NRC FORM 313 :10-2005) IO CFR 30, 32.33, M,35,36,39, and 40

U.S. NUCLEAR REGULATORY COMMISSION

. THIS IS AN APPLICATION FOR (Check 8pprOpriefe ifem)

A. NEW LICENSE

APPLICATION FOR MATERIAL LICENSE

2. NAME AND MAILING ADDRESS OF APPLICANT (Include ZIP code)

,&e%m?s &,-?.owl /'&es _ .

APPROVED BY OMB: NO. 3150-0120 EXPIRES: 10/31/2( Estimated burden per response to comply with this mandatory collection request: hours. Submittal of the a plication is necessary to determine that the applican ga l i f ied and that ad u a L procedures exist to protect the public health and safe

end comments r ag ing burden estimate to the Records and FOlAlF'rivacy Servic Branch (T-5 F53),?.S. Nudear Regulatory Commission, Washington, DC 2055500 or by internet e-mail to infocollects nrc ov, and to the Desk Officer, Office Information and Regulatory Affairs, NE%B-1%02, (3150-0120), Office of Managem and Budget, Washington, DC 20503. I f a means used to impose a n informati collection does not display a currenUy valid OMB control number, the NRC may I conduct or sponsor, and a person IS not required to respond to, the informati collection.

. RADIOACTIVE MATERM a. Element and mass number: b. chemical andlor physical form; and c. malxlmum amount

which will be possessed at any one time.

INSTRUCTIONS: SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLlCATlOh SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW. 4PPLICATION FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH:

6. PURPOSE(S) FOR WHICH LICENSED MATERIAL WiLL BE USED.

DIVISION OF INDUSTRIAL AND MEDICAL NUCLEAR SAFETY OFFICE OF NUCLEAR MATERIALS SAFETY AND SAFEGUARDS U.S. NUCLEAR REGULATORY COMMISSION WASHINGTON, DC 20555-0001

4LL OTHER PERSONS FILE APPLICATDNS AS FOLLOWS:

F YOU ARE LOCATED IN: br, 3 UABAMA, CONNECTICUT, DELAWARE, DISTRICT OF COLUMBIA, FLORIDA, GEORGIA (ENNCKY, MAINE, MARYLAND, MASSACHUSETTS, MISSISSIPPI, NEW HAMPSHIRE, N M IERSEY, NEW YORK, NORTH CAROLINA PENNSYLVANIA, PUERTO RICO, RHODE SLAND, SOUTH CAROLINA, TENNESSEE, VERMONT, VIRGINIA, VIRGIN ISLANDS. OR NEST VIRQINIA, SEND APPLlCATlONS TO:

. FACILITIES AND EQUIPMENT.

1. WASTE MANAGEMENT.

LICENSING ASSISTANCE TEAM DIVISION OF NUCLEAR MATERIALS SAFETY U.S. NUCLEAR REGULATORY COMMISSION, REGION I 475 ALLENDALE ROAD KING OF PRUSSIA. PA 19406-1415

10. RADtAllON SAFETY PROGRAM.

12. LICENSE FEES (See 10 CFR 77Oand Section 170.31) AMOUNT I ENCLOSED ' FEE CATEGORY

IF YOU ARE LOCATED IN

Ib \PPROVED BY

ILLINOIS, INDIANA, IOWA MICHIGAN, MINNESOTA. MISSOURI. OHIO, OR WISCONSIN, SEI APPLICATIONS T O

DATE

MATERIALS LICENSING BRANCH U.S. NUCLEAR REGULATORY COMMISSION, REGION 2443 WARRENVILLE ROAD, SUITE 210 LISLE. IL 605324352 030 313m

ALASKA, ARIZONA. ARKANSAS. CALIFORNIA, COLORADO, HAWAII, IDAHO, KANSAS, LOUISIANA, MONTANA, NEBRASKA, NEVADA NEW MEXICO. NORTH DAKOTA, OKLAHOW OREGON, PACIFIC TRUSTTERRITORIES, SOUTH DAKOTA. TEXAS, UTAH, WASHINGTON, OR WYOMING, SEND APPLICATIONS T O

NUCLEAR MATERIALS LICENSING BRANCH ~1lo-3rao9-d U.S. NUCLEAR REGULATORY COMMISSION, REGION IV 611 RYAN PLAZADRIVE. SUITE 400 ARLINGTON, TX 7601 14005

'ERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED AATERIAL IN STATES SUBJECT TO U.S.NUCLEAR REGULATORY COMMISSION JURISDICTIONS.

