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{{#Wiki_filter:VIRGINIA AND POWER COMPANY RICHMOND, VIRGINIA 23261 December 18, 2015 Director, Office of Nuclear Material Safety Serial No. 15-581 and Safeguards NAPS/JHL ATT-IN: GLTS Docket Nos. 50-338/339 U. S. Nuclear Regulatory Commission License Nos. NPF-4/7 Washington, DC 20555-0001 Gentlemen:
{{#Wiki_filter:VIRGINIA E*LECTRIC AND POWER COMPANY RICHMOND,   VIRGINIA 23261 December 18, 2015 Director, Office of Nuclear Material Safety               Serial No.     15-581 and Safeguards                                             NAPS/JHL ATT-IN: GLTS                                               Docket Nos. 50-338/339 U. S. Nuclear Regulatory Commission                       License Nos. NPF-4/7 Washington, DC 20555-0001 Gentlemen:
VIRGINIA ELECTRIC AND POWER COMPANY (DOMINION)
VIRGINIA ELECTRIC AND POWER COMPANY (DOMINION)
NORTH ANNA POWER STATION UNITS I AND 2 ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICES In accordance with 10 CFR 31.5, enclosed is NRC Form 664, General Licensee Registration, for registration of generally licensed devices maintained at North Anna Power Station.If you have any questions, please contact Mr. R.. B. Evans at (540) 894-2107.Sincerely, Gerald T. Bischof Site Vice President Enclosure Commitments made by this letter: None cc: U.S. Nuclear Regulatory Commission Attention:
NORTH ANNA POWER STATION UNITS I AND 2 ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICES In accordance with 10 CFR 31.5, enclosed is NRC Form 664, General Licensee Registration, for registration of generally licensed devices maintained at North Anna Power Station.
Document Control Desk Washington, D. C. 20555-0001 U.S. Nuclear Regulatory Commission Region II Marquis One Tower 245 Peachtree Center Ave., NE Suite 1200 Atlanta, Georgia 30303-1 257 NRC Senior Resident Inspector North Anna Power Station N~ill IIII II IIII U I.I li1ii 11iii II I~ NDI~ WII 11 111 1 i llI~i I!GL-7001 15-20 10/30/2015 NRC FORM 664 07 -2015 10OCFR 31.5 APPROVED BY 0MB: NO. 3150-0198 SECTION 1 PAGE 1 of 2 U.S. NUCLEAR REGULATORY COMMISSION GENERAL LICENSEE REGISTRATION EXPIRES: 04/3012016 Estimated burden per response to comply with this mandatory collection request: 20 minutes. NRC will use this information to track general licensees and their devices to ensure a higher level of device aocountability.
If you have any questions, please contact Mr. R.. B. Evans at (540) 894-2107.
Send comments regarding burden estimate to the FOIA, Privacy, and Information Collections Branch (7-5 F53), U. S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail[ to Infocollects.Resource~nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1 0202, (3150-01 9B), Office of[ Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a 1currently valid 0MB control number, the.NRC may not conduct or sponsor, end a. person is not required to respond to, the information collection.
Sincerely, Gerald T. Bischof Site Vice President Enclosure Commitments made by this letter: None cc:   U.S. Nuclear Regulatory Commission Attention: Document Control Desk Washington, D. C. 20555-0001 U.S. Nuclear Regulatory Commission Region II Marquis One Tower 245 Peachtree Center Ave., NE Suite 1200 Atlanta, Georgia 30303-1 257 NRC Senior Resident Inspector North Anna Power Station
Complete -all six sections of this registration form. If any of the preprinted information is incorrect, provide the changes in the applicable boxes. USE CAPITAL LETTERS.General License Registration Number GL-700115-20 SECTION 1 -GENERAL LICENSEE INFORMATION Enter the company name and the street address/physical location of use for your device(s).
 
For portable devices, specify the primary storage location.
N~ill   IIIIIIIIIIUI.li1ii GL-7001 15-20 I 11iii           III~ NDI~ WII     11111      i llI~i1I!                                                                 SECTION 1 10/30/2015                                                                                                                                             PAGE 1 of 2 NRC FORM 664                                                                                                   U.S. NUCLEAR REGULATORY COMMISSION 07 - 2015 10OCFR 31.5                                       GENERAL LICENSEE REGISTRATION APPROVED BY 0MB: NO. 3150-0198                                                                                                               EXPIRES: 04/3012016 Estimated burden per response to comply with this mandatory collection request: 20 minutes. NRC will use this information to track general licensees and their devices to ensure a higher level of device aocountability. Send comments regarding burden estimate to the FOIA, Privacy, and Information Collections Branch (7-5 F53), U. S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail[ to Infocollects.Resource~nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1 0202, (3150-01 9B), Office of[ Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a 1currently valid 0MB control number, the.NRC may not conduct or sponsor, end a. person is not required to respond to, the information collection.
Do not use a P.O. Box address.Company Name: DOMINION VIRGIN.IA POWER Department:
Complete -all six sections of this registration form. If any of the preprinted information is incorrect, provide the changes in the applicable boxes. USE CAPITAL LETTERS.
NORTH ANNA POWER STATIO I Address Line 1: 1022 HALEY DRIVE Address Line 2: END OF ROUTE 700 City: MINERAL State: VA Zip Code: 23117 -0402 wz~ -:For NRC use Only-: C, ategory:" (Do :not write here) : ,. .:... .-.'. .. : '. :".::: .-.:. ,"Packet Receipt Date (MMDDYYY ):: i : ? i I I I' I I L ..1 I~ I I .1J I.. .." -..::. Accession Number:.A A Ii IIIIIIII II 111i-111 IIII III! IIII Iin III IIIII nII 111111111 GL-7001 15-20 10/30/2015 111111111 IIII IIIII IIII III III II111Il SECTION 1 PAGE 2 of 2 SECTION 1 -GENERAL LICENSEE INFORMATION (Continued)
General License                               SECTION 1 - GENERAL LICENSEE INFORMATION Registration Number GL-700115-20 Enter the company name and the street address/physical location of use for your device(s).                                                     For portable devices, specify the primary storage location. Do not use a P.O. Box address.
Company Name: DOMINION VIRGIN.IA POWER Department:               NORTH ANNA POWER STATIO I
Address Line 1:           1022 HALEY DRIVE Address Line 2:           END OF ROUTE 700 City:                     MINERAL State:     VA                                 Zip Code: 23117 - 0402
:For NRC use Only-:
wz~
* C,ategory:"
                                                                                                                          -
(Do :not write here) :             ,.         .       :... . -. '.               .. :
                                                '. * . :".:::
                                                            -. :. ,"Packet       Receipt Date (MMDDYYY ):
: i*-: ?       i                 I I I' I                         I       *
                                                                      .1 .. " .. -..
I~ ::. I Accession I              .1J INumber:.
                                                    .L*
A                                                                                                                                                   A
 
