ML20248G918
| ML20248G918 | |
| Person / Time | |
|---|---|
| Site: | 03034741 |
| Issue date: | 05/18/1998 |
| From: | Prange B NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION IV) |
| To: | |
| References | |
| 50-29121-01, 50-29121-1, 572666, NUDOCS 9806050392 | |
| Download: ML20248G918 (22) | |
See also: IR 05000291/2021001
Text
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i NRC FORM 374 .
PAGE 1 OF 5 fAGEs
U.s. NUCLEAR REGULATORY CoMMisslord
MATERIALS LICENSE
Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93-438), and Title 10
Cod 3 of Federal Regulation., Chapter 1. Parts 30,31,32,33,34,35,36,39,40, and 70, and in reliance on statements and
orpr:sentations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess, and
transfer byproduct, source, and special nuclear material designated below; to use such material for the purpose (s) and at the place (s)
d:signated below; to deliver or trLisfer such material to persons authorized to receive it in accordance with the regulations of the
applicable Part(s). This license shall be deemed to contain the conditions specif,ad in Section 183 of the Atomic Energy Act of 1954,
as amended, and is subject to all applicable rules, regulations, and orders of the Nuclear Regulatory Commission now or hereafter in
siirct and to any conditions specified below.
Licensee l
1. Terra Firma Inc. 3. License number 50 29121-01
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2. 8801 Rendon Drive -
4. Expiration date May 31,2008
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Anchorage, Alaska 99507 p, 5. Docket No. 030-34741
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Reference No.
6. Byproduct, source, and/or special ,~ 8f Maximum amount that licensee may
nuclear material (7. Chemical and/or physical form possess at any one time under this
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y _ license
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A. Americium-241 A. Cealed neutron sCurces A. Not to exceed 100 millicuries
Amersham Corporation: J per source
, ;; Model AMNV.340 -
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B. Americium-241 .
- B. ' Sealed neutron sources , ~ B Not to exceed 300 millicur
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C- Amersham Corporation;.- ' , per source
E ' Model AMNV 339afi r"
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C. Not to exceed 10 millicuries
C. Cesium-137 '/ C. Sealed sources * W
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Amersham CorporaIon
Model CDCW556 or
f* per source
'
isotope Products
Laboratories Model
HEG-0057
! D. Americium-241 D. Scaled neutron sources D. Not to exceed 50 millicuries
9 Amersham Corporation per source
I Model AMNV.997 or
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isotope Products
Laboratories Mode!
HEG-0058
5. Cesium-137 E. Sealed sources E. Not to exceed 10 millicuries
j Amersham Corporation per source
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- - Model CDCW556 or
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isotope Products Model
HEG-137-8M C)
9806050392 980518
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PDR ADOCK 03034741
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i NRC FORM 374A U.s. NUCLEAR RE*1ULAToRY Commission PAGE 2 of 5 PAGEs
Ucense Number
, 50-29121-01
Docket or Reference Number
! MATERIALS LICENSE
SUPPLEMENTARY SHEET 030-34741
!
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9. Authorized use
l
l A. To be used in portable Troxler Electronic Laboratories, Inc. Model 3241-G, asphalt content gauging
l devices to measure properties of construction materials.
, 2 A. or B. To be e *od in portable Troxler Electronic Laboratories, Inc. Model 3241-C, asphalt content
'
i gauging devices to measure properties of construction mshists.
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C. and D. For use in portable Troxter Electronics Laboratories, Inc. Model 3400 Series gauging
devices for measuririg properties of construction materials.
E. For use in portable Troxier Electronic Laboratories, Inc. Model 4 448 thin layer density gauges to
/
measure properties oi con,struction materials. 7-
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10. Licensed material may be used or stored at the licensee's facilities located at 8801 Rendon Drive,
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l Anchorage, Alash and may be'used at temporary job ' sites of the licensee lanywhere in the United States
l where the U.S. Nuclear Regulatory Commission maintains jurisdiction for regulating the use of licensed
material, including areas of exclusive federal jurisdiction within' Agreement States.
1[a .t.; 7 K ' iS .Cg
If the jurisdiction status of a federal agency within an Agreem.ent State is unknown, the licansee should
contact the federal agency c~ontrolling the job site.in question to determine whether the proposed job site
is an area of exclusive federaljurisdiction. Auth6rization for use of' radioactive' materials at job sites in
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Agreement States not under exclusive federal jurisdiction shall be obtained from the appropriate state
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regulatory agency. <
11. A. Licensed material shall only be used by, or under the supervision and in the physical presence of,
Ron J. P. Caron, Tamara Selmer, or individuals who have received the training described in
application dated May 5,1998.
