pan = mmmmmm = n=_=_=.=_=mmm m=mw== == = = = = = ==_=m= = = = = =nw = = = = = = = = = =a| NIC tsem M4 A U.S. NUCLE A2 RE!ULATORY COMMitSION .- ) I Igpg y pyg

I LJceI,3 g;;mbet |, . .

*

| 50-23271-01 II MATERIALS LlcENSE g

3,,,,,,,,,7,,,,,,,,,,,,8I SUPPLEMENTARY SHEET 030-20439

I II f

Amendment No. 1 gi

I ilI

I ti Ni

| Kodiak Testing Laboratories, Inc. [P.O. Box 1945 ,i

i Kodiak, AK 99615 g

ili'l '

I '

I l

| In accordance with NRC form 314 dated November 24, 1992 License No. 50-23271-01 is hereby |terminated.i p

p m R f! G g [,Y,,sj| g

i -\ |I N, A I ,

1 N /p. ps

k !i q)|I r, , -

| n <A 1 A g.

fn.i Q4 us- '- , ,m ,, y 's f,s., , I' [?.[c;s h II

>I $}/I e ',,

\ s 1~ 3I e, e>

' ,,

{#4 o' } 2' p'

. u&. -.. / -,| , yI t i,. 4 ~ v gy ", I,,

>

-

s.,,q q " p y)'? -_

, - pI f'n s-,

,,' f .

* l' -@ ||6ps''

7%.y ', %,d, j

!;

g, % .;

l' 7'

,

1 J.,s , ,,< - 1 %- pI s

-

,1 :: g g ..; e fp. . ,g j., ,

,

ws-L,Q~ j!; f. 6;qr &,,f

- ,

_i g" '<

g', %;'j p yg .n

p. 'l: ,.. yg -

"

t ,

h, k' fx t,, q, $ $ \

I,1 t l

1 FOR THE U. S. NUCLEAR REGULATORY COMMISSION 11 j1

i ,

I

I W OV e s , ,~, Date By: 82|IV/,24rrm ,l '0 fI Beth A. Frange/J B

| Sr. Health PhyYicist (Licensing) IRadioactive Materials Safety Branch - |g

| Region V' >

Pi WI' t

!I D

E D

1 >I h9212230227.921125 i hI PDR ADOCK-03020439

8I C PDR gi .

h*wur-= marmwassw.maavr.was.ws3Eirmw.:r.wsdMDRiMMrWX. ;

._ _

o

-.,

1

NOV 2 51922

Docket No. : 030-20439License No.: 50-23271-01Control No.: 571697

Kodiak Testing Laboratories -

P. O. Box 1945Kodiak, AK 99615

Attention: Alice BergeePresident

Enclosed is the termination amendment which you requested in your Form NRC-314dated November 24, 1992.

Sincerely,

Beth A. PrangeSr.HealthPhysicist(Licensing)Radioactive Materials Safety Branch _

Enclosure: As Stated

. . . .

.

. .,,

5

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 &

omery DSkov BPrangeJMontg/

KPrendergast/ / / II/25h2/ /

REQUEST COPY REQUEST COPY REQUEST COPY REQUEST COPY

YES a NO O YES a N0 o YES O NO a YES o N0 er

.

- ~ ~_ .- . . . ..

-.. . ..

. . . . ... ..~u.......m.....-o. . . . . . . . . . . , . . . . .

e o.x.. .:gy,, ,u . . .A, . , , , , ,,, , i e i, .. a . i m u , , u~

..,m.s.,b..4.c,~mgic,ios.i(';.,.t.2.,u, ....,n..,,,

. . , . . iiiCERTIFICATC Of DISPOSITION OF MATERIAt.S ; gay,y 7,g;i e,* alt,% .,,i'A'gj

. . . . . c. . c. , m.w .

!S$t.4iE~.Tc?..'c,9..:ieoNmm... c i. w, v . wq%f.?c'. Ei M4. 0.lti'

5.c*

cov i ,,e a,vs r o. . .. ,/ <-inst nucT.o 5 .si.ND t,a,t,a i,ett,,eo et nr1,icAt io tas ,u., ,, ,,. m om w m v.. eo Ici ,t3oN3 caivi n ,

o c e ... . . .. .e . ot,. . a ro .. w w.6a

KnDIGK E DTING U noPA7091E.4, INC. 50-P3271-01P. O. BCX 1915 _ ,,,_

mIDAK, AK 99615 ""'"''''''*e'"

10 31-92

THE UttNst t on ANv iNoiviavat erteutiNo tsis ctstir:c Att oN etwatt or tot uttNilt ctatJits t>4AT.1c . . - ue. v.e . ~ wev..>

A M AT L HI Ad D AT A ,cha o,e ena co,apwe es a.ces *yl

] 1. NO M Att ht ALS H AVE tyta .t tN emocuat o cp P011ttltD 6Y THE UCIN5EE UNDE fl TM $ LiCENEl.on

2. A,,tt, MA,iIat A L$ PROCypiD.AND/04 Pott!$$f 0 BY THE ([lCtNili UNDtR THr U..CtNSI NJMbt A CitiD Ato d Avt 81(N DitPC1t0 0F, t ouomo -NNi - , , , , , , , . . . . ~ , . - . . . , ~ , . . . . . . . . . .,

e .w> t e em...u.e ..o ,.. ... . . ,n.... .. o. ..m r.~ c..n c ..s w.v.e .c ir a ser,. rii i v a.. to. d ion..> .et oa. ir c s o *e ir.o.icodeip. cit.cve.i.c.io r 'c .a w .*a.,' e.e. *ci so et.. .r.

re. e ne ... er .o-c.i_ .# etc . die2 iroxler Gueces transfered totMedi@. Qanlity Centrol, Bex 3696, Kedie., AK 99/'15,

HPC # SO - D'iO S'1 - O t _ Dstes_ f t ~ WI ~ 'ari : a , e c. . v it. ..... .,. .. .-. v r. i.ces e .o ni ,a r. .rp..ei . N a c nies . e ow c,< 4..+.~i sme a.+. eoe o, ...nie e

I.w i, m..

iv . rem.v. *ve om e e omt.. e, re uc.ei.. ,,, it-.a u r... ,.e w ,,,,,,e nc.n.... oce. . s o ipei.i . t o, ..... cri,.n o,. e,in t e t,-,

i s.e u 4.. m.. ' p . c. e< .. i. e . ,..., ,. u,,.,.;

D OTHER DAT A

1. Oum UC( NLt N AS NOT vt Y [ Apia 6 0. plt Att it PMiN Ait if

ANY CONTAMah ATiON Mt V AIN5 0N Tral P h t'15t & CGvt Pt D tv Tet Utt N$t t ic.ee.DtOACTJvt M ATt * t ALS AN310 DET E RVINt WntiME R2 % A1 A R AD6ATION 5UPviv CONOUCit D 10 CON'iPe taf 46tf NCE OF UCEN5t D P A

,av

p . . . .. . .,

vel, TMt #1SutT5 fc.n. ea.1~

~. ASE ATT ACHID or

* t P E f o#6 ARCED To NaC ON <ove

3 f eE Pr %3N TO BE CONTACTED htG Am>Na tst iNeDaM ATION PROVIDE D ON THil f 0 AMiii.ut ,6t&*M0%t cv.Ih

Alice Bercee (907) 06 65fA4 Malt ALL evTwet ;.oa goy.g R10.no.N0 tgi5 uttNst To

,

d ],

, [' - 1. fW

n Cd / \ ~!,L Q Qa' (i h r .it?ivn

.

l' s.

-

_

/ , / CERTIFYING OFFICIALn n cm :x.a k,,j

1 CERTir Y UNDER PE dLILCE JEhJuni TN+AbTwENORICorNG IS TRUE AND CORRECT.<

gc.it34%.v..s

l'- M - Wo'~

ynm%t o wawa .%d 1.,6

b L. t C. <* b e f G e* f._ L 8 D e a)T

WARNING: F ALSE STATtVENTS IN THr$ CE RTIFICATE MAY BE SUNECT TO CIVf L AND/OR CRIMINAL PEN ALTIES NRCREGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC Bt COvPLETE AND ACCURATE IN ALL MATERIAL REfJECTS18 U.S C. SECTION 1001 MAKES IT A CRIMAAL OFFENSE TO MAKE A WILLFULLY F AL$E STATEVENT OR REPRESENTATIONTO ANY DEPARTVENT OR AGENCY OF THE UNITED STATES A5 TO ANY MATTER WITHIN IT6 JUR1SbtCTION.

g 4 c7 ).c.c.w,,.....,

--_ -- - -

U u - trtT3UE3 VWU aoaUv P.UU

-.

/ TROXLER ' *""w"e"c*r"ou"w**en"a' "u"e"A.

'

' " ' ' " " " '|,

LEAK TEST ANALYSIS

Device . Model #34ll D , Serial #jv&qh This certfios that the

Source (s) Serial # d3U7 Serial #4IIT-77 fh so m as been"

Dateof Test:#/TJ/M N IT WN analyzed using anapproved monitorInDf ''

i

rc fhsa ys*MMI shows the removableeY001 K % @ .>9(,) I activity to be less than

O. mi roc i ,

,

.

