ML20078P450

Public Version of Rev 4 to Emergency Plan Implementing Procedure FNP-0-EIP-6, Technical Support to Emergency Plan

ML20078P450
Person / Time
Site:	Farley
Issue date:	09/12/1983
From:	Hudspeth J ALABAMA POWER CO.
To:	Office of Nuclear Reactor Regulation
Shared Package
ML20078P441	List: ML20078P450
References
FNP--EIP-6-1, FNP-0-EIP-6-01, NUDOCS 8311080063
Download: ML20078P450 (20)

Text

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VOL. 14 FNP-0-EIP-6 July 22, 1983 Revision 4 FARLEY NUCLEAR PLANT 9

EMERGENCY PLAN IMPLEMENTING PROCEDURE FNP-0-EIP-6 S

A F

E T

Y TECHNICAL SUPPORT TO THE EMERGENCY PLAN R

E L

A T

E D

Approved:

u).AML c Plant Manager Date Approved:

3- *Y3 Date Issued:

9-12-83 List-of-Effective-Page Page Rev. #

DOCUMENT CCNTRCL App. 1,2

. ev CONTROLLED CCPY Tbl. 1,2 Rev. 3 CC NOT REPRODUCE COPY NO. 03%

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VOL. 14 FNP-0-EIP-6, TECHNICAL SUPPORT TO THE EMERGENCY PLAN

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1.0 Purpose i

l This procedure delineates the responsibilities of the Technical and Systems Performance Group during emergencies at the Farley Nuclear Plant.

2.0 References 2.1 Joseph M. Farley Nuclear Plant Emergency Plan 2.2 FNP Operating Manual, Vol. 14, FNP-0-EIP-8, Notification Roster 2.3 FNP Operating Manual, Vol. 14, FNP-0-EIP-9, Radiation Exposure Estimation and Classification of Emergencies.

2.4 FNP Operating Manaul, Vol. 14, FNP-0-EIP-10, Evacuation and Personnel Accountability.

3.0 General All personnel assigned to the technical group shall report to the service building auditorium in accordance with FNP-0-EIP-10, Evacuation and Personnel Accountability.

in the event of an emergency.

4.0 Procedure 4.1 Upon activation of the TSC the Technical Manager l

2 hall:

4.1.1 Assign personnel to handle off-site l

communications and to log off-site communications.

4.1.2 Assign an engineer or technician to perform off-site dose assessment.

4.~.3 Provide engineering support for assessing, mitigating and/or recovering from the emergency.

l 4.1.4 Upon direction from the Emergency Director, establish the plant parameter remote monitoring capability in the Technical Support Center per Appendix 1 or in'the Alternate Technical Support Center per Appendix 2.

4.1.5 Dispatch a liaison person to the Houston County Emergency Operations Center (ECC) when the EOC is manned because of a problem at FNP.

1 Rev. 4

VOL. 14 FNP-0-EIP-6,

'l 4.1.6 Notify the On-Call ADMS Specialist to set up the EOF.

j 4.2 The personnel who are assigned communications responsibilities shall:

4j 4.2.1 Report to the TSC or location directed by the Emergency Director or the Technical l

Manager.

4.2.2 Establish and maintain at least one communications link with the Emergency i

Coordinator.

Refer to FNP-0-EIP-8, j

Notification Roster.

I 4.2.3 Establish communications with other I

off-site authorities as directed by the Emergency Director.

Refer to FNP-0-EIP-8, Notification Roster.

I 4.2.4 Maintain a chronological log of all j

off-site communications noting the organization contacted and a summary of the conversation.

4.3 The engineer or technician who is assigned dose l

assessment responsibilities shall:

4.3.1 Report to the TSC or location directed l

I by the Emergency Director or the Technical Manager.

4.3.2 Initiate EDCM on the TSC ADMS terminal if operable.

Otherwise perform manual dose assessment per FNP-0-EIP-9.

4.3.3 Maintain surveillance of the radiological effluent monitors and meteorological monitors in the control. room if such information is not available on the ADMS i

terminal.

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4.3.4 Complete initial dose assessment within 15 minutes of declaration of the emergency I

condition.

Telecopy the initial dose j

assessment report to the Alabama Department

1 of Radiation Health.

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4.3.5 Complete and telecopy followup dcse" l1 assessment reports as appropriate.

