ML16019A014

GL Registration from Virginia Electric & Power Co

ML16019A014
Person / Time
Site:	North Anna
Issue date:	12/18/2015
From:	Bischof G T Virginia Electric & Power Co (VEPCO)
To:	Office of Nuclear Material Safety and Safeguards
References
15-581
Download: ML16019A014 (8)

Text

VIRGINIA ELECTRIC AND POWER COMPANYRICHMIOND, VIRGINIA 23261December 18, 2015Director, Office of Nuclear Material Safety Serial No. 15-581and Safeguards NAPS/J HLATTN: GLTS Docket Nos. 50-338/339U. S. Nuclear Regulatory Commission License Nos. NPF-4/7Washington, DC 20555-0001Gentlemen:VIRGINIA ELECTRIC AND POWER COMPANY (DOMINION)NORTH ANNA POWER STATION UNITS 1 AND 2ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICESIn accordance with 10 CFR 31.5, enclosed is NRC Form 664, General LicenseeRegistration, for registration of generally licensed devices maintained at North AnnaPower Station.If you have any questions, please contact Mr. R. B. Evans at (540) 894-2107.Sincerely,Site Vice PresidentEnclosureCommitments made by this letter: Nonecc: U.S. Nuclear Regulatory CommissionAttention: Document Control DeskWashington, D. C. 20555-0001U.S. Nuclear Regulatory CommissionRegion IIMarquis One Tower245 Peachtree Center Ave., NE Suite 1200Atlanta, Georgia 30303-1257NRC Senior Resident InspectorNorth Anna Power Station

' I IIIIIII M II IIIIII IIIii IIIII Ilill IIIII IIIII IIII M IIIII IIII IIIISECTION 1PAGE 1 of 2U.S. NUCLEAR REGULATORY COMMISSIONGL-7001 15-2010/30/2015NRC FORM 66407 -201510 CFR 31.5GENERAL LICENSEE REGISTRATIONAPPROVED BY 0MB: NO. 31 50-01 98EXPIRES: 04/30/2016Estimated burden per response to comply with this mandatory collection request: 20 minutes. NRC will use this information to track general licensees and their devices toensure a higher level of device accountability. Send comments regarding burden estimate to the FOIA, Privacy, and Information Collections Branch (T-5 F53), U. S. NuclearRegulatory Commission, Washington, DC 20555-0001, or by internet e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and RegulatoryAffairs, NEOB-1 0202, (3150-0198), Office of Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display acurrently valid 0MB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.Complete all six sections of this registration form. If any of the preprinted information is incorrect, provide thechanges in the applicable boxes. USE CAPITAL LETTERS.General LicenseRegistration NumberGL-700115-20SECTION 1 -GENERAL LICENSEE INFORMATIONEnter the company name and the street address/physical location of use for your device(s). Forportable devices, specify the primary storage location. Do not use a P.O. Box address.Company Name: DOMINION VIRGINIA POWERDepartment: NORTH ANNA POWER STATICAddress Line 1: 1022 HALEY DRIVEAddress Line 2: END OF ROUTE 700City: MINERALState: VAZip Code: 23117 -0402For NRC Use Only; (Do not write here) iAA t III IIII III 1111111111111 1111 ll III111n III III l IIII 1111 11III1GL-700115-2010/30/2015IIIIIIIII 1III IIII 1111 11M11 III IIIIIISECTION 1PAGE 2 of 2SECTION 1 -GENERAL LICENSEE INFORMATION (Continued)Enter the name, teleiphone number and title of the person who is the responsible individual for the device(s).Last Name: EVANSFirst Name: ROBERT Middle Initial: BTelephone: (540) 894-2107 Extension:WEZZIIEWE WITitle: CURRENT SAFETY OFFICEREnter the mailing address where correspondence regarding your devicels) should be sent.This address should be specific to the use or storage location of your device(s).Department: NORTH ANNA POWER STATIONAddress Line 1: 1022 HALEY DRIVEAddress Line 2: END OF ROUTE 700City: MINERALStte V Z p Coe 31 00 -EII IIAA GL-7001 15-2010/30/2015 SECTION 2 -DEVICES SUBJECT TO REGISTRATION SECOur records indicate that you have these devices. Please update the information as necessary. PAGNRC Device Key 595514 (Internal Control Number)Distributor/Distributed By: OXFORD INSTRUMENTS ANALYTICALDistributor License N umber: 29-30342-02GManufacturer Name: METOREX, INCDevice Model (Not Source Model): DOPSDevice Serial Number: 128018Transfer Date (Receipt Date): 08/12/1 999I I II~ _Jl in possession of device (AlsoD] complete Section 4.)MM DD YYYYIuIIIIIII2El1 of 1Isotope (e.g. AM241 )1 AM24123456Activity (e.g. 100)30.000000000Unit (e.g. mCi)mCiEWEWEWWEWEWEAA 111111II II~III II HiII 11111 IIII Ii11 111IIIII 1 1III 11II IIIIII II1111 II II IIIIIII111 I1IIII IIIII IIIIGL-7001 15-2010/30/2015 SECTION 3SECTION 3 -ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1Provide information about other devices you have that are subject to registration. Do not report specifically licensed devices.Manufacturer NameInitial Transferor NameInitial Transferor License Number (if known)Device Model Number (Not Source Model)Device Serial NumberIII0 Manufacturer/initial Transferor listed aboveHow acquired and date (e.g.,I' lfrom a distributor/manufacturer, 0 Other General Licensee Date Transferred: I jj I jj Jother licensee, other source)? -UJ Other Source(Received)MMDDY YY Y1.2.3.4.5.6.7.8.9.10.Isotope (eg. AM241)IIIIIIIIhbIrflIIIILLr lActivity (eg. 100)ilIIIIIIIIIIIIIII[IIUnit (e.g. mCi)WEWEWEWELWWEWEWEWEI I II I 4 II I II t I fW I II I II i I IAA

