IR 05000236/1995001

Matls Licensing Package for Amend 1 to License 50-23695-01 for Admiralty Testing Svc.Control:571698

ML20127F979
Person / Time
Site:	05000236, 03030178
Issue date:	12/30/1992
From:	Prange B NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION V)
To:
References
50-23695-01, 50-23695-1, 571698, NUDOCS 9301210107
Download: ML20127F979 (17)

Text

- ..- . . _ .-.-- ~__...- .---. -- - ~ - . - - - - . . . - - - - _ . -

, 7"NRC Form 374= = = = =.= = = .= mL= =_= = m.= = = =M = =MN4MA*1tMEf3.'1E*E'X%[iqa ap mgy .

13'O . -

.. U.S. NUCLEAR REGULATORY COMMISSION P#" } O' 3 'AUS Ij

.

g

,; Amendment No. 1

[

'

MATERIALS LICENSE

-

Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Pubhc Law 93 -438), and 'litle 10,

'

Code of federal Regulations, Chapter I, Parts 30,31,32,33,34,35,40 and 70, and in reliance on statements and representations .

'

heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess, and transfer byproduct, .!

source, and special nuclear matenal designated below; to use wch material for the purpose (s) and at the pbce(.) designated below;to l T deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the appheable Part(s) This ;

license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, as amended, and is i

_ subject to all applicable rules, regulations and orders of the Nuclear Regulatory Commission now or hereafter in effect and to any. l 1 conditions specified belo i El . _ . . _ i

""* * *

In accordance with application 3 dated September 26, 1992 i 1. Admiralty Testing Services 3. Ucense number 50-23695-01 is amended  ;

in its entirety to read as follows: l

,

!r 2. P.O. Box 7193 r i ~ - -

l l Ketchikan, AK 99901 , N-!- 4. Expiration date Dacember 31, 1997 lpt-

' ~

5. Docket or

] Reference N .

030-30178 l ,

' 6. Byproduct, source, and/or ,

7. Chemical and/or physical ( 8. Maximum anwunt that licensee j special nuclear material form < imay possess at any one time under this license Cesium 137 Sealed Sources Not to exceed 10 (TroxlerOwg. .. t ' millicuries

!

A-102112)

-

l

,

-

, Americium 241 Sealed neutron sources Not to exceed 50 pt

-

(TroxlerDw l millicuries  ;

>

A-102451) -

r

l l Authorized use j t = t i

A. and For use in a Troxler Model 3400 Series Moisture-Density gauge to-measure properties of construction material g V *

' g-CONDITIONS; v -- ; g; ,

1 Licensed material may be used at 2869 South-Tongass Avenue, Ketchikan, Alaska 99901 i

=

and at temporary job sites- of the licensee anywhere in the United States where the F-

-

U. S. Nuclear Regulatory Commission maintains jurisdiction for regulating the use of i

licensed materia [j g

g

l l . . Licensed material shall be used by, or under the supervision and in the physical . g; i

presence of, Mark T. Johnson or individuals who have successfully coinpleted the . t; l- manufacturer's training program for gauge users and who have been designated by the (

l Radiation Protection Officer, Mark T. Johnson. The licensee shall maintain record (

b of individuals designated as user ;i

! g j 1 Scaled sources containing licensed material shall not be opene B B

B li tonnen

[ '

-

1 9301210107 921230 PDR- ADOCK 03030170 PDK -

C i /h L CO ,

'

i WWWI55577&%tXtMTiV55.dQiitM.TNhWh*U .2risisBr&T)fKifdsntLWFW M "

- _

_ . _ _ _ _ _ _ _ . . _ . _ _ _ _ - _ _ _ _ . - _ . - _ . _ _ _ . . ._ __ _

= = = = ==i= .fsmrz=ns ETn AmajlLTx1gazwrzws s mras w ...=7 m3.._g20g_m.._,

une rom m A U.S. NUCLEOR REGULATORY COMMIS$10N Pact

~

OF 'PAGES I

'S 9 *

ucense nuinwr

.

50-23695-01 p M ATERIALS LICENSE nockn or 1Ghrena numb

-

SUPPLEMENTARY SHEET 030-30178 8>

j

'

Amendment No. 1 CONDITIONS (continued)  !