IIIIIIII II111i-111 Ii                    IIII III!IIII IinIIIIIIIInII111111111                      111111111 IIIIIIIII  IIIIIIIIII II111 GL-7001 15-20                                                                                       SECTION 1 10/30/2015 PAGE 2 of 2 SECTION 1 - GENERAL LICENSEE INFORMATION (Continued)
Enter the name, teleiphone number and title of the person who is the responsible individual for the device(s).
Enter the name, teleiphone number and title of the person who is the responsible individual for the device(s).
Last Name: EVANS First Name: ROBERT Middle Initial:B Telephone:
Last Name:   EVANS First Name:   ROBERT                                           Middle Initial:B Telephone:   (540) 894-2107                                   Extension:
(540) 894-2107 Extension:
Title:       CURRENT SAFETY OFFICER Enter the mailing address where correspondence regarding your device(s) should be sent.
Title: CURRENT SAFETY OFFICER Enter the mailing address where correspondence regarding your device(s) should be sent.This address should be specific to the use or storage location of your device(s).
This address should be specific to the use or storage location of your device(s).
Department:
Department:       NORTH ANNA POWER STATION Address Line 1:   1022 HALEY DRIVE Address Line 2:   END OF ROUTE 700 City:             MINERAL State: VA     D ___     Zip Code: 23117 -0402         [                       - z*z          z A                                                                                             A
NORTH ANNA POWER STATION Address Line 1: 1022 HALEY DRIVE Address Line 2: END OF ROUTE 700 City: MINERAL State: VA D ___ Zip Code: 23117 -0402 [ -z A A I IIIHIIII11 II IIIIINVI l iii lii III 1111 11ilIIIIi11 1111111I II I! 111111 i II!1 III IIl III GL-700115-20 10/30/2015 SECTION 2 -DEVICES SUBJECT TO REGISTRATION SECTION 2 Our records indicate that you have these devices. Please update the information as necessary.
 
PAGE 1 of 1 NRC Device Key 595514 (Internal Control Number)Distributor/Distributed By: OXFORD INSTRUMENTS ANALYTICAL Distributor License Number: 29-30342-02G Manufacturer Name: METOREX, INC Device Model (Not Source Model)i DOPS Device Serial Number: 128018 Transfer.Date (Receipt Date): 08/12/1999 rvn Not in possession of device (Also_J __J L D complete Section 4.)MM DD YYYY Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi)1 AM241 30.000000000 mCi 2 3 4*5 6 E.E D IDII'.A.A IIII]111 Iv iIII n !1 Inn I iii1111 UIIII inII III 1111111 III Iin 111 1IIIII 1 IIII In I In I IIi!1 SGL-700115-20 10/30/2015 SECTION 3 SECTION 3 -ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1 provide information about other devices you have that are subject to registration.
IIIIHIIII11 GL-700115-20 IIIIIIINVI l IIIiii li 1111       11ilIIIIi11 II 1111111I                       I!111111 i II!1   III IIl III 10/30/2015                     SECTION 2     - DEVICES SUBJECT TO REGISTRATION                         SECTION 2 Our records indicate that you have these devices. Please update the information as necessary.             PAGE 1 of 1 NRC Device Key                 595514     (Internal Control Number)
Do not report specifically licensed devices.Manufacturer Name Initial Transferor Name Initial Transferor License Number (if known)Device Model Number (Not Source Model)Device Serial Number o Manufacturer/Initial Transferor listed above How acquired and date (e.g., from a distributor/manufacturer, 0 Other General Licensee Date Transferred:
Distributor/Distributed By:     OXFORD INSTRUMENTS ANALYTICAL Distributor License Number:     29-30342-02G Manufacturer Name: METOREX, INC Device Model (Not Source Model)i DOPS Device Serial Number: 128018 Transfer.Date (Receipt Date): 08/12/1999 rvn                                           Not in possession of device (Also
F _7 F _77 other licensee, other source)?L..LJL.LJ U Other Source (Received)
* _J L
MM DD YYYY Isotope (e.g. AM241 )1.3.4.6 .7.8.~D 9.10. DI I Activity (e.g. 100)II II LI m Unit (e.g. mCi)LW~DIDI DID1 WI DIDI DIDJ I I I I I I I I I I A A I II11 IIIII il11111 IIII11 l11 IIII II II II~II i11 liIIIIII II~II ii IIII[II IIIII 1 1L-0/0/215-2 SEcTiON 4 -NOT IN POSSESSION OF DEVICE SECTION 4 Provide information about devices listed in Section 2 or 6, but no longer in your possession.
* __J*
PAGE 1of 1 Part I Transfer Date: NRC Device Key: ______________________(from Section 2 or 6)MM DD YYYY Location of the Device: o Whereabouts Unknown (complete Part 1 only) O 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):
* D complete Section 4.)
Company Name:-Department:
MM           DD           YYYY Isotope (e.g. AM241)               Activity (e.g. 100)                                           Unit (e.g. mCi) 1   AM241                               30.000000000                                                 mCi 2
Adrs ine 1:l l l ~l II Address Line 2: City:*Part 3 Enter the name of the individual responsible for. this device: Last Name: First Name: Middle Initial: Title: A A GL-7001 15-20 SECTION 5 -CERTIFICATION SECTION 5 10/30/2015 PAGE 1 of 1 Ihereby 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 on this form has been checked against the device labeling.C. l am aware of the requirements of the general license, p~rovided in 10 CFR 31.5.(Copies of applicable regulations may be viewed at the NRC website at: http://www, nrc.gov/reading-rm/doc-collections/cfr)
3 4*
SIGNATURE  
5 6
-RESPONSIBLE INDIVIDUAL (Listed in Section 1) DATE WARNING: FALSE STATEMENTS MAY BE SUBJECT TO CIVILAND/OR CRIMINAL PENALTIES.
E.E                                                                                         DIDII
NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL ASPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY WRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER IN ITS JURISDICTION.
          .A                                                                                                 '.A
A A GL-700115-20 10/30/2015  
 