B. The Radiation Safety Officer for this license is Ron J.P. Caron.
12. A. Sealed sources shall be tested for leakage and/or contamination at intervals not to axceed 6 months
or at se u other intervals as specified by the certificate of registration referred to in 10 CFR 32.210 or
by an Agreement State.
B. In the absence of a certificate from a transferor indicating that a leak test has been made within the
intervals specified in the certificate of registration issued by the NRC under 10 CFR 32.210 or by an
Agreement State prior to the transfer, a sealed source or detector cell received from another person
shall not be put into use until tested.
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. NRC FORM 374A u.s. NUCLEAR REGULATORY Commission PAGE 3 of 5 PAGES
Licenso Number
50-29121-01
Docket or Reference Number
MATERIALS LICENSE
SUPPLEMLWTARY SHEET
030-34741
!
12. (Continued)
C. Sealed sources need not be tested if they are in storage, and are not being used. However, when
they are removed from storage for use of 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
shall be stored for a period of more than 10 years without being tested for leakage and/or
contamination. ,.
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D. 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 Dri<e, 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. y -
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E. Tests for leakage and/or contamination shall be performed by persons specifically licensed b'y the
Commission or an Agreement State to perform such services, in addition, the licensee is authorized
to collect leak test samples but not perform the analysis; analysis of leak test samples must be
performed by persons specifically licensed by the Commission or an Agreement State to perform
'
such services.
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13. Sealed sources or sourco rods containing licensed" material shall not be opene'd or sources removed or
detached from source rods or gauges by the licensee, except as specifically authorized.
.
14. The licensee shall conduct a physical inventory every 6 months, or at other interval spproved by NRC, to
account for all sources and/or devices received and possessed under the license.
15. Each portable 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 must be
locked when in transport, storage, or when not under the direct surveillance of an authorized user.
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NRC FORM 374A U.s. NUCLEAR REGULATORY CoMMtssioN PAGE 4 of 5 PAGEs
l
Licenn Number
50-29121-01
Docket or Reference Number
MATERIALS LICENSE
SUPPLEMENTARY SHEET 030-34741
.
16. Except for maintaining labeling as required by 10 CFR Part 20 or 71, the licensee shall obtain
authorization from NRC before making any changes in the sealed source, device, or source-device
combination that would alter the description or specifications as indicated in the respective Certificates of
Registration issued either by the Commission pursuant to 10 CFR 32.210 or by an Agreement State.
17. Any cleaNng, maintenance, or repair of the gauges that requires detaching the source or source rod from
the gauge shall be performed only by the manufacturer or by other persons specifically licensed by the
~
Commission or an Agreement State to perform such services. s
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18. The licensee is authorized td trdnsport licensed material only in accordance with the provisions of 10 CFR
Part 71," Packaging and Transportation of Radioactive Material." 1J
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19. A. If the licensee uses unshieiUed sealed sources extended more than 3 feet below the surface, the i
licensee shall use surface casing that extends.from the lowest depth to 12 inches above the surface l
l
and other appropriate procedures to reduce the probability of the source or probe becoming lodged
below the surface. .lf it is not feasible to extend the casing 12 inches above the surface, the licensee
~
shallimplement procedures to ensure that the' cased hole is free of obstruction before making
measurements. ' r 4.1 3 c, X- T . d,~
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B. If a sealed source or a probe containing sealed so'urces becomes lodged below the surface and it
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becomes apparen, that effor's' t to recover the sealed source or probe may not be successful, the
licensee shall notify the U. S. Nuclear Regulatory _Comm,ission and submit the report required by
10 CFR 30.50(b)(2) and (c). The licensee shall not abandon the sealed source or probe without
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obtaining the Commission's prior written codie'nt. C .
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20. In addition to the possession limits in item 8, the licerisee 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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, NRC FORM 374A U.s. NUCLEAR RESULAToRY Commission PAGE 5 of 5 PAGES
License Number
l 50-29121 01
MATERIALS LICENSE Docket or Reference Number
SUPPLEMENTARY SHEET 030-34741
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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 govern unless the
statements, representations, and procedures in the licensee's application and correspondence are more
restrictive than the regulations.
. ~c,.