'l 4.4 The engineer who is assigned remote monitoring maintenance responsibilities shall:

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VOL. l4' FNP-0-EIP-6

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4.4.1 Report to the TSC or location directed by the Emergency Director or Technical j

Manager.

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4.4.2 From the main control room computer console make changes to the TSC CRT display group and Block Trend parameters as directed by the Emergency Director or l

Technical Manager.

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l 4.4.3 Perform other plant parameter information displays or trends as directed by the Technical Manager.

4.5 The Houston County EOC liaison person shall:

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'I 4.5.1 Report to the Dose Assessment Room at the Houston County Courthouse.

4.5.2 Provide state and county government i

personnel with explanations of plant terminology, hardware and operation.

i 4.5.3 Notify the Technical Manager (TSC) or i

Dose Assessment Director (EOF) if communication problems become evident or if significant l

off-site actions (e.g. evacuation) are pending or in progress.

4.5.4 Refrain from providing information or comments to news media personnel.

I 4.6 The On-Call ADMS Specialist will:

4.6.1 Report to the Emergency Operations Facility or location directed by the mergency Director or Technical Manager.

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4.6.2 Unlock all outside doors to the EOF.

4.6.3 Unlock the Emergency Equipment Storage Area (Room 118? and install the status i;

boards in the Communcation Monitoring, Conference and Command Area (Room 106).

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4.6.4 Set up communications equipment in the Dose Assessment Area (Classroom 104) and 4

j in the APCO Command Center (Room 10,6).

l 4.6.5 Initialize the Analytics.1 Data Management System (ADMS) computer terminals in the i

l following locations and priority.

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Rev. 4 l

t VOL. 14 FNP-0-EIP-6 i

4.6.5.1 Dose Assessment Area (Classroom 104).

l 4.6.5.2 APCO Command Center (-Room 106) 1 4.6.5.3 NRC Staff Area (Classroom 105) j i

i 4.6.5.4 Other areas designated by the 1

Technical Manager or Dose Assessment Director.

I, 4.6.6 Insert EOF emergency / drill room labels in place of normal Training Center room labels.

l 4.6.7 Secure all EOF equipment and lock all spaces when authorized by the Technical Manager, Emergency Director or Recovery Manager.

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Rev. 4

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FNP-0-EIP-6 APPENDIX 1 i

l' PLANT PARAMETER REMOTE MONITORING CAPABILITY j

IN THE TECHNICAL SUPPORT CENTER I

1.0 Activation of Remote Monitoring Capability j

1.1 The Emergency Director shall direct one of the personnel in the TSC to set up an available l

plant computer CRT for monitoring purposes by TSC personnel.

I 1.2 Perform the following steps to reposition the computer console CRT (computer device #14) for lj monitoring by TSC personnel:

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1.2.1 Disconnect the power cable and the red, I

green, and blue signal coax cables from the rear of the CRT (inside console housing).

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6 1.2.2 Connect the red, green, and blue, signal coax cables to the load box located on the right-hand side of the console j

housing.

1.2.3 Roll the CRT out of the rear of the console housing and position at the designated location in the TSC moni-toring area as directed by the Emergency Director.

1.2.4 Disconnect the coax cables from the red, green, and blue signal connectors on the left side of the cable box for the affected unit in the TSC.

I 1.2.5 Open the cable box for the affected unit and remove the coax extension cables and the power feed cable.

1.2.6 Connect the coax extension cables to the red, green and blue signal connectors on the left side of the cable box for i

the affected unit, and to the CRT.

Cables and Jacks are labelled as to color 8

signal.

I 1.2.7 Connect the power feed cable to the CRT and plug into a wall power outlet.

l 1.2.8 Depress the "CRT" function pushbutton.

Appendix 1 Page 1 of 5 Rev. 3

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FNP-0-EIP-6 a

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1.2.9 Depress the "1"

and then "6" numeric pushbuttons.

'l 1.2.10 Depress the "VALUE 1" pushbutton'.

1.2.11 Depress the "2" numeric pushbutton.

1.2.12 Depress the "VALUE 2" pushbutton.

1.2.13 ' Depress the " START" pushbutton, 1.2.14 Verify all parameters listed in Table 1 appear on the CRT.

l 1.3 Perform the following steps to start trending Trend Blocks 6, 7, 8, 9,

and 10 on the line-printer:

1 1.3.1 Depress the " BLOCK TREND LOG" function pushbutton.