1 The source (s) specified in Item (s) 7.A. and 7.B. shall be tested for leakage and/or contamination at intervals not to exceed 6 months. Any-source received i;l from another person which is not accompanied by a certificate indicating that l 1 a test was performed within 6 months before the transfer shall not be put into j j use until teste Any source in storage and not being used need not be tested. When the source is removed from storage for-use or transfer to another person, it shall be j

. tested before use or transfe f k> l The test shall be capable of detecting the presince of 0.005 microcurie of 11 l radioactive material on the test sample. If the test reveals the presence of j

0.005 microcurie or more of removable contamination,'the source shall be removed from service and decontaminated, repaired, or disposed of in ,

q accordance with Commission regulations. A report shall be filed within-5 days !

q of the date the leak test result is known with the U. S. Nuclear Regulatory Commission, Region V, Radioactive Materials Safety Branch,1450 Maria Lane,

-

I

,

I Walnut Creek, California _94596. __The _ report shall specify tne source involved, the test results, and corrective action take Records of leak test results l shall be kept in units of microcuries and shall be maintained for inspection q

g, by the Commission. Records may be disposed of following Commission ,

inspectio j

{  ; The licensee is authorized to collbct leak-test samples for mlysis by Troxler Electronic Laboratories.. Inc. or tests for leakage ana/or h[l -

q

contamination shall be performed by persor.s specifically licensed by the Commission or an' Agreement State to perform such service .

4l 1 The licensee shall conduct a physical inventory every six (6) months to account for M{

>

F Ri Records of the -

all sources shall inventories and/or bedevices received maintained for twoand p(ossessed under the license.2) years from th k

4l1 The licensee may transport licensed material in accordance with the provisions of 10

% CFR Part 71, " Packaging and Transportation of Radioactive Material".

=1  ;

-

W (a:

('

(4 Al

(, i di i ( '

i i

'

%[ !4

< $

u.m m x.a m ax a x m a x a m m aa m m m w ~ w ax m 1 .

. _ _ . _ . . _ _ . _ _ . . _ _ . _ . _ . _ - _ . _ _ . . -_ _ _ _ . _ _ . . _ _ _ _ . . . _ . _ _ . _ _ _ ___

ew = =a= = = =.=M]E08"J'WTIE*3ON3f Mwaf aam.mjjEM4 '

U.S. NUCLE AR REGULATORY COMMISSION OF PAGE$ h ( une 15 " 1 r... anA

PAOC ucenie nurnde'

,

50-23695-01 l MATERIALS LICENSE g,g, g ,7,,, ,,, ,,,,w, I

'

SUPPLEMENT ARY SHEET 030-30178- >

>

Amendment No. 1 l

,

>'

, CONDITIONS 8 l 4 (continued) i

8 1 Except as specifically provided otherwise in this license, the licensee shall j'

,

l conduct its program in accordance with the statements, representations, and procedures contained in the documents including any enclosures, listed below. The i Nuclear Regulatory Commission's regulations shall govern unless the statements, representations and procedures in the licensee's application and correspondence are 6 more restrictive than the regulation f

.

. . . - ,

~ Application dated September 26, 1992 h Letter dated December 19, 1992 'c >

k v

'

R:'

"c

.

, V

. h, k

>:

k,

,

R: ,;.

-

y

<- > -;

>

l E

, V

! >:

'

q' p'

q F

-

.

'

>:

(gl F qt b

-

, , >

q'!

(  !>

FOR THE U. S. NUCLEAR REGULATORY COMMISSION q' >

4 4

'

4l DEC 3 01992 o

-

By: D RIM Marw,.

[Date BethA.PrangeJ q!-

q! _ Sr.HealthPhysicist(Licensing)

q; Radioactive Materials-Safety Branch 4; Region V 4:

4l

.

+ -

di  !

3-Mi q;

N

.

L______J z

. .

C

.'

DEC s o ,gy Docket No. : 030-30178 License No.: 50-23695-01 Control No.: 571698 Admiralty Testing Services P.O. Box 7193 Ketchikan, AK 99901 Attention: Mark T. Johnson Enclosed is the NRC license renewal which you requeste Please review the enclosed document carefully and be sure that you understand all conditions. If there are any errors or questions, please notify us so that we can provide appropriate corrections and answer Any future correspondence relating to your license should specifically reference your license and docket numbers to expedite your inquir

Sincerely, Beth A. Prange Sr. Health Physicist (Licensing)

Radioactive Materials Safety Branch

Enclosure:

Attachment A Amendment No. I to License No. 50-23695-01

,

?