A. Application dated May 5,1998 . -
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B. Telefacsimile dated May 15,1998 ,
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FOR THE U.S. NUCLEAR REGULATORY COMMISSION
MAY 18 35
NMIC7 NT&cdE.
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D:te By
Beth A. Prange
Materials Branch
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Region IV, WCFO
Walnut Creek, California 94596
__ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ - _ _ _ _ _ - _ _ _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ - _ _ _ ~
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, INFORMATION FROM LTS
BETWEEN: .
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License Fee Management Branch. ARM Proytam Code:
and Status Code: 3 >
Regional Licensing Sections .
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. Fee Comments:
Decom Fin. .
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LICENSE FEE TRt.NSMITTA'.
A. REGION LO C F 0
1. APPLICATION ATTACHED
Applicant / Licensee: TERRA FIRMA INC.
Received Date: 980512
Docket No: 3034741
Control No. 572666
License No.
Action Type: New Licensee
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Check No.,
3. COMMENTS
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B. LICENSE FEE MANAGEMENT BRANCH (Check when milestone 03 is entered / /)
Fee Category and Amount: 3 7ID
1rrect Fee Paid. Application may be processed for:
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UNITED STATES
NUCLEAR REIULATORY COMMISSION
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je REGION IV
k Walnut Creek Field Office
1450 Maria Lane, Suite 3oo
9 ,,,,,
Walnut Creek. California 94596-5368
May 18,1998
Terra Firma Inc.
ATTN: Tamara Selmer
Vice President
8801 Rendon Drive
Anchorage, Alaska 99507
SUBJECT: NEW LICENSE
Please find enclosed License No. 50-29121-01. You sheuld review this license carefully and be
sure that you unden>tand all conditions. If you have any questions, you may contact the
reviewer who signed your license at (925) 975-0250.
The NRC is required to have your Taxpayer identification Number in order to make payments
(refunds). The self-addressed, stamped NRC Form 531, " Request for Taxpayer Identification
.
Number"is enclosed. ,
l
NRC expects lic9nsees to conduct their programs with meticulous attention to deteil 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. Operata 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 Agains' Radiation," and other applicable regulations.
2. Possess radioactive material only in i>J quantity and form indicated in your license.
3. Use radioactive material only for the purpose (s) indicated in your license. ,
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4. Notify NRC in writing of any change in mailing address (no fee required if the location of j
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l radioactive material remains the same).
5. Request and obtain written NRC consent before transferring your licanse or any right
thereunder, either voluntarily or involuntary!y, directly or indirectly, through transfer of
control of your license to any person ci entity. A transfer of control of your license
includes not only a total change of ownership, but also a change in the control'ing
interest in your company whether it is a corporation, partnership, or other entity. In
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Terra Firma Inc. -2-
addition, appro;date license amendmerts must be requested and obtained for any other
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 fee-exempt category.
6. Maintain in a single document decommissioning records that have been certified for
completeness and accuracy listing all the following items applicable to the license:
- Onsite areas designated or formerly designated as restricted areas as defined in
10 CFR 20.3(a)(14) or 20.1003.
- 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,
equipment, or site have occurred that required reporting pursuant to 10 CFR
30.50(b)(1) or (b)(4), including areas where subsequent cleanup procedures
,
have removed the contamination.
- Specific locations and radionuclides 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 involyed in licensed
operations that is to remain onsite after license termination. '
7. Submit a complete renewal application with proper fee, 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. J
8. Request termination of yourlicense if you plan to permanently discontinue activities
involving radioactive material.
You will be periodica4y inspected by NRC. Failure to conduct your program in accordance with
NRC regulations, license conditions, and representations made in your license application and
-
suppiemantal correspondence with NRC will result in enforcement action against you. This
could include issuance of a notice of violation; impositicn of a civil penSty; or an order
suspending, modifying, or revoking your license as specified in the "Goeral Statement of
Policy and Procedure for NRC Enforcernent Actions"(Enforcement Policy), NUREG 1600.
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Terra FPrna Inc. -3-
Also enclosed, please find the NRC letter dated July 12,1995, to all materials licensees which
transmits the NRC Policy on Communications Between the NRC and Licensees. It is the intent
of this policy to foster greater openness and candid communications and to improve
interactions with our licensees. We encourage you and your staff to become familiar with these
principles so that we can maintain a high level of professional communication at all levels in our
organizations.
Thank you for your cooperation.
