07-09-09;11:04AM; # 1/ 17

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ACURENMaterials Englneering & T-sting

7515 Company Dr. Ste.BIndianapolis, IN 46237

Phone: (317) 890-9729Fax: (317) 890-8577WWW.ACUREN.COM

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itConfidentiality Notice: This message, Including any attachments, is for the sole use of the intended recipient(s) and may contain

confidential and privileged information. Any unauthorized review, use, disclosure or distribution Is prohibited. if you are not theintended recipient, please contact the sender by faxtemall and destroy all copies of the original message.

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07-09-09;11:04AM; # 2/ 17

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AC.. REN Date: 7/9/2009

U.S. NRC HeadquartersRockville MarylandAttention: Operations OfficerSubject: 10 CFR Part 34,101 Notifications

Event # 45132 30 Day Written Report

This notification is to comply with the requirements per the above regulation in Subpart F(a) (2), "inability to retract the source assembly to its fully shielded position and secure itin this position."

Event # 45132

Description:Extension tube crimped while source was exposed.

Cause of Incident;Magnetic tank stand fell offside of tank after the source was.fully extended and with thesevere angle at which it was hanging from the camera it could not be retracted.

Equipment Information:Camera Amersham Model # 660B (S/N B4252)Source - QSA Model 424-9 Ir-1 92 65,2 Curies (S/N 54482B)Guide Tube - QSA 7' Model # TAN48906 (S/N B4227)

s:, •Extension Tube - QSA 7' Model # TAN48907 (S/N B4227)Controls - QSA 25' Model # TAN66425 (S/N B4227)Survey Meters - NDS Products Model # ND2000 S/N's 39206 and 24673

Place, Date and Time:Cargill Plant - 173 West 1100 North Linden, Indiana 4795506/13/2009 at 9:10 am.

Actions Taken to Establish Normal Operations:Per condition 14 of our license we conducted a source retrieval to secure the source. Theretrieval technician Joe Lassuy received a whole body dose of 148 mrem as recorded on aspare film badge that was worn solely for the source retrieval. (Landauer Report-Attached)

Corrective Actions Taken or Planned to Prevent Recurrence:1.) Evaluate the proper positioning techniques of magnetic tank stands with employeesinvolved with incident, Completed2.) Communicate / train all radiographers in the proper maintenance and use of magnetictank stands. Completed

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3.) Review with all radiographers proper positioning techniques, tools and safety itemsv,, available for use of and with magnetic tank stands, Completed

4.) Ensure this incident is included in Annual Radiation Safety Refresher training lessonplan for 2009-2010.

Oualifications of Personnel Involved in the Incident: (Attachment A)

Cheryl Faith, Clinton Leisure, Joseph Lassuy

* IEMA Carded Radiographer* 40 Hour Radiation Safety Class* Most Recent Radiographer Performance Audit* Radiographer Approval Checklist

The retrieval went well and in accordance with Acurens written procedures. Notechnicians received any reportable exposure and no members of the general publicreceived any exposure or were in danger of receiving any exposure. Please feel free tocontact me with any questions, concerns or comments.

Respectfblly,

Joseph A. LassuyFRSOAcuren Inspection Inc.,Office (317) 890-9729Mobile (317) 281-6065jlassuy~acuren.cor

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07-09-09; 11:04AM; #4/ IT7/

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if IEMA Division of Nuclear Safety

A#4wiW Ve~uw(Wz11 fl4OectorO Industrial Radiographer Certification Card

Nam• Cheryl Faith

Cateqory:Caerltied - Radioactive Materials & X-RWuy

C2)%t2Jk Expires 2/28/2013pot; Guarantead; 1035 Outer Park flijc, S•pI.nqeld, ]llinoi 67714

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LO. 41USINSPECTION

SERVICESNDE & METALLURGICAL SERVICES

Certificate of TrainingThis is to certify that US Inspection Services Hereby Recognizes That

