McConnell Dowell (American Samoa) Ltd; Amendment Request ... · McConnell Dowell Constructors Ltd -...

Hill, Carol

From: Hammond, Michelle Sent: To:

Thursday, March 14, 20136:18 AM Hill, Carol

Subject: Attachments:

Re: Please set up this action as an AMENDMENT img-314112928-0001.pdf

Hi Carol,

Can you please set this up as an amendment?

Thanks

Michelle Hammond!!

From: Murray Holmes [[email protected]] Sent: Wednesday, March 13, 2013 6:55 PM To: Hammond, Michelle; Pouifi Tufuga; Basil Ake Subject: RE: PLEASE RESPOND ASAP_REQUEST FOR ADDmONAL INFORMATION

Michelle

Please find attached our Application for Licence NRC Form 313 and copies of Certification for:

Toetau Pouifi Tufuga Pangia Emelio Vitolio Mauga Charlie Atisano'e

We advise our Radiation Safety Officer is Toetau Pouifi Tufuga

To complete sections 5·11 it says to refer to the Licence Application Guide I have been on to the NRC website but can find the application forms but not the Guides Would you be able to sent me a copy of the guide to enable me to complete

thanks

Murray Holmes I Finance Manager I McConnell DOWQII ( AmerIcan Samoa) Limited Tafllna , Pago Pago . American Samoa p. (684) 699-2239 i In. (684) 252-50251 f. (G84) 699-2552 ~cconnelldowell.com

From: "Hammond, Michelle" <[email protected]> To: 'Murray Holmes' <[email protected]>

PUBLIC o immediate Rele_ ~nnaI R.a ••

IION-PUBUC o .u Sensitive-Seeurity ~1aIId Q A.7 SenslUve Internal Q 0IhIr.;_-n-___ _

RrMMr: ~te: 3 - 27-20 G ,

Cc: '"[email protected]'" <[email protected]>, '"[email protected]'" <[email protected]>, "'[email protected]'" <[email protected]>

1 1b 5 802 5 3

NRC FORM 313 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 315()-O120 EXPIRES: (05/311201 5)

(0$-2012) EsUmated Durden per N!$ponse 10 COmply with lhis mard:a~ coll..'<:Ilon reqlRSt 4.3 I'Klurs. Sutlmi~ of 10 eFR 30. 32. 33. the <1I'P/i:3tCln Is necessary to delemWIe tI\:;! \he applicant Isquati!i8d and !hal a:lEl:lIJaI~ procadlns exiSl 34,~. 36. 39. 3~ 40 10 proled the pubic health and sa!s\y. Send convnenlS regMling blr.:Ier. e~ kl the ~':oonaiOn

SerVi:es Branch (T·S F53), U.S. Nucl6...- Regutaklry Commssico"" Washin!ltcn, DC 2055$-0001, or I!y

APPLICATION FOR MATERIALS LICENSE Interne! e-mail kl [email protected], ilIld 10 II"IEI [)esI; O!f\c[lr, Ofika of lnlOm1a:(ln and R!gUiatlry Aff~, NEQB.l0202. (3150-0120), otf:ce 01 Managemetll and 3udgeL Washk\g!On. DC Wi03. 11 a IIl6UlS tJSe(! kl ~ &1'1 inlonnar.on coII9ctbn Goui rot d'lSiilay a o.rrenty vafd Ql.(6 control number, lh! NRC may no! CClidu;1 or SPOOSOI, an:! a person Is no! reQulrBd to responll 10. !lle r.forma{bll co!lmn.

INSTRUCTIONS: SEe THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION. SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW.

A"'?lICATION FOR OISTfUS1JTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH: IF YOU ARE LOCATED IN:

OFFICE OF FEOERAl.. t. STATE MATERIALS A,/.o ILLINOIS,IN01ANA, IOWA, MICtUGAN, MINNESOTA, MISSOURI, OHIO, OR WISCONSiN, Etf'I.'RONMEtlTAl..I.1Aw.GiOMENT PROGRAMS SEND APPU CAl1DNS TO: DIVISION OF MATERIAlS SAFETY AND STATE AGREEMENTS U.S. NUCLEAl::1 REGULATORY COMMISSION MATERtA1..S lICE:NSING BRANCH WASHII\,'GTON, OC 20555-0001 us. NUCL£Afl r..EGVLATORY COMMISSION, REGION III

ALL OntER PERSONS FILE AJ'?LlCA11ONS AS FOLLOWS: 2443 WARRENVILLE "-OAD. SUITE 2tO lISlE.Il 505324352

If" YOU ARE LOCATED Itl :

AIJ.8AMA. CONNECTICUT, DELAWARE, DISTRICT OF COLUM6IA, FLORIDA, GEORGIA, ALASKA, ARIZONA, ARKANSAS. CALIFORNIA. COLORADO, HAWAII. IDAHO, KANSAS, KENTUCKY, MAINE, MARYlAtm , tAASSACHUSEns, NE\'I HAMPSHIRE, NEW JeRSEY, LOUISIANA, MISSISSIPPI. MONTANA, NEBRASKA, NEVADA, NE\."J MEXtcO, NORTH NEW YORK, 'IORTlf CAROLINA, PENNSYLVANIA, PUERTO RICO, RHODE ISLAND, SOun! DAKOTA, OKLAHOMA, OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, TEXAS, CAROUNA, TENNESSEE, VERMONT, VIRGINIA, VIRGIN ISLANDS, OR WEST VIRGINIA, UTAH, WASHINGTON, OR WYOMING,

