NRC Form 241 for Ronan Engineering Company, Initial. · 2012-11-18 · NRC FORM 241 U.S. NUCLEAR...

NRC FORM 241 U.S. NUCLEAR REGULATORY COMMISSION OEBY OM NO. 31t0-0013 CPiRm 07.311m2euapo n, fid madtowtv

(7-19MIII)1 T: Icss h aired so s t( NRC muy

waIu nspecticaof aim acntimtes to enas V he r Cnsieii

ccoance wth requirit for protiont of th. public health end

REPORT OF PROPOSED ACTIVITIES IN shety Send commentrdrdIn burden estmat o the Rcords

NON-AGREEMENT STATES, AREAS OF EXCLUSIVE Wflts t OfCe, Oflic Y of nd doryir

FEDERAL JURISDICTION, OR OFFSHORE WATERS N2 oVI1o2C205. * means usedtoimpos n Infnilatoncdictin d s ot iso y cuwnty v1i0ObB control number, the

(Please read the instructions before completing this ftonn) nt not oonu ol spono

*. NAME OF UCENSEE (P c, rm pvpo to oduc t b ecMt .d 2. TYPE OF REPORT

Ro nan En ineerin Comrany INITIAL j REVISION n CLARIFICATION

. ADDRESS OFLICENSEE .w nmy e 4 uCENSEECONTACT AM4 ThnE

8050 Production Drive Tony Sholler, Field Service Manager

Florence, Ky 41042 TnEy4E NER , . FACSMLE NUMBER

- ke Ca - Afe ccd)

859-342-8500 859-342-6426

7. ACTIVITIES TO BE CONDUCTED UNDER THE GENERAL UCENSE GIVEN IN 10 CFR 15020

H WELL LOGGING LEAK TESTING AND/OR CALIBRATIONS FI TELETHERAPYARRADIATOR SERVICE

H PORTABLE GAUGES H OTHER (SpeIfy) >D

REGISTERED AS USER Of PACKAGING (11CR ATES OF CPLuANCE N _Ws)

U RADIOGRAPHY 4> _______________________

& WJENT NAME ADORESS. CICO(UNTY STATE ZIP CODE 9g. AA P4 A RESWOLOCATION

10 CLIENTTES'PHONENMJBER II. WORKiLCATONTElEPHONE NUMBER

13. NUMBER OF 14. 15. 1IC LOCATION12 DATES SCHEDULED WORK DAYS ADD DELETE REFERENCE NUMBER

FROM 7 MJBE TO BEASSGi~e By NcC

UST ADDmONAL WORK SITES ON SEPARATE SHEET S TO INCLUDE AiLLINFORMATION CONTAINED IN iTEMS 9-16 ABOVE.

17. LIST RADIOACTIVE WAERAH ICH W11LL BE POSSES. SD.INSTA1.12D. SERVICED, OR TlE

7rllide cescrdoao, w~end quwsywfrel coacv eLsadw e5,ft ~c ratI flebusedJ

Sai- frrTah'-tYe bisT

1& AGEREEMENT STATESFIUCi SE WiCIAUTh ESfLERSNlTOOXCT |tESENUMBER StATE DFPA1O4DATE

ABOV~,n. . r-7Fn Ft V 201260-95 | Ky - Sent. 30 2002by SO' rAA, I

tS. CIERTIFiCATION (MU4iBA J~r-atr~r~u

1, THE UNDERSIGNED. HEREBY CERTIFY THAT:

a1* *, on.M In tn .s rnnd k true and CXmOnlte.a. Ail -- ' -m.m -- un m r on. - …_w -

b. I have read and understand the provion of the generl leans 10 CFl 10.20 repInted on the trunS of this torn; and I understand m t I -l

required to comply with these proviIons as to all byproduct, sou . or speal nuuear m baeial which I passes and use In non-afenMWPIeIt StaeS or

offshoreystes under te geneal lIcense or which th fqort Is fld with the US. Nuclear Regulaoy CommlIssi

undertandt tteIudingsog nduc In n e nt Stats d ge a license 10C r 11S0.2 aEtd to a tAlW 10ay

hi calendar year. With the eXceptin Of wok conducted In oiff sh wars, which is authoized or unmtd pedod o tbra I t calndar yer

d I undestand that I may be Inspected by NRC at the above listed wok site locatIons and at Vth Ucense home otfe adidets for activities pedomted In

noncAgreement States or Sore waters.