.. ...... .....IflL 5~ F C~r I (~ t'J R~t.. I -UtVIU~ rJU ~UI~JIL. I iLl ~ ~AI HUN PAGE lofI NRC Device Key: 825331 Manufacturer License No: 12-04933-04G Manufacturer Name: PERKINELMER LIFE SCIENCES Model Number: B310000 Serial #: DG08129527 Isotope: BA133 Activity:
IIII]111 IviIIIn!1 SGL-700115-20 10/30/2015 Inn  Iiii1111 UIIIIinII III 1111111  IIIIin                                111 1IIIII 1IIIIInIIn SECTION 3 IIIi!1 SECTION 3   - ADDITIONAL DEVICES SUBJECT TO REGISTRATION                                 PAGE 1 of 1 provide information about other devices you have that are subject to registration. Do not report specifically licensed devices.
0.020000000 Unit: uCi Transfer Date: 07/20/2012 NRC Device Key: 689428 Manufacture Manufacturer Name: GE ION TRACK Model Number: ITEMISER III Serial #: 09'-8424 Isotope: N163 Activity:
Manufacturer Name Initial Transferor Name Initial Transferor License Number (if known)
10.000000000
Device Model Number (Not Source Model)
;r License No: 20-15525-04G Transfer Date: 06/30/2003 Unit: mCi NRC Device Key: 707159 " Manufacturer Name: METOREX, INC.Model Number: 880 Isotope: CD109 Activity:
Device Serial Number o   Manufacturer/Initial Transferor listed above How acquired and date (e.g.,
10.0 Manufadturer License No: 455-01G Serial #: 128018 Transfer Date: 02/27/2002 00000000 Unit: mCi NRC Device Key: 547351 Manufacturer Name: CONCO SERVICES CORP.Model Number: 101 Seria Isotope: N163 Activity:
from a distributor/manufacturer, 0 Other General Licensee             Date Transferred:   F   _7 F     _77 *
5.000000000 Manufacturer License No: MD-3 1-076-01 l#: N596 Transfer Date: 02/15/1994 Unit: mCi VIRGINIA AND POWER COMPANY RICHMOND, VIRGINIA 23261 December 18, 2015 Director, Office of Nuclear Material Safety Serial No. 15-581 and Safeguards NAPS/JHL ATT-IN: GLTS Docket Nos. 50-338/339 U. S. Nuclear Regulatory Commission License Nos. NPF-4/7 Washington, DC 20555-0001 Gentlemen:
* other licensee, other source)?L..LJL.LJ U Other Source                     (Received)           MM       DD             YYYY Isotope (e.g. AM241 )               Activity (e.g. 100)                                                 Unit (e.g. mCi) 1.
IIm LW~
3.
4.
II                        DIDI 6      .
DID1 7.
I    I   I   I   I   I   I     I LI                        WI 8.~D                                                                                                                DIDI
: 9.                                                                                                                  DIDJ
: 10.        DI              I I     I A                                                                                                         A
 
III11  IIIII 1L-0/0/215-2 il11111IIII11 l11 IIII    IIIIII~II SEcTiON 4 i11 liIIIIII
                                                  - NOT IN POSSESSION OF DEVICE II~II  ii IIII[II  IIIII 1 SECTION 4 Provide information about devices listed in Section 2 or 6, but no longer in your possession.                 PAGE 1of 1 Part I                                                         Transfer Date:
NRC Section (from  Device Key:
2 or 6) ______________________                    MM         DD         YYYY Location of the Device:
o   Whereabouts Unknown (complete Part 1 only)         O 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:
Adrsine 1:l                                             l l         ~l                     II Address Line 2:
City:
*Part 3           Enter the name of the individual responsible for. this device:
Last Name:
First Name:                                                                                   Middle Initial:
Title:
A                                                                                                       A
 
GL-7001 15-20                                   SECTION 5 - CERTIFICATION                                 SECTION 5 10/30/2015                                                                                                 PAGE 1 of 1 Ihereby 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 on this form has been checked against the device labeling.
C.     l am aware of the requirements of the general license, p~rovided in 10 CFR 31.5.
(Copies of applicable regulations may be viewed at the NRC website at:
http://www, nrc.gov/reading-rm/doc-collections/cfr)
SIGNATURE       - RESPONSIBLE INDIVIDUAL (Listed in Section 1)               DATE WARNING:         FALSE STATEMENTS MAY BE SUBJECT TO CIVILAND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL ASPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY WRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER IN ITS JURISDICTION.
A                                                                                                         A
 
GL-700115-20 10/30/2015                 ..   . . .     . ..   .   . .   . .
                            ~t.. I       - UtVIU~ rJU         ~UI~JIL. I iLl ~
IflL
                                                                                          ~AI HUN 5~ F C~r I(~ t'J R PAGE lofI NRC Device Key: 825331                           Manufacturer License No:     12-04933-04G Manufacturer Name: PERKINELMER LIFE SCIENCES Model Number: B310000                 Serial #: DG08129527 Transfer Date: 07/20/2012 Isotope: BA133         Activity: 0.020000000                         Unit: uCi NRC Device Key: 689428                           Manufacture ;r License No:  20-15525-04G Manufacturer Name: GE ION TRACK Model Number: ITEMISER III             Serial #: 09'-8424 Transfer Date: 06/30/2003 Isotope: N163           Activity: 10.000000000 Unit: mCi NRC Device Key: 707159         "                 Manufadturer License No:    455-01G Manufacturer Name: METOREX, INC.
Model Number: 880                     Serial #: 128018                                       Transfer Date: 02/27/2002 Isotope: CD109          Activity: 10.0 00000000                       Unit: mCi NRC Device Key: 547351                           Manufacturer License No:    MD-3 1-076-01 Manufacturer Name: CONCO SERVICES CORP.
Model Number: 101                     Seria l#: N596                                       Transfer Date: 02/15/1994 Isotope: N163          Activity: 5.000000000                        Unit: mCi
 