' UM'

Your Name: L Cr. T5te % v e"~ / l- LM

-

Tafephone: $Cr7) ML-4T(/(,ORIGINAL COPY

I Jp TROXLER "" '"" u** c*"ro"m"i enn u"s"A"*"#"''"'"-

LEAK TEST ANALYSIS

Device - Model #77%D --- , S orial # 30 g This certifies that thesomate accompanying

Source (s)-Serial #Cil37 #UK, Serial #Aff MB *I this form has been

Date of Test:ad'h 5 /*L analyzed using an '

approved monitoring-i

method that measuresNase print legibly and firmly. Ilus as your retum address label. both beta / amma & alphaDh contamination; and, that- -

'KOD)fl% M YLi@ the results of this analysts3e 06K s347 shows the removable

, ppg gp actMty to be less than0.005 mictoct 1 s.&9G\Te p

Your Name:\ |r;'hERhni <v'Tetophone; fXiT) 4-C.ITI- '

ORIGINAL COPY ~

_

|

|

.

l

..

!!

:

.

57AVf7- . - . - _ . . .- . .-

,. , ,,

i

(f0R ifMS U5t): INFORMAi!ON FROM LTS

btiwilN: ' ...............+....

1

License fee Management Branch, ARM : Program Code: 031?)and Status Code ?

Regional Licensing Sections fee Category: 3P: lap. Date: 199?l031: Iee Connents

Decom Iin Assui~ ret F W::::::::::::::::::::::::::::::::::::::

LIC[N51 f[[ TRANSM11TAL

A. RfCION

1. APPilCATION ATTACHID-

Applicant / Licensee: KODI AK lt511NG LABORA10Ril5. INC. nReceived Date: 9?O930 L- /Docket No: 3020439 YW QControl No.: 571fs97 /

n 1 rd! et$ewa t d#t

?. I A AQ g g)D 4 p!,,Ncrfa!?A2 gpACheck No.: gi g j

3. COMMLN15 Ir ..pSigned . [N N'NI O

//- 6 - 65Date *

B. LICINSI f[[ HANAG[MlN1 BRANCH (Check when milestone 03 is entered [y/)

1. fee Category and Amount: 3[2. rt t f ee Paid. Application may t>e processed fo

Renewal ~V ~

License

3. OTHER

/Si$nedDa e o th[$ -f

K

k:

' .ain

.

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

,

.

K0DIAK QLALITY CONTROL'

-

P. O. Box 3898Ko(Wak, AK 898f5(907) 400-4995

27 October 1992Post Ir'WW lu transmittoi memu 7571 eeipp..

Hs. Beth Frange M IfW'- M @ebik'""UOHRC Region V dC. U " }Gh) qc.,

Nuolear Hateriale safety Section 0+rt mdT1450 Haria Lane gg

-., , , ,Walnut Creek, CA 94596-5368 b0 T7f 0M 'fW

~

SUDJECT Transfer of nuclear densometers from Kodiak TestingLaboratories, Ino, to Kodiak Quality Control.

Hs. prangei

I recently purchased certain assets of Kodiak TestingLaboratories, Inc., which I plan to use in a new business namedKodiak Quality Control. Included was a variety of materialstesting equipment, including two- Troxler model 34112 nucleardensometers.

Kodiak Testing Laboratories (ETL) submitted an application dated23 Septmeber 1992 to NRC for renewal of their materials license850-23271-01. I submitted an application dated 22 October 1992to HRC for a new materials license.

The purpose of my application is to enable me to take possessionof the nuclear materials now in the custody of KTL. All mynuclear materials will come from KTL, with the possible futureaddition of new densometers from Troxler or Seaman. KTL willretain no nuclear materials.

Immanuel G. and Alice Berges, officers of KTL, intend toliquidate the stock of KTL and dissolve the corporation. KTLwill then cease to exist. I. O. and Alice Berges have no plansto possess nuclear materials in the future. I have appended acopy of the purchase agreement executed between the Bergoes andme.

KTL recently received a lotter from Harnella Rodriguez informingthem that the annual license fee has increased f rom $400 to S540,and stating that the license renewal application will lapse in 30days it they do not provide the additional S140. The letterreferred to control number 571697. -

We would be very pleased if KTL's license renewal applicationwere to lapse, provided NRC can issue a license to Kodiak QualityControl before KTL's present license lapses, and particularly ifKTL could get their original S400 back. Could we perhaps callthis a transter rather than two separate applications for-materials licenses?

5~7577.c= w

, - . . - - . . - . ,- . . - . . _ - - - , - - - _ . - - . - - _ . - - - - - - . - - --. . - .. .

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

*;.

.

. .

!

Ms. Seth Prange - Nuclear Natarials safety 8ection !27 October 1992 .

'

Page 2 *

I. don't-know how much leeway you have regarding reesi

really ha .

business, ppening is that the 8stgees are getting out but what is.

,

and I am of the nuke Igetting in. It would seemthey should not be required to pay $540 tur a license for

reasonable thatnatorials which they willgives me a license. transfer to me just as soon as NRC :

In any eventI have included a check for $140 for my-license

i

I

application. , I have also included a copy of my Troxler trainingcourts 90Ytificate, as you requested.Please call or fex me if

"

you have questions, or if you need additional information.-

,

4

81ncorely, I

!i L

Mark Blakaslee, P.E., owner- .

Kodiak Quality Controlt

1

4

%

h

57M757acc-

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

. __ _., . _ _ _ __ _ _ _ _ _ _ _ __ . ._ . . __. _ _ _ . _ . _ _ _ . _ _ _ _ _ . _ _ _ . . _m

.

*. . .,

,

ME1MORANDUM e.

.Immanuel. O. and Alice Bergee, officers of KTL, -$ntend to

liquidate the stock of XTL and dissolve the corporation. KTLwill then cease tu exist. 2. G. and Altoo Berges have no plansto possess nuolear materials in the future.

|l

1<o diak Tomting Labo ra to rie ns I|\

I . G . B ep ['''

|D # ,! E1 aL 1W41 e is ^2' daite

05v . Lt A k A $ 0 ~ OS *H },' Alice Bergeo d date

f'

_. . - , _ _ . . . _ . ~ . _ . _ . . . . . . . _ - _ - . - . - - _ - . _ . _ _ _ - _ - - - . _ - . _

. - - . - . - . -_

..

*<

. .,

,

AQUALIFE ENGINEERING... ,

P.O. Box 8994Koolak, Alaske 99915

(90'f) 440 4998Voloo & FAX

26 September 1992

PURCHASE AGREEMENT,

AquaLife Engineering hereby offers to purchase eartain assets ofKodiak Testing Laboratories, Inc. This offer includes allmaterials testing equipment - and- supplies, accounts receivable -

dated later than 16 September 1992, and the good reputation ofthe company. All stock, and any liabilities of the corporation(other than those incurred by AquaLife while operating the labduring 1992) remain the property and responsibility of I. G. andAlice Berget. The terms of sale are Es-follows.1) Furchase price will be $18,000 plus 25% of the accounts

receivable balance as of 16 8eptember 1992. 2. O. and AliceBergee will collect the accounts receivable to 16 September1992, and pay 75%, less qualifying expenses, to AquaLifeper our' agreement of 6 May 1992. Payments will be made onthe 15th of each month, or whenever the balmnee owed exceeds

'

$3000, whichever_is more frequent.

2) A down payment of $3000.00 will be made'when this agreementis comPlated.-

3) Honthly payments of- 8600.00 will be made on the first day of feach month, July through December, 1993 through 1995.

4) A final balloon payment of_the remaining balance will be:made with the final monthly payment on 1 December 1995.

5) Lab equipment and lab product will be removed from their-current location no-lat'er-than 1 May.1993. No charges willbe incurred =for storage of equipment at the presentlocation.

6) AquaLife Engineering will immediately apply for aradioactive materials license ~from the NRC,-and will takepossession of the nuclear densometers upon-receipt of thelicense.

. - . - - - ..

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

_.

**

.,

*-.,,

.

Purchase Agreement26 September 1992Page 2 of 2

7) i

I. G. Bergee consents to provide field density and concretetesting as required by clients from $ October through 31December 1992.the testing performed.Bergee will be compensated the full value of

The above terms are accepted by the principals, as follows.AqumL1:Ee IDngineering

Agreeda N 71^ - '

Hark BjaXeslee, owner ' dnteKodiak Testing Laboratories

Agreed _ C)h Yw 7,f. G.''aelges 'o ' ~

'date

0 * _ M , _e mAgreed._ 9 3o.92_ -

Alice Bergee Odate

1

i '

, -.-. -,. . . - ... - . - . _ - - - .- - - - - - . . . _ - . _ . . - - - - - -

- --- -

. .

Vf- -

ti ? !,! %/dfy g%jff Vif siff___

._

,

op spp y, T,n , > . ~ i -ifipp __ y.c =

. . - . _ . _. ._ - 3_ _. __ . .,

i'd.> ,g. . . .

#$N e 9CTRONIC LABORA70

"

!9 gO /Ne $ I:r~f HEREBY CERTIFIES THAT * *f? ; ; 3b i 3

MARK BLAKESLEE E *Et$ d I

z

s. ,

r' r

KODIAK TEST LAB "M(. {1 i ;[ HAS SUCCESSFULLY COMPLETED THE TROXLER ELECTRONIC LABORATOR2S, INC. ) @'gT TRAINING COURSE FOR THE USE OF NUCLEAR TESTING EQUIPMENT.