Sincerely,
0
&aca.7m
'
Beth A. Prange
Sr. Health Physicist (Licensing)
Materials Branch
Docket: 030-34741 i
License: 50-29121-01
Control: 572666
Enclosures: As stated
cc: State of AK
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Terra Firma Inc. -4-
bec:
LFARB, T-9, E-10
WCFO Inspection File
Docket File
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DOCUMENT NAME: G:\Beth\572666
To receive copy of document, indicate in box:"C" = Copy without enclosures "E" = Copy with enclosures "N" = No copy
RIV:MB M
BPrange bQf
6 ATl98
OFFICIAL RECORD COPY
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NAY-15-90 00:47 n ti p. , g g
Terra Fi a Inc
8801 Ren e on Drive {
Ak 99507
Anchoraq'
Ph (907) 3 45934 ~
,
Fax (907) 3445934
l
. . . . ._ . ._ ____ _ .
To Ms. Beth Prango From Ron J.P. Caron
Pam (925)97M)381 Pagee: 1 1
Phone: (925)975-02$0 note: 05/16/98 l
Ite: NRC Uca>nse Applicabon CC:
X Urgent X ror Review O Please Comment O please neply O Please stocycle
Esth
Sorry streut the confbalen, we will not be vaing Trexler Modelo SMM and 3430-M with the
Cf 292 eewrees. Our application submittal was latended to use geppes with Am and Ce
soureen only.
I greatly appreciate your personal attention in et pediting our application.
K further Irdermetten le regelred, please de not hooltate k contact me.
JO L ---
Men J.F. Caron
Freeldent
. _ _ _ _ _ - _ - _ _ _ _ - - _ _ _ _ - _ _ _ _ _ _ _ _ _
DATE
U.S. NUCLEAR REGULATORY COMMISSION -
tim
78ME
- TELECOPIER TRANSMITTAL
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WARNING:
lAost taesimile machines produce copies on thermal paper. The image produced is highly
l' unstable and will deteriorate significantly in a few years. Reproduce copies onto plain paper prior to f
a record. {
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TELEPHONE
NAME
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NAME AND LOCATION OF COMPANY (# other than NRC)
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NUMBER OF PAGES
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SPECIAL! INSTRUCTIONS
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DISPOSITION OF ORIGINAL
PROBLEMS
i After telecopy has been sent, process the origina3 as requested
If any problems occur or if you do not receive aff the pages, ca!!: below. Lif none am checired, the original wlR be eftscarded)__
RETURN TO SENDER
CALL AND SENDER W!LL PICK UP
TELEPHONE
DISCARD
VERIFIED BY (INITIALS)
PROCESSED BY (INITIALS)
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3AO FoW 366 (12-523
_--- __ _ __ _
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4
j#nen%& UNITED STATES
[b
g NUCLEAR RESULATORY COMMISSION
g j REGION IV
- Walnut Creek Field Office
b ,,,,, 1450 Maria Lene, Suite 3oo
Walnut Creek, California 94596-5368
MAY 12 3
Terra Firma Inc.
ATTN: Tamara Selmer '
Vice President
8801 Renden Drive ,
Anchorage, Alaska 99507 )
SUBJECT: ACKNOWLEDGMENT OF REQUEST FOR LICENSING ACTION
REFERENCE: Application dated May 5,1998
We have completed the administrative review and initial processing of your application
for a new license. ,
Please note that the technical review may identify additional omissions in the submitted
information or technical issues that require additional infomiation.
Applications for new licerises are normally processed within 90 days, unless the technical review
identifies:
. Major technical deficiencies
. P.olicy issues that require input and coordination with other NRC Regional offices,
Agreement State offices, or NRC's Office of Nuclear Materials and Safeguards
A copy of your correspondence has been forwarded to our License Fee an'd Accounts Receivable
Branch, Office of the Controller, who will contact you separately if the appryriate license fee has f
not been submitted for your request, or for billing if your request is subject to full cost recovery. I
Any correspondence about this application should reference the Control number listed below.
Sincerely,
~hiAfRJ '
Beth A. Prange
Sr. Health Physicist (Licensing)
Materials Branch
Control No. 572666
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Terra Firma Inc. -2-
]
bec:
Docket File 4
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G:\ 572669.aki
To receive a copy of this document, indicate in the box "C"- Copy without attachment / enclosure
"E"- Copy with attachment / enclosure "N"- No Copy
OFFICE RIV:WCFQ'.MB b
NAME J. Garci B. Prange 8[
lDATE- ,
h2/98 O 6//2/98
.- - -- -- -- -- -_- . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _ _ - - _ _ - - - - - _ - __-
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TERRA FIRMA INC.
