ML20210A972

Ack Receipt of NRC Form 241,dtd 990630 & Filing Fee in Listed Amount

ML20210A972
Person / Time
Issue date:	07/06/1999
From:	Kinneman J NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I)
To:	Shillaber R AFFILIATION NOT ASSIGNED
Shared Package
ML20210A954	List: ML20210A949 ML20210A972
References
000980, NUDOCS 9907230028
Download: ML20210A972 (22)

Text

-

UNITED STATES 9,

[

p, NUCLEAR REGULATORY COMMISSION 5

j REGloN I 1

475 ALLENDALE ROAD g *****,d,a 4

KING oF PRUSslA, PENNSYLVANIA 19406-1415 July 6,1999 Mr. R. Scott Shillaber Vice President Sanborn, Head & Associates, Inc.

6 Garvins Falls Road Concord, NH 03301 1

SUBJECT:

APPROVAL OF PROPOSED ACTIVITIES IN NON-AGREEMENT STATES (NRC FORM 241) FOR CALENDAR YEAR 1999

Dear Mr. Shillaber:

)

This acknowledges receipt of NRC Form 241 dated June 30,1999, and the $1,100 filing fee, which you submitted to report proposed activities in Non-Agreement States under the authority of the generallicense pursuant to 10 CFR 150.20.

In the future, please use the NRC Form 241 and mark the appropriate box for submitting revisions and clarifications. Please fax your revision or clarification and a copy of the appropriate fee to (610) 337 5393.

The NRC Form 241 must include specific changes, such as locations, dates of work and personnel. Work locations are subject to NRC inspection in accordance with requirements for a general license.

i The total days of usage / storage through this reciprocity request is 178 days. If you have any questions, please call Cheryl Buracker on (610) 337-5093 or Rebecca Brown on (610) 337-5260. Your cooperation is appreciated.

Sincerely,

)qw g.

{"

John D. Kinneman, Chief Nuclear Materials Safety Branch No. 2 Division of Nuclear Materials Safety License No. NH-3904 Control Nos. 000980

Enclosure:

NRC Form 241 cc: State of Vermont 9907230028 990706 PDR STPRO ESGNH PDR NEO6 RETURN TO REGION I o

! )

s A vtay UNITED STATES

[

NUCLEAR REGULATORY COMMISSION 5

j REGloN f 475 ALLENDALE ROAD

,d KING oF PRUsstA, PENNSYLVANIA 19406-1415 f

g 1

July 6,1999 Mr. R. Scott Shillaber

{

Vice President j

Sanborn, Head & Associates, Inc.

6 Garvins Falls Road Concord,.NH 03301

SUBJECT:

APPROVAL OF PROPOSED ACTIVITIES IN NON-AGREEMENT STATES (NRC FORM 241) FOR CALENDAR YEAR 1999

Dear Mr. Shillaber:

This acknowledges receipt of NRC Form 241 dated June 30,1999, and the $1,100 filing fee, which you submitted to report proposed activities in Non-Agreement States under the authority of the general license pursuant to 10 CFR 150.20.

In the future, please use the NRC Form 241 and mark the appropriate box for submitting revisions and clarifications. Please fax your revision or clarification and a copy of the appropriate fee to (610) 337-5393.

The NRC Form 241 must include specific changes, such as locations, dates of work and personnel. Work locations are subject to NRC inspection in accordance with requirements

{

for a general license.

The total days of usage / storage through this reciprocity request is 178 days, if you have any questions, please call Cheryl Buracker on (610) 337-5093 or Rebecca Brown on (610) 337-5260. Your cooperation is appreciated.

Sincerely, W.

fJohn D. Kinneman, Chief Nuclear Materials Safety Branch No. 2 Division of Nuclear Materials Safety License No. NH-3904 Control Nos. 000980 i

Enclosure:

NRC Form 241 cc: State of Vermont 9907230028 990706 PDR STPRO ESGNH PDR NE06 RETURN TO REGION I o

. N

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[ 2,j.c

)$()l' $i% heSSier REGION I TRANSMrITAL FOR NRC FORM 241 & REVISION SlTdMITTALS

- [

INITIAL 241 PACKAGE

[ ] REVISION.

LICENSEE NAME:

07;n/Jof17 Mc4d [ h6 Sod /aMe9

LICENSE No:

/1 4 - 3 70 R CHECK NO:

0 '/ h/0 I-

/, /dd. j e

CHECK AMOUNT: $

O h

A k eX & aa k

%/n Proce'ssor Signature -

Date' 5

. Attachments:

1. Check

2. Approvalletter/ Revision Sheet

3. NRC Form 241 (for initial 241 pkg.)

4. Agreement State License (for initial 241 pkg.)

LOC-- d -.d.__._glj/

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Rev. 08/23/94 7[p~f]~~~i~~~~~

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Fco CatcCory.