. , m:%

-[ SUBJECTS INCLUDED IN THIS COURSE WERE AS FOLLOWS: E F -#: ~

:.|Radiological Safety

--

$ ggii 1. Principles and practices of radwtion 5. Radioactivity measurement standardi~a sc-n i "_jgotecnors.

_ and monitoring tecInniques and ~

h_.

'

h ?. $i3. ne sa' ~ .

Tgifuse*~an[S&OL&Q[iMN S>'i ~ ~yr. Proceduits fotnudeh_ gauge storage'41 % *

#~~ f [.'rodioattivity.) 4l$iN[if5_

B. k #"d k d"3 @g prEAi$k N@ hI

- [.5 4. iBiological effe{ts of5iikTEduidiG) [!].

jhe 3 ,sa ons g ~y ge. ww.m - ., e - ., r w w. .m=-, -.

%i j h $h $$.i het 5 Y N5 hex --

,. =

shh.ga%,7. h h:ff.m._hkf_,QgkhMjef,hf._ {?nstrumcfi:,. v

. -_ & _. Tf..f. $.&. . .$.i\.\ms]1., , , . 0i 1.. uw._ y-

1- 2. Operating proce ures uge tron .

.4 gt[ 3 .. Main nanceCERTIFICATE :': 054105 [hk %

**

Sk (*

CHRIS MORIE 6/24/92 WILLI AM F. T R3XLER%. : msmucion g [

#

i onttw, mos:oser f --

). . . " . , - -

-- % - *w_

1- w - ,. . + . - 4{B I

' . y*' ,\ 'W) g ''Y/q g '' ( *

}*' pp ia3

|

h ? _ b-_ _ -

-

$'

?b>ws &*

_ _

% w w - -e

.

,)* "'%-.

,

'8~

UNITED STAM8i NUCLEAR REGULATORY COMMISSION'

wAsNINGToN, D.C. 30gus

00T 2 2 E

Kodiak Testing Laboratories, Inc.ATTN! Alice Berges, PresidentP.O. Box 1945Kodiak, AK 99615

Gentlement

This refers to your letter dated September 23, 1992, for rwneWalof Materials License 50-23271-01. Your check No. 1420 ($400) inpayment of annual fee Invoice AH07256 was received.

Your request is subject to a renewal fee of $540 as specified infee category 3P of $170.31, 10 CFR 170, which went into effectAugust 24, 1992. A copy of the July 23, 1992, Faderal Racisternotice regarding the revisions to the Commission's license andannual fee regulations (10 CFR 170 and 10 CFR 171) is enclosed.

Payment of the $$40 fee should be made to the U.S. NuclearRegulatory Commission and mailed to the following address:

U.S. Nuclear Regulatory CommissionATTH: J. Marnella RodriguezLicense Fee and Debt Collection Branch, OC/DAFHall Stop HNBB 4503Washington, D.C. 20555

Your application will bo processed by the RV Licensing stafflocated at 1450 Maria Lane, suite 210, Walnut Creek, California94596. The foe, however, is required prior to issuance of therenewal. When submitting the fee, please refer to CONTROL NUMBER571697.

If we do not receive a reply from you within 30 oniendar daysfrom the date of this letter, we shall assume that you do notwish to purnuo your application and will void this action.

Sincerely,

$/A4<dLA-eJ f '

Marne11a Rodr un,

i icense-Fee and Debt Collection Branchj Division of Accounting and Finance| Office of the Controller

Enclosuret July 23, 1992, Federal Reaister notice

ocs RV

|

|

Lt

- _ - ._ - -

. . - -- - . . , .. ~ .. . . -. . . . . - -

OCT 2 21992 (1W# '**

. v)W id'

W h - t4 b,

Kodiak Testing Laboratories, Inc. /- 2 (1-

ATTN: Alice Bergee, President- | y {;+'_ [ fig [b. ,P.O. Box 1945 g "

M M /*Kodiak, AK 99615 i

p M , c-) p* 7')&

//

centlemen: 4M<

k (, fe

This refers-to your letter dated September 23, 199 for renewal c,'

of Materials License 50-23271-01. Your check No 1420 ($400) in '

payment of annual fee Invoice A1107256 was rece ed.

Your request is subject to a renewal fee of $540 as specified infee Category 3P of 5170.31, 10 CFR 170, w ich went into effectAugust 24, 1992. A copy of the July 23 1992, f.pderal Reaisternotice regarding the revisions to the ommission's license-andannual fee regulations (10 CFR 170 a 10 CFR 171) is enclosed.

Payment of the $540 fee should be ade to the U.S. NuclearRegulatory Commission and maile ._to the following address:

U.S. Nuclear Regula ory CommissionATTN: J. Marnell RodriguezLicense Fee and bt Collection Branch, OC/DAFMail Stop MNBB 503Washington, D 20555.

Your application will be processed by the RV Licensing staffjlocated at 3450 Maria Lane, Suite 210, Walnut Creek, California94596. The fee, ho/ever, is required prior to issuance of therenewal. When sub itting the fee, please refer to CONTROL NUMBER571697.

If we do not re elve a reply from you within 30 calendar daysfrom the date ,df this letter, we shall assume that you do notwish to purs year application and will void this action.

Sincerely,

Sign 8d DY .

y }pmsm R00'GucIJ. Marnella Rodriguez

/ License Fee and Debt Collection BranchsDivision of Accounting and FinanceOffice of the Controller

Enclosure: July 23,-1992, Federal Recister notice

cc: .RV -

RISTRLBUTIONPending Fee File,-OC/DAF R/F, LFDCB R/F (2), MAC#1 - A:\KTLI.TXT

$ /h fB OC/L OC/LFDCbOFFICE:NAME: B8%w JMRoddiguez MMessierDATE: [/ O /o /SJ // V /0/If////

S3/MJ. . .. - .

DCT 2 21992- -' p gggggg

RIcEwED 0 1- - -.

,

Kodiak Testing Laboratories, Inc. p,3 y NOV 61992 t.''.

.ATTH: Alice Bergee, President- __} .

''

Kodiak, AK 99615 L _

..jP.O. Box 1945 p3 |,7| _n I.'; O 53 : immGentlemen:

This refers to your letter dated September 23, 1992, for renewalof Materials License 50-23271-01. Your check No. 1420 ($400) inpayment of annual fee Invcice AM07256 was received.

Your request is subject to a renewal fee of $540 as specified infee Category 3P of $170.31, 10 CFR 170, which went into effectAugust 24, 1992. A copy of the July 23, 1992, Federal Reaisternotice regarding the revisions to the commission's license andannual fee regulations (10 CFR 170 and 10 CFR 171) is enclosed.

Payment of the $540 fee should be made to the U.S. NuclearRegulatory Commission and mailed to the following address:

U.S. Nuclear Regulatory CommissionATTN: J. Marnella RodriguezLicense Fee and Debt Collection Branch, OC/DAFMail Stop MNBB 4503Washington, D.C- 20555

Your application will be processed by the RV Licensing stafflocated at 1450 Maria Lane, Suite 210, Walnut Creek, California94596. The fee, however, is required prior to issuance of therenewr.l. When submitting the fee, please refer to CONTROL NUMBER571697.

If we do not receive a reply from you within 30 calendar daysfrom the date of this letter, we shall assume that you do notwish to pursue your application and will void this action.

Sincerely,

Signad D'l3, pp,mpa RodrigucI

J. Marnella RodriguezLicense Fee and Debt Collection BranchDivision of Accounting and FinanceOffice of the Controller

Enclosure: July 23, 1992, Federal Reaister notice

cc: RV

pISTRIBUTION,,

Pending Fee File, OC/DAF R/F, L DCB R/F_(2),\ gyl - MAC#ggg*'Ky?EOIU!

A LI.TXT'

OFFICE: RD B OC/LF B OC/LFDNAME: W JMRod;iguez MMessiet4 l|0|5I1;DATE: ,/ /o / SJ / /j 7 fo / y / - .'O .'

w . _,

,

.,.

THE MINIMAL INFORMATON REQUESTED FOR THIS CERTIFICATON DOES NOT CONSTITUTE AN INFORMATION COLLECTON''

AND, THEREFORE. DOES NOT REQUIRE OMB APPROVAL..

NJ.C FORM $24 U.S. NUCLEAR REGULATORY COMMISSION INVOCE NUMBER ,

g, i

.-

AM07256-92CERTIFICATION OF SMALL ENTITY STATUS

FOR PURPOSES OF ANNUAL FEESWENSE NUMBER

IMPOSED UNDER 10 CFR PART 171

50-232T1-01see Instructions on rearse side.Att etems MUST to completed-print or type. Incomplete Ibrms will be retumed.

NAME AND ADDRESS OF LCENSEE (as it appears on the ineke):

KOLIAK TESTING LABOP.ATORIES, INf'.P. O. box 19h5KODIAK, AK 99615

NOTE- See Instruction W. 2 on the reverse side - Check one box only.

1. BUSINESS OR NOT.FOR-PROFIT ORGANtZATION WITH MAXIMUM ANNUAL FEE PER LICENSED CATEGORYGROSS ANNUAL RECE! PTS OF:

A $250,000 TO $3,5CO,000 $1,800

y B. LESS THAN $250,000 $ 400 j

2. PRIVATE PRACTCE PHYSICIAN WITH GROSS ANNUAL MAXIMUM ANNUAL FEE PER UCENSED CATEGORYRECElPTS OF:

A $250.00010 $1,000,000 $1.800.