SEND APPUCATlONS TO: SE.-'.IO APPLICATlONS TO:

LICENSING ASSISTANCE TE.tJo1 NUCLEAR MATERIALS LICENSING 2Ftl),NCH DMSION OF NUClEAR MATERIALS SAFETY U.S. NUCLEAR REGULATORy COI'''.1rSS10~. REGION IV U.S. NUCLEAR REG'JLATORY CCt.~MISSION. REGION I '600 E. LAMAR BOULEV .... RD 2100 RENAISSANCE SOULEVARO. SUITE '00 ARUNGTON, TX 760'1-4511 KING OF PRUSSI.",- PA U14oe·2113

PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LI CENSED MATERIAL IN STATES SUBJECT TO U.S.NUCLEAR REGULATORY COMMISSION JURISDICTIONS.

,. THIS IS AN APPLICATION I=OFl (Ct. flr:/f flpproprllrliJ (jllm) 2. NAME AND M~UNG ADO"," 0' AP"'~T """"" ~p ~'"J )

0 A NEW LICENSE tn «(~.,~L. D,j • ., ... lJ... Il""",u.... S,~'- L U ()jl....Ao, --rO'<k. ~ /(J ':y (,1.,(,</, .. Op;o.~j c-; B. A~lENOMENT TO UCENSE NUM!!:ER , ~ -213';1, '''' .01

'-" p" '30" LJ H -I

0 C. RENEWAL OF LICENSE NUMSER {)"I"., , 'iZJ"t-Y'1V j'" m.,"" 3 AOORE5S 'MiERE LICENSED MATERIAL WILL BE USED OR POSS;;:SSEO • NAME Of PERSON TO BE CONTACTED AeOOT THiS APPUCATION

'rU. " 1'nF=""""'~ "/. .... i;) ... !..~!!,/1'z.,. P~eIL --("I-<, .... 1" ' .., ,. .... ,..., - I(.,t« ~- 1'", 1.>'1 U~A""

rrn l'''''/l BUSINESS TeLEPHONE NUMBeR .1 BUSINESS CELLUlA"! TELSP1ioNE NUMBEr<

r-; I"r) fn! I (/j-V S4~"'A 6&.., (.<f'J.zt J', "'1 " .,S,.,

BUSINESS EMAIl.. J. DORESS ,

SUBMIT ITEMS 5 THROUGH" ON 8,1/2 X 11" PAPER THi: TYpe AND SCOPE OF INFORMATION TO BE Prl.OVIDEO.S DESC>MEO IN THE LICENSE APf'UCATION GUIDE

5. RADIOACTIVE UATERlAL • Elemelll and mau n!,lmber. b. dlfllTlre:Il1i1'Ldlor phytic;;l fonn; .. .o c rr.Dixim:lm alU~t 6. PURPOSE(S) fOR WHICH LICENSED MA.TERIAL WlU BE USED.

whlc:t\ wil lit posst~tecl at any on. lillie.

7 INOIVlOUAl.(S) RESPONSIBLE FOR RADIATION SAi'ETY PROGRAM AND THEIR a TRAINING FOR INDIVIDUALS WORKING IN OR FREOUENTING RESTRICTED AREAS. TRAINING EXPERIENCE , FACIUTIES A:{D ECUj?~',[;"''T. ". RA.."'tATIO~~ 5.:.F:'!Y PP.OO!" ....... 1.

". LICENSE FEES (Su 10 CFR 170 ~nd S~clion 110.31)

". V'IASTE MANAG::;ME,,'T. AMOUNT feE CATEGORY ENCLOSED S

" CERTIfiCATION (Mull /.10 r:oIflpteroo by 3ppllClllm) 1HE /lPPUCANTUfJDERSTANDS THAT AU STATEMENTS AND REPRESENTATIONS MADE IN THIS Ai'PL/CAnON AAE BINDING UPON THE APPUCK.VT.

THE AP?lICANT AND AH'f OfFICIAL EXECUTING THIS CERTIfICATION ON BEKAt.F OF THE APPLICANT. N!"MEO IN ITEM 2. CERTIFY TH.AT THIS APPLICATION IS PH.EPAAEO IN CQNFO>I.MITY 'MTH TIRE 10. COO!:. OF FEDERAL REGULATIONS, PARTS 30. n. 33. 3". 35.36.39. ANO <10. AND THAT ALL INFORMATION CONTANEO HEREIN IS TRUE ANO ~RECT TO THE BEST OF THEIR Kl\O\M..EOGE AND BELIEf. WARNING: 1SU.S.C. SECTION 1001 ACT Of JUNE 25. 19./., e2 STAT. 749 MAKES IT A C RIMINALOFFENSE TO MAKE A \'ALLfU1..LY FALSE STATEMENT OR REPRESENTATION TO ANY OEPAR7MENT OR AGENCY OF THE UN!TI:O STATES AS TO AtN MATIER ..... 'ITHIN ITS JURISDiCTION.