- _ _ . _ _ _ _ _ _ _ _ . _ _ _ _
LaForatory Testing & Constmction Monitoring Services
May 5,1998
Nuclear Materials Licensing Section
U.S. Nuclear Regulatory Commission, Region IV
811 Ryan Plaza Drive, Suite 400
Arlington, Texas 76011-8064 4
I
Attention: Ms. Beth Prange
l
Subject: New License Apphcation
!
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Dear Ms. Prange:
Terra Finna Inc. is submitting two copies of the Application For Material License for your
immediate review. We are a soils laboratory and construction monitoring company operating in
the State of Alaska. As part ofour construction monitoring services we anticipate purchasing five 4
(five) Troxler nuclear densometers used in measuring physical properties of materials, I
specifically, soils and asphalt. The manufacturer models may be any one of the following:
Model 3241
Model Series 3400 (inclusive of all model numbers)
Model 4640B l
!
The attached Conns are from the NUREG-1556, Vol. I booklet and we trust the information
enclosed is in the proper order. Al.;o enclosed is a check for $750.00 for the license fee. Please
do not hesitate to contact either Ron Caron or the undersigned at (907) 344-5934 if you have any
questions or require further information. !
Sincerely, '1 I
TERRA FIRMA INC. 7
4
.
7
%% W '
Tamara Selmer ., i
Vice President ]
_
Encl.
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t
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l 5 22 @
880l Rendon Drive * Anchorage, Alaska 99507 * Phone: 907-344-5934 * Fax: 907-344-5934 * terrafirWalaska. net
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
r ,
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NRC FORM 313 . Appandix A
(748) U. 5. NUCLEAR REGULATORY COMMisseON APPROVED Y 0118: NO. 818NH30
EAPIRES: Te13e
10 CFR 30. 32,23
34, M 30, 3t ang 40 Esemmed bureen per reasones to sempy weh se ardermanen sessene n
mouest T hows. Submfeel el to esoteesen a neesseery le eedomwietWe
pie oosheens e emeses and eiet esseuses psomosume meet le pream e si
-
pubhc homen ene esseny Forward sammente ugereisig bureen asemmle h
the informonen and Romern
,
I
APPLICATION FOR MATERIAL LICENSE "*"a c-a*== * e Monocement fbaneh (T4 F33), U S. Nuelse r
a'aaa oc - '"w = **=--*
Resueten Piesent Ot940120). Olhes of Management see Budgel
Weenagem. DC 20001. NRC may not sensuet er egenser, and a poseen se
not noeuwed to mesend to. e esenaten er : __ untene a employe e
ousney vehe OMS sensel number
INSTRUCTIONS:
SEND TWO COPIES OF EEE THETHE ENTIRE APPROPRIATE
COMPLETED APPLICATION LICENSE APPUCATION TO THE NRC OFFICE GUIDE F
SPECI
APPUCAflood POR DISTsuSUTION OF EXEeIPT PRODUCTS FLE APPUCATIONS WITH:
IP YOU ARE LOCATEJ IIt:
DIVISION OF INDUSTRIAL AND MEDICAL NUCLEAP W
OPPICE OF NUCLEAR MATERIALS SAFETY AND & COUARDS ILLasOIS, ledOaANA IOWA SAICHIGAN. BNetNESOTA M$80URI, OHIO, Ost W'erm
U $ NUCLEAR REOULATOftY PfWam88'Nd SENO APPUCATIOest 70-
WASHINGTON. OC 20506 4001
MAMRIALS UCENSNQ SECTION
ALL OTHER PERSOest FILE APPUCATIONS A8 POLLOWS
U S. NUCLEAR REGULATORY COMMISSION. REGION B
F YOU ARE LOCATED m: 801 WARRENVLLE RD.
URLE,L 806324361
OOessetCTICUT, DELAWARE, DISTItiCT OF COLualSA IIAME, eAARYLANO,
htASSACMUSETTS, esEW MAmoreHNts, esEW JERSEY, ffEW YORK, PEstNSYLVANLA, ALASMA **"* ARRAe8SAS, CAUPOftedlA, COLORADO, MAWAN, CANO. KANSA
RMOOE ISLANO, oft 44880887, SEsfD APPUCAfsDNS TO: LOUmlAMA, teOesTANA NEARASMA edEVADA,9 DEW RIEJUCO. NORTM DAKOTA,
UCENSING ASSISTANTSECTION
OKLAHOGAA, OREGON, PACIPic TRUST TERft!TO8tES, SOUTH DAs OTA, TEKAS
WASHINGTOed, Oft WTOeflNG, SENO APPLICATIOees TO:
NUCLEAft MATERIALS SAFETY BRANCH
U S NUCLEAR REOULATORYema***r'W REGION 1 .
