ML22075A224

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GL Annual Registration Form from Dominion Virginia Power, North Anna, Units 1 and 2
ML22075A224
Person / Time
Site: North Anna  Dominion icon.png
Issue date: 12/16/2021
From: Simmons G
Dominion Virginia Power
To:
Office of Nuclear Material Safety and Safeguards
References
GL-700115-27
Download: ML22075A224 (12)
v • d • e


Text

f UNITED STATES*

NUCLEAR REGULATORY COMMISSION WASHINGTON, b.c. 20555-0001 11/19/2021 TO: Users of Devices Subject to General License Registration

SUBJECT:

ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICES The U.S. Nuclear Regulatory Commission (NRC) requires annual registration of certain devices that an~

possessed under the general license issued in Section 31.5 of Title 1O U.S. Code of Federal Regulations (10 CFR 31.5). Devices subject to registration include those containing the radioactive material and activity listed in Table 1 of the attached NRC Form 664. You are receiving this notice because NRC records indicate that you have one or more such devices. Information about the general license registration program is available at the following NRC website:

https://www.nrc.gov/materials/miat:.J/general-use/toolkit.html Note that under 10 CFR 31.5(c)(11), the attached General Licensee Registration Package must be completed, signed, and returned to the NRC within 30 days from the date of this letter. Read all of the instructions prior to completing the package. Mail the completed package in the enclosed envelope to:

Director, Office of Nuclear Material Safety and Safeguards

  • ATTN: Document Control Desk/GLTS U.S. Nuclear Regulatory Commission Washington DC 20555-0001 .

Registration Fee: Commission regulations (1 O CFR 170.31, Category 3Q) require that you submit a registration fee with each registration on an annual basis. The registration fee is subject to change yearly, and you are required to submit the fee that is in effect as of the date of this letter. An invoice for the current amountdue will be sent to you under separate cover. If you have any questions about the fee or the invoice, please contact the License Fee Billing Help Desk at (301) 415-7554 or e-mail at fees.resource@nrc.gov.

NRC amended 10 CFR Parts 170.11 and 170.31 to provide that 10 CFR Part 170 fees be assessed to Federal agencies, where applicable, in accordance with the Energy Policy Act of 2005. Therefore, those Federal facilitie~ required to register certain generally licensed devices in their possession will be required to pay the annual registration fee.

Attachment:

NRC Form 664 -- General Licensee Registration and Instructions Sincerely, IRA/

Joseph D. Rolland U.S. Nuclear Regulatory Commission Office of Nuclear Material Safety and Safeguards Division of Materials Safety, Security, State, and Tribal Programs Materials Safety and Tribal Liaison Branch

TO: User's of Devices Subject to General License Registration

SUBJECT:

ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICES The U.S. Nuclear Regulatory Commission (NRC) requires annual registration of certain devices that are possessed under the general license issued in Section 31.5 of Title 1O U.S. Code of Federal Regulations (10 CFR 31.5). Devices subject to registration include those containing the radioactive material and activity listed in Table 1 of the attached"NRC Form 664. You are receiving this notice because NRC records indicate that you have one or more such devices. Information about the general license registration program is available at the following NRC website:

https://www,nrc.qov/materials/miau/qeneral-use/toolkit.html Note that under 10 CFR 31.5(c)(11 ), the attached General Licensee Registration Package must be completed, signed, and returned to the NRC within 30 days from the date of this letter. Read all of the instructions prior to completing the package. Mail the completed package in the enclosed envelope to:

Director, Office of Nuclear Material Safety and Safeguards ATTN: Document Control Desk/GLTS U.S. 'Nuclear Regulatory Commission Washington DC 20555-0001 Registration Fee: Commission regulations (10 CFR 170.31, Category 30) require that you submit a registration fee with each registration on an annual basis. The registration fee is subject to change yearly, and you are required to submit the fee that is in effect as of the date of this letter. An invoice for the -

current amount due will be sent to you under separate cover. If you have any questions about the fee or the invoice, please contact the License Fee Billing Help Desk at (301) 415-7554 or e-mail at fees.resource@nrc.gov.

