ML22027A599
| ML22027A599 | |
| Person / Time | |
|---|---|
| Site: | 07007020 |
| Issue date: | 11/24/2021 |
| From: | Cassidy T Sensor Concepts & Applications |
| To: | Office of Nuclear Material Safety and Safeguards |
| Rick Jervey NMSS/DFM/FFL 301-415-6201 | |
| Shared Package | |
| ML22021B671 | List: |
| References | |
| EPID L-2021-RNW-0012 | |
| Download: ML22027A599 (1) | |
Text
NRC FORM 313 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY 0MB: NO. 3160-0120 EXPIRES: 01/31/2023 (01-2020) 10 CFR 30, 32, Estimated burden per response to comply with 1/Jis mandatory collection request 4.3 tntrs. SubmittBI ol lhe 33, 34, 35, 36, application Is necessay to detennlne 1/Jat Iha applicant is qualified and that ad9"late procedures exlsl lo protect the public health and safely. Send comments regardilg burden eslimate to the lnlonnation Services Branch (T-6 A10M),
37, 39, and 40 APPLICATION FOR U.S. Nuclear Regulatory Commission, Washingtoo, DC 20555--0001, or by e-mail to lnfocollects.Resource@nrc.gov, MATERIALS LICENSE and to the Desi< Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0120), Office of Management and BudgeL Washington, DC 20503. ff a means used kl impose an infonnation collection does nol risplay a currenUy vatid 0MB control number, Iha NRC may not conduct or sponsor, and a person Is not required to respond lo, fle lnfonnation collection, INSTRUCTIONS: SEE THE CURRENT VOLUMES OF THE NUREG-1556 TECHNICAL REPORT SERIES ("CONSOLfDATED GUIDANCE ABOUT MATERIALS LICENSES") FOR DETAILED INSTRUCTIONS FOR COMPLETING THIS FORM; http*l/www nrc.goy/reading-nn/doc-co(Iections/nucegs/stafflsrtSSB/. SEND lWO COPIES OF THE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW.
APPLICATION FOR DISTRIBUTION OF EXEMPT PRODUCTS ALE APPLICATIONS WITH: IF YOU ARE LOCATED IN:
MATERIALS SAFETY LICENSING BRANCH ILLINOIS, INDIANA, IOWA, MICHIGAN, MINNESOTA. MISSOUR~ OHIO, OR WISCONSIN, SEND DIVISION OF MATERIAL SAFETY, STATE, TRIBAL AND RULEMAKING PROGRAMS APPLICATIONS TO:
OFFICE OF NUCLEAR MATERIALS SAFETY AND SAFEGUARDS U.S. NUCLEAR REGULATORY COMMISSION MATERIALS LICENSING BRANCH WASHINGTON, DC 20555-0001 U.S. NUCLEAR REGULATORY COMMISSION, REGION Ill 2443 WARRENVILLE ROAD, SUITE 210 ALL OTHER PERSONS ALE APPLICATIONS AS FOLLOWS: LISLE, IL 60532-4352 IF YOU ARE LOCATED IN: IF YOU ARE LOCATED IN:
ALABAMA, CONNECTICUT, DELAWARE, DISTRICT OF COLUMBIA, FLORIDA, ALASKA, ARIZONA, ARKANSAS, CALIFORNIA, COLORADO, HAWAI~ IDAHO, KANSAS, GEORGIA, KENTUCKY, MAINE, MARYLAND, MASSACHUSETTS, NEW HAMPSHIRE, LOUISIANA, MISSISSIPPI, MONTANA, NEBRASKA, NEVADA, NEW MEXICO, NORTH NEW JERSEY, NEW YORK, NORTH CAROLINA, PENNSYLVANIA. PUERTO RICO, DAKOTA, OKLAHOMA, OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, TEXAS, RHODE ISLAND, SOUTH CAROLINA, TENNESSEE, VERMONT, VIRGINIA, VlRGIN UTAH, WASHINGTON, OR WYOMING, ISLANDS, OR WEST VIRGINIA, SEND APPLICATIONS TO: SEND APPLICATIONS TO:
LICENSING ASSISTANCE TEAM NUCLEAR MATERIALS LICENSING BRANCH DIVISION OF NUCLEAR MATERIALS SAFETY U.S. NUCLEAR REGULATORY COMMISSION, REGION IV U.S. NUCLEAR REGULATORY COMMISSION, REGION I 1600 E. LAMAR BOULEVARD 2100 RENAISSANCE BOULEVARD, SUITE 100 ARLINGTON, TX 76011-4511 KING OF PRUSSIA, PA 19406-2713 PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION JURISDICTIONS.