N'JCLEAR MATERIALS LCENSING SECTION
47$ ALLENDALE ROAD
U S NUCLEAR REQULATORY COMM6 MON. REGION IV
10NG OF P0tVSSIA. PA 1940E 1415 011 RYAN PLAZA DRIVE. SurrE 400
ARLNGTON. TX 780114064
m masa FLORIDA,0E08104A, KENTUCMY, MatteSSIPP1,80014TH CAROUNA PUERTO
RIOO. SOUTH CAROLMA, TENNESSEE, VIROINLA, vist08N ISLANOS 04 WEST VWt04NIA,
GENO APPUCAfsDe88 70;
NUCLEAR MATERIALS LICENSING SECTION
U & NUCLEAR REGULATOftY r.mmman". REGION N
101 MARIETTA STREET. NW. SulTE 200
ATLANTA, GA 30323 4100
PgsteOest LOCATED IN 'a**'*88*87 STATES SENO APPUCATIONS TO THE U.S. NUCLEAR REGULATORY OOeMstSSION O
SAATERIAL M STATES SUBJECT TO U.S. NUCLEAR REOULATOftY haa***" JustiSDICTIONS SS AND USE UCEssSED
1.
Tvet b8 AN APPUCATION FOft (CAose n ~ seem) 2
TA
~
NEW uCENSE NAME AND MALNG ADORESW ANAM W&M
B AMENDMENT TO UCENSE NUMeER Terra Firma Inc.
]C RENEWAL OF LCENSE NUMPER 8801 Rendon Drive
Anchorage, Alaska 99507
ADOREsS(ES) WHERE UCENSED MATEmAL WLL BE USED OR primesmem
4
NAME OF PEPVIN TO BE CONTACTED ABOUT THIS
Motste-Density Por1able gauges wdl be stonsd at 8801 Rendon Dnve, APPUCATION
Anchorage, Alaska,99507. Gauges mil be dispatched from 8801 Rendon Ron J.P. Caron
Dnve and used only at ternparary Job snes for itmited penods of time for the
purpose of mensunng physical properties of rnatenals (sods and/or asphal" TELem NuMaER
M01) 394-5934
SUBMff
8 RAD'OACTTVE ffEMS
MAfr hAL. S THROUGH 11 ON &1/2 X 11" PAPER THE TYPE AND SCOPE OF INFORMATION _
.
e Element one mese number D. Chomscal enerer physsel almn, and s mammum amount
ween .m mees.amessienyoneame S
PURPOSE (S) FOR WMCH UCENSED MATERIAL WILL BE USED.
T.
INOMDUAL(S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND ThaR
TltAINHO EXPEftfENCE.
p
e FACLfDES AND EQUIPMENT l
10. RADIATION SAFETY PROGRAM
ti. WASTE MANAGEMENT in UCENSEE FEES (see 90CFR f10mc h-,- 11031)
FEE CATEoORY P
13. CERTIFICATION. (eduef to - @O1 $750.00
UPON THE APPUCANT TeF . - , THE APPUCAP(IUNDERSTANDSTHAT ALL STATEMENTS AND REPRES6NTATIONS MADE N THa8 APPUC
THE APPUCANT AND ANY OFFICIAL EXECUTNG THtt CERTIFICATION ON BEHALF OF THE APPUCANT, NAMED W
CossFORMrrY WTTH TTTLE 10. CODE OF FEDERAL REGULATIONS. PARTS PC. 32. 73. 34 alk 3
CoststECT TO THE BEST OF THElft KNOWLEDGE AND DEUEF.