  • NRC amended 10 CFR Parts 170.11 and 170.31 to provide that 10 CFR Part 170 fees be assessed to Federal agencies, where applicable, in accordance with the Energy Policy Act of 2005. Therefore, those Federal facilities required to register certain generally licensed devices in their possession will be required to pay the annual registration fee. *-

Attachment:

NRC Form 664 -- General Licensee Registration and Instructions Sincerely,

-/RA/

Joseph D. Rolland U.S. Nuclear Regulatory Commission Office of Nuclear Material Safety a'nd Safeguards Division of Materials Safety, Security, State, and Tribal Programs, Materials Safety and Tribal Liaison Branch -

Dirstribution:

MSTR r/f ML21326A197 Office NMSS Name J. Rolland Date 11/15/21 OFFICIAL RECORD ONLY

11111111111111111111111111111111111111111111111 llll 1111111111111111111 I 11111111111111111 llll 111111111111111111 GL-700115-27 SECTION 1 11/15/2021 PAGE 1 of 2 NRC F9E,II/I 664 (11 - 2020) U.S. NUCLEAR REGULATORY COMMISSION 10 CFR 31.5 GENERAL LICENSEE REGISTRATION APPROVED BY 0MB: NO. 3150-0198 0MB EXPIRATION DATE: 09/30/2022 Estimated burden per response to comply with this mandatory collection request: 20 minutes. NRG will use this information to track general licensees and their devices to ensure a higher level of device accountability. Send comments regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 A 1OM), U. S. Nuclear Regulatory Commission, Washington, DC *20555-0001, or by e-mail to lnfocollects.Resource@nrc.gov, and the 0MB reviewer at: 0MB Office of Information and Regulatory Affairs, (3150-0198), Attn: Desk Officer for the Nuclear Regulatory Commission, 72517th Street NW, Washington, DC 20503; e-mail: oira submission@omb.eop.gov. The NRG may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the document requesting or requiring the collection displays a currently valid 0MB control number.

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-700115-27 Enter the company name and the street address for the physical location of use for your devi_ce(s). For portable devices, specify the primary storage location. Do not use P.O. Boxes.

Company Name: DOMINION VIRGINIA POWER I I I I I I I I I I I I I I I I I I I I I I Department:

I I I I I I I I I. I I I I I I I I I I I I I Address Line 1: 1022 HALEY DRIVE I I I I I I I I I I I I I I I I I I I I I I I Address Line 2: END OF ROUTE 700 I I I I I I I I I I I I I I I I I I I I I I City: MINERAL I I I I I *1 I I I I I I I I *1 I I I I I I I I I State: VA [I] ZipCode: 231174527 I I I *I I I- I I I I I

.111111111111111111111111111 111111111111111 11111 llll 111111111111111 1111 GL-700115-27 I11111111111111111 llll 111111111111111111

  • 11/15/2021 SECTION 1 PAGE 2 of 2 SECTION 1 - GENERAL LICENSEE INFORMATION (Continued)

\

Enter the name, telephone number and title of the person who is the responsible individual for the device(s).

Last' Name: SIMMONS I I I I I I I I I I I I I I I I I I I I I I I I First Name: GEORGE Middle Initial: R 11.1111111111 . 11 D Business Telephone Number: (540) 894-2107 Extension:

I I I II I I II I I I I I I I I. I I Business E-mail Address: Bob.Simmons@dominionenergy.com I I I I I I I I I I I I I I I I I I I I I I I I I I I */ I I I

Title:

RAD PROTECTION MANAGER I 1* I I I .1 I I I I I I I* I , I I I I I I I I *1 I Enter the mailing address where correspondence regarding your device(s) should be sent.

Department: NORTH ANNA POWER STATION I I I I I I I I -I I I l I I I I I I I 1- I I I I Address Line 1: 1022 HALEY DRIVE I I -I -I I *I I I I I

  • I- I I I I I I I I I I I I I Address Line 2: END GF ROUTE 700 I I I I I I I I I I I I I I I I I I I I I I I I.

City: MINERAL .

I I I *1 I I I I I I I I I I I I I I

  • I I I I I I State: *vA . rn Zip Code: 231174527 I I I I *I I - I I I I I _

. 1111111111111111 IIIIII IIIII 11111 1111111111 111111111111111 IIIII IIII IIII I 11111111111111111111111111111 GL-700115-27 1111512021

. 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: Metorex Incorporated 1* I I I . I I -I

  • 1 I I I I 1* I - I I I I I I I I . I I Distributor License Number: 29-30342-02G .