Distribution bec w/ original concurrence, copy of license and original correspondence:

License docket folder bec w/ copy of license and correspondence:

Inspection folder bec w/ copy of license:

Reading file bec w/ correspondence and 2 copies of license:

Shirley Crutchfield, LFMB, MNBB 4503 License only:

State of AK KPrendergast JMontgomery DSkov B nge

/ / / / / / 12 /30/42 REQUEST COPY REQUEST COPY REQUEST COPY REQUEST COPY YES a NO O YES O NO O YES a NO O YES a NO R'

.

-. . - - . - - _ _. . -+ . ~ . ~ . . - -. . .-_

a

>

.

'

.

I 12-19-92-U.S. Nuclear Regulatory Commision-Region V 1434 Maria Lane, Suite 210 Walast Creek , Calif. 94596 ,

.r Re: Licease No. "A-23695-81 '

Cestrol No. 571698

.

Dear Beth:

As requested this is in response to your letter dated 11-20-9 . Admiralty Testing Services is committed to insuring that our guage will be stored at 2869 5. Tongass Ave when met la use. It will never be left samattended and will be stored in a secure area when met la us . Leak tests will be performed by myself at six meath intervals utilizing a Trexler leak test kit. Smears will be seat to Trexler Laboratories at P.O. box 12057 -Research Triangle Pk. N.C. 2779 Investery will be conducted at six month latervals with records being kept for 2 years. coc wsr wit 2ww uwPc vuutec 3. Amy maintamance er clemains of the guage will be performed with the radioactive source in the shellded positie . Transportation of the guage will be conducted la a

REGION APPLICATION ATTACHED Applicant [ Licensee: ADMIRALTY T[511NG SER Received Date: 920930 Docket No: 3030178 Control No.: 571698 License No.: 50-23695-01 Action Type: Renewal Fit ATTACHED Amount:

l Check No.:

3. COMMENTS Si ned i Oake / /D -ppy U B. LIC[NSE FE[ MANACIMENT BRANCH (Check when milestone 03 is entered /_g) fee Category and Amount: 3[ hMo Correct Fee Paid. Application may be processed for:

Amendment Renewal 7 License HER Signed /

Date fl'

g b s o.//,Y./ %.

,_, ,

K

.

i

/ \o,, UNITED STATES E"

'

a NUCLEAR REGULATCRY COMMISSION E < ,I REGION V g higo MARIA LANE SUITE 210 WALNUT CREEK, CALIFORNIA Mtio6-5308

"94 , . . . . ,o OCT t 6 sq Docket No.: 030-30178 License No.: 50-23695-01 Control No.: 571698 Admiralty Testing Services P.O. Box 7193 Ketchikan, AK 99901 SUBJECT: LICENSE RENEWAL APPLICATION This is to acknowledge receipt of your application for renewal of the material (s) license identified above. Your application is deemed timely filed, and accordingly, the license will not expire until final action has been taken by this offic Any correspondence regarding this renewal application should reference the control number specified above and your license numbe

Sincerely,

$ 0. ffiz Beth A. Frange Sr. Health Physicist (Licensing)-

Nuclear Naterials and Fuel Fabrication Branch

?:

,,

Mh ~

/

s .

g 636 30/7g NRC Form 3131 RECEgED (1241) U.S. NUCLE AR Rt GULATNb$bWSION 1. APPLICATION FOR; (Check and/or complete as sopropnare/

-

APPLICATION FOR BYPRODUCT 3AblAk L E SE INDUSTRIAL a. NEW LICE NSE See attached instructions for deraus b AYTNDVENT TO LICE NSE NUMBE R Completed appl.c8tions are f.ie>J m dantocate nith the D:aisioh of fvH C$cie ank %teoa! Safet Offee of Notlear %terd $#erv. and Safeguards. U S Nuctear Rega!atory Commmion'

Wssh ngron. DC 20555 or anplaations rwy be fotni m person at the Comm; won's artice at i

c' RE NE WAL OF-1717 H Street, NW, mshmyton. D C or 1315 Eastern A venue. Silver Soring. %rylan ggm

/

2 APPLlCANT'S N AME //nsterarson. /,rm, pe son. etc / 50-2.% RS-01 V kDPligA1.TY TEST s% SrJ2,QcES 3. N AME AND TITLE OF PERSON TO BE CONT ACTED REGARDING THIS APPLICATION MA9K L ZC M SQJL WW T W(t60Y TE LEPHONE NUMBE R ARE A CODE - NUMBE R E XTE NSION TELEPHONE NVMEkR: ARE A CODE - NUMBE R E XTE NSION 9 o 1 - %2. 5 - Ip_45 clot - 2.2.s - to'45 4. APPLIC AN T'S MAILING ADDR ESS //nclude 2,p Codf/

.

