ML14057A398

Single Positive Test Form, for Pre-Access, Collected on 12/18/2013

ML14057A398
Person / Time
Site:	Palisades
Issue date:	02/13/2014
From:	Dotson B, Rabideau B Entergy Nuclear Operations
To:	Document Control Desk, Office of Nuclear Security and Incident Response
Shared Package
ML14057A574	List: ML14057A389 ML14057A390 ML14057A391 ML14057A392 ML14057A393 ML14057A395 ML14057A397 ML14057A398 ML14057A399 PNP 2014-016, Single Positive Test Form, for Pre-Access, Collected on 11/25/2013
References
2013-PAL-007, PNP 2014-016
Download: ML14057A398 (1)

Text

• L.S.N f::J rogl am Pel fOllllclllce Dellcl f'\epoillllg System , -S'ilCJlc 1)['0,' 'J:) I il (llill I , D Submission o Oolote IIRB: Update Submission

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_opt _0 ma,lrerl*opt/_. ZJEntIfo.In._"""_",.,.to.ultln_".,,._

Unique Reference Number (Ucansaa SIJI)Pliedl

__ """'fIo/da. 12013-PAL-007 I 3) II .. A_ Roorler' 01' 'ole, for fills ""'" 10 ---'I'. 4J Hold YOUI' IIIOUH ov.,.. fomt field to view Select Facility Ipalisades

[50-255] I Date 01 Collaction (mmiddlyyyy) 112118/2013 I R .. aon for T_nt/-26.717(b)(5)

P .... Access Testing Raeson (optionaQ Plaese elaborate (optional)

I Pre-Access I Iinitial Authorization I I I Employment Type-26.717(b)(3)

IcontractorNendor I I.abor Ca1ef1 01Y-26.717(b)(3)

IMaintenance (Craft) I Refuaa/* 26.717(b)(7)

& 26.75 Was this collection refusod (yos' No)? Tuf R .. ub -26.717(b)(4)

Test Validity IVaiid I Test Type(s) for Result(s)

Reported -26.717(b)(2)

Drug Testing IDrugonly I IUrine I We.ttl/a collection aba.1Wd (Yu I No}1-26.717(b)(7)

& 26.75 INo I Suba1ance-26.717(b)(2)

& (b)(6) Addltlona' Suba1ance (a. appllcab'e)

Additional Subatenee (u applicable)

IMarijuana I /Please Select I /Please Select I Use NRC Cutoff (yes' No)? I. thl ** Z4-HourReportlnt/

EII8n1 (Y * .mo}1-Sub"",'on Attempta -26.717(b)(7) and 26.75(b) Did this coRaction involve a subvorsion attempt (Yes/No)?

INO I ""'ef18tJl8n1 A_. -26.717(b)(8)

& 26.75 Roason lor the Action IFirst drug or alcohol positive I Sanction Applied (NRC Minimum or Ucens .. Adm i nistrated) ILicensee Administrated I Specific Sanction Appliod 13-Year Denial I Person(a}

Reapona/b/.

for Inform81lon Provided Person 1 (required)

IBrion IlsuPervisor. Aoce .. Authoriz._FD I bnlbide,;.ntefgy

.com First Name cast Name Pos i tionTltla Company Email Address Person 2 (optional)

IBam !l eomon Iluconli1 D Sp.cllllst I First Name LSstName t'osition nus Company E mail Address Flnel sr.p (Required)

-NRC will consider this form authentic in accordance with 26.11 only when the "Validate

& Lock" bulton has been selected and all errors (i.e .* those highNghted in red) have been corrected.

The "Validate

& Lock" button will change to "Locked" alter the data validation procass has boan successtuny completed and the form is ready for submission.

_ Form Locked On: I Feb 13, 2014 at 2:03:55 PM I I Seve to Local PC I I Print this Report I Single Positive Test Form (version 1.5.0 -January 1, 2014)