1.3.2 Depress the numeric pushbutton(s.) for the desired Trend Block.

(i.e.

"6" for Trend Block 6).

1.3.3 Depress the "VALUE 1" pushbutton.

1.3.4 Depress the "4" numeric pushbutton.

l 1.3.5 Depress the "VALUE 2" pushbutton.

1.3.6 Depress the numeric pushbutton for the desired time interval (in seconds) hatween trending: (i.e. 120 for 2 minute I

trends).

1.3.7 Depress the "VALUE 3" pushbutton.

j 1.3.8 Depress the " START" pushbutton.

I 1.3.9 Repeat steps 1.3.1 - 1.3.8 for Trend Blocks 7, 8,

9, and 10, and verify trending on the lineprinter.

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1.3.10 Verify all parameters listed in Table 2 appear in the trend blocks.

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i 1.4 Perform the following steps to place points On the Trend Recorders:

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Appendix 1 l

Page 2 of 5 Rev. 3 I

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FNP-0-EIP-6 NOTE:

Steps 1.4.1 through 1.4.8 are performed i

to establish the pen scale.

Steps 1.4.9 3

through 1.4.18 establish parameter trend-for the specified pen.

i 1.4.1 Depress the " ANALOG TREND SCALE SET" i

function pushbutton.

1.4.2 Depress the numeric pushbutton for the desired pen (i.e.

"5" for pen 5, or "6"

for pen 6).

l 4.3 Depress the "VALUE 1" pushbutton.

1.4.4 Depress the numeric pushbuttons for the low limit of the pen scale.

(Enter desired numerical lower limit).

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1.4.5 Depress the "VALUE 2" pushbutton.

1.4.6 Depress the numeric pushbuttons for the i

high limit of the pen scale.

(Enter i

desired numerical lower limit).

1 1.4.7 Depress the "VALUE 3" pushbutton.

1.4.8 Depress the " START / ADD" pushbutton.

j 1.4.9 Depress the " ANALOG TREND ADD /CMIT" function pushbutton.

i 1.4.10 Depress the alpha-numeric pushbuttons for the desired address point (i.e.

i "PO499A" for RCL SYSTEM PRESS.

Address l

Point descriptions are in AP symbol description book located on the operator i

l console.)

i 1.4.11 Depress the " ADDRESS" pushbutton.

1.4.12 Depress the numeric pushbutton for the desired pen (i.e.

"5" for pen 5, or "6"

for pen 6).

1.4.13 Depress the "VALUE 1" pushbutton.

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l.4.14 Depress the numeric pushbutton(s) for the desired time (in seconds) between updates (i.e.

"5" for 5 second updates).

1.4.16 Depress the "2" numeric pushbutton.

1.4.17 Depress the "VALUE 3" pushbutton.

Appendix 1 Page 3 of 5 Rev. 3

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7 FNP-0-EIP-6 d

't 1.4.18 Depress the " START / ADD" pushbutton.

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2.0 Deactivation of Remote Monitoring Capability,

a 2.1 Perform the following steps to reposition the i

remote CRT back in the computer console:

4 2.1.1 Disconnect the power feed from the CRT q

and the wall socket.

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'l 2.1.2 Disconnect the coax extension cables J.i from the CRT and the connectors on the left side of the cable box for the affected unit'.

b 2.1.3 Place the coax extension cables and

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the power feed cable in the cable box

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for the affected unit, and close the cable box.

2.1.4 Reconnect the coax cables that were disconnected in step 1.2.4 to the red, green, and blue signal connectors on

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the left side of the cabl(.

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2.1.5 Roll the CRT into the rec ae console.

2.1.6 Disconnect the red, green,

.a blue signal I

coax cables from the load box located

.i on the right-hand side of the console

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housing, and connect them to the CRT.

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2.1.7 Reconnect the power feed cable to the CRT.

e 2.2 Perform the following steps to stop trending Trend

,j Block 6, 7, 8, 9,

and 10 on the lineprinter:

2.2.1 Depress the " BLOCK TREND LOG" function q

pushbutton.

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2.2.2 Depress the numeric pushbutton(s) for i

the desired Trend Block.

(i.e.

"5" for

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Trend Block 6) d 2.2.3 Depress the "VALUE 1" pushbutton.

2.2.4 Depress the "4" numberic pushbutton, td l3 2.2.5 Depress the "VALUE 2" pushbutton.

lil l '1 2.2.6 Depress the "STOP" pushbutton.