9, (Address to which NRC corresponder,ce notices butietens, et . STREET ADDRESS (include Zip Codel WHERE LICENSED MATERIAL k.lLL E USED -

'

hould be sent >

ts@ %t Twms '

N T d ' N M ( M q of Kere-* KA4 AL AsvA Fu g V % m T o p _L % 5r. w .le n cm ,

(tF MORE SPACE IS NEEDED FOR ANY ITEM USE ADDITIONAL PROPERLY KEYED PAGES.)

6. INDIVIDUAL (S) WHO WILL USE OR DIRECTLY SUPERVISE THE USE OF LICENSED MATERI AL (See items 16 and 17 for required training end expenence of each Indivx. fusi named belowl FULL N AME I TITLE

'

IdhTdR45c61 kC5LDEaLT[ow/w(L b .___ k LC3 I O [_M --- 7bb AK Rcr.itET b ~iR4h J *bf4N 7. RADIATION PROTECTION OFFICER c'.2 90.wpke frin I

Attach a resume of pc s4W1 t&mng a I h we ars?venect m~ttt%

16 and 17 and desenbe h[s erwonsibnir.gs.w3 J zew_15_ _ . . _ . . . .

bkELNs I. MM> I i ;y, ,_,

'g _______,

__ m m 8. LICENSED MATERIAL L NL WG ELNC----

L ELEMENT NAME OF MANUFs CHEMICAL  % QF--

4 AND AND!OR AND dONE g~ ' ;Q@3;'

fi LtAMdN D,e, ]NDf0R $(RE,p N MASS NUMBER PHYSICAL FORM MODEL NUM 3EW TOlfRC N f1 PM m " " ' ^ m '

E (IISea<ed Source / VITY PER SOURCE WHICH WILL BE POSSESSED AT ANY ONE TIME N A .-e a q]Q '/ \ C D

"'

C ES% v e t*S7 YcD %tcc % der *A-102 .

t\~L Ont %cc 84

'2>

Astaave 2np m %erce Trotter A-(Ces'n rodece e sc (3)

03MD3B m

,

DESCRIBE USE OF LICENSED MATERIAL E

NS-I l 3" bM L-60._ __id ONC- b e E C_T P CrQ iC $ _._f. n E;C P b M 6 ___

,

'=>

le Rcb2 %l -E %tCee Gaw ['

tncA w.,_

QSG MEMute fAOLcAurP A_M D Ocn5

m oF saqiacersq V Nrehc

NRC FORM 313 l(12 8 t h J

59/( 99

- ._ . . . _

'

'

~

.1

. _< _

.

u_ . _ o ._a _ < < _a _ _ _ > _ _ <

_

?

i __ 1 -

A-.e _m_ o ._ ___< _-

l

,._I_,:_b _ _. 4

s t-:,;. ros oi ch'a swl o ts wroi nic.,4w: oK T ol e h A nw. 0 U;,;soarc,t ois wick roro s ca

. ._

_ - - - -

,

'

Q H v 41,s wrc wI oi oI omi o l SECTROXIC LA8 ORA?ORfpg j 1

HEREBY CERTIFIES THAT E

,,

.

.<,..

,- Mark T. Johnson ,

- of  :'

W.1.;  ; )- Cv g< 3 Constructors Testing Laboratory  ; -

'5 I, i E'

%.5 HAS SUCCESSTULLY COMPLETED TIIE TROXLER ELECTRONIC LABORATORIES, IN >M ::2 t

• >& A

'

TRAINING COURSE FOR Tile SE OP NUCLEAR TESTING EQUIPMENT.

,

-

, .