- 1. THIS IS AN APPLICATION FOR (Check appropriate llem) 2. NAME AND MAILING ADDRESS OF APPLICANT (Include zip code)
A NEW LICENSE Sensor Concepts & Applications, Inc B. AMENDMENT TO LICENSE NUMBER 5200 Glen Arm Road, Suite A Glen Arm, MD 21057 0 C. RENEWAL OF LICENSE NUMBER SNM-2017
- 3. ADDRESS WHERE LICENSED MATERIALS W1LL BE USED OR POSSESSED 4. NAME OF PERSON TO BE CONTACTED ABOUT THIS APPLICATION Benjamin (Ben) Lewis Sensor Concepts & Applications, Inc BUSINESS TELEPHONE NUMBER BUSINESS CELLULAR TELEPHONE NUMBER 5200 Glen Arm Road, Suite A Glen Arm, MD 21057 (410) 593-9909 ext. 240 BUSINESS E-MAIL ADDRESS I (304) 433-2988 blewis@scainc.biz SUBMIT ITEMS 5 THROUGH 11 ON 8-112 X 11" PAPER. THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED IN THE LICENSE APPLICATION GUIDE.
- 5. RADIOACTIVE MATERIAL 6. PURPOSE(S) FOR WHICH LICENSED MATERIAL WlLL BE USED.
a Elamenl and mass number, b. chemical and/or physical fonm; and c. maximum amount 7. INDIVIDUAL(S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR TRAINING AND which will be possessed at any one time. EXPERIENCE.
- 8. mAJNING FOR INDIVIDUALS OORKING IN OR FREQUENTING RESmlCTED AREAS. 9. FACILITIES AND EQUIPMENT.
- 10. RADIATION SAFETY PROGRAM,
- 12. LICENSE FEES (Fees required only for new applications, with few exceptions*)
(See 10 CFR 170 and Section 170.31)
- 11. WASTE MANAGEMENT.
CA~'ii"oRY I
- Amendments/Renewals that Increase the scope of the ex.Jstlng license to a new or higher fee category will require a fee.
PER THE DEBT COLLECTION IMPROVEMENT ACT OF 1996 (PUBLIC LAW 104-134), YOU ARE REQUIRED TO PROVIDE YOUR TAXPAYER IDENTIACATION NUMBER. PROVlDE THIS INFORMATION BY COMPLETING NRC FORM 531: https*/lwww ore goy/reading-nn/doc-co(Iectjons/Jorms/nrc5311nfo html
- 13. CERTIFICATION. (Must be completed by appficant) THE APPLICANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENTATIONS MADE IN THIS APPLICATION ARE BINDING UPON THE APPLICANT.
THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEHALF OF THE APPUCANT, NAMED IN ITEM 2, CERTIFY THAT THIS APPLICATION IS PREPARED IN CONFORMITY WITH TITLE 10, CODE OF FEDERAL REGULATIONS, PARTS 30, 32, 33, 34, 35, 36, 37, 39, AND 40, AND THAT ALL INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF.
WARNING: 18 U.S.C. SECTION 1001 ACT OF JUNE 25, 1948 62 STAT. 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WlLLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
CERTIFYING OFFICER - TYPED/PRINTED NAME AND TITLE DATE Thomas W. Cassidy, President FOR NRC USE ONLY j/
TYPE OF FEE FEE LOG IFEE ~TEGORY I$ A/IIOUNT _RECEIVE[? CHECK NUMBER COll:IMENTS I\PPROVED BY I DATE NRC FORM 313 (01 -2020)