B. LESS THAN $250,000 $ 400

3 GO'4RNMENTAL JURISDCTON WITH A POPULATION OF: MAXIMUM ANNUAL FEE PER LICENSED CATEGORY

A 20,000 TO 50,000 $1,800,

!

B. LESS THAN 20,000 $ 400

4. EDUCATIONAL INSTITUTON THAT IS SUPPORTED DY A

..

QUAUFYING GOVERNMENTAL JURISDICTON WITH A MAXIMUM ANNUAL FEE PER LfCENSED CATEGORY

POPULATON OF:

'A 20,000 TO 50,000- $1,800

B. LESS THAN 20,000 $ 400

EDUCATONAL INSTITUTION THAT IS NOT STATE OR- PUBLCLY SUPPORTED, AND HAS 500 OR LESS $1,800

- EMPLOYEES

CERTIFICATION

This certdication enust be signed by the owner of ttu entity named above or an omcial empowered to act on behan of the entity.

I certify that the above named NRC licensee qualifies as a small entity under the size standards established by the NRC for its licensees onNovember 6,1991, (56 FR 56671) and in accordance with Title 10, Code of Fsderal Regulations, Part 171, as cevised (56 FR 57587). Thelicensee qualifies as a small entity under the specific size standard indicated above.

WARNING: 18 U.S.C. Section 10ff., N4 of June 25,1948,62 Stat. 749, makes it a criminal offense to make a willfuffy tales statement orrepresentation to any Department or A .ncy of the United States as to any matter within its jurisdiction. The submitta; of willful falso statementsis punishable by fine or imprisonment. or both, and for purposes of this certi$ cation, may result in revocation or suspension of the license.

I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.

TYPED OR PRINTED NAME AND TTTLE SIGNATURE DATE

0@C, a p 17-32n.x_ m rr, m anz __

,,,,. v ._a -__

p-

.

'. . .

REOS., NUCLE AR REGUL ATORY' COMMISSION42 Annuai- Materials Fee InvoicRECEIVED

.-

. Ns 10-CFR 171.16 NREGIO!L Y p e c.RC. . ,

-

-

,,

invoice Date Inv ice Number12 MP 30 P3:14 ._0028888888=8 ESRBB=255=E===

-08/24/1992 AM07256-92

KODIAK TESTING LABORATORIES, INC.ATTENTION: RADIATION-SAFETY OFFICER

''

-P.O. BOX 1945

KODIAK- AK 99615

***** Mark THIS COPY with'any billing address changes *****

License / Approval /Rogistration/ Code Annual Fee Surcharge

Cortificate Number AA905 Category (s) Fee Amount Amount, ================== ===== ===========

=========,====.00== ==============

50-23271-01 ANN 3P $ 2 100 8 150.00_______________ ______________

TOTAL: $ 2,100.00 4 150.00

TOTAL INVOICE: 4 2,250.00ako-Checks Payable To:======================

.S. Nuclear Regulatory Commission <=== 151s PO Box address 'I s.Jconse Fee.& Debt Collection Branch <=== iur receipt of payments0 Box 954514 <=== 0.11y.t. Louis, MO 63195-4514

.oras and conditions are-attached. Nonpayment of your annual feeay result in the revocation of your license (s) in accordance withho enforcement provisions of 10 CFR 171.23 of the Commission's.ogulations.

unnum**mam****************m**w*** *

* PAYMENT C0PY *m *

N*NNNNM*nnNKNhNNNNNNN*MKnKKunN%%

===> To ensure accurate credit, return this copy of the <===,

,

===> invoice with your payment.- Processing may-be <======>-delayed if the invoice is:not included. <===

.

, swpson {paanL,, r i * 7

K0018k est,ao ma'30i'atoi'ies, a3c..

o' ~

.' OP. O. Box 1945

Kociak, AK 89815

& *lO9 Vj -- -- -

Lc;. / [ . ; . .; ;4,

september 23, 199' ! f ' 'N

Nuclese Materialc Safety Section : . k g ' j' ;-[J ,, l'' &-'

~~ ~,T ' ,

#U.S. Nuclear Regulatory Commission, Region V gg ' ~ '

1*150 Maria Lane ; . _ , p g. pWalnut Creek, CA 94596-5368 g ,. . ,@ je, yPE: M a t e r '. p l License Renewal

~ . ~ . . . xh.lv ..Un-..

Fod i r.L Terting Laboratories. Inc., License 49 50-23271-01

Dear Sirs.

In rnsponse to the " Instructions for Preparation of

Application for License benewal" supplied by your agency, Iam enclosing copleu ott

1. Materia,la License # 50-23271-01 pages 1 througn "" da t edOctober 6. 1Q87.

2. The Arplication for Material License dated August 17, 1987which is attached to and made part of the Material License **

50-23271-01.

3. A copy of Kodiak Testing Laboratories, Inc.'s letter ofSeptember 21, 1987 to Beth A. Riedlinger which is attached toand made part of the Material License # 50-23271-01.

Each of the above documents accurately represent the.management control program, facilities, equipment, personnel,radiation safety procedures, waste disposal Procedures,location of use of flodiak Testing Laboratories, Inc. ett c eP tas follows:

,

,

Application Attachment II, item 8. Add:

Mark Blaleslee, Licensed Civil Engineer, has completed the: Tronler Electronics Laboratories, Inc. Training course for( the use of Nuclear Testing Equipment Certificate *:0541051 (ct.r;> a t t ached ) and is authori::ed by the Safety Officer to

operatu the devices containing radioactive material.

| APplicatton Attachment II, item 9. Amend " Storage"to:

Page 1 of 3

|

57/6f7|

(S07)486-850S

.,

*s'

,4-

.

*.

.

.-*

U.S. Nuclear Regulatory Commission, Region VSeptember 23, 1992 Page 2 of 3

When not in-use the guage will be stored in alocked c3 binet, in a locked room with no outsideaccess as per attached drawing on-Attachment III.

Application Attachment II, item 2. Amend "While intranstt" to:

The gauge will be tran9 Ported to the site in thetransport case, inside a locked box,. bolted to thebed of a pickup.

Attachment III, item A. SAFETY PROCEDURES, its 10 is amendedas follows:

Tronler Electronic Laboratcries. Inc.11300 Sanders Drive. Suite 7Rancho Cordova, CA 95742

Attachment III. item B. EMERGENCY PROCEDURES, 1. Accidents,

stem d. is amended as follows:

Region V, USNRCOffice of Inspection t< Enf orcemen t

'

1990 N. California Blvd, Suite 202Wa:Inut Creek, CA 94596(301) 951-0550- Any Time

Attachment IV, item 11, amend address to:

Troxler International, Led.3OOu- Cornwallis Rd. at Alexander DriveResearca Triangle Park, NC 27709

A11zother items include'd in.the APP lication for Materials-Lisence Renewal are-true and correct. Please issue-license s

renewal and forward to: Kodiak Testing Laboratories, Inc.,P. O. Box 1945, Kodiak, AK 99615

.

_ _ _ _ _ _ _ - _ _ _ _ _ _ _

. .. . . . . ..

.

*

3 .

.. . . . ..

*. .. .

,

*

.

.

U.S. Nuclear Regulatory Commission, Region VSeptember 23, 1992 Page 3 of.3

If you have any questions regarding this application forMaterial License Renewal please phone (907) 486-6506 duringregular business hours.

Sincerely,

Alice Bergee Immanuel-G.-BergeePresident Safety Officer

AB

cc: Material License File

'

' t

- f

4

e

, ,,.v- - r-- - 1

S

%;;sg

,

.. .

,

'.

, _ .

+

.

September 21, 1987

Docket N. : 030-20439Control M. : 70630-

United StatesNuclear Regulatory Commission, Region IV1450' Maria Lane, Suite 210Walnut Creek. CA 94596

- ATTN: Beth A. Riedlinger |

Health Physicist (Licensing)Nuclear Materials Safety Section

Dear Ms. Riedlinger,

In response to your letter of September 8, 1987 regarding theadditional information requested to complete the review ofour licenseing applicatton, the following should answer yourquestions:

1. The manufacturer and model number of the sealed sourceholders are Troxler 3411, there are two of these. They aremanufactured by Troxler Electronic Laboratories, Inc., 3008Cornwallis Rd. at Alexander Drive, Research Triangle Park,North Carolina 27709The Sealed sources ares

Cos'ium 137 Troxler #A-102112 Once source 8 mci (each)Americium 241 Troxler #A-102541 One soruce 40 mci (each)

2. With regard to personnel monitoring devices, the name of,

the supplier is Radiation Detection Co., P. O. Box 1414,Sunnyvale, CA 94088-3414. The-type of devices used will befilm badges and they-will be exchanged monthly.

3. Leak test as required will be performed every six months'-

by the radiation safety officer with the Troxler Model 3B80Leak Test Kit.

Page 1 of 2

. . - - .~.. . .. . .. - .-

k .

-.

.

.

United States September 21, 1987Nuclear Regulatory commission

4. I spoke with Bob Thomas of your office regarding who tonotify in the event of an emergency. He gave me the name andphone number of the person to contact in Alaska and advisedhe should be contacted also.