' !.'1 - i

' 'f . SUBJECTS INCLUDED IN THIS COURSE WERE AS FOLLOWS:- .f Q>- ~~ .*ll Radiological Safety ll MCW

-

>

Radioactivity measurement standardination

. 5, i

.>- ' Principles and practices of radiation %i protectio and monitoring techniques and t .

p. H Leak testing procedure instrument i p&

,

'

i 3. INatisematice ~ and calculations basic to 6. ' Accident and incident procedure i 7. ' Procedures for nuclear gauge storage

,

t,

,

the use and measurement of

r, 3 .-i.: *

,  ;

-

Q radioactivit and transportat.i .. General safety prceaution .

i 4 5 ' Biological effects of radiatio Q 4l**-

Gauge Operation' .:

l, Instrunent theory Field application  ! ? ~

.i '4.

!~

>~ Q  : Operating procedures Gauge calibration L>W+

.Mai enance .

A-Qi -

'tu g k h g April 5 &.6, 1978 DATE William,F. Troxler PRESIDENT -

L_ . -

l W ha *

INSTRUCTOR 5 . F j

,

. -

.

........,....~.....,........- ..n... c...-...,........ . , . . ... .:

'

. ..... . . . . . . . . , , . . . . .

W%h .

!

-),

.

. . . . . . . . , ,

4

% M ip1(C4f8 Q rim 9}9 QR %g.g' ... ., .

2 %;G W

.' ,-.aQ '

+ .

, , , .. .. , +

s --- - .,%,,

e

!

- 1 3 __

l

-.

^ </

w

,,/ ,

. . . . _ -

/- -

-..

,e

~4 p3 -

,A -

y_,

-

E, _i MPN CarasJ y

~

bu

. _ . - ~

g . ra,

' ' e- 3 r- - ; 1y

\ tris.q,',140 e 0

__

k -- 4 +

I A

~ }'

-

El EVA7 IOM ~L I-,

_

811 - l --

u .

__ - eaa - -_ -. -. _

1. _-

~,y -

• • /- ,

_ ..

-_ n u e w . _ -

N by**0D

~

44 / w Fe.dLivy j

.,_. % "- 1 p1

}

,

t o

21s3 s.soas

_

Av ;

b Y

.

• .. -

DCOR S

l-oc Aitot4 b Pe u .

uts

-.

Ad WT4/ roe

'

N.TS AnsicAcr TE%tC-) '5TD1% .'o rs:: g --

'

-4-

' '; .

% E R M A LBAR F \ W REA i

we ?.o. %v. m %

i j

.

hway, AMwi  % D' 3 %\\ Q

.%

__ __ . _ - _ _ _ _ _ _ . - . _ _ _ _ _ _ - _ - _ . . _ _ . _ _ _ _ __

.o .,

~

'

U *

. . ,

k ADMIRALTV' TESTING SERVICES Construction Materials Testing i

'

P.O. Box 7193 Ketchiksn, Alaska 99901 9-26-92 U.S. Nuclear Regulatory Commission Regles 5 1450 Maria Lane Yalaut Creek, Calif,94596 Atta: Gregory P. Tuhas Subject: Response te letter dated 9-9-1992 This is la response to your letter concerning license 30-23693-01. The first thing I would like to de is apologize for taking se long te get back to you. I just returned from a project la a remote estime villiage en the west coast of Alaska (Pistinum). I was scheduled to be en the project for a short duration (approx. ene week) however it turned late a six week stay. The remeteness_of this site made it impossible to respond untill new. I hope that you understand that it is met that I place a low priority em this actima it was just that it was impossible to correspond from this site. I realize the severity of this and understand that this is a serious subject. Below I would like to respond to the Items la your lette ~

Da June gth 1988 Mr. Paul Zurakowski performed an inspectio During that laspecties Paul was latermed that Therme Bay was a temporary constructica site. The constructica site was a project om a remote read constructica project appres.15 miles from the community of Therme Bay. Due to remeteness of the project we agreed that my records would be stored at Seethcoast Constructica effice la Ketchikan which was our main headquarters for verk throughout Alaska. Since the project was to be a 1 year plus project I gave him a address to correspond to me with in Therme Bay. I them seat a letter to your offices explalaing that I would he la Thorne Bay and lacluded an address te-contact me through. I aise indicated la this letter that my records voeld-he stored la Ketchikan at Southcoast constructions office. The project la Thermo Bay turned late a 3 year plus project. Each year an additiemal phase was aquired by Southcoast constructies and I was requested to stay em. Da my original license I had my permanent certified storage site at a former asseclates laboratory at BC02 ber 7387 Palmer Ak,9964 I considered all the projects I have been en slace to be temporary construction site Soils Testing Concrete Testing Asphalt Testing Pile Tes ting _,

PrwfessionalServicer at Conwelitive Prices l

_ _ _ _ ._ _ _ _ _ _ _ _ - .