Type et Fee ___

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Date CY ch Rec d ~~ ~~~~~,~~~~

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f JdN-33-BB 11:32 FROMs SANBORN HEAD CONCORD HH ID.

16032291919 PACE 3

un.ons. MAD USSOCES, NC.

Q1@1Q$

OATE INVOICE NO.

DESCnlPTION INVOICE AMOUNT DEDUCTION DALANCE

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7-01-99 70199 1,100.00

.00 1,100.00

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7-01-99 csEcx 16100 1,100.00

' 00 1,100.00 NUM8EP

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SANBORN, HEAD & ASSOCIATES,INC.

GRANITE BANK 54-7016/2117 6 GARVINS falls i.D.

Keene. New Hampshire 6 08 CONCORD, NEW HAMPSHIRE 03301 5174 (603)229-1900 Pay: one thousand one hundred dollars and no cents DATE CHECK NO.

AMOUNT July 1, 1999 16100 $*****1,100.00**

U.S. Nuclear Regulatory PAY commission AA9 5 APP.34/

to me ORDER

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I JUN-33-CD 11:42 FRoMe SANBoRN HEAD CONCORD NH ids 1G332291919 PACE 20 M

Sanbom, Head & Associates am e,4,,ec,s & sat.a.

March 10,1998 Mr. Dennis P. O'Dowd, Supervisor Radioactive Material Section Dureau of Radiological Health Department of Heahh and Human Services P.O. Box 95,6 Hazen Ddve Concord,NewHampshire 03302 Re: Amendment Application for Radioactive Material License No. 390R

Dear Mr. O'Dowd:

This letter is to request that your department expedite review of Sanborn, Head & Associates, Inc.'s (SHA's) Radioactive Matedal License amendment request dated January 6,1998. During a March 10,1998 telephone conversation, Mr. Mario Iannacconi of your office suggested that SH A send you a letter outlining our basis for this request. Based on pdor discussions with Mr. Chris Pide (fonnerly o f your office) we understand that most license amendments are reviewed in 60 days. Mr lannacconi had informed me that license amendments have taken up to 2 years to process and that a 60 day j

response time is unrealistic.

If granted, the requested amendment would allow us to store our Troxler Nuclear Density Gauge at a secured on-site consuuction trailer. We have an upcoming job in northem New Hampshire approximately 2 hours2.314815e-5 days <br />5.555556e-4 hours <br />3.306878e-6 weeks <br />7.61e-7 months <br /> from our Concord, New Hampshire office which will require field density testing using the Troxler gauge. We believe it would be safer to leave the nuclear gauge locked and stored in a secure on-site traller at the northern New Hampshirejob site rather than to transport it in a vehicle. Given the travel time and the projected hours the contractor will be working, SHA's technician will be staying in hotels and would otherwise be required to keep the gauge in his vehicle during the evening hours.

We would appreciate yourprompt review ofthis license amendment. Should you have any questions or require further information, please do not hesitate to contact the undersigned.

Very truly yours, SANaORN, HEAD A ASSOCIATES,1NC.

a.Jf1

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. Se t [hi!!aber, P.E.

Dennis o r Radiation Safety Officer Vice President DRP/pmm sMMDRPiOJO9edowd 8tf PaulJL Seeinsen e Charica L llrad a R. brott Skillebre Charlen,s. Comest e Alanbre.,\\. mniare a Dan,el B. Carr a Danawa It' lig

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J1JN-39-@3 11:43 FROM. SANBORN HEAD CONCORD NH ID: 1Ge32291919 PAGE 21 AUDIT R N" 99127390R RU FORM BRH-2B PAGE 1 of1 PAGE STATE OF NEWHAMPSHIRE (e'

DEPARTh4ENT OF HEALTH AND HUMAN SERECES OFFICE OF COMMUNITY & PUBLIC HEALTH BUREAU OF RADIOLOGICAL HEALTH RADIOACTIVE MATERIAL LICENSE Pursuant to the State of New Hampshire, Department of Health and Human Services' Bureau of Radiological Health regulations and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued authonsing the licensee to receive, acquire, own, possess, and transfer radioactrve material listed below; and to use such radioacthe material for the purpose (s) and at the place (s) C'y.sW below. This license is subject to all applicable rules, regulations, and orders of the Department of Health and Human Services' Bureau of Radiclogical Health now or hereafter in effect and to any conditions specified below.

LICENSEE

3. uCENSE NO.

390R, Amendment No.10 s.NAMa Sanbom Head & Associates,Inc.