VIRGINIA E*LECTRIC AND POWER COMPANY RICHMOND,   VIRGINIA 23261 December 18, 2015 Director, Office of Nuclear Material Safety               Serial No.     15-581 and Safeguards                                             NAPS/JHL ATT-IN: GLTS                                               Docket Nos. 50-338/339 U. S. Nuclear Regulatory Commission                       License Nos. NPF-4/7 Washington, DC 20555-0001 Gentlemen:
VIRGINIA ELECTRIC AND POWER COMPANY (DOMINION)
VIRGINIA ELECTRIC AND POWER COMPANY (DOMINION)
NORTH ANNA POWER STATION UNITS I AND 2 ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICES In accordance with 10 CFR 31.5, enclosed is NRC Form 664, General Licensee Registration, for registration of generally licensed devices maintained at North Anna Power Station.If you have any questions, please contact Mr. R.. B. Evans at (540) 894-2107.Sincerely, Gerald T. Bischof Site Vice President Enclosure Commitments made by this letter: None cc: U.S. Nuclear Regulatory Commission Attention:
NORTH ANNA POWER STATION UNITS I AND 2 ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICES In accordance with 10 CFR 31.5, enclosed is NRC Form 664, General Licensee Registration, for registration of generally licensed devices maintained at North Anna Power Station.
Document Control Desk Washington, D. C. 20555-0001 U.S. Nuclear Regulatory Commission Region II Marquis One Tower 245 Peachtree Center Ave., NE Suite 1200 Atlanta, Georgia 30303-1 257 NRC Senior Resident Inspector North Anna Power Station N~ill IIII II IIII U I.I li1ii 11iii II I~ NDI~ WII 11 111 1 i llI~i I!GL-7001 15-20 10/30/2015 NRC FORM 664 07 -2015 10OCFR 31.5 APPROVED BY 0MB: NO. 3150-0198 SECTION 1 PAGE 1 of 2 U.S. NUCLEAR REGULATORY COMMISSION GENERAL LICENSEE REGISTRATION EXPIRES: 04/3012016 Estimated burden per response to comply with this mandatory collection request: 20 minutes. NRC will use this information to track general licensees and their devices to ensure a higher level of device aocountability.
If you have any questions, please contact Mr. R.. B. Evans at (540) 894-2107.
Send comments regarding burden estimate to the FOIA, Privacy, and Information Collections Branch (7-5 F53), U. S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail[ to Infocollects.Resource~nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1 0202, (3150-01 9B), Office of[ Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a 1currently valid 0MB control number, the.NRC may not conduct or sponsor, end a. person is not required to respond to, the information collection.
Sincerely, Gerald T. Bischof Site Vice President Enclosure Commitments made by this letter: None cc:   U.S. Nuclear Regulatory Commission Attention: Document Control Desk Washington, D. C. 20555-0001 U.S. Nuclear Regulatory Commission Region II Marquis One Tower 245 Peachtree Center Ave., NE Suite 1200 Atlanta, Georgia 30303-1 257 NRC Senior Resident Inspector North Anna Power Station
Complete -all six sections of this registration form. If any of the preprinted information is incorrect, provide the changes in the applicable boxes. USE CAPITAL LETTERS.General License Registration Number GL-700115-20 SECTION 1 -GENERAL LICENSEE INFORMATION Enter the company name and the street address/physical location of use for your device(s).
 
For portable devices, specify the primary storage location.
N~ill   IIIIIIIIIIUI.li1ii GL-7001 15-20 I 11iii           III~ NDI~ WII     11111      i llI~i1I!                                                                 SECTION 1 10/30/2015                                                                                                                                             PAGE 1 of 2 NRC FORM 664                                                                                                   U.S. NUCLEAR REGULATORY COMMISSION 07 - 2015 10OCFR 31.5                                       GENERAL LICENSEE REGISTRATION APPROVED BY 0MB: NO. 3150-0198                                                                                                               EXPIRES: 04/3012016 Estimated burden per response to comply with this mandatory collection request: 20 minutes. NRC will use this information to track general licensees and their devices to ensure a higher level of device aocountability. Send comments regarding burden estimate to the FOIA, Privacy, and Information Collections Branch (7-5 F53), U. S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail[ to Infocollects.Resource~nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1 0202, (3150-01 9B), Office of[ Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a 1currently valid 0MB control number, the.NRC may not conduct or sponsor, end a. person is not required to respond to, the information collection.
Do not use a P.O. Box address.Company Name: DOMINION VIRGIN.IA POWER Department:
Complete -all six sections of this registration form. If any of the preprinted information is incorrect, provide the changes in the applicable boxes. USE CAPITAL LETTERS.
NORTH ANNA POWER STATIO I Address Line 1: 1022 HALEY DRIVE Address Line 2: END OF ROUTE 700 City: MINERAL State: VA Zip Code: 23117 -0402 wz~ -:For NRC use Only-: C, ategory:" (Do :not write here) : ,. .:... .-.'. .. : '. :".::: .-.:. ,"Packet Receipt Date (MMDDYYY ):: i : ? i I I I' I I L ..1 I~ I I .1J I.. .." -..::. Accession Number:.A A Ii IIIIIIII II 111i-111 IIII III! IIII Iin III IIIII nII 111111111 GL-7001 15-20 10/30/2015 111111111 IIII IIIII IIII III III II111Il SECTION 1 PAGE 2 of 2 SECTION 1 -GENERAL LICENSEE INFORMATION (Continued)
General License                               SECTION 1 - GENERAL LICENSEE INFORMATION Registration Number GL-700115-20 Enter the company name and the street address/physical location of use for your device(s).                                                     For portable devices, specify the primary storage location. Do not use a P.O. Box address.
Company Name: DOMINION VIRGIN.IA POWER Department:               NORTH ANNA POWER STATIO I
Address Line 1:           1022 HALEY DRIVE Address Line 2:           END OF ROUTE 700 City:                     MINERAL State:     VA                                 Zip Code: 23117 - 0402
:For NRC use Only-:
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IIIIIIII II111i-111 Ii                    IIII III!IIII IinIIIIIIIInII111111111                      111111111 IIIIIIIII  IIIIIIIIII II111 GL-7001 15-20                                                                                       SECTION 1 10/30/2015 PAGE 2 of 2 SECTION 1 - GENERAL LICENSEE INFORMATION (Continued)
Enter the name, teleiphone number and title of the person who is the responsible individual for the device(s).
Enter the name, teleiphone number and title of the person who is the responsible individual for the device(s).
Last Name: EVANS First Name: ROBERT Middle Initial:B Telephone:
Last Name:   EVANS First Name:   ROBERT                                           Middle Initial:B Telephone:   (540) 894-2107                                   Extension:
(540) 894-2107 Extension:
Title:       CURRENT SAFETY OFFICER Enter the mailing address where correspondence regarding your device(s) should be sent.
Title: CURRENT SAFETY OFFICER Enter the mailing address where correspondence regarding your device(s) should be sent.This address should be specific to the use or storage location of your device(s).
This address should be specific to the use or storage location of your device(s).
Department:
Department:       NORTH ANNA POWER STATION Address Line 1:   1022 HALEY DRIVE Address Line 2:   END OF ROUTE 700 City:             MINERAL State: VA     D ___     Zip Code: 23117 -0402         [                       - z*z          z A                                                                                             A
NORTH ANNA POWER STATION Address Line 1: 1022 HALEY DRIVE Address Line 2: END OF ROUTE 700 City: MINERAL State: VA D ___ Zip Code: 23117 -0402 [ -z A A I IIIHIIII11 II IIIIINVI l iii lii III 1111 11ilIIIIi11 1111111I II I! 111111 i II!1 III IIl III GL-700115-20 10/30/2015 SECTION 2 -DEVICES SUBJECT TO REGISTRATION SECTION 2 Our records indicate that you have these devices. Please update the information as necessary.
 
