ML25148A366

11-PV 2025-05 Public Forms

ML25148A366
Person / Time
Site:	Palo Verde
Issue date:	05/15/2025
From:	Heather Gepford NRC/RGN-IV/DORS/OB
To:	Arizona Public Service Co
References
Download: ML25148A366 (1)

Text

Facility:

2025 E

A V

M P

E I

P N

T N

L T

O I

I T

M C

T A

U A

Y S

A B

S A

B S

A B

S A

B L

M N

P R

T O

R T

O R

T O

R T

O T

E O

C P

O C

P O

C P

O C

P RX 0

1 1

0 U1 NOR 1

1 2

1 1

1 I/C 2,3,4,5, 6,8,9 2,3,4,5, 7,8 13 4

4 2

MAJ 7

6 2

2 2

1 Man. Ctrl.

0 1

1 0

15 TS 5,6 2,4 4

0 2

2 RX 0

1 1

0 R1 NOR 1

1 1

1 1

I/C 2,3,4,6, 9

3,4,5,8 9

4 4

2 MAJ 7

6 2

2 2

1 Man. Ctrl.

4,9 3

3 1

1 0

10 TS 0

0 2

2 RX 0

1 1

0 R2 NOR 1

1 1

1 1

I/C 5,6,8 2,4,5,7 7

4 4

2 MAJ 7

6 2

2 2

1 Man. Ctrl.

5 4,7 3

1 1

0 8

TS 0

0 2

2 RX+NOR

+I/C RX+NOR

+I/C RX+NOR

+I/C Scenarios PVNGS 5/5/2025 Operating Test Number:

Form 3.4-1 Events and Evolutions Checklist - Crew A Date of Exam:

RO SRO-I SRO-U 1

2 3

4 POSITION POSITION POSITION POSITION

Facility:

2025 E

A V

M P

E I

P N

T N

L T

O I

I T

M C

T A

U A

Y S

A B

S A

B S

A B

S A

B L

M N

P R

T O

R T

O R

T O

R T

O T

E O

C P

O C

P O

C P

O C

P RX 0

1 1

0 U2 NOR 1

1 2

1 1

1 I/C 2,3,4,5, 6,8,9 2,3,4,5, 7,8 13 4

4 2

MAJ 7

6 2

2 2

1 Man. Ctrl.

0 1

1 0

15 TS 5,6 2,4 4

0 2

2 RX 0

1 1

0 R3 NOR 1

1 1

1 1

I/C 2,3,4,6, 9

3,4,5,8 9

4 4

2 MAJ 7

6 2

2 2

1 Man. Ctrl.

4,9 3

3 1

1 0

10 TS 0

0 2

2 RX 0

1 1

0 R4 NOR 1

1 1

1 1

I/C 5,6,8 2,4,5,7 7

4 4

2 MAJ 7

6 2

2 2

1 Man. Ctrl.

5 4,7 3

1 1

0 8

TS 0

0 2

2 Form 3.4-1 Events and Evolutions Checklist - Crew B PVNGS Date of Exam: 5/5/2025 Operating Test Number:

Scenarios 1

2 3

4 POSITION POSITION POSITION POSITION RO SRO-I SRO-U RX+NOR

+I/C RX+NOR

+I/C RX+NOR

+I/C

Facility:

2025 E

A V

M P

E I

P N

T N

L T

O I

I T

M C

T A

U A

Y S

A B

S A

B S

A B

S A

B L

M N

P R

T O

R T

O R

T O

R T

O T

E O

C P

O C

P O

C P

O C

P RX 0

1 1

0 U3 NOR 1

1 2

1 1

1 I/C 2,3,4,5, 6,8,9 2,3,4,5, 7,8 13 4

4 2

MAJ 7

6 2

2 2

1 Man. Ctrl.

0 1

1 0

15 TS 5,6 2,4 4

0 2

2 RX 0

1 1

0 R5 NOR 1

1 1

1 1

I/C 2,3,4,6, 9

3,4,5,8 9

4 4

2 MAJ 7

6 2

2 2

1 Man. Ctrl.

4,9 3

3 1

1 0

10 TS 0

0 2

2 RX 0

1 1

0 R6 NOR 1

1 1

1 1

I/C 5,6,8 2,4,5,7 7

4 4

2 MAJ 7

6 2

2 2

1 Man. Ctrl.

5 4,7 3

1 1

0 8

TS 0

0 2

2 Form 3.4-1 Events and Evolutions Checklist - Crew C PVNGS Date of Exam: 5/5/2025 Operating Test Number:

Scenarios 1

2 3

4 POSITION POSITION POSITION POSITION RO SRO-I SRO-U RX+NOR

+I/C RX+NOR

+I/C RX+NOR

+I/C

Facility:

2025 E

A V

M P

E I

P N

T N

L T

O I

I T

M C

T A

U A

Y S

A B

S A

B S

A B

S A

B L

M N

P R

T O

R T

O R

T O

R T

O T

E O

C P

O C

P O

C P

O C

P RX 0

1 1

0 U4 NOR 1

1 2

1 1

1 I/C 2,3,4,5, 6,8,9 2,3,4,5, 7,8 13 4

4 2

MAJ 7

6 2

2 2

1 Man. Ctrl.

0 1

1 0

15 TS 5,6 2,4 4

0 2

2 RX 0

1 1

0 R7 NOR 1

1 1

1 1

I/C 2,3,4,6, 9

3,4,5,8 9

4 4

2 MAJ 7

6 2

2 2

1 Man. Ctrl.

4,9 3

3 1

1 0

10 TS 0

0 2

2 RX 0

1 1

0 R8 NOR 1

1 1

1 1

I/C 5,6,8 2,4,5,7 7

4 4

2 MAJ 7

6 2

2 2

1 Man. Ctrl.

5 4,7 3

1 1

0 8

TS 0

0 2

2 Form 3.4-1 Events and Evolutions Checklist - Crew D PVNGS Date of Exam: 5/5/2025 Operating Test Number:

Scenarios 1

2 3

4 POSITION POSITION POSITION POSITION RO SRO-I SRO-U RX+NOR

+I/C RX+NOR

+I/C RX+NOR

+I/C

Facility:

2025 E

A V

M P

E I

P N

T N

L T

O I

I T

M C

T A

U A

Y S

A B

S A

B S

A B

S A

B L

M N

P R

T O

R T

O R

T O

R T

O T

E O

C P

O C

P O

C P

O C

P RX 0

1 1

0 I1 NOR 1

1 1

1 1

I/C 2,3,4,6, 9

2,3,4,5, 7,8 11 4

4 2

MAJ 7

6 2

2 2

1 Man. Ctrl.

4,9 2

1 1

0 12 TS 2,4 2

0 2

2 RX 0

1 1

0 I2 NOR 1

1 2

1 1

1 I/C 2,3,4,5, 6,8,9 3,4,5,8 11 4

4 2

MAJ 7

6 2

2 2

1 Man. Ctrl.

3 1

1 1

0 13 TS 5,6 2

0 2

2 RX 0

1 1

0 R9 NOR 1

1 1

1 1

I/C 5,6,8 2,4,5,7 7

4 4

2 MAJ 7

6 2

2 2

1 Man. Ctrl.

5 4,7 3

1 1

0 8

TS 0

0 2

2 Form 3.4-1 Events and Evolutions Checklist - Crew E PVNGS Date of Exam: 5/5/2025 Operating Test Number:

Scenarios 1

2 3

4 POSITION POSITION POSITION POSITION RO SRO-I SRO-U RX+NOR

+I/C RX+NOR

+I/C RX+NOR

+I/C

Facility:

2025 E

A V

M P

E I

P N

T N

L T

O I

I T

M C

T A

U A

Y S

A B

S A

B S

A B

S A

B L

M N

P R

T O

R T

O R

T O

R T

O T

E O

C P

O C

P O

C P

O C

P RX 0

1 1

0 I3 NOR 1

1 1

1 1

I/C 2,3,4,6, 9

2,3,4,5, 7,8 11 4

4 2

MAJ 7

6 2

2 2

1 Man. Ctrl.

4,9 2

1 1

0 12 TS 2,4 2

0 2

2 RX 0

1 1

0 I4 NOR 1

1 2

1 1

1 I/C 2,3,4,5, 6,8,9 3,4,5,8 11 4

4 2

MAJ 7

6 2

2 2

1 Man. Ctrl.

3 1

1 1

0 13 TS 5,6 2

0 2

2 RX 0

1 1

0 R10 NOR 1

1 1

1 1

I/C 5,6,8 2,4,5,7 7

4 4

2 MAJ 7

6 2

2 2

1 Man. Ctrl.

5 4,7 3

1 1

0 8

TS 0

0 2

2 Form 3.4-1 Events and Evolutions Checklist - Crew F PVNGS Date of Exam: 5/5/2025 Operating Test Number:

Scenarios 1

2 3

4 POSITION POSITION POSITION POSITION RO SRO-I SRO-U RX+NOR

+I/C RX+NOR

+I/C RX+NOR

+I/C

Facility:

2025 E

A V

M P

E I

P N

T N

L T

O I

I T

M C

T A

U A

Y S

A B

S A

B S

A B

S A

B L

M N

P R

T O

R T

O R

T O

R T

O T

E O

C P

O C

P O

C P

O C

P RX 0

1 1

0 I5 NOR 1

1 1

1 1

I/C 2,3,4,6, 9

2,3,4,5, 7,8 11 4

4 2

MAJ 7

6 2

2 2

1 Man. Ctrl.

4,9 2

1 1

0 12 TS 2,4 2

0 2

2 RX 0

1 1

0 I6 NOR 1

1 2

1 1

1 I/C 2,3,4,5, 6,8,9 3,4,5,8 11 4

4 2

MAJ 7

6 2

2 2

1 Man. Ctrl.

3 1

1 1

0 13 TS 5,6 2

0 2

2 RX 0

1 1

0 R11 NOR 1

1 1

1 1

I/C 5,6,8 2,4,5,7 7

4 4

2 MAJ 7

6 2

2 2

1 Man. Ctrl.

5 4,7 3

1 1

0 8

TS 0

0 2

2 Form 3.4-1 Events and Evolutions Checklist - Crew G PVNGS Date of Exam: 5/5/2025 Operating Test Number:

Scenarios 1

2 3

4 POSITION POSITION POSITION POSITION RO SRO-I SRO-U RX+NOR

+I/C RX+NOR

+I/C RX+NOR

+I/C

Facility:

2025 E

A V

M P

E I

P N

T N

L T

O I

I T

M C

T A

U A

Y S

A B

S A

B S

A B

S A

B L

M N

P R

T O

R T

O R

T O

R T

O T

E O

C P

O C

P O

C P

O C

P RX 0

1 1

0 SURR NOR 0

1 1

1 I/C 0

4 4

2 MAJ 0

2 2

1 Man. Ctrl.

0 1

1 0

0 TS 0

0 2

2 RX 0

1 1

0 R12 NOR 1

1 1

1 1

I/C 2,3,4,6, 9

3,4,5,8 9

4 4

2 MAJ 7

6 2

2 2

1 Man. Ctrl.

4,9 3

3 1

1 0

10 TS 0

0 2

2 RX 0

1 1

0 R13 NOR 1

1 1

1 1

I/C 5,6,8 2,4,5,7 7

4 4

2 MAJ 7

6 2

2 2

1 Man. Ctrl.

5 4,7 3

1 1

0 8

TS 0

0 2

2 Form 3.4-1 Events and Evolutions Checklist - Crew H PVNGS Date of Exam: 5/5/2025 Operating Test Number:

RO SRO-I SRO-U RX+NOR

+I/C RX+NOR

+I/C RX+NOR

+I/C Scenarios 1

2 3

4 POSITION POSITION POSITION POSITION

IP 21 Operator Licensing Exam Schedule From 10/01/2024 to 09/30/2025 Phase Code: 3 - Pre-operational, 5 - Operational Region: 4 By Date

1. Candidates Exam Start Exam End Site Docket #

Insp Rpt Cac #

RO LSRO SROI SROU Type Exam Author Chief Examiner Examiner 3/30/2025 4/5/2025 Palo Verde 05000528-1, 05000529-2, 05000530-3 2025301 000956 0

0 0

0 FB-OR-ONSITE VALIDATION OF INITIAL LICENSE EXAMINATION (OV)

Farina, Thomas

Farina, Thomas; Clayton, Kelly; Kirkland, John; Hernandez, Nick; You, David; Murphy, Kevin; Hayes, Mahdi; Iskierka-Boggs, Travis Prepared on 4/30/2025 1:49:48 PM Activity Codes: EXAD, NEXAD, NOV, OV Exam Author: ALL Orgs: ALL Sites: PALO

IP 21 Operator Licensing Exam Schedule 5/4/2025 5/10/2025 Palo Verde 05000528-1, 05000529-2, 05000530-3 2025301 000500 13 0

6 4

FB-OR-INITIAL LICENSE EXAM ADMINISTRATI ON (EXAD)