4. axPIRATION DATE June 30,2000

2. ApoRess 6 Garvins Falls Road

5. FILE NUMBER Concord,New Hampshire 03301

-s RA0lOACTfVE MATERIAL (EC'S AND

1. CCM ANoroR PHYSICAL FORM

8. MAXIMUM AMOUNT OF MASS NUM8aR)

RADIOACTIVITY WHICH UCENSEE MAY POSSESS AT ONE TIME C.

s. AuTwoRizEcuss h

cowomous In accordance with application dated May 3,1999, signed by R. Scott Shillaber, Vice President and Treasurer, New Hampshire Radioactive Material License No. 390R is hereby amended to extend the expiration date noted in Condition 4 above.

For the Deped,,,...; of Hoanh and Human Senaces Omos of Communty & Public Heellh OAM OF ISSUANCE May 6.1999 Diano a. Tofft. Admrnistrator Ruromu of Hadelogeal Heath

JUN-3-93 11:41 FR opi., SAN!aRN NEAD CONCORD NH ids 18332291918 PAoE la M

Sanbom, Head & Associates Gmu%intEryrkwrx &.%ntists January 6,1998 Mr. Dennis P. O'Dowd, Supervisor Radioactive Material Section Bureau of Radiological Health Department of Health and Human Services P.O. Box 95,6 Hazen Drive Concord, New Hampshire 03302 Re: Radioactive Material License No. 390R

Dear Mr. O'Dowd:

This letter is to request an amendment to our above referenced Radioactive Material License.

Sanbom, Head & Associates,Inc. (SHA) would like to amend our Radioactive Material License No.

390R to include the ovemight storage ofTroxler Nuclear Density Gauges (maximum of 3 sources total) at temporaryjob sites. SHA would meet the following requirements:

1.

The Troxler gauge will be padlocked at the source rod and stored in a locked Troxler case. In

)

addition, the locked Troxler case will be stored in a locked room or locked storage cabinet.

If a locked room or locked storage cabinet is not available, the Troxler storage case will be chained and locked to a fixed and immovable object within the storage room. The gauge will be kept at a minimum distance of 15 feet from any work ares actively used by any employee during the temporary storage period.

2.

The Troxler gauge storage area will be clearly identified and marked with a Nuclear Radioactive sign and Fonn RHP.S. New Hampshire Division of Public Health Services Bureau of Radiological Health " Notice to Employees" and the name and phone number of Dennis R. Porter, SHA Radiation Safety Officer.

3.

Access to the temporary storage facility will be limited to the licensed SHA gauge u::r and the manager of the site. *Ihe temporary storate facility will be locked and secured during times of gauge storage.

The Troxler gauge will only be stored at the tempomry facility as long as the project is active 4.

and will be returned to the SHA corporate office at 6 Garvins Falls Road, Concord, New Hampshire (Approved New Hampshire Radioactive Material License No. 390R) upon completion of the project.

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I healM. Seeborn e Chartro L. Iloed a 12. Sawet Satun6,r CAerire A. Caerwerd a Maranar,;d DiMete o DendelR. Care e Deacon H' 88med asumaru.tqued & Asmuseuses sac.

0 c. amps fa.ns.Ro.oo..a cornsti, esse Homparwe o.3301 I

JUN-351-C3 11 42iFROM. SANIORN HEAD' CONCORD NH ids 10332291919 PACE 19 o

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l Des:ortment ofHealth and Human Sernces January 7. I998 glo 01030DOWLTM Pase 2 l

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All remaining conditions of our Radiological Material License will still be in effect.

1 i

[We would appreciate your prompt review of this license change and can be contacted if any l

' questions arise.

l Very truly yours, SA ORN, HEAD & ASSOCIATES,INC.

%k h l

Dennis R. Poner R. Scott Shillaber Radiation Safety Officer Vice President DRP/prnm s.toATAsomoiosooow t.Tx i

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JUN-33-23 11 43 FROHi SAN 20RN HEAD CONCORD NH ID.

1G332231918 PACE 17 State of New Hampshire hee _L et 1 page Department of Health and Human Services Office of Health Management I

Bureau of Radiological Health Liceme No.122E Amendment No. _2 Radioactive Material License EWE N 2 9 m suppi.m.ntary sh..t Sanbom, Head & Associates,Inc.

6 Garvins Falls Road, Suite 1 Concord,Lw Hampshire 03301 5174 In accordance with letters dated January 6,1998 and March 10,1998, signed by R. Scott Shi!!aber, P.E., Vice President, and Dennis R. Porter, Radiation Safety Officer, New Hampshire Radioactive Material License No. 390R is hereby amended as follows:

Condition 23 changed to read:

23. Except as specifically provided otherwise by this license, the licensee shall possess and use the radioactive material authorized by this license in accordance with statements, representations, and procedures contained in the documents, including any enclosures, listed as follows:

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application dated November 19,1993 letters dated May 31,1994 November 8,1994 March 21,1997 May 14,1997 i