I*I I I I I I I I I I I I I Manufacturer name: METOREX, INC I I I I I

  • I I I I 1* I I I I I I I I I I I I I I Device Model (Not Source Model): OOPS I I I I I I I "I I I I I I I I I I I I I I I I I Device Serial Number: 128018 I I I I I I I I I I I I I I I I I I I I I I I I Transfer Date: 08/12/1999 Not in possession of device (Also CDITJI I I I I complete Section 4.)

MM DD YYYY Isotope (e.g. AM241) Activity (e.g. 1005) Unit (e.g. mCi) 1 AM241 30 mCi I I I I I I I I I I I I I I I I I I I I I I I 2 CD109 10 mCi 3

I I I I I I I I I I I I I I I I I I I I I I I 4

I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 5

)I I I I I I I I I I I I I I I I I I I I I I I 6

I I I I I .I I I I I I I I I I I I I I I I I I

1111111111111111 IIIIII IIIII 11111111111111111111 llll 1111111111111111111' IIIIIIIII IIII IIIII IIII IIII IIII GL-700115-27 11/15/2021 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. Do not report specifically licensed devices.

Manufacturer Name 1

  • I I I I I I I I I I I I I I I I I I I I I I I I I I I I Initial Transferor Name I I I I I I I I I I I I I I I I I I I I I I I I I I I I Initial Transferor License Number (if known)

I I I I 1* I I I I I I I I Device Model Number (Not Source Model)

  • I I I I I I I I I I I I I I I I I t I I I I I I I I I I Device Serial Number I I I I I I I I I I I I I I I I I I I I I I I I I I How acquired and date (e.g., 0 Manufacturer/Initial Transferor listed above
  • from a_ distributor/~anufacturer, 0 other licensee, otner source)? .

Other General Licensee

  • Date Transferred: ITJ ITJ I I I I I O . Other Sources MM DD YYYY Isotope (e g. AM241) Activ*ty (e g. 100) Unit (e.g. mCi) 1.

I I I I I I I I I 2.

I I I I I I I I

3. ~

I I I I I I 4.

I I I .I 5.

I I 6.

I I 7.

I I 8.

I I I I I '

9.

I I I I I I I 10.

I I I I I I I I

11111111111111111111111111111111111111111111111 GL-700115-27 IIII 11111111111 IIIIUII . I 11111111111111111 111111111111 11/15/2021 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. PAGE 1 of 1 Part 1 Transfer Date:

I ~:~~:~~~=nK;~r6) I I I I I I I I ITJITJI I I I I

, MM DD YYYY Location of the Device:

  • 0 Whereabouts Unknown (Complete Part 1 only) 0 Transferred to another general licensee (Complete Parts 2 and 3) 0 Never Possessed the Device (Complete Part 1 only) 0 Transferred to a Specific Licensee (Not the manufacturer)

, 0 Returned to Manufacturer (Complete Part 1 only) (Complete Part 2)

Part 2 License Number of Recipient (if transferred to a specific licensee):

  • I I I I I- I I I I I I I I I Company Name: _

I I I I I I I I I I I I I I I I I I I I I I I I I I I I Department: -

I I I I I I I I I I I I I I I I I I I*I I I I I I I I I Address Line 1:

I I I I I I I I I I I I . 1* I I I . I I I I I I I I I I I I Address Line 2:

I I I I I I I I I I I I I I I I I 1* I 1* I I I I I . I I I City:

  • I I I I I I I I I I I I I I I I I I I I I I I I I I I I State: [I] Zip Code: I I I I I I - I I I I *1 Part 3 - Enter the na.me of the individual responsibe for this device: * -

Last name:

I I I I I I I I I I I I I I I I I I I I I I I I I I I I First name: Middle Initial: -