NFF

Farina, Thomas

Farina, Thomas; Clayton, Kelly; Kirkland, John; Hernandez, Nick; You, David; Murphy, Kevin; Hayes, Mahdi; Iskierka-Boggs, Travis Prepared on 4/30/2025 1:49:48 PM Activity Codes: EXAD, NEXAD, NOV, OV Exam Author: ALL Orgs: ALL Sites: PALO

EXAM ASSIGNMENT TICKLER Chief:

TJ Farina Facility:

PVNGS 5/15/2025 U/I:

Start of Op Test:

5/5/2025 5/9/2025 Due Date Date Complete Initials 9/2/2024 7/11/2024 TF 10/7/2024 7/11/2024 TF 10/7/2024 7/11/2024 TF 10/7/2024 na TF 10/7/2024 7/11/2024 TF 10/21/2024 na TF 12/2/2024 12/2/2024 TF 12/16/2024 12/17/2024 TF 1/27/2025 na TF 2/17/2025 2/10/2025 TF 3/3/2025 na TF 3/17/2025 2/21/2025 TF 3/31/2025 3/3/2025 TF 3/31/2025 3/31/2025 TF 3/31/2025 3/31/2025 TF 4/7/2025 4/7/2025 TF 4/14/2025 4/7/2025 TF 4/21/2025 4/21/2025 TF 4/28/2025 4/28/2025 TF 4/28/2025 N/A TF 4/28/2025 4/28/2025 TF 4/28/2025 5/13/2025 TF 4/28/2025 5/5/2025 TF 5/5/2025 5/5/2025 TF 5/23/2025 5/13/2025 TF 6/4/2025 5/21/2025 TF 6/12/2025 N/A TF 6/12/2025 5/22/2025 TF 6/19/2025 5/22/2025 TF 6/26/2025 5/28/2025 TF 7/3/2025 N/A TF 7/3/2025 5/30/25 est.

TF 7/3/2025 5/1/2025 TF 7/24/2025 N/A TF 7/31/2025 TBD TF 8/7/2025 N/A TF Rev. 12 Examiners document op test results on Form 5.1-2 Replaces NUREG-1021, Revision 12, Forms 2.1-1 and 5.1-1 Post exam operating test comments reviewed and ES-303-1 updated Signed Form 5.1-2 to BC produced by CE License/Proposed Denial letters mailed; Facility notified of results Ref Mat'l Returned after Final Resolution of Appeals Examination Report Issued 21 days after proposed denial letters mailed.

Post exam comments and graded exams received Final Denial Letters mailed (if no request for informal review)

RPS/IP number of examinees updated print Report-21 Waivers/deferrals reviewed for impact on licensing decision Post exam written comments reviewed and incorporated and NRC grading completed Chief examiner review of operating test and/or written exam grading completed Branch Chief review of exam results completed Date of Written Exam:

Description Notes Examination administration date confirmed For NRC prepared exams, arrangements made for the facility to submit reference materials End of Op Test:

Written Exam Developed By: NRC / Facility Operating Test Developed By: NRC / Facility Both OP and Written comments are with the licensee Examination review results discussed between NRC and facility licensee NRC examiners and facility contact assigned Facility contact briefed on security and other requirements Operating test outline(s) and other checklists due Forms 1.3-1, 2.3-1, 3.2-1, 3.2-2, 3.4-1, 3.3-1 Reference material due for NRC prepared exams ES-2.1.F Corporate Notification Letter sent Letter 2.1-1 produced by CE NRC developed written examination outline sent to facility contact Forms 4.1-BWR/PWR and COMMON Approved scenarios and JPMs distributed to examiners BC signs Exam Approval Letter (Form 2.3-1)

Operating test outline(s) reviewed by NRC and feedback provided to facility licensee Form 2.3-1 signed by CE & BC Peer review of written exam complete Form 2.3-5 Proposed exams, outlines, supporting documentation, and reference materials due.

Written exam and operating test reviews completed Document review on Forms 2.3-1 and 2.3-5 NRC-prepared examinations approved by the NRC supervisor and forwarded for facility licensee review Feedback approved by Branch Chief Final applications reviewed and audited; exam approval and waiver/excusal letters sent On-site validation & 10% audit of license applications Administer Operating Test Preliminary license applications & waiver/excusal requests due NRC Forms 398/396 Final license applications & waiver/excusal requests due Form 2.2-1 Proctoring/written exam administration guidelines reviewed with facility licensee Preliminary license applications and waivers reviewed Facility licensee management feedback on the examination requested by the NRC supervisor Written exams and operating tests approved by Branch Chief