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, w:le:- I' ALLEGATION D AT A FORM U 5 C:tt'" *!GMo Covv 550' ni4:
...s,.r.c.......-
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p RECOVING OF FICE 4 -f4 N'5 D chet Number (if applicable)
- 1. Facilitylles) involved:
IN em.1
- N O I O
O O M b E hn.<ic
. GtNtmics
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- 2. Functional Areals) Involved:
sch.ch owopnete bo t i t operations onsite health and safety construction offsite health and safety safeguarda emergency preparedness other' esp cit,)
3.
Description:
IGlEINICIMl4lL] lAll>IllflGIAlil llOIAtlGI lRlRl614]Rl I bl f 19161 l Kl cl $lel 14 lulo I 101ol A 11,1 I I rl v1 I FI i Ie 1 151T1 I I I I I I I I I I I I I I I I I I I i 1 I I IIIIIIIIIIIIIIIIIIIIIIIIIl
- 4. Source of Allegation:
tchech ew@ie boil contractor employee security guard licensee employee news medie NRC employee private citizen I
organisation isp.cityl
[
other esp city)
M t e*
- r E s./o ee MM DD YY
- 5. Date Allegation Received:
/ 1
/ alf y A.
A r e c [4 t/
- 6. Name of Individual triest twe initi.i..no i.. n.m.
Receiving Allegation:
- 7. Of fice:
g g
ACTION OFFICE Te b c 4 b (>4 44
- 8. Action Office
Contact:
tr.,si two inii.i no i., n.m.)
- 9. FTS Telephone Number:
7 p,
g g
- 10. Status:
scheck on.)
., Open, if followup actions are pending or in progress Closed,if followup actions are completed MM DD YY
- 11. Date Closed:
l
- 12. nemarks:
1l ll i i i i iiil l iil l l i i ; i ; i i ;
i%,
so s,..o.,.i IIIIIIIIIIIIIIIIIIIIIIIIII
- 13. Allegation Number:
A t
U 1 f-/ *A' 0 / 't Y
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