I am enclosing updated attachments I, IV and V with thisadditional information, to be attached to our originalApplication for Materials License. Please contact us as soonas possible if additional information is-requested.

Yours Truly,

Alice BergeeKodiak Testing Laboratories, Inc.

AB

Page 2 of 2

!

. . . , .

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

!. fLg ) / / *} * ** ? / )fe /- ,. ., w , ,

mmc psaw 313 U.S NuCL( An StGWL A101Y COMMissiO4I (4* e APPitOvtpav Owg+

i leCam30 n.2 04'

|tW/LICATION FOR M ATERIAL LICENSE m.a o u.e , nne t . .,.e 3

.

INSTfiUCTIONS: SEE THE APPROP46 ATE LICENSE APPLICATION GUIDE FOR DETAILEO INSTRUCTIONS 7OR COMPLE TING APPLICATION SEND TWO COPIESOF THE ENTIRE C097LETED APPL 1 CATION TO THE NRC OFFICE SPECIFIED BELOW.

$ 80t RAL AGl4Citt fit t AP941C ATION% RITM IF YOU Amt LOC AYtD IN

U $ NUCLE Am *!GVL AtCav COvv ss:ON ILttNoit INO A N A Iowa. M6 CHIC A N. WINNISOT A. MissOVal. OMio. OnDiv'1 SON C 8 8 Lli C v C.t AND MATimeA L 1Af tTV. NW13 niSCON58N,$tNO ArettCATIONS TODASHsNGTON OC PM66

V $ NuCLIa m alGULAf ont COWW15& ION, mtciON : :&LL OTHt m et #$0NS F ett AP'LICATIONS Al FOLLowS,17 VOU A mt Maf ta:Ats LACE N5'NG 5tCTIONLOCAft0IN 7M ADOstvtLT mOAD

GLE N E LLYN, IL 6C137CONNICTICUT OE L A ma nt DitT alCT OF COLUWSI A M AINE. M Am VL AkD.MAESACHu%t TTl Nt * JI P$l v. hte YOR K.PE NNSVLV ANI A. mMOct ISLAND. ARK ANSAS COLOR ADO :DAMO E ANSAJ LOUISi AN A MONt&NA Int s m asm A,ca vemuCNT. 5tND AppLIC ATiONS TO Ntyv Mi a:CO NOmTM D As OT A Ca LA MOMA, $0VTM DanOT A,781A$ UT AM,

Om WYOwho,8840 APf tiCATIONS 10U S NUCL t A m atGUL A TCa v COVW:$3 ION. R EG ON INUCLE Am Matt miat $tCTION B U S NUCLE AR af GUL Atomv cowwll'ON mtGIO4 ev631# Ann avfNuf M Af t m AL m AOiATiON po'JT tCTION 5tCTIONRING 08 PmV15e A. P A 19A06 sit a v &N 9( A2 A Omivt. Sutti 1000

&L&BAM A 9tomiDA. CEOma A u t hTUC K Y; MISSIMSIP*t. Non TM CA ROttN A.*

PutatO miCO SOUTM C anOtiNA f tNNt tse t, vimCiNtA, vinGIN isLANos. Om Al&5K A. Am:20N A CALIFORNta M AR All Niv&DA, On tGON W ASHINGTONnali VinGINSA.StND APPLiCAflONS TO ANO U S. TimmeTOmitt AND POS5815aONS 84 TMt pacific 54 NO APPLICATIONS

10U S NUCLlan af GULATCav Covvi3SiON mtGtON ilwaf t mi AL R AOimtiON pmOf t CTION stCTIO's U S NUCLE Am mlGutATony COMwiss#0N mtGiON vtot W Amit TT A StatIT. 8viT E 2900 M Af t mi&L N ADia TION PmCTICTION SEC* TON&TLANT A. GA 3GJ23 1450 U AmiA L ANI SUITE 210

WALNUT CattK CA 945M

FIS10N1 LOC Af tD IN AGattWtNT ST Af tS SEND APPLIC ATIONS TO THE U 1 Nuckt AR mtOUL ATOmv COMMISSION ONLY IP TMtv vviSM TO POSSits AND ull LittNsto MAf talALIN ST ATillsaJECT 10 u $ NUCLE AR mt GUL ATOmv COMMIE & ION JVaiSDiCTION

TM $ 4 AN 4 *PL C AT QN FOm IC7een esaw ere nsem/ 2 N AME AND W AILING ADDat1S 08 AprLiCANT Owvoele Cooed

A N4* LCEN181 Kodiak Testing Laboratories, Inc,e AvtNovtNT vo t:Ctsst Nuves Bor 1945 *

]: mtNan AL O eCINst Nuue'" - Kodiak, AK 996151

3.Ac:,ets: Es a-t at sCtN5to uAf tm1At wilt et u5to Om PcEt uto

/6 l'fA. Primary gauge storage at iden m ? 1 by 9d.e v diak, AlaskeoB. Used at temporary job sites with m the ?+ rete at Alaska

e Navt * 8 t a ;C'. * C 54 CONT ACit3 A&OUT TMt3 APPLIC A*lON TlittMON4 Nvv8tm

Alice Bergee (9071486-6506SVBY * *t"5 5 *-8 h ~e 11 ON t i e 11 '' APEm THE TvPt AND SCort OF INeomuaTION TO st PmovlOED i$ OtScmit t o IN TMt LiCINSI APpLIC ATION GuiOE

s ma: :A;T',tva*ta et4 * v4 r.r i i . . w h ee .co. eae.w oamA+ 'wm. eas e mes=m em at a Pum*0stist FOm wMiCH LiCENsto wAYtme AL wiLL ei vsto.e ** ne.- r es, one time AttachTNent I Attarh*ent T

T iN:s C. AL s; meseON$ SLt FOm maot ATION 5AF ETY PROGR AM AND TMtimTae N.N 'a AND & iPImitNCE 9 TRAINING 50R INDiviOUALS WORKING tN Om 7mtOVtNTING mtSTmiCTED ARE AS

httRrhVPnt T hYfRekPnnt TT

$ PACMTit $ ANO (OgifvtNT 10, R ADI ATION 5AFETY PmOGma u

A*_tachrent II At+Nrhena* TTTia.LictNsu ots,4. ,u n m m m an

st .c t v nelNT AMOUNTFEtCAftGomy P <Nnost o 5230.00m rx-y e T t,

tJ <i2* *2A' ;N W ar se co+ >e ws e, ece,icenti THE APPLICANT uNot m1T ANDS TM A F ALL ST ATtutNis ANO mientsgNT A T CNS M ADt .N THis APPLIGATiON Am ti U Ni ,a;g*.gAedygagy

T>t 448 CANY d.NO ANY 088ici AL I at CUTING THIS CERTt8 scatiON O s htM A. 06 THE APPLiC ANT. N AMED nN iTE W 2 Ctatif V TH AT TMSS AP'LICAfiON 11P8t'A44* N CCN8 0R uivv WIT H T TLE 10. COOT OS F EDi n AL of GVL ATiON5 PamT$ 30. 37. 33. 34. 35. AN0 40 AND TM AT ALL .NsOmvAfiON CONT A,NEO Ma ntis,L5 tnt AND CO,8 AE CT TO THE gt1T 08 TMaim ENOWLEDGE ANO e tLit7sk A E*dN 's 'd V ! C SECTION uce ACT 08 NNE 71 1948 67 $T AT '44 w Au nt IT A CalMiN AL 088tNSt to Mant A vetLLru(Lv patst STAf gutNT Om utpatstNT ATICC'O ANT Ot* An've NT 04 AGENCY Cr T=t UNITED ST ATk3 A1 TO ANY W ATita ettarN ITS Jvmi$0iCTION

5dGNA* dl - a P T + - NJ C5 8eCin T YPE D:Pm:NTED Navt TIT L 4 ATE~

Alice Bergcc President 8-17-87

.a s m wtaa,tccN M rave_ ! *'' a NWiliM O8 tv8. Ort:5 f ate. fes a WOULD 10U 61 WiLLiNG TO sts*N ia COST INFOsw ATsCN Qa J er '.s " t. w 't

u g,y ,3ey esto rec s.tv eenwe,af an,N oe centreeferW ON Twt (CONOw'C IMPACT Os cumm f NT Na == > ( A*icrg ^g $>v>L % 4PeopO530 NRC mtGu(ATIONS Tw&T vay 4Mrc! ** o 'A AC wmsas eenn e g

, ^%. 3 g3gy,yy of FO Dreeert fed''e 34 seme#8T.eder % ost geogr etery.en.*ermefren Amsened gg '

the agenew ** een6de Aser9 9 ,,gy - Nwvet4C* SECS

vt3 NOy3

FOR NRC USE ONLYTV'. * * 14 -siLCS Fit CattGCav CCvutNT3 AP*movtaev

AW ' * * k t w ie CHtCA NLVeta OATE

- - .- -- -- __

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

'

.

._*

1 ,

,

PRIVACY ACT STATEMENT

Pursuant to 5 U.S.C. 552 ate)(3), enacted into law by section 3 of the Privacy Act of 1974 (Public Law 93 579), the follow-ing statement is furnished to individuals who supply information to the Nuclear Regulatory Commission on NRC Form313. This information is maintained in a system of records designated as NRC 3 and described at 40 Federal Register 45334(October 1,1975).