* I understand that oonduct of any activities not descrtbed eIncluding onduct of attles on dates locatns dierent from ode d

above orwmthoult NRC a*ut ktJo , may ublect me to efoeii aon, PehfdS

CERIFYNOFC Rso r t__l Rpresey1a T. a rd S7INATU.QE I 17/3/ /2

75gq, SW4W F: p,'( £FLJC kls,.sWARNING: False statements In this certicate maly be subject to mistrial penaltie NRC regultons requi that m1bntsslons to

thes NRC be complete nd accurate In all material rspects. 16 U5S.C. Section 1001 makes It a odmkia offense to make a wmilfy bfse

stattment o representation to any departnent or agencY Of the United States as to any matter within Its juisdictlon. II

FOR NRC | REVEItdGIAL (d IypIatwAac A SMAIU.E IUnTE I

USE ONLY I .-,j

us P 1 sq PRINv ON RECVCLED PAPER

CABINET FOR HEALTH SERVICESCOMMONWEALTH OF KENTUCKY

RADIOACTIVE MATERIAL LICENSE

1. LICENSEE AND 2. ADDRESS

PAGE 1

RONAN ENGINEERING COMPANY8050 PRODUCTION DRIVEFLORENCE, KY 41042

ATTENTION:TELEPHONE:

CRAIG CARIS859-342-8500

PURSUANT TO KRS 211.842 ET SEQ., THE KENTUCKY CABINET FOR HUMANRESOURCES REGULATIONS, 902 KAR 100, AND IN RELIANCE ON STATEMENTSAND REPRESENTATIONS HERETOFORE MADE BY THE LICENSEE, A LICENSE ISHEREBY ISSUED TO RECEIVE, ACQUIRE, OWN, POSSESS AND TRANSFERRADIOACTIVE MATERIAL LISTED BELOW; AND TO USE SUCH RADIOACTIVEMATERIAL FOR THE PURPOSE(S) AND AT THE PLACE(S) DESIGNATED BELOW.THIS LICENSE IS SUBJECT TO ALL APPLICABLE RULES, REGULATIONS, ANDORDERS OF THE CABINET FOR HEALTH SERVICES, NOW OR HEREINAFTER INEFFECT AND TO ANY CONDITIONS SPECIFIED BELOW.

3. LICENSE NUMBER:AMENDMENT NO.

201-267-9532AMENDS IN ITS ENTIRETY

4. EXPIRATION DATE: FEBRUARY 28, 2003

5. REVIEWER: 44

6. LICENSED MATERIAL 7. FORM 8. POSSESSION LIMIT

A. CESIUM 137

B. AMERICIUM 241

A. SEALED SOURCE(AS AUTHORIZED INCONDITION 9)

B. SEALED OR FOILSOURCES (ASAUTHORIZED INCONDITION 9)

A. NOT APPLICABLE

B. NOT APPLICABLE



LICENSE NUMBER: 201-267-95 AMENDMENT 32 PAGE 2…____________________________________________________________________

C. COBALT 60 C. SEALED SOURCE C. NOT APPLICABLE(AS AUTHORIZEDIN CONDITION 9)

…___________________________________________________________________

9. AUTHORIZED USE

A. - C. DISTRIBUTION OF GAUGING DEVICES CONTAINING SEALED OR FOILSOURCES AS SPECIFIED IN ITEM 6 OF THIS LICENSE TO PERSONSGENERALLY LICENSED PURSUANT TO 902 KAR 100:050 OR EQUIVALENTPROVISIONS OF THE REGULATIONS OF THE U.S. NUCLEAR REGULATORYCOMMISSION OR AN AGREEMENT STATE.