Jaauary 6,1998 March 10,1998 The New Hameshire Rules for the Control of Radiation shall prevall over the statements contained in the above documents unless such statements are more restrictive than the Rules.

b l

l For the Depamnent of Health and Human Services

)

Omco of Heshh Management Date:

Mev 27. t 99s aal

/

Diane E. Tefft. AdministrutcfV

r JUN-33-83 11:40 FROM. SANBORN HEAD CONCORD NH ids 1G232291919 PAGE 1G

\\

Auorr R N 98uuso FORM BRH-2B -

REF__

PAGE 1 of 1 PAGE STAE OF NEWHAMPSHIRE l

DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF HEALTH MANAGEMENT BUREAU OF RADIOLOGICAL HEALTH RADIOACTIVE MATERIAL LICENSE Pursuant to the State of"Now Hampshire, Department of Health and Human Services' Bureau of Radi regulations and in reliance on statements and representations heretofore made by the beensee, a l authorzing the licensee to receive acquire, own, possess, and transfer radioactive rnatenal listed below; and radsoactive matenal for the purpose (s) and at the place (s) designated below. This license is subject to regulations, and orders of the Department of Health and Human Services' Bureau of Radiological Health offect and to any conditions specified below ucENSEE

3. UCENsE NO.

390R, Amendment No. 8 Sanbom Head & Associates,Inc.

4. min ^noN cars i.r m ic June 30,1999

2. AnonEss 6 Garvins Falls Road, Suite I

s. r:Le NuusEn Concord,NewIIampshire 03301-5174 D(2) 6 HADIOACTIVE MATERIAL

1. CHEMICAL AND/OR PHYSICAL f-O!tM

8. MAXIMUM AMOUNT OF RAOlOAcflVITY WHICH (ELEMENT AND MASS NUMBER)

UCENSFE MAY POSSESS AT ONE TIME

9. AUINORIZED USE CONDmONS In accordance with application dated April 17,1998, signed by R. Scott Shillaber, Vice President an Treasurer New Hampshire Radioactive Material License No. 390R is hereby amended to extend th I

expiration date to that noted in Condition 4 above.

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ror m. o ni or N....no som.n ano.

Office of Health Management Dm _L JCE. TefrL Aaministrator w*

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Sureau of RsosologicalHesRh

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.run-as 9:z 11,29 ruon, sanaonn nEno Concono un ro, 1GO32291919 PACE 14 RECEIVED MAY 1 9 1997 I

l New Hampshire Omce ofIIcalth Management hae Lof :Lpasno i

Bureau of Radiological Health l

l Supplementary Sheet License No. 390R I

Amendment No. 7 Sanbom, Head & Associates. Inc.

6 Garvins Falls Road, Suite i

, Concord, New Hampshire 03301 5174 l

In cecordance with letters dated March 21,1997 and May 14,1997, signed by R. Scott Shillaber, P.E., Vice President, and Dennis R. Porter, Radiation Safety Officer, New Hampshire Radioactive Material License No. 390R is hereby amended as fo!!ows:

Conditions 6,7, and 8 changed to read:

6. RAol0ACTrK MA1 TRIAL

7. CHEMICAL ANDroR PHYSICAL FORM

8. MAXIMUM AMOUNT oF RAolOACTIVITY (ELEMENT ANo MA55 NUMBER)

WHICH UCENSEE MAY Pos5ESS AT ONE TIME A. Cesium 137 A. Scaled sources (Troxler A. No single source to exceed 9 Dmwing No. A-102112) millicuries; 3 sources total B. Americium 241: Deryllium B. Scaled sources (Troxler B. No single source to exceed 44 DrawingNo. A-102451) millicuries; 3 sources total 9 AUTHORIZED USE A. and B. To be used in a Troxler Model 3400 Series surface moisture / density gauge for use in measuring moisture and density of construction materials.

Condition 13 changed to read:

13. Radioactive material listed in Item 6 above shall be used only by individuals who have satisfactorily completed the manufacturer's training course for the use ornuclear gauging equipment and who have been instructed in the licensee's operating and emergency proceduren and have been designated by the licensee's Radiation Safety Omcer. Copies of the certificate of training for each user shall be maintained by the licensee.

