ML21348A773
| ML21348A773 | |
| Person / Time | |
|---|---|
| Site: | 07000020 |
| Issue date: | 12/07/2021 |
| From: | Downing J Domtar |
| To: | Office of Nuclear Material Safety and Safeguards |
| Rolland J | |
| References | |
| Download: ML21348A773 (1) | |
Text
NRC FORM 314 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY 0MB: NO. 3150-0028 EXPIRES: 03/31/2023 (01-2021)
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Estimated burden per response to comply with this mandatory collection request 30 minutes. This submittal is used by NRG as
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CERTIFICATE OF DISPOSITION part of the basis for its determination that the facility is released for unrestricted use. Send comments regarding burden estimate to 40.420)(1 ); 70.380)(1 ): ii i1 the FOIA, Library, and Information Collections Branch (T-6 A 10M), U.S. Nuc~ar Regulatory Commission, Washington, DC and 72.54(k)(5)(1 )(1)
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OF MA TE RIALS 20555-0001, or by e-mail to lnfocollects.Resource@nrc.gov, and the 0MB reviewer at 0MB Office of lnfonnation and Regulatory
~ "l' Affairs, (3150-0028), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; e-mail: oira submissiori@omb ego gov. The NRG may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the document requesting or requiring the collection displays a currently valid 0MB control number.
LICENSEE NAME AND ADDRESS LICENSE NUMBER DOCKET NUMBER DOMTAR 700020 700020 ATTN: Jeff Downing 1700 WASHING TON A VENUE LICENSE EXPIRATION DATE PORT HURON, MI 48060 A. LICENSE STATUS (Check the appropriate box) 0 This license has expired.
[Z] This license has not yet expired; please terminate it.
B. DISPOSAL OF RADIOACTIVE MATERIAL (Check the appropriate boxes and complete as necessary. If additional space is needed, provide attachments)
The licensee, or any individual executing this certificate on behalf of the licensee, certifies that:
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- 1. No radioactive materials have ever been procured or possessed by the licensee under this license.
[Z] 2.
All activities authorized by this license have ceased, and all radioactive materials procured and/or possessed by the licensee I
under this license number cited above have been disposed of in the following manner.
[Z] a. Transfer of radioactive materials to the licensee listed below:
RAM Services, 510 County Highway V, Two Rivers, WI (WI# 071-1234-01) ob. Disposal of radioactive materials:
- 01. Directly by the licensee:
O 2. By licensed disposal site:
- 03. By waste contractor:
oc. All radioactive materials have been removed such that any remaining residual radioactivity is within the limits of 1 O CFR Part 20, Subpart E, and is ALARA.
C. SURVEYS PERFORMED AND REPORTED 0
- 1. A radiation survey was conducted by the licensee. The survey confirms:
Oa. the absence of licensed radioactive materials ob. that any remaining residual radioactivity is within the limits of 10 CFR 20, Subpart E, and is ALARA.
0
- 2. A copy of the radiation survey results:
0
- a. is attached; or O
- b. is not attached (Provide explanation); or O
- c. was forwarded to NRC on:
[Z] 3. A radiation survey is not required as only sealed sources were ever possessed under this license, and Date 0
- a. The results of the latest leak test are attached; and/or (Z] b. No leaking sources have ever been identified.
The person to be contacted regarding the information provided on this form:
NAME TITLE TELEPHONE (Include Area Code)
E-MAIL ADDRESS Jeff Downing Engineering Manager, RSO 810-650-0976 jeff.downing@domtar.com Mail all future correspondence regarding this license to:
C. CERTIFYING OFFICIAL I CERTIFY UNDER PENAL TY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT PRINTED NAME AND TITLE S,G"9w j?,;~
DATE Jeff Downing 12/7/2021 Engineering Manager, Radiation Safety Officer WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENAL TIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECT. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
NRC FORM 314 (01-2021)