PAGE 1 of 1 NRC Device Key 595514 (Internal Control Number)Distributor/Distributed By: OXFORD INSTRUMENTS ANALYTICAL Distributor License Number: 29-30342-02G Manufacturer Name: METOREX, INC Device Model (Not Source Model)i DOPS Device Serial Number: 128018 Transfer.Date (Receipt Date): 08/12/1999 rvn Not in possession of device (Also_J __J L D complete Section 4.)MM DD YYYY Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi)1 AM241 30.000000000 mCi 2 3 4*5 6 E.E D IDII'.A.A IIII]111 Iv iIII n !1 Inn I iii1111 UIIII inII III 1111111 III Iin 111 1IIIII 1 IIII In I In I IIi!1 SGL-700115-20 10/30/2015 SECTION 3 SECTION 3 -ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1 provide information about other devices you have that are subject to registration.
IIIIHIIII11 GL-700115-20 IIIIIIINVI l IIIiii li 1111       11ilIIIIi11 II 1111111I                       I!111111 i II!1   III IIl III 10/30/2015                     SECTION 2     - DEVICES SUBJECT TO REGISTRATION                         SECTION 2 Our records indicate that you have these devices. Please update the information as necessary.             PAGE 1 of 1 NRC Device Key                 595514     (Internal Control Number)
Do not report specifically licensed devices.Manufacturer Name Initial Transferor Name Initial Transferor License Number (if known)Device Model Number (Not Source Model)Device Serial Number o Manufacturer/Initial Transferor listed above How acquired and date (e.g., from a distributor/manufacturer, 0 Other General Licensee Date Transferred:
Distributor/Distributed By:     OXFORD INSTRUMENTS ANALYTICAL Distributor License Number:     29-30342-02G Manufacturer Name: METOREX, INC Device Model (Not Source Model)i DOPS Device Serial Number: 128018 Transfer.Date (Receipt Date): 08/12/1999 rvn                                           Not in possession of device (Also
F _7 F _77 other licensee, other source)?L..LJL.LJ U Other Source (Received)
* _J L
MM DD YYYY Isotope (e.g. AM241 )1.3.4.6 .7.8.~D 9.10. DI I Activity (e.g. 100)II II LI m Unit (e.g. mCi)LW~DIDI DID1 WI DIDI DIDJ I I I I I I I I I I A A I II11 IIIII il11111 IIII11 l11 IIII II II II~II i11 liIIIIII II~II ii IIII[II IIIII 1 1L-0/0/215-2 SEcTiON 4 -NOT IN POSSESSION OF DEVICE SECTION 4 Provide information about devices listed in Section 2 or 6, but no longer in your possession.
* __J*
PAGE 1of 1 Part I Transfer Date: NRC Device Key: ______________________(from Section 2 or 6)MM DD YYYY Location of the Device: o Whereabouts Unknown (complete Part 1 only) O 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):
* D complete Section 4.)
Company Name:-Department:
MM           DD           YYYY Isotope (e.g. AM241)               Activity (e.g. 100)                                           Unit (e.g. mCi) 1   AM241                               30.000000000                                                 mCi 2
Adrs ine 1:l l l ~l II Address Line 2: City:*Part 3 Enter the name of the individual responsible for. this device: Last Name: First Name: Middle Initial: Title: A A GL-7001 15-20 SECTION 5 -CERTIFICATION SECTION 5 10/30/2015 PAGE 1 of 1 Ihereby 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 on this form has been checked against the device labeling.C. l am aware of the requirements of the general license, p~rovided in 10 CFR 31.5.(Copies of applicable regulations may be viewed at the NRC website at: http://www, nrc.gov/reading-rm/doc-collections/cfr)
3 4*
SIGNATURE  
5 6
-RESPONSIBLE INDIVIDUAL (Listed in Section 1) DATE WARNING: FALSE STATEMENTS MAY BE SUBJECT TO CIVILAND/OR CRIMINAL PENALTIES.
E.E                                                                                         DIDII
NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL ASPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY WRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER IN ITS JURISDICTION.
          .A                                                                                                 '.A
A A GL-700115-20 10/30/2015  
 
.. ...... .....IflL 5~ F C~r I (~ t'J R~t.. I -UtVIU~ rJU ~UI~JIL. I iLl ~ ~AI HUN PAGE lofI NRC Device Key: 825331 Manufacturer License No: 12-04933-04G Manufacturer Name: PERKINELMER LIFE SCIENCES Model Number: B310000 Serial #: DG08129527 Isotope: BA133 Activity:
IIII]111 IviIIIn!1 SGL-700115-20 10/30/2015 Inn  Iiii1111 UIIIIinII III 1111111  IIIIin                                111 1IIIII 1IIIIInIIn SECTION 3 IIIi!1 SECTION 3   - ADDITIONAL DEVICES SUBJECT TO REGISTRATION                                 PAGE 1 of 1 provide information about other devices you have that are subject to registration. Do not report specifically licensed devices.
0.020000000 Unit: uCi Transfer Date: 07/20/2012 NRC Device Key: 689428 Manufacture Manufacturer Name: GE ION TRACK Model Number: ITEMISER III Serial #: 09'-8424 Isotope: N163 Activity:
Manufacturer Name Initial Transferor Name Initial Transferor License Number (if known)
10.000000000
Device Model Number (Not Source Model)
;r License No: 20-15525-04G Transfer Date: 06/30/2003 Unit: mCi NRC Device Key: 707159 " Manufacturer Name: METOREX, INC.Model Number: 880 Isotope: CD109 Activity:
Device Serial Number o   Manufacturer/Initial Transferor listed above How acquired and date (e.g.,
10.0 Manufadturer License No: 455-01G Serial #: 128018 Transfer Date: 02/27/2002 00000000 Unit: mCi NRC Device Key: 547351 Manufacturer Name: CONCO SERVICES CORP.Model Number: 101 Seria Isotope: N163 Activity:
from a distributor/manufacturer, 0 Other General Licensee             Date Transferred:   F   _7 F     _77 *
5.000000000 Manufacturer License No: MD-3 1-076-01 l#: N596 Transfer Date: 02/15/1994 Unit: mCi}}
* other licensee, other source)?L..LJL.LJ U Other Source                     (Received)           MM       DD             YYYY Isotope (e.g. AM241 )               Activity (e.g. 100)                                                 Unit (e.g. mCi) 1.
IIm LW~
3.
4.
II                        DIDI 6      .
DID1 7.
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: 9.                                                                                                                  DIDJ
: 10.        DI              I I    I A                                                                                                         A
 