(Continued on page 2)

New Ilampshire Orrice of Health Management Bureau of Radiological Health I

Date of Issuance May 14.1997 rN

~

Diane E Tem Administrator L

T JIJN-G3-DD 11s3D FROMe,SANBORN HEAD CONCORD NH IDe 10932291019 p Agg, 3 g; New IIsmpshire Office of Health Management hae _A.or 2 =sem Bureau of Radiological IIcalth Supplementary Sheet License No. 390R Amendment No. 7

~

, Condition 23 changed to read:

23. Except as specifically provided otherwise by this license, the licensee shall possess and use the radioactive material authorized by this license in accordance with statements, representations, and procedures contained in the documents, including any enclosures, listed as follows:

application dated November 19.1993 letters dated May 31,1994 November 8,1994 March 21,1997 j

May 14,1997 l

l The NHRCR shall prevail over the statements contained in the abc ee documents unless such statements are more restrictive than the Rules.

l l

I i

JUNd33-C3 11:33 FRoMe,SANBoRN HEAD CONCORD NH ID: 1GD32291919 PAGE 13

.,,,.....~ r y

.);Y

..v M New Hampshire Omce ofIIealth Management nse_l of_.L pasuo Bureau of Radiological IIcalth g

'I Supplementary Sheet License No. 390R Arnendment No. 6

[

Sanborn, Head & Associates,Inc.

6 Garvins Falls Road, Suite 1 Concord, New Hampshire 03301-5174 in accordance with letter dated April 14,1997, signed by R. Scott Shi!!aber, P.E., Vice President, New Hampshire Radioactive Material License No. 390R is hereby amended as follows:

Condition 13 changed to read:

13.

Radioactive material shall be used only by Dennis A. Porter, Timothy C. Carnay, James A. Chabot, Scott R. Nerney, Matthew R. Poirier or Robert S. Blunt, i

i i

i New Ilampshire Omce of Hentth Manngement Bureau of Radiological Henith D:te of Issuance _ Anrft IR 1997

(

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g f,,, p Diane E. TeflY Administrator i

P un-as-ca ti.sv rnon. sansona neno concono un io, isea22sissa enos se AUDIT R N 9'7105390R RFF PAGE 1 of 1 PAGE FORM BRH 2B NEW HAMPSHIRE OFFICE OF HEALTH MANAGEMENT BUREAU OF RADIOLOGICAL HEALTH RADIOACTIVE MATERIAL LICENSE Pursuant to the New Hampshire Office of Health Management, Bureau of Radiological Health regulations and in reliance on statements and representations heretofcre made by the licensee, a license is hereby issued authorizing the licensee to roccive, acquire, own, possess, and transfer radioactive material listed below; and to use such radioactive material for the purpose (s) and at the place (s) designated below, This license is subject to all applicable rules, regulations, and o l

I New Hampshiro Office of Health Management, Bureau of Radiological Health now or hereafter in effect and to any cond l

specified below.

LICENSEE

3. UCENSE NO.

390R, Amendment No,5 3.NAME Sanborn, Head & Associates,Inc.

4. EXPlRATION DATE June 30,1998 l

2. ADDRESS 6 Garvins Falls Road, Suite I

s. ntc NUMDER Concord,NewHampshire 03301 D(2) l

6. RADIOACTIVE MATE RIAL

7. CHEMICAL AND/OR PHYSICAL FORM

6. MAxlMUM AMOVNT OF RADIOACTIVITY WHICH UCENSEE MAY POSSESS AT ONE TIME l

(ELEMENT AND MASS NUMBER) f l

l

9. AUTHORIZED USE l

CONDITIONS In accordance with application dated April 10,1997, signed by R. Scott Shillaber, Vice President and Treasurer, New Hampshire Radioactive Material License No, 390R is herchy amended to extend the l

expiration date to that noted in Condition 4 nhove.

NEW H/NF4 HIRE OFFICE OF HEALTH MANAGEMENT BUREAU OF RADIOLOGICAL HEALTH m

DATE OF ISSUANCE Anrl! " 1007 k-.-

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r 2^$hhl'A'T

i JtfN-33-99 11:38 FROMs SANBoRN HEAD CONCORD HH ID: 180322B1919 PAGE 12 m.

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New Hampshire Division of Pubtle Heahh Serviced Es'

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Bureau of Radiological Health Ocense No. 390R S 'y f.7 d

Supplementary Sheet Amendment No. 5 Sanborn, Head & Associates,Inc.

6 Garvins Falls Road, Suite 1 Concord,New Ilampshire 03301-5174 In accordance with letter dated June 4,1996, signed by R. Scott Shillaber, P.E., Principal, New Ham Radioactive Material License No. 390R is hereby amended as follows:

Condition 13 changed to read:

13. Radioactive material shall be used only by Dennis A. Porter, Timothy C. Carnay, Jame Nerney or Matthew R. Poirier.

e New Hampshire Dwision of Public Heahh Services i

Bureau of Radiologicalllealth

/

i. m 4 Date ofIssuance Rentemb" 6_1996 Diane E. Tcfft Administrator

'JUN-35-C3 11 37 FROMs SANBoRN HEAD CONCORD NH ids 16332201919 PAGE 11 AUDIT R N 96121390R REF PAGEiof 1 PAGES

' FORM BRH-2B h

NEW HAMPSHIRE DIVISION OF PUBLIC HEALTH SERVICES BUREAU OF RADIOLOGICAL HEALTH RADIOACTIVE MATERIAL LICENSE Pursuant to tne New Hampshire Division of Pubic Health Services, Bureau of Radological Health regulabons and in reliance on statements and representations honetofore made by the licensee, a license is hereby issued authonzing the licensee to recewe, acquirv, own, possess and transfer radcactive material hated below; and to use such radioactwo matenal for the i

purpose (s) and at the place (s) designated below. This license is subject to all applicable rules. regulatens, and orders of the New Hampshre Ohnsion of Pubhc Health Services, Bureau of Radiological Health now or hereaner in effect and to any condibons speci5ed below.