Has successfiully completed the educational curtciciln has maintained the requited attendance and hasdemonstrated proficiency by a satisfactory completion of a general examination and is therefore issued this

certificate attesting to 40 hours of formal training on topics required by 10 CFR 34.43 on the subject of:

Radiation Safety:Radiation - It's Origin, Measurement, Effects and the Control of Dose

Awarded on this 1OW day of September, 2004

Final Score: 94

Instructor Radiation Safety Officer

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I Radiographer Performance Audit Form'

Client/ Location ,e :5s

Radiographer#1 CdE*ýMU rcOýtrMRadlographer 02 PcLŽ,( INgt&Lr

.Date: & 110

Ba dgea iYL,

Badge 11I3S3

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Radogrepherl#3 Badge _ -

m1 Dsmeter er.No. 1 6SI D,4 DuDate3/ /o Rarn set, No, 5 0 4 DueDate -1•509

* flzosIrnota~r~eo. i744516 Due Date C5 Rom~er.No. 4"Z70 -* DueDate____

#3 Do5imeter Ser.No, 1 Due Date ___ _ Prn 3cr, No. Duo Date

* 15 8rr19 r Aciviy(Gq'sL j~~erll # W ~3iDevice Model #_?22_bevkAe Serial ftJ Ns s9SSurvey Meter Model U.DZ O2 c Serial No.2 qL 7 I Calibration Due Date: ZN1

I.'Werc Individuals working withln the restricted area wesring badges,doslmeters,and rate alarm meters?2, Was the restricted area posted with "%autio (or danger) radiation wee signs?3. Was the restrIcted area proparly controlled to prevent uinauthortzed entry?4. Was the High radiation' area posted with "Caution (or Danger) High Radiation Area" signs? i:5, Did the r-ologruphey crew have a ca~lbrated and properly operating survey meter available? V:6. W as the utilization properly filled out?7. Did the radlographer and radllographin- assistant hame sufficient knowledge of s~afty rules-?(Ascertained by oral questions)8. Was the radiographey crew working with properly Inspected and operable equipment? . -S. Did the radiographerlasslstant perform the correct survey of the exposure deviMce afterdompletion,of the *osure?I¶O W as the eposure device locked and secured during transport and T.I. Indca properly posted? -

11. Was the source storage area'posted with "Caution (or Danger ) Radlowctjve Material "signs?12, Did the crew posses and uae a copy of Acuren Inspectlo's Operating & Emergency prQcedure•.stata or NRC rules and regulations, a copy of the license, DOT. Manual, current All D.O.T. Hazrnat card.& NRC Form 3 or equivalent? V13. Were iny other safety Items found to be lackdng? If yes, expIain In remarks.

Remarks:M ~ ,

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Date:

Date:

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07-09-09;11:04AM; # 7/ 17

ACUREN.

RADIOGRAPRER APýPROVAL REQUET-mai ýo a oYt~h~i~m,,Rda~

Cormr•ict aul sections of this form ande-mail or fax a copy to th Corporate Radiation.Safety Ofe. forbhis'sigatmte. You must Mainain a COpy of this aRpprOval form an fifor review.

1. Personal Data

DOB: ,LD#

Stt,1Iiti.n• flaminatonrsoni"nn Thformadon:

*.. Demonstrated Compyenqe usng X-Ray/Radioactive Materials by Practicalit.: Examination on 12-11/Ot. "04

Completed•40 hour Radiation Safety Training on 0/2L0Q/0.

Approved Trairing provided by US-.Inaection Servi"es

OJT Trainng Confimed -..Ym No

lIt. ladiographer Certification Card issued by:._ .D.klinois.

ExpwrataonDate:. CudNumber

IV. A en Inspection Office location; .. iWnnpoli ,

V. Corporate ESO ApprovalThe individual named above bas beea approved as a Radiographer.

Date

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07-09-09;11:04AM;IJEMAIllinois Emergency Management Agency

Division of Nuclear Safety

# 9/ 17

Rod R. Blagojevich, GovernorAndrew Velasquez Ill, Director

Joseph G. Klinger, Assistant Director

December 19, 2008

>&

Clinton Leisure

Certification: 700500801

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On December 17, 2008, you were examined in Industrial Radiography in the category ofRADIOACTIVE MATERIALS. I am pleased to inform you that you have passed the examinationwith a score of 79.