…___________________________________________________________________

CONDITIONS:

10. THE LICENSEE SHALL COMPLY WITH THE PROVISIONS OF THE KENTUCKYCABINET FOR HEALTH SERVICES ADMINISTRATIVE RADIATIONREGULATIONS, 902 KAR 100.

11. THIS LICENSE DOES NOT AUTHORIZE POSSESSION OR USE OF LICENSEDMATERIAL.

12. EXCEPT AS SPECIFICALLY PROVIDED OTHERWISE IN THIS LICENSE,THE LICENSEE SHALL CONDUCT ITS PROGRAM IN ACCORDANCE WITH THE

STATEMENTS, REPRESENTATIONS, AND PROCEDURES CONTAINED IN THEDOCUMENTS, INCLUDING ANY ENCLOSURES, LISTED BELOW. THE CABINETFOR HEALTH SERVICES REGULATIONS, 902 KAR 100, SHALL GOVERNUNLESS STATEMENTS, REPRESENTATIONS, AND PROCEDURES IN THELICENSEE'S APPLICATION AND CORRESPONDENCE ARE MORE RESTRICTIVETHAN THE REGULATION.

A. APPLICATION DATED APRIL 30, 2001, SIGNED BY THOMASNIINEMENTS, GENERAL MANAGER.

B. LETTERS DATED:

1. SEPTEMBER 27, 2001, SIGNED BY THOMAS NIINEMENTS,GENERAL MANAGER.

2. NOVEMBER 12, 2001, SIGNED BY J.E. ECKHARDT, DIVISIONCONTROLLER.



LICENSE NUMBER: 201-267-95 AMENDMENT 32 PAGE 3

3. JANUARY 3, 2002, SIGNED BY CRAIG A. CARIS, QUALITYMANAGER.

, ~ 6? 4--- 0< J MARCIA R. MORGAN

. SUPERVISOR SECRETARYTH SERVICESXAIIvA.LuN | AX ClNl 6 luA..l

AGENTS BRANCHW~~~ I s1n llvvr s

DATE ISSUED FEBRUARY l, 2002



1. LICENSEE AND 2. ADDRESS

PAGE 1

RONAN ENGINEERING COMPANY8050 PRODUCTION DRIVEFLORENCE, KY 41042

ATTENTION:TELEPHONE:

CRAIG A. CARIS859-342-8500

PURSUANT TO KRS 211.842 ET SEQ., THE KENTUCKY CABINET FOR HUMAN

RESOURCES REGULATIONS, 902 KAR 100, AND IN RELIANCE ON STATEMENTSAND REPRESENTATIONS HERETOFORE MADE BY THE LICENSEE, A LICENSE IS

HEREBY ISSUED TO RECEIVE, ACQUIRE, OWN, POSSESS AND TRANSFERRADIOACTIVE MATERIAL LISTED BELOW; AND TO USE SUCH RADIOACTIVEMATERIAL FOR THE PURPOSE(S) AND AT THE PLACE(S) DESIGNATED BELOW.

THIS LICENSE IS SUBJECT TO ALL APPLICABLE RULES, REGULATIONS, AND

ORDERS OF THE CABINET FOR HEALTH SERVICES, NOW OR HEREINAFTER INEFFECT AND TO ANY CONDITIONS SPECIFIED BELOW.