UCENSEE

3. UCENSE NO.

390R. AmendmentNo.4 i.NAME Sanborn, Head & Associates,Inc.

'"^" "

June 30,1997

2. ADoREss 6 Garvins Falls Road Concord,NewHampshire 03301

s. FILE NUMBER

6. RADIOVTIVE MATERIAL

- 7. CHEMICAL ANoCR PHYSICAL FORM

8. MAXIMUM AMOUNT OF RAolOACTMTV WHICH UCENSEE MAY POSSE 55 AT ONE (ELPANT AND MASS NUMSER) nMe

s. AUTHoRizEo uss l

l CONDITIONS In accordance with application dated. April 19,1996, signed by R. Scott Shillaber, Vice President & Treasurer.

New Hampshire Radioactive Material License No. 390R is hereby amended to extend the expiration date to that noted in Condition 4 above.

NEW HAMPSHIRE DMslON OF PUBUC HEALTH SERVICES BUREAU OF lOLOGICAL HEALTH DATE OF l88uANCer Anrit in 1006

' a N _b wa-L

JUN-32-53 11 30 TROMs S.*.ND o R N HEAD CONCORD NH 3De 10532201D1D r' AG E D hti.,civtu StP 0 t 12 New flampshire Divkion af Pa,olic H1alth Services ran L,,r l. pass Bureau of Radiological Hemith l

1.iceme No. 390R Amendment No..J Sanborn, Head & Associates,Inc.

6 Garvins Falls Road, Suite i Concord, New Hampshire 03301 5174 In accordance with letter dated June 30,1995, signed by R. Scott Shillaber, P.E., Principal, New Hampshire Rndinactive Material License No. 390R is hereby amended as follows:

Condition 11 changed to read:

11. This license is subject to an annual fec. in accordance with Part fle P 4070, New Hanmaire lhic3Judhc fontrulaf Radiation (NHRCR), for the applicable amount specified in Table 4070.1 of that l' art.

1 Condition 12 changed to read:

l

12. The licen ce shall comply with the provisions of Parts He P 4001,4001,4019,4020,4021. 4022 on i 4023, NHRCR.

l Condition 13 changed to read; e

13. Radioactive material shall be used only by Dennis /. Porter, James A. Chabut, or 'limothy C. Carnfy.

Condition 23 to read.

l

23. Except as specifically provided otherwise by this license, the licensee shall powen and use the radiunctive material authnri7ed by this license in accordance with statements, representations, and procedures enntained in the documents, including any enclosures, listed as follows:

ppplication da'.ed November 19,1993 letters dated May 31,1994 November 8,1995 The New Hamnaire stules for the Control of Radistina shall prevail over the staternents, representations, ano procedures unless such statements, representations, and procedures are more restrictive than the Rules.

New Hampshire Division of Public Health Services...

Bureau of Radiological Health Date: Auaust 30.1995 emd

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Diane E. Tefft F "

Administrator l

NEW HAMPSHIRE fMVISION OF PUDUC Ht'ALTH $EMPCES BUAFAU OF IDLOGICAL HEALTH C

N

^ * * " ' " ##

DATE or 188uANCE _

DIANE E. TEFd h

unnusmuun I

JON-33-99 11 35 FROHe SANBORN HEAD CONCORD NH ID: 18232291919 PAGE 9 APR 271995 AULT R wa 95114390R REF

~ORM BRH 2B PAGE 1 of 1 PAGES c

NEW HAMPSHIRE DIVISION OF PUBLIC HEALTH SERVICES BURt.AU OF HAUlOLOGICAL HEALTH RADIOACTIVE MATERIAL LICENSE Pursuant to the New Hampshire DMsion of Public Health Sennces, Bureau of Radiological Health regulations and in r;liance on statements and representations heretofore made by the licensee, a license is hereby issued authorizing the licenses to receive. acquire, own, possess, and transfer radioactive material hsted below; and to use such radioactive material for the purpose (s) ind at the place (s) designated below. This license is subject to all applicable rules, regulations, and orders of the New Hampshire DMason of Public Health Se. vices, Bureau of Radiological Health now or hereafter in effect and to any conditions specified below.