- 0 8. AMENDMENT TO LICENSE NUMBER

0 c. RENEWAL OF LICENSE NUMBER

. ADDRESS WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED

N

E3 4

/q(y/Q/?/WiVs WLLE, / .x +92.4/ 4. NAME OF PERSON TO BE CONTACTED ABOUT THIS APPLICATION - 2

;UBMIT I E M S 5 THROUGH 11 ON 8-112 X 11. PAPER. M E TYPE AND SCOPE OF INFORMATION TO BE PROVlDED IS DESCRIBED IN THE LICENSE APPLICAllON GUIDE.

18. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS. . INDIVIDUAL(S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR TRAINING EXPERIENCE.

WARNING: 18 U.S.C. SECTION 1001 ACT OF JUNE 25 1948 62 STAT. 749 MAKES ITA C RlMlNAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STiTES AS TO ANY MATTERWlTHlN ITS JURISDICTION.

:ERTIFYING OFFICER -- TYPEDlPRlNTED N+ME AND TITLE SIGNATU$

YPE OF FEE I FEE LOG I FEE CATEGORY 1 AMOUNT RECENEI

PRINTED ON RECYCLED PAPI NRC FORM 313 (10-2005)

Appendix B

Suggested Format for Providing Information Requested in Items 5

through I 1

APPENDIX B

ITEMS 5 AND 6: MATERIALS TO BE POSSESSED AND PROPOSED USES

Yes No Radioisotope IE Manufacturer or

Sealed source manufacturer or distributor and model number: 7M*)l8K - 343@

Device manufacturer or distributor and model number: 7k!U%LEk! -3430

B-1

Not to exceed either the maximum activity per source or maximum activity per device as specified in Sealed Source and Device Registration Certificate

Yes 0

Specific description of the gauge use: r/Af?/ad5

Of&%?CUMd

$/ r n

d N o t applicable

0 Uses are:

(Submit safety analysis supporting safe usel

NUREG - 1556, Vol. 1, Rev, 1

APPENDIX B

ITEMS 5 AND 6: MATERIALS TO BE POSSESSED AND PROPOSED USES

I cesium-137

Manufacturer or Distributor Model No.

Sealed source manufacturer or distributor and model number: 2 d a - &&,& Device manufacturer or distributor and model number:

Sealed source manufacturer Dr distributor and model

Device manufacturer or 3istributor and model aumber:

B-1

Not to exceed either the maximum activity per source or maximum activity per device as specified in Sealed Source and Device Registration Certificate

Yes 0

Specific description of the gauge use: Z / ~ ~ / O ~ . / s

is / 7%

d o t applicable

0 Uses are:

(Submit safety analysis supporting safe use)

NUREG - 1556, Vol. 1, Rev. 1

APPENDIX B

ITEMS 5 AND 6: MATERIALS TO BE POSSESSED AND PROPOSED USES

Yes No Radioisotope

1_1 Manufacturer or

Distributor Model NO.