/ I l III1I11 I1I1 11IIIII11 HIIIill 111111 HIill11111 111111il1l11II1 Il111I11 I 11111111 IIII iii IIII I11III IlGL-0/0/1201 SECTION 4 -NOT IN POSSESSION OF DEVICE SECTION 4Provide information about devices listed in Section 2 or 6, but no longer in your possession. PAGE 1 of 1Part 1Transfer Date:NRC Device Key: _ L -J(from Section 2 or 6)MM DD YYYYLocation of the Device:o Whereabouts Unknown (complete Part 1 only) 0 Transferred to another general licensee (complete Parts 2 and 3)o Never Possessed the Device (complete Part 1 only) 0 Transferred to a Specific Licensee (Not the manufacturer)o Returned to Manufacturer (complete Part 1 only) (complete Part 2)Part 2 License Number of Recipient (if transferred to a specific licensee):Company Name:Department:Address Line 1:Address Line 2:City:Part 3 Enter the name of the individual responsible for this device:Last Name:First Name: Middle Initial:Title:1 K KAA I 111IIII11111I11I11IIIII11ii 1I1ii1I1111 III II IIMI 011I1111 lIII IIIIIMII111 IIII IIII IIIIIIIIIIIGL-7001 15-2010/30/2015SECTION 5 -CERTIFICATIONSECTION 5PAGE 1 of 1I hereby certify that:A. All information contained in this registration is true and complete to the best of my knowledge and belief.B. A physical inventory of the devices subject to registration has been completed, and the device information onthis form has been checked against the device labeling.C. Ilam aware of the requirements of the general license, provided in 10 CFR 31.5.(Copies of applicable regulations may be viewed at the NRC website at:http:llww.nrc. gov/reading-rm/doc-collections/cfr)SIGNATURE -RESPONSIBLE INDIVIDUAL (Listed in Section 1)DATEWARNING: FALSE STATEMENTS MAY BE SUBJECT TO CIVILAND/OR CRIMINAL PENALTIES. NRCREGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALLMATERIALASPECTS. 18 U.S.C. SECTION 1001 MAKES ITACRIMINAL OFFENSE TO MAKEAWILLFULLYWRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITEDSTATES AS TO ANY MATTER IN ITS JURISDICTION.A A