CERTIfYING OFFICER TYPEDIPRINTEO NAME AND TITLE SIGNATURE IDATE

BASIL AKE - PROJECT MANAGER . ' ; f!J." 1';1 ;,

1 FOR NRC USE ONLY

TYPE OF FEE ! F!;E lOG I FEE CATEGORY I~NTRECEIVED CHECK NUMBER COMMENTS

, ' I APPROVeD BY

I""TE NRC FORM 313 05.2012

3

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This is to certify that

Toetau Pouifi Tufuga of

McConnell Dowell Constructors Ltd -American Samoa

Has attended and satisfied the performance criteria of:

Radiation Safety NRL C15

As recognized by the National Radiation Laboratory as satisfying the training requirements as specified in NRL document

QM:DAT/L1C/006H, Care of Knowledge: Use of nuclear density meters

Da te: 22/2/13

Stuart R/"7g/.- Tutor/Director

Expires: 5/2/15

.

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Pangia Emelio of



Radiation Safety NRL C15


QM:DA T / LiC/006H, Core of Knowledge: Use of nuclear density meters

Date: 22/ 2/ 13

St uart R~M~g) Tutor/Director

Expires: 5/ 2/15

(

iviltrai


Vitolio Mauga of

McConnell Dowell Constructors Ltd -

American Samoa

Has attended and satisfied the performonce criteria of:

Radiation Safety NRl C15


QM:DA T /LiC/006H, Core of Knowledge: Use of nuclear density meters

Date: 22/2/13 Expires: 5/2/15

l 5 8C 2 5 3

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iviltrain


Charlie Atisano'e of



Ra ia ion Safety NRL C15


QM:DA T /LIC/006H, Core of Know/edge: Use of nuclear density meters

Date: 22/2/13 Expires: 5/2/15

NRC FORM 532 U. S. NUCLEAR REGULATORY COMMISSION (1·2012)

DATE

03/25/2013

NAME AND ADDRESS OF APPLICANT ANDIOR LICENSEE LICENSE NUMBER

McConnell Dowell (American Samoa) Ltd ATTN: Lindsay Murray

Radiation Safety Officer P.O. Box 4664 Pago Pago, American Samoa 96799

This is to acknowledge the receipt of your:

[{] LEITER and/or [{] APPLICATION

56-29396-0 I

MAIL CONTROL NUMBER

580253

LICENSING ANDIOR TECHNICAL REVIEWER

ch

DATED: 03/ 13/2013

The initial processing, which included an administrative review, has been performed.

[{] AMENDMENT 0 TERMINATION 0 NEW LICENSE 0 RENEWAL

[{] There were no administrative omissions identified during our initial review.

o 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 office.

o Your application for a new NRC license did not include your taxpayer identification number. Please fill out NRC Form 531, located at the following link:

http://www . nrc.gov/reading-rm/doc-collections/forms/n rc531 . pdf

Send the completed NRC Form 531, by facsimile, to the following number: (301) 415-5387

A copy of your action has been emailed to our license Fee and Accounts Receivable Branch,in our Headquarters office in Rockville, MD. You will be contacted separately ifthere is a fee issue involved.

Your application has been assigned the above listed MAIL CONTROL NUMBER. When calling to inquire about this action, please refer to this control number. Your application has been forwarded to a technical reviewer. Please note that the technical review, which is normally completed within 180 days for a renewal application (90 days for all other requests), may identify additional omissions or require additional information. If you have any questions concerning the processing of your application, our contact information is listed below:

NRC FORM 532 (1-2012)

/3/x!e;

Region IV U. S. Nuclear Regulatory Commission DNMS/NMSB - B 1600 E. Lamar Boulevard Arlington, TX 76011-4511 (817) 200-1103 or (817) 200-1140

BETWEEN:

Accounts Receivable/Payable and

Regional Licensing Branches

[ FOR ARPB USE)

INFORMATION FROM WBL

Program Code: 03121 Status Code: Pending Amendment Fee Category: 3P

Exp. Date:

Fee Comments: Decem Fin Assur Reqd: N

License Fee Worksheet - License Fee Transmittal

A. REGION

1. APPLICATION ATTACHED ApplicanVUcensee: MCCONNEll DOWELL (AMERICAN SAMOA) LTD

Received Date: 0311412013 Docket Number: 3038318 Mail ContrOl Number: 580253 License Number: 56-29396-01

Action Type: Amendment

2. FEE ATTACHED

Amount:

Check No.:

3. COMMENTS

Signed: CJIcJ/~

Date: 3PS,b3 B. LICENSE FEE MANAGEMENT BRANCH (Check when milestone 03 is entered

1. Fee Category and Amount:

2. Correct Fee Paid. Application may be processed for:

Amendment

Renewal:

License:

3. OTHER ______________ _

Signed:

Date:

McConnell Dowell (American Samoa) Ltd; Amendment Request ... · McConnell Dowell Constructors Ltd -...

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