3. LICENSE NUMBER:AMENDMENT NO.

201-260-9551AMENDS IN ITS ENTIRETY

4. EXPIRATION DATE:

5. REVIEWER:

SEPTEMBER 30, 2002

44

6. LICENSED MATERIAL

A. CESIUM 137

7. FORM

A. SEALED SOURCES, ASEVALUATED ANDAPPROVED BY THECABINET, THE U.S.NUCLEAR REGULATORYCOMMISSION UNDER10 CFR 32.210 ORANOTHER AGREEMENTSTATE UNDER EQUIVAL-ENT REGULATIONS

POSSESSION LIMIT

A. NO SINGLE SOURCE TOEXCEED 5000 MILLI-CURIES. TOTALPOSSESSION LIMITNOT TO EXCEED 425CURIES




B. COBALT 60

C. AMERICIUM 241

B. SEALED SOURCES, ASEVALUATED ANDAPPROVED BY THECABINET, THE U. S.NUCLEAR REGULATORYCOMMISSION UNDER 10CFR 32.210 ORANOTHER AGREEMENTSTATE UNDER EQUIVAL-ENT REGULATIONS

C. SEALED SOURCES ORFOILS, AS EVALUATEDAND APPROVED BY THECABINET, THE U. S.NUCLEAR REGULATORYCOMMISSION UNDER 10CFR 32.210 ORANOTHER AGREEMENTSTATE UNDER EQUIVAL-ENT REGULATIONS

B. NO SINGLE SOURCE TOEXCEED 2000 MILLI-CURIES. TOTALPOSSESSION LIMITNOT TO EXCEED 30CURIES

C. NO SINGLE SOURCE TOEXCEED 1000 MILLI-CURIES. TOTALPOSSESSION LIMITNOT TO EXCEED 40CURIES

D. ANY RADIOACTIVEMATERIAL

D. ANY D. NOT TO EXCEED 500MICROCURIES

9. AUTHORIZED USE

A. - C.

(1) RESEARCH AND DEVELOPMENT WITH SOURCES IN SOURCE HOLDERS;MANUFACTURE AND TESTING OF RONAN ENGINEERING COMPANYGAUGING DEVICES;

(2) INSTALLATION INTO OR REMOVAL FROM RONAN ENGINEERINGCOMPANY GAUGING DEVICES;

(3) INSTALLATION, RELOCATION, REPAIR, AND SERVICING OF RONANENGINEERING COMPANY GAUGING DEVICES INCLUDING THE LEAKTESTING OF SEALED SOURCES AND RADIATION SURVEYS OFDEVICES; .

(4) INSTALLATION, RELOCATION, AND SERVICING OF GAUGING DEVICESNOT MANUFACTURED BY RONAN ENGINEERING COMPANY.



LICENSE NUMBER: 201-260-95 AMENDMENT 51 PAGE 3_____________________________________________________________________

(5) PICKING UP, STORAGE, AND TRANSFER OF SEALED SOURCES ANDDEVICES USED FOR GAUGING FROM CUSTOMERS FOR TRANSFER TOSPECIFIC LICENSEES.

(6) DISTRIBUTION OF ANY RONAN DEVICE OR SEALED SOURCE THATHAS BEEN EVALUATED, APPROVED AND REGISTERED WITH THECABINET UNDER 902 KAR 100:058 TO PERSONS AUTHORIZED TORECEIVE THE RADIOACTIVE MATERIAL PURSUANT TO THE TERMSAND CONDITIONS OF A SPECIFIC LICENSE ISSUED BY THECABINET, U. S. NUCLEAR REGULATORY COMMISSION OR ANAGREEMENT STATE.

(7) STORAGE.

D. FOR POSSESSION INCIDENT TO LEAK TESTING RONAN ENGINEERINGCOMPANY GAUGING DEVICES.

____________________________________________________________________

CONDITIONS:

10. THE LICENSEE SHALL COMPLY WITH THE PROVISIONS OF THE KENTUCKYCABINET FOR HEALTH SERVICES ADMINISTRATIVE RADIATIONREGULATIONS, 902 KAR 100.

11. RADIOACTIVE MATERIAL SHALL BE USED AT:

THE LICENSEE'S FACILITY LOCATED AT 8050 PRODUCTION DRIVE,FLORENCE, KENTUCKY.