WARpeNQ 18 U S C. SECTION 1001 ACT OFJUNE 261844 02 STAT T40 MAMES ff A CftlMN/.c DFFENSE N
ANY DEPARTMErff OR AGENCYOF THE UNrTED STATES AS TO ANY MATTER WfTHW FTS JUR 8DICTICIfg,
TOO MAKE A WILL
! _ _ _
CaRTIFYING OFFCER - TYPE 7PRWTED NAME AND TTrL
)
! hcpOsu,tE7i l -
EI- DATE
WS/D
TYPE aF ,EE PEE loo
FOR NRC U6E ONLY
FEECaTEoORY l ~~ wT p ECErvED CHECuNuMSER COMueN'S
}s
APPROVEosv
oATE
NftC fores 313 (T40)
Page A-1 PRIMTED ON RECYCLEO PAPER
NUREG - 1556. Vol.1
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APPENDIX B
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ITEMS 5 & 6: MATERIALS TO BE POSSESSED AND PROPOSED
'
USES
YES j NO RADIOISOTOPE MANUFACTURER / QUANTITY MOST SPECIFY
MODEL NO. COMMON USE OTIIER USES
i NOT LISTED
ON SSD
CERTIFICATE
Cesium-137 Scaled sources in Not to exceed Measure Physical [ ] Not apphcable
'y compatible gauges as maximum activity Properties of
specified in Scaled per source as Materials t ] Uses are:
Source and Device specified in Scaled
Registration Sheet Source and Device
Registration Sheet
Americium-241 Scaled neutron sources Not to exceed Measure Physical [ ] Not applicable
in compatible gauges as maximum activity Properties of
X specified in Scaled per source as Materials [ ] Uses are:
'
Source and Device specifie.1 in Scaled
Registration Sheet Source and Device
Registration Sheet
Califormum-252 Scaled neutron sources Not to exceed Measure Physical [ ] Not apphcable
in compatible gauges as maximum activity Properties of
i specified in Scaled per source as Materials
y Source and Device specified in Scaled
[] Uses are:
Registration Sheet Source and Device
Registration Sheet
Other (specity)
FINANCIAL ASSURANCE REQUIRED AND EVIDENCE OF FINANCIAL ASSURANCE PROVIDED
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Page B-1 NUREG - 15 56, Vol. I
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APPENDIX B ,
ITEMS 7 THROUGH 11: TRAINING AND EXPERIENCE, FACILITIES
AND EQUIPMENT, RADIATION SAFETY PROGRAM,
AND WASTE DISPOSAL
ITEM NO. AND TITLE SUGGESTED RESPONSE YES ALTERNATIVE ,
'
PROCEDURES
ATTACHED i
7. INDIVIDUAL (S)
RESPONSIBLE FOR
Before obtainmg licensed materials, the proposed RSO will have [] {j
successfully completed one of the training courses described in
RADIATION SAFETY Criteria in the section entitled " Individual (s) Responsible for
PROGRAM AND x
Radiation Safety Program and Their Training and Experience -
THEIR TRAINING Radiation Safety Officer" in NUREG-1556, Vol.1, dated May l
AND EXPERIENCE. 1997.
RADIATION SAFETY AND
OFFICER Before being named as the RSO, future RSOs will have
successfully completed one of the training courses described in
Name: Criteria in the section entitled " Individual (s) Responsible for
Ron J.P. Caron Radiation Safety Program and Their Trainmg and Experience -
Radiation Safety Officer"in NUREG-1556. Vol.1. May 1997.
8. TRAINING FOR Before usmg hcensed matenals, authonzed users will have
INDIVIDUALS
[] []
successfully completed one of the training courses described in X
WORKING IN OR Criteria in the section entitled " Training for Individuals Working
FREQUENTING In or Frequenting Restricted Areas"in NUREG-1556, Vol. I,
RESTRICTED AREAS dated May 1997.
9. FACILITIES AND No information needs to be submitted m response to this item; Separate item 9 Response
EQUIPMENT key issues are addressed under " Radiation Safety Program - Need Not Be Submitted
Public Dose" and " Radiation Safety Prograin - Operating and With Application
Emergency Procedures",
j
10. RADIATION SAFETY The apphcant is ngl required to, and should not, submit its audit Need Not Be Submitted
PROGRAM - AUDIT program to the NRC for review during the licensing phase. With Application
PROGRAM
10. RADIATION SAFETY The apphcant is nDI required to submit a response to the Need Not Be Submitted
PROGRAM - termination of activities section during the initial application. With Application
TERMINATION OF However, when the license expires or at the time the licensee
ACTIVITIES teases operations. FRC Form 3R must be submitted.