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Appendix 1

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FNP-0-EIP-6

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a 2.2.7 Repeat steps 2.2.1 - 2.2.6 for Trend i

Blocks 7, 8,

9, and 10, and verify trending has stopped on the line-printer.

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2.3 Perform the following steps to remove points from the Trend Recorders:

2.3.1 Depress the ANALCG TREND ADD / OMIT" function 3

pushbutton.

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' 3.2 Depress the " ADDRESS" pushbutton J

'j 2.3.3 Depress the numeric pushbutton for the desired t

pen (i.e.

"5"

'for pen 5, or "6"

for pen 6 ).

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2.3.4 Depress the "W\\LUE 1" 'pushbutton.

2.3.5 Depress the "STOP/CMIT" pushbutton.

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Appendix 1 Page 5 of 5 Rev. 3

FNP-0-EIP-6 I

TABLE 1 STEAM GENERATOR TUBE RUPTURE CRT MONITORING PARAMETERS COMPUTER ADDRESS PARAMETER LO480A PRESSURIZER LEVEL (1)

LO481A PRESSURIZER LEVEL (2)

PO480A PRESSURIZER PRESS (1) i PO481A PRESSURIZER PRESS (2)

I j'

PO499A RCL SYSTEM PRESS i

j UOO90 HOTTEST THERMOCOUPLE T0419A RCL 1 WIDE RNG HOT LEG T l

T0406A RCL 1 WIDE RNG COLD LEG T LO403A STM GEN 1 WIDE RNG LEVEL i

P0400A STM GEN 1 STM OUT PRESS t

T0439A RCL 2 WIDE RNG HOT LEG T T0426A RCL 2 WIDE RNG COLD LEG T LO423A STM GEN 2 WIDE RNG LEVEL PO420A STM GEN 2 STM OUT PRESS T0459A RCL 3 WIDE RNG HOT LEG T T0446A RCL 2 WIDE RNG COLD LEG T LO443A STM GEN 3 WIDE RNG LEVEL P0440A STM GEN 3 STM OUT PRESS i

P1000A CONTAINMENT (1) PRESS P1001A CONTAINMENT (2) PRESS i i R0011A CONTAINMENT AIR PARTICLE R l 4 i

R0012A CONTALVMENT GAS R I

l Table 1 Page 1 of 2 Rev. 3

1 FNP-0-EIP-6 1

TABLE 1 (con't)

COMPUTER ADDRESS PARAMETER t

j R0019A STM GEN BLOWDOWN DRAIN R I

I R0021A VENT AIR PARTICLE R R0015A STEAM AIR EJECTOR EXHAUST R R0050A GROSS FAILED FUEL DETECTOR l

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Table 1 Psge 2 of 2 Rev. 3

FNP-0-EIP-6 APPENDIX 2 PLANT PARAMETER REMOTE MONITORING CAPABILITY

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IN THE ALTERNATE TECHNICAL SUPPORT CEICER 1.0 Activation of Remote Monitoring Capability 1.1 The Emergency Director shall direct one of the personnel in the Alternate TSC to set up an available plant computer CRT for monitoring purposes by TSC personnel.

1.2 Perform the following steps to reposition the computer console CRT (computer device #14) for monitoring by TSC personnel:

'f 1.2.1 Disconnect the power cable and the red, green, and blue signal coax cables from J

the rear of the CRT (inside console housing).

1.2.2 Roll the CRT out of the rear of the console housing and position at desired location as directed by the Emergency Director.

1.2.3 Connect the " control room" end of the coax signal extensions cables and power feed cable to the existing color signal cables and power feed cable in the computer console (extension cables are located in control room overhead).

1.2.4 Connect the "TSC" end of the coax extension cables and power feed cable to the remotely located CRT.

1.2.5 Depress the "CRT" function pushbutton.

1.2.6 Depress the "1" and then "6" numeric pushbuttons.

1.2.7 Depress the "VALUE 1" pushbutton.

1.2.8 Depress the "2" numeric pushbutton.

1.2.9 Depress the "VALUE 2" pushbutton.

1.2.10 Depress the " START" pushbutton.

1.2.11 Verify all parameters listed in Table 1 appear on the CRT.

Appendix 2 Page 1 of 3 Rev. 3

s FNP-0-EIP-6 1.3 Perform the following steps to start trending Trend' Blocks 6, 7, 8,

9, and 10 on the lineprinter:

1.3.1 Depress the " BLOCK TREND LOG" function a

pushbutton.