1. AUTHORITY: Sections 81 and 161(b) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2111 and 2201(b)).

2. PRINCIPAL PURPOSE (S): The information is evaluated by the NRC staff pursuant to the criteria set forth in 10 CFRParts 30,32,33,34,35 and 40 to determine whether the application meets the requirements of the Atomic Energy Act of1954, as amended, and the Commission's regulations, for the issuance of a radioactive material license or amendmentthereof.

3. ROUTINE USES: The information may be (a) provided to State health departments for their information and use;and (t) povided to Federal, State, and local health officials and other persons in the event of incident or exposure,for the r informatton, investigation, and protection of the public health and safety. The information may also be dis-c!Med to appropriate Federal, State, and local agencies in the event that the information indicates a violation or potential ;vio.atico of law and in the course of an administrative or judicial proceeding. In addition, this information may be trans.ferred to an appropriate Federal, State, or local agency to the extent relevant and necessary for an NRC decision or toan appropriate Federal agency to the extent relevant and necessary for that agency's decision about you.

4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVID-ING INFORMATION: Disclosure of the requested information is voluntary, l' the requested information is not furn-ished, nowever, the app |! cation for radioactive material license, or amendment thereof, will not be processed. A requestthat information be held from public inspection must be in accordance with the provisions of 10 CFR 2.790. Withhold.ing from public inspection shall not affect the right, if any, of persons properly and directly concerned need to inspectthe document.

5. SYSTEM MANAGER (S) AND ADDRESS: U.S. Nuclear Regulatory CommissionDirector, Division of Fuel Cycle and Material SafetyOffice of Nuclear Material Safety and SafeguardsWashington, D.C. 20555

.

e

.

,.

..- ,: q. . .

. .'..m 4. s . s%. - . ...,s. . . . . ..s

. )(c. Q' 4(,g. ..

t.e d d. -Q -. ..,.. . A .. .J a . '. . . .. . . , <. . . A. , . . W. r''1&.& , .. . . . ' . . . . , . ..

-

e, M E c. M. 4 |. Q .. ,s.. -

' y; . ,y '* -~ '..: . .

N . E. . c r 7.. D c N . N. o -}t 7.. M. f\; My d d . t.. f\jd h.4 ';, e,. L--

. ...

v |:.0 W .. M. f\.v ~ (. ed.t..ed,.t.Q,M,M..gy.

.,, sw m - . ~ . - . - _~' .e s . .-~. .- xs .-..-

e, E. - -h .r, - - -

-u ...... .

g, Q. u,. ,) ,. . , .

_

sh .:<> . V .r~.

q ,.g:!I,1 .

jg" ECTROSIC LA3ORATOpfg3' #v~ h.q

r*th. @ e, 4HEREDY CERTIFIES THAT I. 1. 4b.,.g-.~.~ w. - t. . , . . .

$:ybC p ).L: , .

r@A .,h. i-y .'A ~ Immnucl_Berece e3. n ;.- -

ofU,,.fg.-E. :': .G. ,) -.

e

j:hh.- 'i Kodiak Testinn Laboraaries. Inc.

eS.f'

, n. .

"

liAS SUCCESSTULLY COMPLETED TIIE TROXLER ELECTRONIC LABORATORIES, INC. I P'4.yj.ig'l TRAINING COURSC TOR TIIE USE- OF NUCI. EAR TESTING EQUIPMENT. *-

h& '

I' " .3h [:, , SUBJECTS INCLUDED IN THIS COURSE WERE AS FOLLOWS:

k (N, ' . y-Radiological Safety -

r, .

.f E *f 1. . Principles and practicco of radiaticn 5. Radioaetivity measurment standardi::ation ~1~ (::.:

7 protection. . and monitoring techniques and f|' -

YWQ 2. 'L.cak testing procedures. ins t ricen ts.,

' %, .|

'j 3. Mathematics and calculations basic to G. Accident and incident procedurcs. [f]*

t.

N| the use and mcacurement of 7. ' Procedures for nuclear gauge storage .].3@-1' {s&. ?

'

. .

' ,i},4"*; i . radioactivity. and transportation.' I,

.Of ;' 4. Biological effects of radiation. 8. General safety preca'ttions.*.

.- .

%Q, |a,3. :{.s . D.4| Gauge Operatton 3 s; .lp i-

.

gu; '} :. 1. Instr. ment theorgj 4. Field application ..a;,

{ ,&,;.'

2. Operating procedures 5. Gange milibration ,'*I'

).,3. . p .,, ,

3. Maintenanca((-D.g 9 .-

h );., .i [ 2tl . h ifht. 5/18/R7 W. F. Troxler

.

INSTHdCTOR DAll PREtrDENT,A..

%.$g .:,,4,,

NO 19296 >., 7 .

M, . ,Q_ fW 6 W.Qiy . m ._ . _ _ ...Q k. Q G ".s L.J. ..w. -, . _ .- . .. . . . . . . _ ..._ .. ,._ . .. . . . . - _ . . . ..

_ _,

:m . . w. 3 ; .w .a... ..

. / ; v- ' v -

\/. v - V - ya y

-

. .1,.y. j ,, ,* *

;>

y .. . 3 . c.

., . - . ._.

. .

..

.N , ,, ',- W- 1 a | d, '##.'#., ,@ ':. i, k,_.5 3 ,48 (* p

. p y)'F

p'.'xw.. p,p.pgy(q.$ s. : +. . .u ' c. . . . . y .~ J .+ -s -

f. y , - :-.. ..u.- y . - .. . . . _ ~,.

I,'.p 4, p-1,:;bg:.7;,:;/{-fQLYjz8'

2' ,, 3. .- <! V . ,9 '| '

'., / . ,5

'

..

.

.s- - -....y .. ... .- . . ..- ... . . . . - - . -- . .. . - . - .- - .-. ,

.. ns.+. n. ,.

..

--

SEca Oi UC _A3 ORATOR /Es#.~hh.

M., 6 f h ,%.-

MD'

Y<o.hU.:. .).- -

. HEREBY CERTIF4ES THAT a. ,t .C... . . . . . -

b$ #.%@[Mi

,

fs.V;r My Alice Bergee .q; .4

{.,,. ..,',\f Of $~:.;ji-

.N.;

og

;Q.k? Kodiak Testing Laboratories, Inc. {pp .s . .siA .I

:19. h.*

i-j[MN'I'i HAS SUCCESSFULLY COMPLETED TIIE TROXIIR ELECTRONIC LABORATORIES, INC. 'c

$f.- TRAINING COURSE FOR THE USE OP NUCLEAR TESTING EQUIPMENT.

g[a! Ifh.yh.t4 .-

.h.,} W.g fJ SUBJECTS INCLUDED IN THIS COURSE WERE AS FOLLOWS:

g

|1 ); '; Radiological Safety .

; -:, :..

t" Or 1. Principles and practices of radiation S. Radioactivity measurement standardization W %.'%.A,f%,;.$' protcet. ion. and monitoring techniques and Y.fE.%

'

,

j& 2. Leak testing procedures. ins t rwnen ts. . h?N.,

{k')-3. Mathematica and calculations basic to G. Accident an.i incident procedures.

'

^)Q*t

j., ,

%^ the use and measurement of 7. Procedurco for nuclear gauge stomge r3.p? *:

''Q|_ *{ h| *},.['',; mdioact.ivi ty.

.

and transportation.; 4. Biological effects 'of radiation. 8. Cencrat safety preca:stions.

. s. /.].. '-(, ... .e4-QC. Cauge Opomtton ; ; >,.;

.

:. 1. Instruncnt theorg . 4. Field application f.5.-,2. Operating procedures 5. Gauge calibration ,,Q,f(. ,}.

AQ. 3. Maintenanca. , C.i (3, .y. ', j,

d.'.h. C / / 5/18/87 W. F. Troxler01 & 34n i r 7/{J971'

' 'i

-

D. EI,'t

$'iq*J .L . msTp JCTOR

~ '~

DATE PREStDENT.-

M % 'll5 9'"'L..- . . - . . -.. . w . w .N9 19301 h

_w- . :. . . .z... m j: w ,.w. ...;- . .;. . . . & y '.

. .

w, Y|YjN.N* kh N.Nh. _,N.N.'' N .hg h.N' .;. .h h h' N.b ' .k 'N!N k.&ff i-

4 -

_. . . ee. w.. ; . p.a. .. . .

.. +

t

j,.. f-. y. . + - - .#4. .%. - ,w ~ . - . , ,

'

'-

. ..

,.Y*

,

s v:- "Reolaw' Testing Lacorateries.-Inc.'

f -J '

cJ Application for M a t e r i a .! LicenseAttachment-1

! TEM #

5. Radioactive Material

s. Element and mass numberCesium 137 and Americtu.m 241

b. Chemical and/or pnysical formSealed Source ,

c. Maximum amount which will_be possesed at any onetime

Cesium 137 - One source 8 mC1 (each >,

One source a0 mci teacn)Americium 241 -

,

4. Purposes for whlen licensed material will be usec

Measure moisture and_denisty of construction -

materials.:

'. Inciv$ duals responsible for_ radiation safety' programand their training and experience.

Immanuel G. BergeeTroxter Electrontes Laboratories. Inc. TrainingCourse for the use of Nuclear TestingEquipment. Certificate #19296

I' Alice A. Bergee.