WENSM

3. UCENSE NO. 390R, Amendment No. 2 Sanborn, Head & Associates, Inc.

,, w

4. EXPIRATION DATE June 30, 1996 6 Garvins Falls Road, Suite 1 Concord, New Hampshire 03301-

s. MLE NUMSER D (2) 5174

s. RADIOACTIVE MATERIAL

7. CHEMICAL AN0/OR PWSICAL FORM

s. MAXNUM AMOUNT OF (ELEMENT AND MASS NUMBER)

RAolOACTMTV WHICH UCIW5EE MAY POSSESS AT ONE TIME

)

s. AurHoruzzo uss CONDmONS j

In accordance with application dated April 20. 1995. signed by R. Scott Shillaber, Vice President. New Hampshire Radioactive Material License No. 390R is hereby amended to extend the expiration date to that noted in Condition 4 above.

NEW HAMPSHIRE DIVISION OF PUDUC HEALTH sfMVICES suREAu 0F RADIOLOGICAL HEALTH

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April 26. 1995 e,.m DATE OP issuANCr IMANE E. TEFFT-acmsmemAton i

JuN-3D-99 11:35 FROM SANDORN HEAD CONCORD NH ID: 16032291919 PAGE-7 JAN 051995 9

ew Hampshire Division of Public Health Services N

res. L or.L pas.

Bureau of Radiological Health Suppleinentary Sheet I,1cesse No. J00R Amendement No. _.l Sanborn, need & Associates, Inc.

6 Garvins Falla Road, Suite 1 concord, New Hampshire 03301-5174 In accordance with letter dated November 8, 1994, signed by Dennis R.

Porter,, Radiation Safety Officer and R. Scott Sh111aber, P.E.,

Principal, New Hampshire Radioactive Material License No. 390R is hereby amended as follows:

Condition 2 Address changed from:

125 North State Street, Suite 2 Concord, New Hampshire 03301 to:

6 Garvins Falls Road, Suite 1 Concord, New Hampahire 03301-5174 Condition 10 changed to read:

J0. Radioactive material may be stored only at the licensee's facility at 6 Garvins Falls Road, Concord, New Hampshire, and may be used at temporary job sites of the licenses throughout the state of New Hampshire.

Condition 23 to read

23. Except as specifically provided otherwise by this licenan, the licensee shall possess and use the radioactive material authorized by this license in accordance with statenients, representations, and procedures contained in the documents, including any enclosures, listed as follows:

application dated November 19, 1993 letters dated May 31, 1994 November 8, 1994 The New Mmenshire Rulen for the rennevol of RadIntinn shall prevail over the f

statementa, representations, and procedure;s unless such statements, representations, and procedures are more restrictive than the Rules.

New Hampshire Lvinion of Public Boalth Services Bureau of Radiological Health eb Dates la nna w 4-1995

f C Diane E. Tefft Administrator

I JdN-3e-99 11:33 FROMs SANBORN HEAD CONCORD NH ID: 18038291919 PAGE 4

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R wo AUDIT 94153390 FORM BRH 2B FIEF PAGE 1 of 3 PAGES NEW HAMPSHIRE DIVISION OF PUBLIC HEALTH SERVICES BUREAU OF RADIOLOGICAL HEALTH RADIOACTIVE MATERIAL LICENSE Pursuant to the New Hampshire Division of PetWe Hea'th Sr. hrs, Aum rif Radiological He hcenses to feceive, acquire, own, poJuea, and t.aussier radioa a liconte is hereby issued authorizing the material for the purpose (s) and at the place (s) designated below. This beense is subje and orders of the New Hampshire Division of Public He'llth Services, Bureau of Radiological He effect and to any conditions specified below.

UCENSEE

3. UCENSE NO.

39OR 1.NAME Sanborn, Head & Associates, Inc.

2. ADDnEss

4. EXPIRAT10N DATE June 30, 1995 i

125 North State Street, Suite 2 I

Concord, New Hampshire 03301 S FILE NUM8ER D(2)/III 6 HADloACTIVE MATERIAL tELEMENT AND MASS NUMBER)

7. CHEMICAL ANDtOR PHYSICAL FonM

8. MAXIMUM AMOUNT oF RAoloACTMTY WHICH UCENSEE MAY POSSESS AT ONE TIME A. Cesium 137 A. Sealed source (Troxler A. 9 millicuries Drawing No. A-102112)

I B. Americium 241: Beryllium B. Sealed source (Troxler B. 44 mil 11 curies Drawing No. A-102451)

9. AUTHORI2ED USE A.

and B.

To be used in a Troxler Model 3400 Series surfa-materials. gauge for use in measuring moisture and M. ay o;f constructionmolature/ density CONDITIOMs i

10. Radioactive material may be stored only at the licensee's facility at 125, North State street, Concord, New Hampshire, and may be med at temporary Job sites of the licensee throughout the state of New Hampsh c.re.