III11  IIIII 1L-0/0/215-2 il11111IIII11 l11 IIII    IIIIII~II SEcTiON 4 i11 liIIIIII
                                                  - NOT IN POSSESSION OF DEVICE II~II  ii IIII[II  IIIII 1 SECTION 4 Provide information about devices listed in Section 2 or 6, but no longer in your possession.                 PAGE 1of 1 Part I                                                         Transfer Date:
NRC Section (from  Device Key:
2 or 6) ______________________                    MM         DD         YYYY Location of the Device:
o   Whereabouts Unknown (complete Part 1 only)         O 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:
Adrsine 1:l                                             l l         ~l                     II Address Line 2:
City:
*Part 3           Enter the name of the individual responsible for. this device:
Last Name:
First Name:                                                                                   Middle Initial:
Title:
A                                                                                                       A
 
GL-7001 15-20                                   SECTION 5 - CERTIFICATION                                 SECTION 5 10/30/2015                                                                                                 PAGE 1 of 1 Ihereby 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 on this form has been checked against the device labeling.
C.     l am aware of the requirements of the general license, p~rovided in 10 CFR 31.5.
(Copies of applicable regulations may be viewed at the NRC website at:
http://www, nrc.gov/reading-rm/doc-collections/cfr)
SIGNATURE       - RESPONSIBLE INDIVIDUAL (Listed in Section 1)               DATE WARNING:         FALSE STATEMENTS MAY BE SUBJECT TO CIVILAND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL ASPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY WRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER IN ITS JURISDICTION.
A                                                                                                         A
 
GL-700115-20 10/30/2015                 ..   . . .     . ..   .   . .   . .
                            ~t.. I       - UtVIU~ rJU         ~UI~JIL. I iLl ~
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                                                                                          ~AI HUN 5~ F C~r I(~ t'J R PAGE lofI NRC Device Key: 825331                           Manufacturer License No:     12-04933-04G Manufacturer Name: PERKINELMER LIFE SCIENCES Model Number: B310000                 Serial #: DG08129527 Transfer Date: 07/20/2012 Isotope: BA133         Activity: 0.020000000                         Unit: uCi NRC Device Key: 689428                           Manufacture ;r License No:  20-15525-04G Manufacturer Name: GE ION TRACK Model Number: ITEMISER III             Serial #: 09'-8424 Transfer Date: 06/30/2003 Isotope: N163           Activity: 10.000000000 Unit: mCi NRC Device Key: 707159         "                 Manufadturer License No:    455-01G Manufacturer Name: METOREX, INC.
Model Number: 880                     Serial #: 128018                                       Transfer Date: 02/27/2002 Isotope: CD109          Activity: 10.0 00000000                       Unit: mCi NRC Device Key: 547351                           Manufacturer License No:    MD-3 1-076-01 Manufacturer Name: CONCO SERVICES CORP.
Model Number: 101                     Seria l#: N596                                       Transfer Date: 02/15/1994 Isotope: N163          Activity: 5.000000000                        Unit: mCi}}

Revision as of 02:46, 31 October 2019

GL Registration from Virginia Electric and Power Company (Dominion) North Anna Power Station Units 1 and 2
ML15357A053
Person / Time
Site: North Anna  
Issue date: 12/18/2015
From: Gerald Bichof
Virginia Electric & Power Co (VEPCO)
To:
Office of Nuclear Material Safety and Safeguards
References
15-581, GL-700115-20
Download: ML15357A053 (8)
v • d • e


Text

VIRGINIA E*LECTRIC AND POWER COMPANY RICHMOND, VIRGINIA 23261 December 18, 2015 Director, Office of Nuclear Material Safety Serial No.15-581 and Safeguards NAPS/JHL ATT-IN: GLTS Docket Nos. 50-338/339 U. S. Nuclear Regulatory Commission License Nos. NPF-4/7 Washington, DC 20555-0001 Gentlemen:

VIRGINIA ELECTRIC AND POWER COMPANY (DOMINION)

NORTH ANNA POWER STATION UNITS I AND 2 ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICES In accordance with 10 CFR 31.5, enclosed is NRC Form 664, General Licensee Registration, for registration of generally licensed devices maintained at North Anna Power Station.

If you have any questions, please contact Mr. R.. B. Evans at (540) 894-2107.

Sincerely, Gerald T. Bischof Site Vice President Enclosure Commitments made by this letter: None cc: U.S. Nuclear Regulatory Commission Attention: Document Control Desk Washington, D. C. 20555-0001 U.S. Nuclear Regulatory Commission Region II Marquis One Tower 245 Peachtree Center Ave., NE Suite 1200 Atlanta, Georgia 30303-1 257 NRC Senior Resident Inspector North Anna Power Station

N~ill IIIIIIIIIIUI.li1ii GL-7001 15-20 I 11iii III~ NDI~ WII 11111 i llI~i1I! SECTION 1 10/30/2015 PAGE 1 of 2 NRC FORM 664 U.S. NUCLEAR REGULATORY COMMISSION 07 - 2015 10OCFR 31.5 GENERAL LICENSEE REGISTRATION APPROVED BY 0MB: NO. 3150-0198 EXPIRES: 04/3012016 Estimated burden per response to comply with this mandatory collection request: 20 minutes. NRC will use this information to track general licensees and their devices to ensure a higher level of device aocountability. Send comments regarding burden estimate to the FOIA, Privacy, and Information Collections Branch (7-5 F53), U. S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail[ to Infocollects.Resource~nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1 0202, (3150-01 9B), Office of[ Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a 1currently valid 0MB control number, the.NRC may not conduct or sponsor, end 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 the changes in the applicable boxes. USE CAPITAL LETTERS.

General License SECTION 1 - GENERAL LICENSEE INFORMATION Registration Number GL-700115-20 Enter the company name and the street address/physical location of use for your device(s). For portable devices, specify the primary storage location. Do not use a P.O. Box address.

Company Name: DOMINION VIRGIN.IA POWER Department: NORTH ANNA POWER STATIO I

Address Line 1: 1022 HALEY DRIVE Address Line 2: END OF ROUTE 700 City: MINERAL State: VA Zip Code: 23117 - 0402

For NRC use Only-:

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IIIIIIII II111i-111 Ii IIII III!IIII IinIIIIIIIInII111111111 111111111 IIIIIIIII IIIIIIIIII II111 GL-7001 15-20 SECTION 1 10/30/2015 PAGE 2 of 2 SECTION 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: EVANS First Name: ROBERT Middle Initial:B Telephone: (540) 894-2107 Extension:

Title: CURRENT SAFETY OFFICER Enter the mailing address where correspondence regarding your device(s) should be sent.