7 Troxier Electronics Laboratories. Inc. TrainingCourse for the use of Nuclear TestingEquipment. Certificate #19301

.

9

e

.

9

.

9

e

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

-, . ..

*.

.1as-

Mod'iak' Testing L3toratories. Inc.y* -.

?' Application for-Material License' Attachment 11

ITEMn

i. Tryining for individuals working in-or f r equ e'r. t i n grestricted areas,

it is not the intentien of Ecdiak TestingLaboratories. Inc. to hire employees, either toecnauct-testing with the portable gauging devise, orhave access to r e s '. r i c t e d . a r e a s . h: wever. if in thefuture amployees are hired they will be required tot

1. Complete the training program of sne devicemanuracturer.

2. Read and understand Nuclear RegulatoryCommissien Regulations applicacle to portablegauging devices.

3. Commit to memory the safety and emergency-procedures as described in this applicationin section 10.

.

14. Facil,ities and equipment. -

Storage: When not in use the gauge will be-stered inthe transport case. in a locked esonet. in a lockedrcom with no outside access as per attached dra wir.gon Attachment !!!.

While in transit: The gauge will be transported tc thesite in the transport case, either-in the_ reat i of alocked station wagon or in-the bed of a pickup chainedto mounted-rails.

At the-job site: The device will be under theconstant surveillance and immediate control of one of-:ne 'icensees. It will never be left unattended.

.

9

.

.

.

t

, - e v

-.

..

..,

,

,. . .k 4

*

g/ F.tefan,Tos, ting Laccratories. Inc.,

7p' plica'. ion for Materials License'

/p'.

A t '. a : hm e n t IIE<,

~

KODIAK TESTING LABORATORIES. INC.P. 0. Box 1945

Mediak, AK 99615(?O7: 486-6506-

RADIATION SAFETY PROGRAM

A. SAFETY FROCEDURES

1. Do not operate or attempt to operate a gauge unless your.s v e been authorized to do so.

1. Do nct attempt to repair, modify or open the' sealed sourceun er any circumstances.

3. Wear a film badge at all times while operating orranrporting a gauge.

Fellcw operating procedures, when uaing the gauge, in.

se:Oroance with'the Troxler instruction manual, the radiationmontret regulations and this safety program.

: --

E. Keep unauthorized persons away from the gauge.

4. Do net leave the gauge unattended when in use or outside:f the storage enclosure or locked vehicle.

'. Meep the gauge in the " SAFE" or storage position when net:n use.

3. Se sure a. the gauge is. locked-w'Ithin.an authori:edr

ancl:sure (, g. closet, cabinet, vehicle, etc.) when it_is

| not in use. Security against theLtheft'of a radioisotopefisor utmest importance.and must not be neglected. The storageenclosure must'be labeled'with a radiation warning sign,

bearing the symbol as described in 10 CFR-20.003 and tnewcres " CAUTION RADIOACTIVE MATERIALS".-

3 Gaugas-may only'be transported 1by autheri:ed personnel _:narprovec v e h'i c l e s . The gauges may not be transported on1the:: :nt or rear seats o: any vehicle. If a pickup trucu is

~

usse the geuges must be locked in an enc!osure (e.g.-cabinet.inipping case, etc.> and the enclosure tiec securely (e.g.

,

chairec. bolted, etc.) to the-body of the truck in order te!

prevent loss or-theit.,

|

'? ate i or 3

.

9

o

V -

o

I- _ . _ _ - - _ _

-. , .

..

= . ' , [ 10. Ensure-that the gauge-l's' leak tested st the4I1nterva'Is*'

* ' ' ^ ,requiredfbv the' licensee's'hadioactive Materials'Licenre.,

i n e ' w ' ye saople will os collected by the Radiation Safety-. -

. Officer using a-Troxler model 3660 leak test kit. The leaktest-measurement on the wipe sample w'ill be performed by*

.

~

-Troxter Electronie Laboratories, Inc.'

P..O. Box 12057 ,s

Research Triangle Park, NC 27709'

11. When in douot, ask your Radiation Safety Officer.

E. EMERGENCY PROCEDURES-

1. Accidents'

a. In the event of possible damage to source orsource control mechanism, the operator will keepunauthorized persons at least fifteen feet from thegauge and prevent removal of guage from the siteuntil authorized by the Radiation Safety Officer orappropriate authority.

,

b. If there is any possibility the source capsulemight be ruptured, the location must be covered oy asheet of material (plastic, tarp, etc), held cown byweights (rocks, bags of material.-etc.) to preventscattering of radioactive material by the elements. . . ;

c '. The operator must then-immediately notify his/herRadiation Safety Officer of the incident and give anappraisal of the probable condition of the source.

c. The Radiation Sarety Officer will then immeciatelynotify the following authority who will provideinstructions and assistance in accordance with thecircumstances of the incident

Region V,-USNRCOffice of Inspection L Enforcement1990 N. California Blvd., Suite 202Walnut Creek, CA 94596(415)a86-3141 -daytime, nights le

holidays

2. Source stolen or lost.

a. The operator.must immediately notify local policeor other law enforcement agency.within whosejurisdiction the incident occurred.

b. The operator must also notify his/her RadiatienSafety:Orf.icer who will notify the authority listed

e in item'B-1-d above.

:sge 2 or 3,

<

O

. e

.

, , , ,- , m._ _.__ _m_ ___

*-.. *

'

,...f +''

1 ,C.. DUTIE5'0F THE RADIATION SAFETY 0FFICER-

1. Assure compliance with all pertinent parts of the Nuclear'

Regulatory" Commission's regulations. . ;-:

2. Assure compliance with the conditions in licensee's.Radioactrive Materials License ano- amendments and above itemsgiven in this safety program.

t''

2. !!a i n t a i n t he following items in a radiation file and. keepavailatle for inspection by controlling agency if-requested.

a. Current Radioactive Materials License.b. copies of license application, attachments<

and all pertinent correspondence referred toin the conditions of the license and amendments.

c. Gauge Source Certificates issued with the"

Eauges by the man;facturer.d. Film badge or TLD reports.e. Leak test reports. _

1r. Records concerning disposal, inventory anduseage or sources,

,

g. Copies of this safety program,h. A current copy of the controlling agency's

regulations.

.

'

s

.

Ezge 3 of 3.

4

9

*.

9

., .~

. - .- .- _ _ ____. -- _ - - - _ -

..

,

. -

.. ..>**

,,

sa * .

',

', , _

'..| +

'

.

4

.: ciak Tecting Laboratories. Inc.Apoliesti:n for Materials LicenseA . .s e ne.e n t 1V

-

item =

11. All waste materials will be returned to:

Troxler International, Ltd.P. O. Box 12057 -

Cornwallis Rd. at Alexander Dr.1

fer disposal. '

_

>u

4

9

.

e

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

3pgxxac .xx,nmzEr3rs:xxxaw.uua.xa.xx.1,xxmxxxa,axxx,x cr;xx.xax,( (t:c rp,m 274 1 3

.

a aal U.S. NUCLEA2 GEGULATO'.Y COMMIS$10N ##GE OP PAGES i.

.

.

MATERIALS LICENSE y

Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public 1.aw 93-438), and Title 10,

g Code of Federal Regulations, Chapter I, Parts 30,31,32. 33,34,35,40 and 70, and in reliance on statements and representations pq heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess, and transfer byproduct, p

i source, and special nuclear material designated below; to use such material for the purpose (s) and at the piace(s) designated below;to NI deliver or transfer such matenal to persons authorized to receive it in accordance with the regulations of the applicable Part(s). This kN !license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, as amended, and is

subject to all applicable rules, regulations and orders of the Nuclear Regulatory Commission now or hereafter in effect and to anya conditions specified below. '

ji '

i

ljcenseeg

1-4 Kodiak Testing Laboratories, Inc. 3. License number 50-23271-01

p|4 F

y< __._2. P.O. Box 1945 - 4 *- -

~,,.

| Kodiak, Alaska 99615 4. E,xpiration date October 31, 1992*

5 5. Docket or p'~

3 Reference No. 030-20439 p4 6. Byproduct, source, and/or$ special nuclear material

~

7. Chemical and/or physical -J. Maximum amount hat licensee fg,

f, form _ - may possess at any one time E-

s . 'under this license Il',

j g .' ' ['W'r.,, gv';-'

E-~

gQ A. Cesium 137 A. ' Sealed sources A. ^ Not to exceed g-

IE(TroxlerDwg.A-102112), * ;10 mil 11 curies p''-

9 :, ; \ p ; .; ..per source g'

[ :,

m, = . - , -,I- '

B. Sealed neutron s'ources ' B. Not to exceed EB. Americium 241150 millicuries h

.

(TroxlerDwg.A-102451) *#.

E-, .- i . . + . -

'

- ri;s " 4' % per source g

'

',.,;'--

j -7,

4 9. Authorized use ; -- g.s .._-: g 3 ; '- >... >

A. and B. For use in Troxler Model 3400 Series Moisture-Density gatlges to measure g|.

. .9 .

properties of construction materials,. * ' O', g..

p-s s

.- CONDITIONS N p

I 5'% \

10. Licensed material may be used at 1614 Mill BayTRoad, Kodiak, Alaska, and at W

p}jD- temporary job sites of the licensee anywhere in the United States where the

U. S. Nuclear Regulatory Commission maintains jurisdiction for regulating theuse of licensed material,

E11. Licensed material shall be used by, or under the supervision and in the physical F

presence of, Alice Bergee, Immanuel Bergee, or individuals who have successfully (completed the manufacturer's training program for gauge users and who have been Fj,

[q designated by the Radiation Protection Officer, Immanuel Bergee. The licensee ;

shall maintain records of individuals designated as users.