[rtnclosed is an application for certification in Industrial Radiography. Please completethe application and return it with the $100.00 application fee.

As part of the certification process you will need to attest that you have completed theminimum experience appropriate to the category of Industrial Radiography for whichyou are applying. (200 hours - Radioactive Materials, 120 hours - X-Ray Machines,or 320 hours for both.)

Your pending application for certification has been processed and your certificationcard is enclosed. The card must be on your person, or immediately accessible, at alltimes when you are performing industrial radiography.

Your pending application for certification as a trainee has been processed and yourcertification card is enclosed. The card must be on your person, or immediatelyaccessible, at all times when you are being trained to perform industrial radiographyand radiation is being used. Such training must be conducted by, and under thedirect supervision of, a certified industrial radiographer.

Your pending certification will be issued upon receipt of the $100 certification fee.

Should you have any questions, please contact Linda Jenkins at (217) 785-9913.

Enclosure

103I Outer Park Drive * Springfield, Illinois * 62704-4462 * Telephone (217) 785-9900 , http;//www.iemaillinois.gov

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# 10/ 1707-09-09;11:04AM;

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r Clionton Lelijurehas met the necessary quatllctions tor Radiation SafetyCertlfltalion in the method shown an the reverse side ofthis card, This certification Is In accordanCe with the trainingand certification procodures set forth by MOS Inspection,Inc.

tRadiatiwi Safely 0 1, *A

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07-09-09;11:04AM; For )W190

I Radiographer Performance Audit Form -.C~etfl Locztion

R~iographer #1

'5MP'Lj1V&- /Sol9~?&~ZTr W~bPUrA~/

Date: _______•

Badge

Radlograahar#/2 O'L/IAJFoAJ i&OgiUR

Radlographer #3 IV / I7 Badge_ _____#DoimeerSer.No. -/ Du- Date 10-4. Ram Ser, No._ _ DueDate

#2tDosimeter Ser.No. I $' -~Ductate I -(.7Oý2Rarner.No. 3_7Ur5t Du.Daie, 10~-~-

#3 Dosimeter Ser.No, "" 1/.l." Due Date Ram Ser. No. Due Date

Isotope :rkq&ActMty(G~q'r-) _j,ý _9 > Seia /3~c Mode 175,Suroy Meter Model S$erial No,~ Callbration Due OetY CNr

1.'Were individuals working within the restricted arre woarin badgesr,dos•meters,an-d rate alarm materf? •

2. Was the rositiied area posted with caulin (or danger) radistion aroa eigns?

3. Was the restricted area properly controlled to prevent unauthorized entry?

4. Was t5 High radlatior area posted with "Caution (or Danger) High Radiation AreW signu? J _. -

5. Did lie radlographey crew have a calibrated and properly operating survey meter awaielale? -

s. Was the utilizatiom properly filled cut97. Did the radiographer and radlogrephbr aesiatant hae suffIcient knoq edgo of Uaety.rules?

(Ascertained by oral 4ueations)5, Was the radlographoy crew working with prope ry inpxected and operable equipment?9. Did the radiographerlasulutant perform the crrfot survey of the qxosuro devce afterdompletlonof tho aiposure?10% Was the exposure d&Ace locked and secured during transport pnd TI, Index properly posted? -

11, was the source storage area posted with *Caution (or Danger) Radioacttge Material "slgns? _)_O.12. Did tha crew posses and use a copy of Acuren lnspedion's Operating & Emergency proceduros.state or NRC rules and regulations, a copy of the license, D.O.T. Manual, current All D.O.T. Ha=nit card.& NRC Form 3 or equivalent?13. Were any other wifety lRama found to be laoking? If yes, explain In rernas. 2

Remarks: t)tL I Z?_irt 0 / TO "" 0) F1z ~ . ~

-Ao--f j:,•-_/•'a.mb-,D~ ,g f (EQ ,,IK Q_

-AuditConducted By -. 4 ate: 5 -(0-0

Radiographer Slgnatufew. 2~ Date _______

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07-09-09;11:04AM; # 12/ 17

ACUREN.