10. RADIATION SAFETY We will either possess and use, or have access to and use, a
PROGRAM - SURVEY radiation survey meter that meets the Criteria in the section [{
-
[]
INSTRUMENTS entitled Radiation Safety Program - Instruments" in NUREG-
1556. Vol.1. dated May 1997. in the event of an incident.
10. RADIATION SAFETY Physical inventories will be conducted at intervals not to exceed
PROGRAM -
[] [}
6 months, to account for all sealed sources and devices received
MATERIAL RECEIPT and possessed ur der the license. X
AND
ACCOUNTABILITY
10. RADIATION SAFETY Either we will maintam, for mspection by NRC, documentation
PROGRAM -
[] []
demonstrating that unmonitored individuals are not likely to
OCCUPATIONAL receive a radiation dose in excess of 10% of the allowable limits X
DOSIMETRY in 10 CFR Part 20 or we will provide dosimetry processed and
evaluated by a NVIAP-approved processor that is exchanged at
a frequency recommended by the processor.
10. RADIATION SAFETY The applicant is nol required to submit a response to the public Need Not Be Submitted
PROGRAM - PUBLIC dose section during the licensing phase. This matter will be With Application
DOSE examined during an inspection.
NUREG - 1556, Vol.1 Page B-2
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APPENDIX B
l
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- ITEM NO. AND IIILE SUGGESTED RESPONSE YES ALTERNATIVE
l PROCEDURES
A'ITACHED
10. RAulATION SAFETY We will implement and maintain the operating and [] []
I PROGRAM - emergency procedures in Appendir H of NUREG-1556, X
'
OPERATING & Vol.1, dated May 1997, and provide copies of these
'
G
g procedures to all gauge users and at each job site.
OR gj
Operating and emergency procedures will be developed.
implemented, and maintained and will meet the criteria in l
the section entitled " Radiation Safety Program - Operating
and Emergency Procedures" in NUREG-1556, Vol. I,
dated May 1997.
i 10. RADIATION SAFETY Leak tests will be performed at inte Yals approved by the [] []
[ PROGRAM - LEAK NRC or an Agreement State and specified in the Sealed The information in
X
l TEST Source and Device Registration Sheet. Leak tests will be #Pendix J
' supporting a
performed by an organization authorized bv NRC or an
Agreement State to provide leak testing seEvices for other Ped
licensees or using a leak test kit supplied by an
Qu _d
,,,p , ,,,g y ,g, g,
g
organization authorized by NRC or an Agreement State to attached.
provide leak test kits to other licensees and according to
the kit supplier's instructions.
10. RADIATION SAFETY ROUTINE C1 EANING & LUBRICATION
PROGRAM -
MAINTENANCE We will implement and maintain procedures for routine U II
maintenance of our gauges according to each
manufacturer's recommendations and inst:uctions.
NON-ROUTINE MAINTENANCE . [q
'
[]
The information
We will send the gauge to the manufacturer or other listed in #pendix
person authorized by NRC or an Agreement State to G supporting a
perform non-routine maintenance or repair operations that mruest to pedom
require the removal of the source or source rod from the ""f',"" g
house is attached.
10. RADIATION SAFETY Re applicant is act required to submit its response to Need Not Be Submitted
PROGRAM - transportation during the licensing process. However, this With Application
TRANSPORTATION issue will be reviewed during inspection.
11. WASTE he applicant is not required to submit a response to waste Need Not Be Submitted
MANAGEMENT - management during the licensing process. However, the With Application
GAUGE DISPOSAL & licensee should develop, implement, and maintain gauge
TRANSFER
transfer and disposal procedures in its radiation protection
program.
Page B-3 NUREG - 1556, Vol. I
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TERRA FIRMA INC.
Laoratory Testing & Construction Monitoring Services
s Facility Location
and Storage Area
8801 Rendon Drive
Anchorage, Alaska 99507
(907)344-5934
Pa. king Area
.. - -
f
j
Overhead Bay Door Locked
Storage
, y,;,,,,_g g,3,,
tu,rneters stored
-
Area in k=LiJ urut on
nonh side of
_.
(6'xb')
Secured
l laixratory. Gagxs
f may consist orany
Door --*- of the following
Access M'xlel3241
Mixiel Series 34(X)
LABORATORY (*ll i"cl""I)
.g and Matel 4640)
E (550 sq/ ft. )
F
'is
$
$
m Work Bench
u
l'
Secured Door
Access (Entry
into 2nd floor
Office Area)
+- Main Entrance
OFFICE AREA
(Located on 2nd Floor)
880l Rendon Drive * Anchorage, Alaska 99M7 * Phone: 907-344 5934 * Fax: 907-344-5934 *
terrafir@ alaska. net
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