RADIOACTIVE MATERIAL MAY BE USED AT TEMPORARY JOB SITES, INAREAS NOT UNDER EXCLUSIVE FEDERAL JURISDICTION, ANYWHERE IN THECOMMONWEALTH OF KENTUCKY WHERE THE CABINET MAINTAINS JURISDIC-TION FOR REGULATING THE USE OF RADIOACTIVE MATERIAL. (THISCONDITION DOES NOT PROHIBIT USE IN OTHER STATES UNDER RECIPRO-CITY PRIVILEGES WHICH MAY BE GRANTED BY THE REGULATORY AGENCYHAVING JURISDICTION.)

12. RADIOACTIVE MATERIAL SHALL BE USED BY, OR UNDER THE SUPERVISIONOF INDIVIDUALS DESIGNATED BY THE RADIATION SAFETY OFFICER INWRITING. THE LICENSEE SHALL MAINTAIN RECORDS OF INDIVIDUALSDESIGNATED AS USERS FOR THREE YEARS AFTER THE INDIVIDUAL'SLAST USE OF RADIOACTIVE MATERIAL.



LICENSE NUMBER: 201-260-95 AMENDMENT 51 PAGE 4_____________________________________________________________________

13. THE RADIATION SAFETY OFFICER FOR THE ACTIVITIES AUTHORIZEDBY THIS LICENSE IS CRAIG A. CARIS .

14. SEALED SOURCES CONTAINING RADIOACTIVE MATERIAL SHALL NOTBE OPENED.

15. THE LICENSEE SHALL CONDUCT A QUARTERLY PHYSICAL INVENTORY TOACCOUNT FOR ALL SEALED SOURCES RECEIVED AND POSSESSED UNDER THELICENSE. THE RECORDS OF THE INVENTORIES SHALL BE MAINTAINEDFOR FIVE (5) YEARS FROM THE DATE OF THE INVENTORY FORINSPECTION BY THE CABINET, AND SHALL INCLUDE THE RADIONUCLIDES,QUANTITIES, MANUFACTURER'S NAME AND MODEL NUMBERS, LOCATION OFSEALED SOURCES, THE DATES OF THE INVENTORY, AND THE NAME OF THEINDIVIDUAL CONDUCTING THE INVENTORY.

16. FIELD SERVICE WORK SHALL BE PERFORMED BY INDIVIDUALS WHO HAVESUCCESSFULLY COMPLETED THE RONAN RADIATION SAFETY SCHOOL.

17. THE LICENSEE SHALL SURVEY THE SOURCE HEAD DURING "ON" AND"OFF" MODES OF OPERATION FOLLOWING INSTALLATION AND/ORREINSTALLATION OF THE DEVICE AND SHALL PROVIDE A COPY OF THERESULTS TO THE CUSTOMERS.

18. THE LICENSEE SHALL MANUFACTURE AND DISTRIBUTE GAUGING DEVICESIN ACCORDANCE WITH STATEMENTS AND REPRESENTATIONS, INCLUDINGTHE QUALITY CONTROL PROGRAM, CONTAINED IN THE REQUESTS FOREVALUATION AND REGISTRATION OF SAFETY INFORMATION REGARDING THEGAUGING DEVICES.

19. THE LICENSEE MAY TRANSPORT RADIOACTIVE MATERIAL, OR DELIVERRADIOACTIVE MATERIAL TO A CARRIER FOR TRANSPORT, IN ACCORDANCEWITH THE PROVISIONS OF 902 KAR 100:070, AND OTHER DEPARTMENTSOF THE COMMONWEALTH OF KENTUCKY HAVING JURISDICTION.

20. SEALED SOURCES OR DETECTOR CELLS NEED NOT BE LEAK TESTED IFTHEY ARE IN STORAGE AND NOT BEING USED. PRIOR TO REMOVAL FROMSTORAGE FOR USE OR TRANSFER TO ANOTHER PERSON, THE SEALEDSOURCE OR DETECTOR CELL SHALL BE TESTED BEFORE USE OR TRANSFERIF IT HAS NOT BEEN TESTED WITHIN THE REQUIRED LEAK TESTINTERVAL. NO SEALED SOURCE OR DETECTOR CELL SHALL BE STOREDFOR A PERIOD OF MORE THAN 5 YEARS WITHOUT BEING TESTED FORLEAKAGE AND/OR CONTAMINATION.