1.3.2 Depress the numeric pushbutton(s) for the desired Trend Block.

(i.e.

"6" for Trend Block 6).

1.3.3 Depress the "VALUE 1" pushbutten.

1.3.4 Depress the "4" numeric pushbutton.

1.3.5 Depress the "VALUE 2" pushbutton.

1.3.6 Depress the numeric pushbutton for the desired time interval (in seconds) between trendings (i.e. 120 for 2 minute trends).

1.3.7 Depress the "VALUE 3" pushbutton.

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1.3.8 Depress the " START" pushbutton.

1.3.9 Repeat steps 1.3.1 - 1.3.8 for Trend Blocks 7, 8,

9, and 10, and verify trending on the lineprinter.

1.3.10 Verify all parameters listed in Table 2 appear in the trend blocks.

2.0 Deactivation of Remote Monitoring Capability 2.1 Perform the following steps to reposition the remote CRT back in the computer console:

2.1.1 Disconnect the power cable and coax extension cables from the rear of the CRT and from the computer console.

i 2.1.2 Roll the CRT into the rear of the console and reconnect the coax and power cables.

2.1.3 Place the coax and power extension cables in the control room overhead.

2.2 Perform the following steps to stop trending Trend i

Blocks 6 7, 8, 9, and 10 on the lineprinter:

2.2.1 Depress the " BLOCK TREND LCG" function push-button.

Appendix 2 Page 2 of 3 Rev. 3 l

l FNP-0-EIP-6 2.2.2 Depress the numeric pushbutton(s) for the desired Trend Block.

(i.e.

"6" for Trend j

Block 6).

2.2.3 Depress the "VALUE 1" pushbutton.

2.2.4 Depress the "4" numeric pushbutton.

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2.2.5 Depress the "VALUE 2" pushbutton.

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2.2.6 Depress the "STOP" pushbutton.

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2.2.7 Repeat steps 2.2.1 - 2.2.6 for Trend Blocks i

7, 8, 9, and 10, and verify trending has stopped on the lineprinter.

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Appendix 2 Page 3 of 3 Rev. 3

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c FNP-0-EIP-6 TABLE 2 LINEPRINTER TRENDING PARAMETERS TREND BLOCK 6 j

COMPUTER ADDRESS PARAMETER T0001A IN CORE T A08 T0002A IN CORE T B05 T0003A IN CORE T B10 T0004A IN CORE T E04 T0005A UP HEAD T/C 101 COL E9 ELEV 46.

T0006A UP HEAD T/C 102 COL E9 ELEV 15.

T0007A UP HEAD T/C 103.

T0008A IN CORE T F03 T0009A IN CORE T F05 T0010A UP HEAD T/C 104 COL E9 ELEV 30.

i T0011A IN CORE T Fil T0012A IN CORE T Gol T0013A UP HEAD T/C 105 T0014A IN CORE T H08 T0015A IN CORE T HIS T0016A IN CORE T J02 TREND BLOCK 7 COMPUTER ADDRESS PARAMETER T0017A IN CORE T J10 T0018A IN CORE T J12 T0019A IN CORE T K03 T0020A UP HEAD T/C 106 COL L7 ELEV 30.

T0021A UP HEAD T/C 107 T0022A UP HEAD T/C 108 COL E9 ELEV 61.

T0023A UP HEAD T/C 109 COL L7 ELEV 14.

T0024A IN CORE T N06 T0025A IN CORE T P08 T0026A IN CORE T R07 T0027A IN CORE T C08 T0028A IN CORE T C12 T0029A IN CORE T D03 T0030A IN CORE T D05 T0031A IN CORE T E08 T0032A IN CORE T E10 Table 2 Page 1 of 3 Rev. 3

FNP-0-EIP-6 TABLE 2 (con't)

TREND BLOCK S COMPUTER ADDRESS PARAMETER T0033A IN CORE T F13 T0034A UP HEAD T/C 110 COL L7 ELEV 46.

T0035A IN CORE T G08 T0036A IN CORE T GIS T0037A IN CORE T H03 T0038A IN CORE T H05 T0039A IN CORE T H09 T0040A IN CORE T H11 T0041A IN CORE T H13 T0042A IN CORE T LO6 T0043A IN CORE T LO8 T0044A IN CORE T 112 T0045A IN CORE T L14 T0046A IN CORE T M03 T0047A IN CORE T M11 T0048A UP HEAD T/C 111 COL L7 ELEV 61.