.. E

-

. , , _

. __ _ . _ _ _ _ __ _ _ _ _ . _ . . _ _ _ _ . _ _ _ _

.

I hevo v:rked cc these roc:ta sites for the last 4 to 5 y:ars.- .  ;

- * contimoesty. .Durlag the last couple of years I have worked la both I Ketchikaa and Therme Bay with a shift of aest of the verk la Ketchika As discussed with J.L. Meatsomery during his laspectica of July I my permensat address has shifted te my P.O. Box la Ketchikaa.

-

I still have my P.O. ben la Therme bay but have met utilised it for quite some time. I ales told Mr. Meatgemory that slace I was going to be applying for a removal en my license at the end of September that I would show my address to be my current P.O. ben la Ketchikaa where I am currently recievlag correspondance. I have just seat la my remeval form with the correct addres I am currently back la Ketchikaa and have gone through my file Some hev part of my files are alssing which shev leak tests and exposure records. I am still trying to locate these records. I understand the importance of malatalalag these records and have included copies of a leak test that I just seat la along with request for sev film badges. I am the sole avaar of my business with me employees and solo user of the guage. I use the guage sa a very ilmited basis sometimes met uslag it for months at a time. However when it does became necessary to utilize the guage I must have it available Le .

perform my job. It is impossible to anticipate when it will be require In response to the transportstloa of the guage between Therme Bay and Ketchikaa I have located Hazardens shipping forms which I did fill est whom transporting the guage. The guage was transported by myself en a sea passenger vessel evned by myself. I have lacluded copies of these forms herei In summary I venid just like to state that I an a small buslaess that would 11ke to continue to be permitted to utilize this guage. I can assure you that I understand the importance of maintalag complete records and maklag sure to keep 11aes of communication open with the NRC. In the future I will make a more concentrated effort to make sure that I comply with the requirments of the conditions of the license. If you have any additional questions please feel free to contact me at 907-225-1045 or Box 7193 Ketchikan Ak. 99901 Thank you for your paticace and understandin Slacerely Admiralty Testing Services b

Mark T. Joh a Owner

_ _ . . _

,:-

.

'

q

• '

SHIPPER'S DECLARATION FOR DANGEROUS GOODS 55pper l Air Waybill No

% Atl i U' s (qb i Page of Pages Shipper s Reference Number fort *One')

Consignee MkuL \ .h, q q o,13 Iwo completed and Srgned copies of this Declaration must WARNING t>e handed to the operator

'

TRANSPORT DETAILS Failure to comply in all respects with the applicable 5 . Dangerous Goods Regulations may be in breach of T hiS Shipment it within the Airport of Departure the applicable law, subject to legal penalties This hmitations presentied for Declaration must not, in any circumstances, be

.

1!!!P* eien nan col <cotses completed and/or signed by a consolidator, a forwarder or an IATA cargo agen h, A A RCRAFT fE i A AIRCR AF T ONLY

,h +

ment hoe ee/m non as/<cew/

Airport of Destination (NON R ADIO ACTIVE lR ADIO ACTIVE l

[

&

fy y N ATURE AND OUANTITY OF DANGEROUS GOODS (see sub-Section 81 of IATA Dangerous Goods Regulations)

W, * *

.. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......-............................................

,

• i' h Dangerous Goods identif tcation e'h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

UN

. . . . . .

Ouentity Paciong Authon2ation 1  ; Hazard '

pi Class ' or Pcw Shwng Name & , 10 Subsid . No N: . ..p............................................. . . . . . . . .