LICENSE NUMBER: 201-260-95 AMENDMENT 51 PAGE 5…____________________________________________________________________

21. THE LICENSEE SHALL REPORT TO THE CABINET, THE U.S. NUCLEAR

REGULATORY COMMISSION, OR AN AGREEMENT STATE, AS APPROPRIATE,

ALL TRANSFERS OF DEVICES TO PERSONS FOR USE UNDER THE GENERAL

LICENSE AUTHORIZED BY 902 KAR 100:050, SECTION 3; 10 CFR PART

31; SECTION 31.5; OR AGREEMENT STATE EQUIVALENT. THE REPORT

SHALL CONTAIN 1)THE IDENTITY OF EACH GENERAL LICENSEE BY NAME

AND MAILING ADDRESS FOR THE LOCATION OF USE; 2) THE NAME,

TITLE, AND PHONE NUMBER OF THE PERSON IDENTIFIED BY THE

GENERAL LICENSEE AS HAVING KNOWLEDGE OF AND AUTHORITY TO TAKE

REQUIRED ACTIONS TO ENSURE COMPLIANCE WITH THE APPROPRIATE

REGULATIONS AND REQUIREMENTS; 3) THE DATE OF TRANSFER; 4) THE

TYPE, MODEL NUMBER, AND SERIAL NUMBER OF THE DEVICE

TRANSFERRED; AND 5) THE QUANTITY AND TYPE OF BYPRODUCT MATERIAL

CONTAINED IN THE DEVICE. IF ONE (1) OR MORE INTERMEDIATE

PERSONS WILL TEMPORARILY POSSESS THE DEVICE AT THE INTENDED

PLACE OF USE BEFORE ITS POSSESSION BY THE USER, THE REPORT

MUST INCLUDE THE SAME INFORMATION FOR BOTH THE INTENDED USER

AND EACH INTERMEDIATE PERSON, AND CLEARLY DESIGNATE THE

INTERMEDIATE PERSON(S). THIS REPORT SHALL COVER EACH CALENDAR

QUARTER AND SHALL BE FILED WITHIN THIRTY (30) DAYS OF THE CLOSE

OF THE QUARTER AND SHALL CLEARLY INDICATE THE PERIOD COVERED BY

THE REPORT.

22. THE LICENSEE SHALL REPORT TO THE CABINET, THE U.S. NUCLEAR

REGULATORY COMMISSION, OR AN AGREEMENT STATE, AS APPROPRIATE,

ALL RECEIPTS OF DEVICES FROM GENERAL LICENSEES. THE REPORT

SHALL CONTAIN (1) THE IDENTITY OF THE GENERAL LICENSEE BY NAME

AND ADDRESS; (2) THE DATE OF TRANSFER; (3) THE TYPE, MODEL

NUMBER, AND SERIAL NUMBER OF THE DEVICE RECEIVED; (4) THE

QUANTITY AND TYPE OF BYPRODUCT MATERIAL CONTAINED IN THE

DEVICE; AND (5) IN THE CASE THE DEVICE IS NOT INITIALLY

TRANSFERRED BY THE REPORTING LICENSEE, THE NAME OF THE

MANUFACTURER OR INITIAL TRANSFEROR. THIS REPORT SHALL COVER

EACH CALENDAR QUARTER AND SHALL BE FILED WITHIN THIRTY (30)

DAYS OF THE CLOSE OF THE QUARTER AND SHALL CLEARLY INDICATE

THE PERIOD COVERED BY THE REPORT.