/ l~III II~III III 11111 III111 II~ I I lIIII IlI 1111!1 IIII lIiiIIIl lGL-700115-2010/30/2015.. ..= .... .....I IIIIIIII IIII IIIII IIII IIII IIII................... .q N kl RPAGE 1 of 1NRC Device Key: 825331 Manufacturer License No: 12-04933-04GManufacturer Name: PERKINELMER LIFE SCIENCESModel Number: B31 0000 Serial #: DG08129527Isotope: BA133 Activity: 0.020000000 Unit: uCiTransfer Date: 07/20/2012NRC Device Key: 689428 ManufactureManufacturer Name: GE ION TRACKModel Number: ITEMISER Ill Serial #: 09-8424Isotope: NI63 Activity: 10.000000000r License No: 20-15525-04GTransfer Date: 06/30/2003Unit: mCiNRC Device Key: 707159Manufacturer Name: METOREX, INC.Model Number: 880Isotope: CD109 Activity: 10.0Manufacturer License No: 455-01GSerial #: 128018Transfer Date: 02/27/2002'00000000Unit: mCiNRC Device Key: 547351 ManufacttManufacturer Name: CONCO SERVICES CORP.Model Number: 101 Serial #: N596Isotope: NI63 Activity: 5.000000000urer License No: MD-31-076-01Transfer Date: 02/1 5/1 994Unit: mCi VIRGINIA ELECTRIC AND POWER COMPANYRICHMIOND, VIRGINIA 23261December 18, 2015Director, Office of Nuclear Material Safety Serial No. 15-581and Safeguards NAPS/J HLATTN: GLTS Docket Nos. 50-338/339U. S. Nuclear Regulatory Commission License Nos. NPF-4/7Washington, DC 20555-0001Gentlemen:VIRGINIA ELECTRIC AND POWER COMPANY (DOMINION)NORTH ANNA POWER STATION UNITS 1 AND 2ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICESIn accordance with 10 CFR 31.5, enclosed is NRC Form 664, General LicenseeRegistration, for registration of generally licensed devices maintained at North AnnaPower Station.If you have any questions, please contact Mr. R. B. Evans at (540) 894-2107.Sincerely,Site Vice PresidentEnclosureCommitments made by this letter: Nonecc: U.S. Nuclear Regulatory CommissionAttention: Document Control DeskWashington, D. C. 20555-0001U.S. Nuclear Regulatory CommissionRegion IIMarquis One Tower245 Peachtree Center Ave., NE Suite 1200Atlanta, Georgia 30303-1257NRC Senior Resident InspectorNorth Anna Power Station

' I IIIIIII M II IIIIII IIIii IIIII Ilill IIIII IIIII IIII M IIIII IIII IIIISECTION 1PAGE 1 of 2U.S. NUCLEAR REGULATORY COMMISSIONGL-7001 15-2010/30/2015NRC FORM 66407 -201510 CFR 31.5GENERAL LICENSEE REGISTRATIONAPPROVED BY 0MB: NO. 31 50-01 98EXPIRES: 04/30/2016Estimated burden per response to comply with this mandatory collection request: 20 minutes. NRC will use this information to track general licensees and their devices toensure a higher level of device accountability. Send comments regarding burden estimate to the FOIA, Privacy, and Information Collections Branch (T-5 F53), U. S. NuclearRegulatory Commission, Washington, DC 20555-0001, or by internet e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and RegulatoryAffairs, NEOB-1 0202, (3150-0198), Office of Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display acurrently valid 0MB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.Complete all six sections of this registration form. If any of the preprinted information is incorrect, provide thechanges in the applicable boxes. USE CAPITAL LETTERS.General LicenseRegistration NumberGL-700115-20SECTION 1 -GENERAL LICENSEE INFORMATIONEnter the company name and the street address/physical location of use for your device(s). Forportable devices, specify the primary storage location. Do not use a P.O. Box address.Company Name: DOMINION VIRGINIA POWERDepartment: NORTH ANNA POWER STATICAddress Line 1: 1022 HALEY DRIVEAddress Line 2: END OF ROUTE 700City: MINERALState: VAZip Code: 23117 -0402For NRC Use Only; (Do not write here) iAA t III IIII III 1111111111111 1111 ll III111n III III l IIII 1111 11III1GL-700115-2010/30/2015IIIIIIIII 1III IIII 1111 11M11 III IIIIIISECTION 1PAGE 2 of 2SECTION 1 -GENERAL LICENSEE INFORMATION (Continued)Enter the name, teleiphone number and title of the person who is the responsible individual for the device(s).Last Name: EVANSFirst Name: ROBERT Middle Initial: BTelephone: (540) 894-2107 Extension:WEZZIIEWE WITitle: CURRENT SAFETY OFFICEREnter the mailing address where correspondence regarding your devicels) should be sent.This address should be specific to the use or storage location of your device(s).Department: NORTH ANNA POWER STATIONAddress Line 1: 1022 HALEY DRIVEAddress Line 2: END OF ROUTE 700City: MINERALStte V Z p Coe 31 00 -EII IIAA GL-7001 15-2010/30/2015 SECTION 2 -DEVICES SUBJECT TO REGISTRATION SECOur records indicate that you have these devices. Please update the information as necessary. PAGNRC Device Key 595514 (Internal Control Number)Distributor/Distributed By: OXFORD INSTRUMENTS ANALYTICALDistributor License N umber: 29-30342-02GManufacturer Name: METOREX, INCDevice Model (Not Source Model): DOPSDevice Serial Number: 128018Transfer Date (Receipt Date): 08/12/1 999I I II~ _Jl in possession of device (AlsoD] complete Section 4.)MM DD YYYYIuIIIIIII2El1 of 1Isotope (e.g. AM241 )1 AM24123456Activity (e.g. 100)30.000000000Unit (e.g. mCi)mCiEWEWEWWEWEWEAA 111111II II~III II HiII 11111 IIII Ii11 111IIIII 1 1III 11II IIIIII II1111 II II IIIIIII111 I1IIII IIIII IIIIGL-7001 15-2010/30/2015 SECTION 3SECTION 3 -ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1Provide information about other devices you have that are subject to registration. Do not report specifically licensed devices.Manufacturer NameInitial Transferor NameInitial Transferor License Number (if known)Device Model Number (Not Source Model)Device Serial NumberIII0 Manufacturer/initial Transferor listed aboveHow acquired and date (e.g.,I' lfrom a distributor/manufacturer, 0 Other General Licensee Date Transferred: I jj I jj Jother licensee, other source)? -UJ Other Source(Received)MMDDY YY Y1.2.3.4.5.6.7.8.9.10.Isotope (eg. AM241)IIIIIIIIhbIrflIIIILLr lActivity (eg. 100)ilIIIIIIIIIIIIIII[IIUnit (e.g. mCi)WEWEWEWELWWEWEWEWEI I II I 4 II I II t I fW I II I II i I IAA