1111111111.1111 D

~~~~~~~ Telephone I I I 11 I I 11 I I I I Extension: .- - - - rI-1----,--I---,---I-.----,II

Title:

I I 1- I I I I I I . I I 1- I I I . I I I: I I 1* I I I I I I I

1111111111111111 IIIIII IIIII 11111 lllll 11111111111111-IIIIII IIIII IIII 1111 . Illllllll llll 11111.111111111111

. GL-700115-27 SECTION 5 - CERTIFICATION SECTION 5 11/15/2021 PAGE 1 of 1 I 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 inf6rmation on this form has been checked against the device labeling.

C. I am aware of the requirements of the general license, provided in 10 CFR 31.5.

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

htt *//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. NRG REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRG 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 JU~ISDICTION ..

111111111111111111111111111111111111111111111111111111111 r111111111111 GL-700115-27 Illllllll llll 11111111111111111 SECTION 6 11./15/2021 SECTION 6 - DEVICE NOT ' SUBJECT TO REGISTRATION PAGE 1 of 1 NRC Device Key: 547351 Manufacturer License No: MD-31-076-01 Manufacturer Name: CONGO SERVICES CORP.

Model Number: 101 Serial#: . N596 Transfer Date: 02/15/1994 Isotope: Nl63 Activity: 5 Uni~: mCi NRC Device Key: 689428 Manufacturer License No: 20-15525-04G Manufacturer Name: GE ION TRACK Model Number: ITEMISER Ill Serial#: 09-8424 Transfer Date: 06/30/2003 Isotope: Nl63 Activity: 10 Unit: mCi I NRC Device Key: 707159 Manufacturer License No:

Manufacturer Name: METOREX, INC.

Model Number: 880 Serial#: 128018 Transfer Date: 02/27/2002 Isotope: CD109

  • Activity: 10 Unit: mCi NRC Device Key: 825331 Manufacturer License No: 12-04933-04G Manufacturer Name: PERKINELMER LIFE SCIENCES Model Number: 8310000 Serial#: DG08129527 Transfer Date: 07/20/2012 Isotope: BA 133 Activity: 20 Unit: uCi

SECTION 6

. PAGE

. 1 OF 3 Date 12/15/2021 SECTION 6 - DEVICES NOT SUBJECT TO REGISTRATION NRC Device Key: IManufacturer License No.:

Manufacturer Name: ._p_E_IO_N_TRA

__ c_K______________________.

Model Numbe~: ~TEMISER III I*serial No.: p9-23953 ITransfer Date: 9/-20-/-20_1_3---,

.-I Isotope: ._f1_6_3_ _ _ _ _ _ ___. I10_ _ _ _ _ _ _ _ _-.....IUnit: ._§_c_i________.

Activity: ....

Isotope: Activity: Unit:

Isotope: .__ ________ __.

Isotope:

=================::::::

Isotope: .__

NRC Device Key: IManufacturer License No.: *---------~~

'---;:::=============---------_:::================::,

Manufacturer Name: ~P_E_I_ON_TRA

__ C_K_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _....,

Model Number: ~TEMISER III I Serial No.: ._P9_-_20_9_43_ _ _ _ _ _ _.I Transfer Date: I...._O_l/_2_0/-20_1_1__,

Isotope: ._f1_6_3_ _ _ _ _ _ _----' Activity:llO IUnit: ::§=c=i=============:::::

Isotope: .___ _ _ _ _ _ _ ___. Activity: Unit: . _ I_ _ _ _ _ _ _ _ _ .

Activity: Unit: . _ I_ _ _ _ _ _ __ _ .

Activity: Unit: . . _ I_ _ _ _ _ _ _ _ _ .

Isotope: Activity: .__ ________ __. Unit: .__ _______ __.

NRC Device Key: I IManufacturer License No.:

~===========-----------====================-.

Manufacturer Name: ~P_E_IO_N_TRA

__ c_K_____________________....,

Model Number: ~TEMISERIII I Serial No.....:-~p_9-=._--8_4-=._3_2 _:,____________________-_,I Transfer Date:

____ .--1 2/_13_/_20_2_0__,

Isotope: ._f1_6_3_ _ _ _ _ _ ___. Activity: 110 IUnit: ._§_c_i________,

Isotope: .__ ________ __, Activity: Unit:

lso_tope:

Isotope: .__ ________ __. Activity: .___________ Unit: .__ _______ __.

Isotope: .__ ________ __. Activity: .___________ Unit: .__ _ _____

