statewide

Radiation Officer in the interim until Mr. Farmer completes the RSO course.

l

Please call Mr. Surian if you have any questions.

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Sincerely yours,

'

Iloward J. Jerue

Statewide Radiation Safety Officer

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467028

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ORM 577

U.S. NUCLEAR REGULATORY COMMISSION

AITN: RITA MESSIER 301 415-8067

-

U.S. Nuclear Regulatory Commission

LICENSE FEE REQUIREMENTS

License Fee and Accounts Receivable Branch

P. O. Box 954614

St. Louis, MO 63195 4614

-

TYPE OF ACTION

NEW LICENSE

RENEWAL OF LICENSE

STATE OF ALASKA

Q AMENDMENT TO LICENSE

NITN: HOWARD J.JERUE

RADIATION SAFETY OFFICER

REQUESTED DATE

$800 E. TUDOR ROAD

10/30/1998

ANCHORAGE, AK 99507-1226

uCENSE NUMBER

50-14102-01

'

CONTROL NUMBER

467026

L APPLICATION FEE DUE

II. FEE NOT REQUIRED

Your request for a licensing action is subject to the fee (s) in the category (ies)

Check

Enclosed is your check which

noted below in accordance with Section 170.31 of 10 CFR Fort 170.

Number

accompanied your request. The

Payment of the fee is required prior to the issuance of the license, renewal, or

fee is not required because:

amendment.

cEIIony

APPLICATION

RENEWAL

AMENDMENT

U

N

r

po

nt

3P

s

6

s

340.00

$

$

$

Date of

The Licensing staff has Iriormed

Request

us that your request is to be

S

$

$

Control

considered as a continuation of the

I

I

.

Number

request hated.

5

S

5

$

$

$

$

5

$

Date of

Your reqmt was combined, prior

(

Request to review, with the request listed.

Control

$

3

$

Number

$

$

$

Ill. CHECK RETURNED

FEE (s) DUE

s

340.00

Check

Enclosed is your check which was

PAYMENT RECEIVED

$

Number retumed to us by the bank for:

4

AMOUNT DUE

s

340.00

INSUFFICIENT FUNDS

Q Your request was received without the prescribed apphcation

ACCOUNT CLOSED

OTHER

U We received your check hated below.

Payment of the additional fee

MAllTHE REPLACEMENT CHECK TO THE ADDRESS LISTED AT TH1

Check Number

noted above is required.

TOP OF THIS FORM AND REFERENCE THE ABOVE CONTROL

$

Amount

f tUMBER.

Your request willincreene the scope of your Icense program.

IV. LICENSE ISSUED WITHOUT THE REQUbRED FEE

Therefore, your request is sutyct to the application fee (s) noted above.

Refer to Secten 170.31 and Footnote 1(d)(2).

hk'*r

The hated

was ad

without the required fee being

Your license expired prior to the receipt of your applicaton for renown!.

ku"m'

en

he ted. The fee required is

ed h e t n i f hos form.

Therefore, your request is subject to the applecaton fee (s) noted abom.

Dak

Refer to Section 170.31 and Footnote 1(a).

Issued

MAKE PAYMENT OF THE FEE (S) TO THE U.S. NUCLEAR

] The scope of your licensed program was increased. Therefore, your

REGULATORY COMMISSION AND MAIL THE PAYMENT TO THE

request is subject ha the applicaten fee (s) noted in Secten 1 of this form

ADDRESS LISTED AT THE TOP OF THIS FORM. IF WE DO NOT

naw tc Secten 170 31 and Footnote 1(d)(2).

RECEIVE A REPLY FROM YOU WITHIN 30 CALENDAR DAYS FROM

THE DATE LISTED BELOW,WE SHALL ASSUME THAT YOU DO NOT

Belca se of the urgency of your request, the hcense was issued without

WISH TO FURSUE YOUR APPLICATION AND WILL VOID THIS

remittance of the prescribed fee noted in Secten 1 of this form.

ACTION.

SIGNATURE - UCENSE FEE ANALYST

LFDCB

l // LFDCB

Distributon:

Pending Cy

REMessier N@

OC/DAF/LFARB S/F (LF-3.2.7)

RITA ME! ilER

11/18/98 I

NN/kRB RF

cc: Region IV

jjfjgf1993

f.9C FORM 577 (5-1998)

PRHrED ON RECYCLED PAPER

This form we s desegrad using informs