/ I l III1I11 I1I1 11IIIII11 HIIIill 111111 HIill11111 111111il1l11II1 Il111I11 I 11111111 IIII iii IIII I11III IlGL-0/0/1201 SECTION 4 -NOT IN POSSESSION OF DEVICE SECTION 4Provide information about devices listed in Section 2 or 6, but no longer in your possession. PAGE 1 of 1Part 1Transfer Date:NRC Device Key: _ L -J(from Section 2 or 6)MM DD YYYYLocation of the Device:o Whereabouts Unknown (complete Part 1 only) 0 Transferred to another general licensee (complete Parts 2 and 3)o Never Possessed the Device (complete Part 1 only) 0 Transferred to a Specific Licensee (Not the manufacturer)o Returned to Manufacturer (complete Part 1 only) (complete Part 2)Part 2 License Number of Recipient (if transferred to a specific licensee):Company Name:Department:Address Line 1:Address Line 2:City:Part 3 Enter the name of the individual responsible for this device:Last Name:First Name: Middle Initial:Title:1 K KAA I 111IIII11111I11I11IIIII11ii 1I1ii1I1111 III II IIMI 011I1111 lIII IIIIIMII111 IIII IIII IIIIIIIIIIIGL-7001 15-2010/30/2015SECTION 5 -CERTIFICATIONSECTION 5PAGE 1 of 1I hereby certify that:A. All information contained in this registration is true and complete to the best of my knowledge and belief.B. A physical inventory of the devices subject to registration has been completed, and the device information onthis form has been checked against the device labeling.C. Ilam aware of the requirements of the general license, provided in 10 CFR 31.5.(Copies of applicable regulations may be viewed at the NRC website at:http:llww.nrc. gov/reading-rm/doc-collections/cfr)SIGNATURE -RESPONSIBLE INDIVIDUAL (Listed in Section 1)DATEWARNING: FALSE STATEMENTS MAY BE SUBJECT TO CIVILAND/OR CRIMINAL PENALTIES. NRCREGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALLMATERIALASPECTS. 18 U.S.C. SECTION 1001 MAKES ITACRIMINAL OFFENSE TO MAKEAWILLFULLYWRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITEDSTATES AS TO ANY MATTER IN ITS JURISDICTION.A A

/ l~III II~III III 11111 III111 II~ I I lIIII IlI 1111!1 IIII lIiiIIIl lGL-700115-2010/30/2015.. ..= .... .....I IIIIIIII IIII IIIII IIII IIII IIII................... .q N kl RPAGE 1 of 1NRC Device Key: 825331 Manufacturer License No: 12-04933-04GManufacturer Name: PERKINELMER LIFE SCIENCESModel Number: B31 0000 Serial #: DG08129527Isotope: BA133 Activity: 0.020000000 Unit: uCiTransfer Date: 07/20/2012NRC Device Key: 689428 ManufactureManufacturer Name: GE ION TRACKModel Number: ITEMISER Ill Serial #: 09-8424Isotope: NI63 Activity: 10.000000000r License No: 20-15525-04GTransfer Date: 06/30/2003Unit: mCiNRC Device Key: 707159Manufacturer Name: METOREX, INC.Model Number: 880Isotope: CD109 Activity: 10.0Manufacturer License No: 455-01GSerial #: 128018Transfer Date: 02/27/2002'00000000Unit: mCiNRC Device Key: 547351 ManufacttManufacturer Name: CONCO SERVICES CORP.Model Number: 101 Serial #: N596Isotope: NI63 Activity: 5.000000000urer License No: MD-31-076-01Transfer Date: 02/1 5/1 994Unit: mCi