11. This license is subject to an annual fee in accordance with Part He-P 2070, New Masaneh i re Ruina for the cnntyn1 of Radiatinn_ (NHRCR), for the applicable amount specified in Table 2000.1 of that Part.

12. The licensee shall comply with the provisions of Parts He-P 2003, 2021, 2022, and 2023, NHRCR.

2019, 2020, NEW HAMP5 HIRE DM$loN OF PueUC HFALTH SERVICES SUREAu OF MADIOLOGICAL HEALTH DATE OF ISSUANCE Mun= 7 i tl e a

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F tre DIANE E. TEFFT mones.orwon

JUN 3D-99 11 33 FRoMe SANDORN HEAD CONCORD NH ID: 1G332291919 PAGE 5

New Ilampshire Division of Public Health Services rw l dieno Bureau of Radiological IIealth Supplementary Sheet License No. 390_n_

13. Radioactive material shall be used only by Dennis R. Porter or James A.

Chabot.

14 The individual designated to perform the duties and functions of Radiation Safety Officer (RSO) for activities covered by this license 18 Dennin R.

Porter.

15.A. Each sealed source containing radioactive material other than Hydrogen 3, with a half-life greater than 30 days and in any form other than gas, shall be tested for leakage and/or contamination at intervals not to exceed six months.

In the absence of a certificate from a transforor indicating that a test has been made within six months prior to the transfer, the sealed source shall not be put into use until tested.

B. The test shall be capable of detecting the presence of 0.005 microcurie of radioactive material on the test sample.

The test sample shall be taken from the sealed source or from the surf aces of the device in which the sealed source is permanently mounted or stored on which one might expect contamination to accumulate.

Records of leak test results shall be kept in units of microcuries and maintained for inspection by the Dureau of Radiological Health (the Bureau).

I C. If the test reveals the presence of 0.005 microcurie or more of removable contamination, the licensee shall immediately withdraw the sealed source from use and shall cause it to be decontaminated and repaired or to be disposed of in accordance with the NHRCR.

A report shall be filed within five daya of the test with the Dureau of Radiological Health, Health &

Welfare Ruilding, 6 Ha2en Drive, Concord, NH 03301-6527, doncribing the equipment involved, the test results, and the corrective action taken.

D. The licensee is authorized to collect leak test samples in accordance with the procedures described in the licensco'n Leak Test Information attachment to letter dated May 31, 1994, for analysis by Troxler Electronics Laboratorico, Inc.

Alternatively, tests for laakaga and/or evntamiaulion (leak test sample collection and analysis) shall be performed by persons specifically licensed by the Bureau, the U.S. Nuclear Regulatory Commission or an Agreement State to perform such service.

16. Sealed sources containing radioactive material shall not be opened or removed from the gauges by the licensee.

17. Maintenance or repair of portable devices involving removal of scaled sources from the device or removal or dismantling of shielding may be performed only by the device manufacturer or by other persons specifically authorized by the Bureau, the NRC or an Agreement State to perform such services.

18. The licensee shall conduct a physical inventory every six (6) conths to account for all licenced devices received and possessed under the license.

The records of the inventories shall be maintained for two (2) years from the datc of the inventory for inspection by the Bureau, and shall include the quantities and kinds of radioactive material, location of sealed sources, and the date of the inventory.

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JUN "T3-99 11:34 FROM S/4N!oRN HEAD CONCORD NH ID: 18332291919 PACE 6 New Hampshire Division of Public Health Services i>.se _L..t.L pesa Bureau of Radiological llealth Supplementary Sheet License No.

390R

19. Each portable nuclear gauge shall have a lock or outer locked container designed to prevent unauthorized or accidental removal of the sealed source from its shielded position.

The gauge or its container shall be locked when in transport or when not under the direct survei' lance of an authorized user.

70. The licensee shall maintain a daily utilization log for the device listed in Condition 9 at the facility address specified in condition 1.

The log shall include the name of the authorized user with the device, the place of intended use, and the date the device was removed and returned to storage.

21. The licensee who uses a gauging device for testing at field sites shall possess at auch locations a current copy of the license, the current leak test certificate and the licensee's operating and emergency procedures.

22. The licensee may transport licensed material or deliver licensed material to a carrier for transport, in accordance with the provisions of Section fle-P 2037.05, N!!RCR.

23. Except as specifically provided otherwise by this license, the licensee chall possess and use the radioactive material authorized by this license in accordance with statements, representations, and procedures contained in the documents, including any enclosures, listed as followas application dated November 19, 1993 letter dated May 31, 1994 The New Hamnshire Rulen for ths.__ control of Radiation shall prevail over the statements, representations, and procedures unless such statements, representations, and procedures are more restrictive than the Rules.

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