23. EXCEPT AS SPECIFICALLY PROVIDED OTHERWISE IN THIS LICENSE,

- THE LICENSEE SHALL CONDUCT ITS PROGRAM IN ACCORDANCE WITH THE

STATEMENTS, REPRESENTATIONS, AND PROCEDURES CONTAINED IN THE

DOCUMENTS, INCLUDING ANY ENCLOSURES, LISTED BELVW. THE CABINET

FOR HEALTH SERVICES REGULATIONS, 902 KAR 100, SHALL GOVERN

UNLESS STATEMENTS, REPRESENTATIONS, AND PROCEDURES IN THE

LICENSEE'S APPLICATION AND CORRESPONDENCE ARE MORE RESTRICTIVE

THAN THE REGULATION.




A. APPLICATIAON DATED APRIL 30, 2001, SIGNED BY THOMASNIINEMENTS, GENERAL MANAGER.

B. RONAN ENGINEERING COMPANY RADIATION SAFTY SCHOOL MANUALDATED APRIL 30, 2001.

C. LETTERS DATED:

1. SEPTEMBER 27, 2001,S IGNED BY THOMAS NIINEMENTS,GENERAL MANAGER.

2. NOVEMBER 12, 2001, SIGNED BY J.E. ECKHARDT, DIVISIONMANAGER.

3. JANUARY 3, 2002, SIGNED BY CRAIG A. CARIS, QUALITYMANAGER.

4. JANUARY 24, 2002, SIGNED BY CRAIG A. CARIS, RSO.5. JANUARY 29, 2002, SIGNED BY CRAIG A. CARIS, RSO.

<$? A 2 C +> MARCIA R. MORGANA - - - - - - - -- -- - j - -- --- - - - - - - - - - - - - -

SUPERVISOR SECRETARYRADIATION HEALTH & TOXIC CABINET FOR HEALTH SERVICESAGENTS BRANCH

DATE ISSUED FEBRUARY 1, 2002

NRC FORM 241 U.S. NUCLEAR REGULATORY COMMISSION APPROVED B3Y O1t3M. NO. 3150-0013 EXPRIh orIIa mc02Ediale bnen er Ispo to comply wit hs O'ada ovPclleationacquest: 15umIn=.Thi otiication Is tequ Fhe C may

schedule Inspedtion of the adhitiies to emur theyM am conducted ineccordance with requiremTents for protection of the public hweahi and

REPORT OF PROPOSED ACTIVITIES IN t Branch r dIr .. GlajmattoUtIh R -cordNod RegulattyrCoission,

NON-AGREEMENT STATES, AREAS OF EXCLUSIVE ashmgon. DC 2tS-OO0 r bIntrnet eomaflito bjstt.,,

FEDERAL JURISDICTION, OR OFFSHORE WATERS (3150.OO13t, af°o, OI3af05°o3°and Bud eto

(Please read the instructions before completing this fonm) NRC may not conduct or sponsor, and a person is not requird to

t. NME OFLIUCENSEE 2P.'ornpou' todcsttiedaib ) t TYPE OF REPORT

Ronan Engineerinm Comyanv E] INITIAL fl REVISION & CLARIFICATION

AWCRESS OF UCENSEE a s4alhv oan my be b 4 LtENSEE CONTAcr AND TITLE

8050 Production Drive Tony Sholler, Field Service ManagerFlorence, Ky 41042 s. TELEPHONE NuMBER I. FACSIMILE NUMBER

- kA. Cod) Q An' Cod)

859-342-8500 859-342-64267. ACTIVmES TO BE CONDUCTED UNDER THE GENERAL UCENSE GIVEN IN 10 CFR 150.20

H WELL LOGGING LEAK TESTING AND/OR CALIBRATIONS H TELETHERAPYARRADIATOR SERVICE

H PORTABLE GAUGES OTHER (Specify) I> Pietr g Paxf i4

RADIOGRAPHY =4> REGISTERED AS USER OF PACAGING TCA1TES OF CrAPlANCE NUMBERS)