Sealed source manufacturer or distributor and model number: &%LEE - 3450 Device manufacfurer or distributor and model number: %oxr!-L5z -3450

Sealed source manufacturer or distributor and model number:

Device manufacturer or distributor and model number: ~ K O ~ L L ~ ; B - JgTO

JrWAL 4%. 3//

Not to exceed either the maximum activity per source or maximum activity per device as specified in Sealed Source and Device Registration Certificate

on SSD Uses Not

Certificate

Yes 11 Specific description of the gauge use:

I

0 Not applicable

0 Uses are:

(,Submit safety analysis supporting safe

B-1 NUREG - 1556, Vol. 1, Rev. 1

APPENDIX B

Item No. And Title Suggested Response Yes Alternative Procedures Attached

INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS

B-3 NUREG - 1556, Vol. 1, Rev. 1

users will have successfully completed one of the training course described in Criteria in the section entitled “Training for Individuals Working In or Frequenting Restricted Areas’’ inNUREG-1556, Vol. 1, Rev 1, dated

PROGRAM - SURVEY INSTRUMENTS

to and use, a radiation survey meter that meets the Criteria in the section entitled “Radiation Safety Program - Instruments” in NUREG-1 556, Vol. 1, Rev. 1, dated November 2001.

APPENDM B

Item No. And Title

10. RADIATION SAFETY PROGRAM - WIATEIUAL RECEIPT AND ACCOUNTABILITY

10. RADIATION SAFETY

OCCUPATIONAL DOSIMETRY

PROGRAM -

10. RADIATION SAFETY PROGRAM - PUBCIC DOSE

10. RADIATION SAFETY

OPERATING AND EMERGENCY PROCEDURES

PROGRAM -

10. RADIATION SAFETY PROGRAM - LEAK TEST

Suggested Response

Either we will maintain, for inspection by NRC, documentation demonstrating that unmonitored individuals are not likely to receive a radiation dose in excess of 10 percent of the allowable limits in 10 CFR Part 20, or we will provide dosimetry processed and evaluated by an NVLAP-approved processor that is exchanged at a frequency recommended by the processor.

We will implement and maintain the operating and emergency procedures in Appendix H of NUREG-1556, Vol. I , Rev. I , dated November 200 1, and provide copies of these procedures to all gauge users and at each job site.

OR

Operating and emergency procedures will be developed, implemented, and maintained and will meet the criteria in the section entitled “Radiation Safety Program - Operating and Emergency Procedures” mwUREG-1556, Vol. 1, Rev. 1, dated November 200 1.

Yes

0

Alternative Procedures Attached

0

NUREG - 1556, Vol. 1, Rev. 1 B 4

APPENDIX B

Item No. And Title Suggested Response Alternative

Need Not Be Submitted PROGRAM -

TRANSPORTATION , this issue will be reviewed

B-5 NUREG - 1556, Vol. 1, Rev. 1

This is to acknowledge the receipt of your letter/application dated

I I I 2? I ado b , and to inform you that the initial processing which includes an administrative review has been performed.

technical reviewer. Please note that the technica.lreview may identify additional omissions or require additional information.

Please provide to this office within 30 days of your receipt of this card

A copy of your action has been forwarded to our License Fee & Accounts Receivable Branch, who will contact you separately if there is a fee issue involved.

Your action has been assigned Mail Control Number 139 rqo . When calling to inquire about this action, please refer to this control number. You may call us on (61 0) 337-5398, or 337-5260.

NRC FORM 532 (RI)

(6-96)

Sincerely, Licensing Assistance Team Leader

I

3ETWEZN :

(?GX L?VS ZSE) ISA?OXYA?'ION %ON LTS . . . . . . . . . . . . . . . . . . . .

: Program Code: 03121 : Status Code: 3 : Fee Category: : Exp. Date: 0 : Fee Comments: : Decon Fin Assur Reqd: - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

License Fee Nanagement Branch, ARM

Regional Licensing Seccions and

LICENSE FEE TRANSMITTAL

A. REGION A 1. APPLICATION ATTACHED

- Applicant/Licensee: ROGERS GROUP, INC. Received Date: 20061211 Docket No: 3037380 Control No. : 139840

Action Type: New Licensee License No.: \L43OU~-6!

2. FEE ATTACHED Amount: Check No. :

3 . COMMENTS

B. LICENSE FEk MANAGEMENT BFANCH (Check when milestone 03 IS entered /-/)

1. Fee Category and Mount:

2 . Correct Fee Paid. Application nay be processed for: Amendment Renewal License

3. OTHER

Signed . -~

__ Date