I A&{U- y"

.

k AD o /3 M s s f i i z +y (;Q

~

q p, 'l.Q l ,

i~, #Me M Al L Lt A j3 6

~

b!

p -

[t

..

d e, [>1 A

'

%, f i. L [ M O:7 V\

'

fgg &z D h '

fWL,!! 4g 07 5"'l i M0% ~

i h[C A 1^ < 4%.oW7 gh -

'

b-- j CY . ,g J

_____-______.____._____L._______--------

Additional Handhog information

% . (,c h: -

. ,o Is - C 2 's~C

_

. b AL e rk T -M i L'A N kQ ytcRe f _4;/ 34 I hareby declare that the contents of this consignment are fully and Name/ Title of S!gnatory accurately descnbed above by proper shipping name and are classifie g 7 g Jr n~f packed, marked and labelled, and are in all respects in the proper Place and Date I condition for transport by air acenrding to the applicable International and "" 4 ;

,

i National Government Regulation NT A b ~

Signature g;"

(see wornmg above] .. /c s

i- i t 3l'

l F-83 DET AILE D

,

s

._ . . .

, ,

LcakTcst Analysis NOTES

.dion'uclide: h I 7/ Md 34 I

,

Removable Activity 1. Follow proc:dures as d;fintd in

%'67 your leak test kit instructions.

>urce Serial: Beta Gamma Alpha 2. Fill out this form and the bag jt. Model: TC O G %' 5 label with required information st* Sstial-' Wn -

-

-

-

PCI uCi where applicable. Seal the filter its of Wipe: ,'l - v b -1 ' paper in the plastic bag. Place dividu11's Name: MAL- h E the plastic bag and this form in the pre-addressed envelop phone: %7 ~M "'0"5 3. Removable activity will be r Certification ported in uCl. A value of "0" EASE TYPE oR PRINT LEGIBLY - Date: Indicates less than .00005 pC l$ IS voVR RETURN ADDRES$ LABEL 4. Federal and State regulations require that sealed sources be removed from service and r ,

ports filed if removable activity A D N i(7 A q

,,

I ._f, T . brj g$ is greater than .005 uC . Due to the potential hazard,

• , , _

,i O O, _

a i9 7 Troxter recommends that an

'

additional wipe be made if re-K T,Q movable activity exceeds .0005

, A^w . .

-\ * 1 -t . , ) u C . You will be notified by telephone collect if the test yields greate-

.sw Ei ctrome Laoorstones.inc., P.O. Bos 12057, Reteerch Triangio Park. N C.27709 919t$4W41 Telex 579474 than .00t PCI removable activ".s

,

, .. .

"

P[t : +qj

' ' '

, . , *

. - . h*.

5 e, . ,

u' = ,

R .

,.*

'.e .- ,

J *.

,_ gsA N , *

, .  % .. * * -

'" n

• &

' - .

,. e .

,

k m .4

. 6 ~8

' ' - .

?

,

, "

' w

,, .4 ' ,.2 , , . .

~

@: - * *  ;

,,.

.

• '*

- -

_;

.

. h

.

sw 4 e-a

' ^ ~ m

~,

':

e T

, %'. w~

,

! ,

I.a;

- ..i.Q. A c;e,p '.

., h.: ! ,,.-

.m- ? hN's.4HN .

..'s,w

.

"

E $ ~~d .=-y* <.

',.,,,,

. + .* . .. < f M. :.:

.~ .g

.. a . . . . .w

[ hM.C 7

.y;Q,9 4 < a. sp,..~~. . .q

. - ,.

.,+

. .y... y .gEv,t*d . I is/.;+[4. .

' ,. n.s... w m . y;y Q W;.}dy:l . -Q " q~" p n5g y ;!* N f " yl, f Q ,g

. .

m'[W .& V p_ JU;f.:)? ipfM y < %. ,,' ~~ t..if q

.

f y)*.Q -n .. ;

.. .

' *' *

Y ~ .. '

~ .

N+

' . .

' ~ ~* .,' - ! !Y. 'l4i? -

-

.? . .s. : , ,.

• '

.

[> e .

. . - .

.

,

s'

, .

..

. e6 ,

• . ,

• " t

,

..

.

.

,.

.

'

'

^U ,, -

' ' u . * - ,

'

_'" -* " .'['

,

b 3 '.

-

.M . ., *

..a.J.*

- ,* . ,tL

.

As c .

'*.

-

'e

'_

... .

,~ **

+ ""',,

-

~, y +

'

,'

4 ,.' . _

c

. , j f_ i j. - Re.a ? , s -

,

, , .

,

,

• s

p'M W