& O =ENT NAMS ADDRESS. C[TY/COUNTY STATE. ZIP COOS 9 ACTUAL PHYSiCAL. ADDRESS OF WORK LOCATION

iPo/T pjj 0t/T SP rV l tvrfccnt CLV12Ab"tf PlstiF

P2otr 61, i'4t wi/ pIT ? 10C iUENTaTEEPtONENUMBER 11. WORK LOCAN TEPHONENUMBER

(30V) 91 tP2 NATESSCHEDULED 13 NUMBER OF 14. IDD IS. LOCATION

1WOATSRK4DUE %Jj DAl A DIS.ETE REFERENCE NUMBER

FROM TO NUBIEER TO BE

I II / / 31 ASSIGND WBY NRC

UST ADDmONAL WORK SiTES ON SEPARATE SHEET(S) TO INCLUDE ALL INFORMATION CONTAINED IN ITEMS 9-16 ABOVE.

17. LIST RADIOACTIVE MATERIAL, WHICH WILL BE POSSESSED tUSED. INSTAIA.ED, SERVICED. OR TESTEDOIclu~d. dettt1Eon oa"4w and qtafty ofmcgobac* 'fl* salad socurs; or deter to bhe utdj

o L '4 IF 65, &eZ14L 4: 6932k), 300 oroC, SP/-C , C5 -/37

IU AGREEMENT STATE SaRC uCSE EW4 AUTH1U2ES TnE URSLNE00rDCNWCT |CENSE NUinER | STAnE 1A | EXIRN DATE

ABOVE. E 201-260-95 Kv Sept. 30, 2002

19. CERTIFICATION (MUSTBECOMPLkIW flyAAPPLsLAJJ

i, THE UNDERSIGNED, HEREBY CERTtFY THAT:. All Information In this report Is true and complete

b. I have read and understandthe provision ofiOe general license 10 CFRi1iO20repdunted onthe Instructions of tbis1orm; and I undenrtandthat l am

required to comply with thee provisions - to all byproduct source, or special nudste material which I posses and us. In nnrAgmement States or

offshortwaters under the general license for whic this rapoRt Is iled wit the U,. Nuclear Regulatory ComrmiSorii

c I undrstand that activites, Including storage, conducted hI non-Areement tates under general tcenst 10 CFR 16020 am tbilted to a total d 110 days

In calendar year. With the exception of work conducted In hff~shore wfes, which Is autoiazed for n- unlimited period cfinme In the calendar year.

d. I understand tt I my be Inspected by NRC at the above listed work site locations and at the Lkensee home office address for activides pedonned in

non-Agreement States or offshore waler..

e. I understnd tht eonduct do any ac not d bed abwe, hudbng onduct dfacvton dat or lto s diffeentfi tho d bedabove orwithout NRC autlortzation, may suabest me to enforcement action, Including dvl Pr criminal pnal

CERTFYING OFFICER. RSO - UanAgent Rfptramf _ Namomsnd TAW I SIGNATURE DATE

Towt 5ftLaft•-1tL 2SWe(f /fl ?fX I ?/ASYOZ /3/vWARNING: False statements In this cartificate may be subject to CNNl atndlCorlrininld penalties. NRC regulationst requirel hdt submissions to

the NRC be complete and accurate In all material respects. 18 U.S.C. Section 1001 makes it a crimninal offense to make a willy false

statenient or representation to any department or agency oftthe United States as to arny mauer within Its jurIsdictiort.q

FOR NRC 'Re'EWV FLoM Tdil iNT) SIGNARE DA7E TTALUSASE-DAYSTDAEI

USE ONLY I I TUINaC FORM 241 (7-1100 �.. � .1. --

NRC Form 241 for Ronan Engineering Company, Initial. · 2012-11-18 · NRC FORM 241 U.S. NUCLEAR...

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Transcript of NRC Form 241 for Ronan Engineering Company, Initial. · 2012-11-18 · NRC FORM 241 U.S. NUCLEAR...