This address should be specific to the use or storage location of your device(s).

Department: NORTH ANNA POWER STATION Address Line 1: 1022 HALEY DRIVE Address Line 2: END OF ROUTE 700 City: MINERAL State: VA D ___ Zip Code: 23117 -0402 [ - z*z z A A

IIIIHIIII11 GL-700115-20 IIIIIIINVI l IIIiii li 1111 11ilIIIIi11 II 1111111I I!111111 i II!1 III IIl III 10/30/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 Our records indicate that you have these devices. Please update the information as necessary. PAGE 1 of 1 NRC Device Key 595514 (Internal Control Number)

Distributor/Distributed By: OXFORD INSTRUMENTS ANALYTICAL Distributor License Number: 29-30342-02G Manufacturer Name: METOREX, INC Device Model (Not Source Model)i DOPS Device Serial Number: 128018 Transfer.Date (Receipt Date): 08/12/1999 rvn Not in possession of device (Also

  • _J L
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  • D complete Section 4.)

MM DD YYYY Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi) 1 AM241 30.000000000 mCi 2

3 4*

5 6

E.E DIDII

.A '.A

IIII]111 IviIIIn!1 SGL-700115-20 10/30/2015 Inn Iiii1111 UIIIIinII III 1111111 IIIIin 111 1IIIII 1IIIIInIIn SECTION 3 IIIi!1 SECTION 3 - ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1 provide information about other devices you have that are subject to registration. Do not report specifically licensed devices.

Manufacturer Name Initial Transferor Name Initial Transferor License Number (if known)

Device Model Number (Not Source Model)

Device Serial Number o Manufacturer/Initial Transferor listed above How acquired and date (e.g.,

from a distributor/manufacturer, 0 Other General Licensee Date Transferred: F _7 F _77 *

  • other licensee, other source)?L..LJL.LJ U Other Source (Received) MM DD YYYY Isotope (e.g. AM241 ) Activity (e.g. 100) Unit (e.g. mCi) 1.

IIm LW~

3.

4.

II DIDI 6 .

DID1 7.

I I I I I I I I LI WI 8.~D DIDI

9. DIDJ
10. DI I I I A A

III11 IIIII 1L-0/0/215-2 il11111IIII11 l11 IIII IIIIII~II SEcTiON 4 i11 liIIIIII

- NOT IN POSSESSION OF DEVICE II~II ii IIII[II IIIII 1 SECTION 4 Provide information about devices listed in Section 2 or 6, but no longer in your possession. PAGE 1of 1 Part I Transfer Date:

NRC Section (from Device Key:

2 or 6) ______________________ MM DD YYYY Location of the Device:

o Whereabouts Unknown (complete Part 1 only) O 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:

Adrsine 1:l l l ~l II Address Line 2:

City:

  • Part 3 Enter the name of the individual responsible for. this device:

Last Name:

First Name: Middle Initial:

Title:

A A

GL-7001 15-20 SECTION 5 - CERTIFICATION SECTION 5 10/30/2015 PAGE 1 of 1 Ihereby 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 on this form has been checked against the device labeling.

C. l am aware of the requirements of the general license, p~rovided in 10 CFR 31.5.

(Copies of applicable regulations may be viewed at the NRC website at:

http://www, nrc.gov/reading-rm/doc-collections/cfr)

SIGNATURE - RESPONSIBLE INDIVIDUAL (Listed in Section 1) DATE WARNING: FALSE STATEMENTS MAY BE SUBJECT TO CIVILAND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL ASPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY WRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER IN ITS JURISDICTION.

A A

GL-700115-20 10/30/2015 .. . . . . .. . . . . .

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~AI HUN 5~ F C~r I(~ t'J R PAGE lofI NRC Device Key: 825331 Manufacturer License No: 12-04933-04G Manufacturer Name: PERKINELMER LIFE SCIENCES Model Number: B310000 Serial #: DG08129527 Transfer Date: 07/20/2012 Isotope: BA133 Activity: 0.020000000 Unit: uCi NRC Device Key: 689428 Manufacture ;r License No: 20-15525-04G Manufacturer Name: GE ION TRACK Model Number: ITEMISER III Serial #: 09'-8424 Transfer Date: 06/30/2003 Isotope: N163 Activity: 10.000000000 Unit: mCi NRC Device Key: 707159 " Manufadturer License No: 455-01G Manufacturer Name: METOREX, INC.

Model Number: 880 Serial #: 128018 Transfer Date: 02/27/2002 Isotope: CD109 Activity: 10.0 00000000 Unit: mCi NRC Device Key: 547351 Manufacturer License No: MD-3 1-076-01 Manufacturer Name: CONCO SERVICES CORP.

Model Number: 101 Seria l#: N596 Transfer Date: 02/15/1994 Isotope: N163 Activity: 5.000000000 Unit: mCi

VIRGINIA E*LECTRIC AND POWER COMPANY RICHMOND, VIRGINIA 23261 December 18, 2015 Director, Office of Nuclear Material Safety Serial No.15-581 and Safeguards NAPS/JHL ATT-IN: GLTS Docket Nos. 50-338/339 U. S. Nuclear Regulatory Commission License Nos. NPF-4/7 Washington, DC 20555-0001 Gentlemen:

VIRGINIA ELECTRIC AND POWER COMPANY (DOMINION)

NORTH ANNA POWER STATION UNITS I AND 2 ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICES In accordance with 10 CFR 31.5, enclosed is NRC Form 664, General Licensee Registration, for registration of generally licensed devices maintained at North Anna Power Station.

If you have any questions, please contact Mr. R.. B. Evans at (540) 894-2107.

Sincerely, Gerald T. Bischof Site Vice President Enclosure Commitments made by this letter: None cc: U.S. Nuclear Regulatory Commission Attention: Document Control Desk Washington, D. C. 20555-0001 U.S. Nuclear Regulatory Commission Region II Marquis One Tower 245 Peachtree Center Ave., NE Suite 1200 Atlanta, Georgia 30303-1 257 NRC Senior Resident Inspector North Anna Power Station

N~ill IIIIIIIIIIUI.li1ii GL-7001 15-20 I 11iii III~ NDI~ WII 11111 i llI~i1I! SECTION 1 10/30/2015 PAGE 1 of 2 NRC FORM 664 U.S. NUCLEAR REGULATORY COMMISSION 07 - 2015 10OCFR 31.5 GENERAL LICENSEE REGISTRATION APPROVED BY 0MB: NO. 3150-0198 EXPIRES: 04/3012016 Estimated burden per response to comply with this mandatory collection request: 20 minutes. NRC will use this information to track general licensees and their devices to ensure a higher level of device aocountability. Send comments regarding burden estimate to the FOIA, Privacy, and Information Collections Branch (7-5 F53), U. S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail[ to Infocollects.Resource~nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1 0202, (3150-01 9B), Office of[ Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a 1currently valid 0MB control number, the.NRC may not conduct or sponsor, end 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 the changes in the applicable boxes. USE CAPITAL LETTERS.