TREND BLOCK 9 COMPUTER ADDRESS PARAMETER T0049A IN CORE T N08 T0050A IN CORE T N10 T0051A UP HEAD T/C 112 UOO90 INST VALUE OF HOTTEST INCORE T/C UOO91 INST VALUE OF AVERATE INCORE T/C UOO92 IDENT OF HOTTEST INCORE T/C LO480A PRESSURIZER 1 L LO481A PRESSURIZER 2 L PO480A PRESSURIZER 1 P P0481A PRESSURIZER 2 P P0499A RCL SYSTEM P T0419A RCL1 WIDE RNG HOT LEG T T0406A RCL1 WIDE RNG COLD LEG T LO403A STM GEN 1 WIDE RNG L PO400A STM GEN 1 STM OUT 1 P Table 2 Page 2 of 3 Rev. 3

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FNP-0-EZP-6 1

TABLE 2 (con't)

TREND BLOCK 10 COMPUTER ADDRESS PARAMETER T0439A RCL2 WIDE RNG HOT LEG T i

T0426A RCL2 WIDE RNG COLD LEG T LO423A STM GEN 2 WIDE RNG L l

PO420A STM GEN 2 STM OUT 1 P T0459A RCL3 WIDE RNG HOT LEG T T0446A RCL3 WIDE RNG COLD LEG T LO443A STM GEN 3 WIDE RNG L PO440A STM GEN 3 STM OUT 1 P P1000A CONTAINMENT 1 P P1001A CONTAINMENT 2 P R0011A CONTAIM AIR PARTICLE R R0012A CONTAIM GAS R R0019A STM GEN BLOWDOWN DRAIN R R0021A VENT AIR PARTICLE R R0015A STEAM AIR EJECTOR EXHAUST R R0050A GROSS FAILED FUEL DETECTOR l

l Table 2 Page 3 of 3 Rev. 3

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AlabamaPower the soutren smtre sniem October 20, 1983 Director, Office of Nuclear g'

Reactor Regulation j

Attn: Document Control Desk USNRC Washington, DC 20555 i

Dear Sir:

In accordance with Alabama Power Company Administrative Procedure FNP-0-AP-4, Control of Plant Documents and Records, attached are revisions j

to Emergency Plan Implementing Procedures.

Please verify that you have the procedures with the corresponding copy numbers that are listed on the Document Transmittal Form.

Please sign and return the forms as soon as possible to the following j

address:

i Alabama Power Company Farley Nuclear Plant Box 470 Ashford, AL 36312 ATTN: Document Control Supervisor If you should have any questions, please call me at (205) 899-5156 Ext. 422.

Sincerely, A u._ <, /.h mll v lv v:Y

. ~ -

' Joey B/ Hudspeth

'? Docoment Control Su ervisor JBH:hre cc: Larry W. Enfinger File

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' 8553 J.

M.

FARLEY NUCLEAR PLANT PRODUCTION DEPARTMENT DOCUMENT CONTROL DOCUMENT TRANSMITTAL FORM -

FOR DOCUMENTS TRANSMITTED TO DOCUMENT CONTROL DESK 1

DATE 831019 DOCUMENT NUMBER REVISION NUMBER COPY DOCUMEtJT CATEGORY FNP-O-EIP-OO6 4

38 H6.17 FNP-O-EIP-OO6 4

39 H6.17 FNP-O-EIP-OO6 4

H6.17 INSTRUCTIONS TO THE ADDRESSEE

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(1)

VERIFY THE DOCUMENTS RECEIVED AGREE WITH THE-ABOVE DESCRIPTION (2)

INCOHPORATE THE TRANSMITTED-DOCUMENTS -INTO -YOUR-FILES-(3)

DOCUMENTS OR PORTIONS OF DOCUMENTS WHICH ARE SUPERCEDED BY THE ABOVE MUST BE DESTROY (4)

SIGN IN THE SPACE BELOW INDICATING THAT YOU COMPLETED THESE INSTRUCTIONS AND RETURN THIS FORM TO THE DOCUMENT CONTROL SUPERVISOR SIctJATURE OF ADDRESSEE esh..-

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