GL - I1 Io.I oI r I 1 I51 - 0] SECTION 6 Date 12/15/2021 PAGE 2 OF 3 SECTION 6 - DEVICES NOT SUBJECT- TO REGISTRATION NRC Device Key: I'"----;::==============-____:_

IManufacturer License No.:

_ _.____ _ _ ___::=:===============::::::;

Manufacturer Name: IGE ION 1RACK ~::::::::::::::::::::::::::::::::::::::::::::::::..::;------;:.::.::.::.-::::'..__ __,

Model Number: IITEMlSERIII I Serial No.: ...lo_9-_l_29__.9_0_____.,. . . . .I Transfer Date: I 02/13/2020 Isotope: =§=6=3================*1 110_________~1 Unit:

Activity: ... §.__c_i________,

Isotope: Activity: .__ ________ ___, Unit: ....__________ _

Isotope: ....__________ __. Activity: .__ ________ ___, Unit: ....__ _______ __.

Activity: Unit: . _ I_ _ _ _ _ _ _ _ _ ,

A~~~ Un~ .__ _______ __.

NRC Device Key: l.__-;::::=====!...IM_an_u_fa_c_tu_re_r.....~_ic_e_ns_e_N_o_._:-=====================::::::;

Manufacturer Name: __C_K_____________________~

I__G_E_I_O_N_1RA Model Number: lrTEMlSERIII I Serial No.: ...lo_9-_1_54_5_4________.I Transfer Date: .-I-0-2/_13_/2-0-20---.I Isotope: §63. Activity: 110 IUnit: §_c_i

__ ________.I

. Isotope: Activity: Unit: I____________.I Isotope: Activity: Unit:

Isotope: .____________.

=================:::::: Activity:
==================:::: Unit: :::===============:::: I I_

Isotope:

Activity: Unit: I I NRC Device Key: I .IManuf?lcturer License No.: . .___ _ _ _ _ _ _ _ _ __.

'"----;::==============-----.:.__ ___::=================::::::;

Manufacturer Name: .__IG_E_I_O_N_1RA

__c_K______________________,

Model Nun,ber: IEN1RYSCAN 4 I Serial No.: 109-14254 (ES4#-150002) ITransfer Date: I 02/08/2006 Isotope: INI63 Activity: I10 IUnit: lmci Isotope: Activity: Unit:

Isotope: . Activity: Unit: I Isotope: Activity: Unit: I Isotope: Activity: Unit:

SECTION 6 Date

  • 12/15/2021 PAGE 3 OF 3 SECTION 6 - DEVICES NOT SUBJECT TO REGISTRATION NRC Device Key: I I Manufacturer License No.:

'--::=========--------___:::_====================:

Manufacturer Name: IG_E_I_O_N_TRA

.... __C_K_*_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __.

Model Number: IENTRYSCAN 4 I Serial No.: I 09-14085(ES4#-150004) I Transfer Date: I 08/20/2006 I Isotope: INI63 Activity: I 10 I Unit: lmci I Isotope: Activity: Unit: I I Isotope: Activity: Unit:

Isotope: Activity: Unit:

Isotope: Activity: Unit:

NRC Device Key:  ! I Manufacturer License No.:

~==========::::::::_----------========================:

Manufacturer Name: jGE ION TRACK

;:::::::::::::::::::::::::::::::::::::::::::::::::_::-----~=-=-=--:::.----,

Model Number: iENTRYSCAN 4 I Serial No.: io9-14086(ES4#-150007) ITransfe-r Date: I 12/29/2005 I Isotope: iNI63 Activity:i....l_O_ _ _ _ _ _ _ _ __.I Unit: ....

im_C_i_ _ _ _ _ ____.i Isotope: .___ ________ __. Activity: Unit:

Isotope: .___ ________ __. Activity:

,_____________, Unit: ::===============:::

Activity:,___ _ _ _ _ _ _ ____, Unit: _ _ _ _ _ _ _ __

Isotope:

Activity: -----------' Un it: ,__ _______ __.

NRC Device Key: I I Manufacturer License No.:

---;::==========------------===================::=;

Manufacturer Name: IG_E_I_O_N_TRA

.... __c_K_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __.

Model Number: IENTRYSCAN 4 I S~ri~I No.: io9-15947(ES4#-150009) I Tran~fer Date: .-I-1-2/-02-/2_0_0_6--,

Isotope: ....

iNI_6_3_ _--,-_ _ _ ____. Activity: .... li_o_ _ _ _ _ _ _ ___.i Unit: .... im_C_i_*._ _ _ _ _ __

Isotope: _________ __. Activity: ' - - - - - - - - - - ~ Unit:

Isotope: Activity: Unit:

Isotope: Activity:

==================:::: Unit: '------'-------'

Isotope:

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