) 12. Sealed sources containing licensed material shall not be opened. ))- p

Ng

WtFN

xamazanxxxs:ssxmaxcan=razzsxzamma.x.amrammm# '

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

, h. 2.,bh4A. . . . . . 33_= = = = = = - --wmTwmwxrmammesswrm-rrr1Tzz2Ta-A m .m .,i 3C U.S. NUCLEAR REoVLATORY COMMISSION 3 Ie r- PAGE OF PAGES_i MI Licen,e numbt )*

.

i 50-23271-01 >

| MATERIALS LICENSE 8oockeior nererenc number .

I SUPPLEMENT ARY SHEET 030-20439 8

i Y

I >

| 8

i >

I >

N|| CONDITIONS

(continued)

| 13. A. The source (s) specified in Item (s) 7.A. and 7.B. shall be tested for fa leakage and/or contamination at intervals not to exceed 6 months. Any Li source received from another person which is not accompanied by a certificate Hq indicating that a test was performed within 6 months before the transfer h

|shall not be put into use until tested. [

| B. Any source in storage and not being used need not be tested. When the y

q source is removed from storage for use or transfer to another person, it >q shall be tested before use or transfer. >q >

*4 C. The test shall be capable of detecting the presence of 0.005 microcurie of| radioactive material on the test sample. If the test reveals the presence |

of 0.005 microcurie or more of removable contamination, the source shall be yg

q removed from service and decontaminated, repaired, or disposed of in (>4 accordance with Comission regulations. A report shall be filed within 5 J

4 days of the date the leak test result is known with the U. S. Nuclear >

4 Regulatory Comission, Region V; Nuclear Materials Safety and Safeguards

{ Branch; 1450 Maria Lane, Suite 210; Walnut Creek, California 94596. Theg report shall specify the source involved, the test results, and correctiveq action taken. Records of leak test results shall be kept in units of

4 microcuries and shall be maintained for inspection by the Comission.4 Records may be disposed of following Comission inspection.

D. The licensee is authorized to collect leak test samples for analysis by p4q Troxler Electronics, Inc or tests for leakage and/or contamination shall h' iq be performed by persons specifically licensed by the Comissior or an #q, Agreement State to perform such services. N

h$(14.The licensee shall conduct a physical inventory every six (6) months to account p

for all sources and/or devices received and possessed under the license, p4g Records of the inventories shall be maintained for two (2) years from the date >iq of each inventory.4

|415. The licensee may transport licensed material in accordance with the provisions

of 10 CFR Part 71, " Packaging _ and Transportation of Radioactive Material".d

(h h,q

4 EIq b6- F

'I k4 >;-

g>>

Ii e

P)i

>

s.iMsOCKEMtasT&TJarsLTdM&XMi& TAT &TEETA'ECTE&T&*MPMJEN>,.

. pM. mi - . 4_ TasmTr:LTzTltsgjrxTTz"zTrzsTxqi

i wac re.m mA U.S. NUCLEAR REGULATORY COMMISSION 3 3 hPAGE OF PAG {l ,

| 45483 License number R.

i 50-23271-01 N

. I MATERIALS LICENSE ppg , , ,, g , ,,,, , ,,,

i SUPPLEMENTARY SHEET 030-20439 ki >

| P

| P

| >~

h>|II CONDITIONS| >

,

| (continued)ti 16. Except as specifically provided otherwise in this license, the licensee shallI conduct its program in acccrdance with the statements, representations, and4 procedures contained in the documents including any enclosures, listed below.8 The Nuclear Regulatory Comission's regulations shall govern unless the| statements, representations and procedures in the licensee's application and

correspondence are more restrictive than the regulations.y

4i A. Application dated August 17, 1987

|j B. Letter dated September 21, 1987q

<H44

4

4

ii F'

I'l

:d

i hi'l4

d| ->>

4 @K F

i >!d FOR THE U.S. NUCLEAR REGULATORY COMMISSION F

Date By $7?f77.[$///|mNr,w hY

h Beth A. Riedlinger/9 Health Physicist [ Licensing) p)p

4 Nuclear Materials Safety Section

| Region V

<44 F'4 WW >'9

'

44.4

4

N'4

4L I,samzazwsmtzmicumenazarxar.wasazzarmammsrazzzzw.h:

.

;$ h' % p? %Y Qff khf |.h %YW... % ..' ,+ # * W'let '.dN (l'.%, . './.. ., .W...% ? ' /. . . .W. l(s '' ' , $ Wf%, '.%. .. ' #.# , ' N|Wftei,,'' /_ ,$Uq,[ > ,+$}*

.,

.

. _ . . , , . . . . . . _...n ,, ..

..>4._ .. .,. , . . , , , , _ , . , , . , ,

@*'~ j''*rijj,,jj

0 gaECnON C ASORATogigg',c

;F $ 4[g*#j HEREBY CERTIFIES THAT *

gi ;(\ **4pp%%.i |,MARK BLAKESLEE

r ipif(frei,|*N *' Ip ty,

n/g:::p+#.: . -

KODIAK TEST LAB .m*%,},

HAS SUCCESSFULLY COMPLETED THE TROXLER ELECTRONIC LABORATORIES, INC. [k ~TRAINING COURSE FOR TIIE USE OF NUCLEAR TESTING EQUIPMENT.

[l//far,.k;l I[t#.=

!#SUBJECTS INCLUDED IN Tills COURSE WERE AS FOLLOWS: r j, /p.-

hh*. Radiological Safety_. ,q'

%Q(fQ1. Principles and practices of radiation 5. Radioactivity measurement standardizationg

and monitoring techniques and=

((flei,. - 3. Ics a'n'd b c c'f p nucle,$.yc_ fp

C=='~; and%Ea ff. ProcTdurgs ar gaug rageyb . . .:;.9

|f[s, tavsty.d 8 '

h"Q'In ans tio . 9, _%opl sa p, fnons.

. y py4. 3l cal e[[e is t ,

l b'g Ga e.Q)) erg.(i.o., ,__ =

' . . 6'T !*,

, Sy, atsoy h|(fr(p, 1. men>

y pqi I :::= - 2. Operating procedures Oauge ca ration.- .y m

$us."'"r"#"C#I

he%##! CERTIFICATE 0: 054105:

:- - CHRIS MORIE 6/24/92 WILLIAM F. T ROXL ER -=

5 INSTRUCTOR DATE PRESIDENT fb'.*'N .~ . ,, ..c .... n,, ...

\

.-. . . . . , , . . . ~ . -- -

'A.

L. ,-

,,,,i.

m" "#bD # m'.. ...,,. ~'.. , .. .. ,,,,, _.. .-

,,,,, cr.c)'#'oD U@*J_ _L\ Uh '$W* "ob Y i .~"*b

; .% af '#bo)|@*A_ )) W' '

' ('##

%#9*A'~# A,4)@*z_a__

# h * #~~ %#.

:.

-

. ..

. .

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

|' KpntAK TESTING LABORATORIES INC. ^ '

P. o. 00X 1945 466-t506 M2'2h- ggfd, KODIAK, AK 936161

,

'

-ro.m,,n y,,,f,n /~J . 0>~nA'~3 S Wgm .

-

v, j#[a-

. . _ . . .

7 o "^"S'

First National Bank| of Anchorage'

. y-- CElVEDM -

-g-~~

D' -

..j, ,

k 2 5 2000 E,0i: 08 { 705 gO__

_

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

08/24/1992 j#e ...=== =======fy / p AH07256-92

ygrfKODIAK TESTING LABORATORIES, INC. "

| ATTENTION: RADIATION SAFETY OFFICERl P.O. BOX 1945 ''

' KODIAK AK 99615

***** Mark THIS COPY with any billing address changes *****

License / Approval /Registration / Code Annual Fee Surcha ge

Certificate Number AA905 Category (s) Fee Amount Amount)================== ===== =========== =============== ==============

50-23271-01 ANN 3P $ 2,100.00 $ 150.00--------------- --------__---_

TOTAL: $ 2,100.00 $ 150.00

TOTAL INVOICE: $ 2,250.00Make Checks Payable To:=======================

jU.S. Nuclear Regulatory Commission <=== 1 Sis PO Box address isLicense Fee & Debt Collection Branch <=== ior receipt of paymentsPO Box 954514 < = = = o .1 1 y .St. Louis, MD 63195-4514

'

l:

Terms and conditions are attached. Nonpayment of your annual fee 1j1: a y result in the revocation of your license (s)Jin acyrdance with

the enforcement provisions of 10 CFR 171.23 of tT e Commission's1egulations.

E;;j 4c3 - n1? D-

i- .T w ,y*vn*****nw***************gW***** a

b [*'

'* PA YMEN T C0PY 3,~

* cp

WNNNN*MNN**NNNNNyNN*WMwwynyywyyy

===> To ensure accurate credit, return this copy of the <===|

,

invoice with your payment. Processing may be <=== |

===>===> delayed if the invoice is not included. <=== j.

;

|

;

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