General License SECTION 1 - GENERAL LICENSEE INFORMATION Registration Number GL-700115-20 Enter the company name and the street address/physical location of use for your device(s). For portable devices, specify the primary storage location. Do not use a P.O. Box address.

Company Name: DOMINION VIRGIN.IA POWER Department: NORTH ANNA POWER STATIO I

Address Line 1: 1022 HALEY DRIVE Address Line 2: END OF ROUTE 700 City: MINERAL State: VA Zip Code: 23117 - 0402

For NRC use Only-:

wz~

  • C,ategory:"

-

(Do :not write here) : ,. .  :... . -. '. .. :

'. * . :".:::

-. :. ,"Packet Receipt Date (MMDDYYY ):

i*-: ? i I I I' I I *

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IIIIIIII II111i-111 Ii IIII III!IIII IinIIIIIIIInII111111111 111111111 IIIIIIIII IIIIIIIIII II111 GL-7001 15-20 SECTION 1 10/30/2015 PAGE 2 of 2 SECTION 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: EVANS First Name: ROBERT Middle Initial:B Telephone: (540) 894-2107 Extension:

Title: CURRENT SAFETY OFFICER Enter the mailing address where correspondence regarding your device(s) should be sent.

This address should be specific to the use or storage location of your device(s).

Department: NORTH ANNA POWER STATION Address Line 1: 1022 HALEY DRIVE Address Line 2: END OF ROUTE 700 City: MINERAL State: VA D ___ Zip Code: 23117 -0402 [ - z*z z A A

IIIIHIIII11 GL-700115-20 IIIIIIINVI l IIIiii li 1111 11ilIIIIi11 II 1111111I I!111111 i II!1 III IIl III 10/30/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 Our records indicate that you have these devices. Please update the information as necessary. PAGE 1 of 1 NRC Device Key 595514 (Internal Control Number)

Distributor/Distributed By: OXFORD INSTRUMENTS ANALYTICAL Distributor License Number: 29-30342-02G Manufacturer Name: METOREX, INC Device Model (Not Source Model)i DOPS Device Serial Number: 128018 Transfer.Date (Receipt Date): 08/12/1999 rvn Not in possession of device (Also

  • _J L
  • __J*
  • D complete Section 4.)

MM DD YYYY Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi) 1 AM241 30.000000000 mCi 2

3 4*

5 6

E.E DIDII

.A '.A

IIII]111 IviIIIn!1 SGL-700115-20 10/30/2015 Inn Iiii1111 UIIIIinII III 1111111 IIIIin 111 1IIIII 1IIIIInIIn SECTION 3 IIIi!1 SECTION 3 - ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1 provide information about other devices you have that are subject to registration. Do not report specifically licensed devices.

Manufacturer Name Initial Transferor Name Initial Transferor License Number (if known)

Device Model Number (Not Source Model)

Device Serial Number o Manufacturer/Initial Transferor listed above How acquired and date (e.g.,

from a distributor/manufacturer, 0 Other General Licensee Date Transferred: F _7 F _77 *

  • other licensee, other source)?L..LJL.LJ U Other Source (Received) MM DD YYYY Isotope (e.g. AM241 ) Activity (e.g. 100) Unit (e.g. mCi) 1.

IIm LW~

3.

4.

II DIDI 6 .

DID1 7.

I I I I I I I I LI WI 8.~D DIDI

9. DIDJ
10. DI I I I A A

III11 IIIII 1L-0/0/215-2 il11111IIII11 l11 IIII IIIIII~II SEcTiON 4 i11 liIIIIII

- NOT IN POSSESSION OF DEVICE II~II ii IIII[II IIIII 1 SECTION 4 Provide information about devices listed in Section 2 or 6, but no longer in your possession. PAGE 1of 1 Part I Transfer Date:

NRC Section (from Device Key:

2 or 6) ______________________ MM DD YYYY Location of the Device:

o Whereabouts Unknown (complete Part 1 only) O 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:

Adrsine 1:l l l ~l II Address Line 2:

City:

  • Part 3 Enter the name of the individual responsible for. this device:

Last Name:

First Name: Middle Initial:

Title:

A A

GL-7001 15-20 SECTION 5 - CERTIFICATION SECTION 5 10/30/2015 PAGE 1 of 1 Ihereby 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 on this form has been checked against the device labeling.

C. l am aware of the requirements of the general license, p~rovided in 10 CFR 31.5.

(Copies of applicable regulations may be viewed at the NRC website at:

http://www, nrc.gov/reading-rm/doc-collections/cfr)

SIGNATURE - RESPONSIBLE INDIVIDUAL (Listed in Section 1) DATE WARNING: FALSE STATEMENTS MAY BE SUBJECT TO CIVILAND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL ASPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY WRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER IN ITS JURISDICTION.

A A

GL-700115-20 10/30/2015 .. . . . . .. . . . . .

~t.. I - UtVIU~ rJU ~UI~JIL. I iLl ~

IflL

~AI HUN 5~ F C~r I(~ t'J R PAGE lofI NRC Device Key: 825331 Manufacturer License No: 12-04933-04G Manufacturer Name: PERKINELMER LIFE SCIENCES Model Number: B310000 Serial #: DG08129527 Transfer Date: 07/20/2012 Isotope: BA133 Activity: 0.020000000 Unit: uCi NRC Device Key: 689428 Manufacture ;r License No: 20-15525-04G Manufacturer Name: GE ION TRACK Model Number: ITEMISER III Serial #: 09'-8424 Transfer Date: 06/30/2003 Isotope: N163 Activity: 10.000000000 Unit: mCi NRC Device Key: 707159 " Manufadturer License No: 455-01G Manufacturer Name: METOREX, INC.

Model Number: 880 Serial #: 128018 Transfer Date: 02/27/2002 Isotope: CD109 Activity: 10.0 00000000 Unit: mCi NRC Device Key: 547351 Manufacturer License No: MD-3 1-076-01 Manufacturer Name: CONCO SERVICES CORP.

Model Number: 101 Seria l#: N596 Transfer Date: 02/15/1994 Isotope: N163 Activity: 5.000000000 Unit: mCi

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