RADIOGII•APER, APPROV,AL. EQUST

Complete all.sections.;of this bform and e-rnml or fax a copy to.the Corýo•te RadiatonSafty Oficer for h is.signartre. You must maintain a copy of this approval form on filefor review.

I. L Peonal DataNaine;4 L(Kie.& (.c,,w

II. Qualification InformationCo erAuen nsp io Radiation Safety Examination on

DemonstraiedComreteqce using X-Ray/Radioactive Materials by Practical

Examination on ( Z, o

Completed 40 houw Radiation Safety Training on L 4 .Approved Trainingptovidcdby tznQS .G~VP

off Training ConfirmedYes No

M. Radiographer Certification Crd. issued by-: . OF, Z ..

Expiration Dati Card Numbet:,.

IV. Acurm Inspection Office location:, •flLb S : :%4.

V. Corporate RSO ApprovalThe individual named above has been approved as a Radiographer.

07-09-09;11:04AM; # 13/ 17

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IEMA DiVIion of Na uclar SafetyWMA"t C~ RJ -l~r', rmh4-tor

IndusDIaI Radiagrapher CertificaUon CardF' ame Joseph Lassuy

-o¶tIf'C3r:*m

• .:a tegoryv

Cetified - Radioactive MaterialB

.,tI. 10/31/2010Pcz;Wgc Guamnt 4; 1035 Outer Park Onv, w Id, Im 6270C. d%, • -l.' > 41n c,)r , &'',t:,l rGn -

U INSPECTIONA ERVICES

Shice 1938

Certificate of Training.This is to certify that

Joseph A. LassuyHas completed the published educational requirements of I OCFR Part 34, Paragraph 34.43 and

applicable State training requirements for

Radiation Safety (40 hours)Awarded on this I3U' day of July, 2000

.u ._ .'. .......... Final Grade: 96%I Instructor

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LANACO &ASSOCIATECertificate of Training

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Presented To:.

Joseph A.. Lassuy|

Attending The Seminar For-1

I, , Radiation Safety Officer

lFebruary. 27, 2008

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LAMQ & ASSOCIjCioAMcoCertficat o[Taining \,TEPresented To: lj

Joseph A. Lassuys

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Attending The SeminarFor. Source RetrievaljiTraining

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1F'FebruJay 29, 2008~2I.

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07-09-09;11:04AM; # 17/ 17

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ACURENForm RSW 138-08

RADIOGRAPHER APPROVAL REQUEST

Complete all sections of this form and e-mail or fax a copy to the Corporate RadiationSafety Officer for his signature. You must maintain a copy of this approval form on filefor review.

I. Personal DataName: LAS55U W-,

L..t First Middle

DOB:• DoCpany I.D#:

II. Qualification InformationCompleted Acuren Inspection Radiation Safety Examination on

o _ /,s/As Score: 9h$%(MMIDD/YY)

Demonstrated Competence using X-Ray/Radioactive Materials by PracticalExamination on 8/fZ/o .

(MM/borY)

Completed 40 hour Radiation Safety Training on.OZ7/z 46 .(MM/DD/YY)

Approved Training provided by us rss-'c n-

OJT Training Confirmed V"Yes No

Mll. Radiographer Certification Card issued by: Zx .n•rt•'

Expiration Date: I /c0ot o Card Numbere.r _

IV. Acuren Inspection Office location: Zx'A, WA4ýA r,.City State

V. Corporate RSO ApprovalThe individual named above has been,*roved as a Radiographer.

Date .Radiftin Safety Dircetor