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DOE/NRC FORM 7.ll(10-2014) Previous sditions are obsoleteMANDATORY DATA COLLECTIONAUTHORIZED BY 1O CFR 30,40, 50,70,72,74,75, 150Public Lffi 83-703, 93-438, 9t91
U, S, DEPARTMENT OF ENERGYAND
U, S. NUCLEAR REGULATORY COMMISSION
NUCLEAR MATERIAL TRANSACTION REPORT
APPROVEDBYOMB: NO.3150-0003 EXPIRES: 10131t2017
Estimaled budsn per rosponse to comply wilh lhis mandaiory collootion roquo6t: t hour and 15 minulos, This informalion is roquired ,or lAElaccounling reports lhal 6how changes in invenlory of nucl€ar malorials. S€nd comments regarding butdon gslimale lo lho FOIA, Privacy anclnlolmalion Colloctions Branch (T-5 F53), U.S. Nuclear Regulalory Commis6ion, Washinglon, DC 20555-0001, or by inl€rnot e{ail klnbmllmto.Rwuro@nrc{ov, md to lhe Dsk Offs, Off@ of lnbmatio md Regulatsy Afiairs, NE0S10202, (3150{003), OffE oMms.m.nl tnd R'dGt WzdihdtM m rnqnl I
' h6a.,'.d t^ ih^m6 a i^Idm.l;n dH; /&. -^t ri.^l-, - ^.-,-^{- --li"
OMB @nlrol numbor, tlE NRC may not @nducl or sponsr, and a ptrson is rct required to respond lo, lh6 inbrmalion ooleolion,
SHIPP€i'SR6 2,NECEIVER'SRI6 3,TRANSACTIONNO, 4,COiRECTPNNO, S,PROCESSINGCOOE 6, ACTION CODE I 7. O@UM EiTATtOtr (On' ir documnt i. .hdn.d 6Ec R ET)
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srtopcn M b. RTCEMER i "^oa oF eAGEa con oF coDrEs 6ERIEg
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NAMEAND ADDNESS b, LICENAEOF REC€NER NO, 10. NooFo^ra uNEs2 1 1, NATURE OF TRANEACTbN DIATRIBUTION OFCOPIES
Cabrera Services Inc,50 Founders Plaza ste 207
East Hartford Ct 06 I 08
' ^TrENrroN' Mike Plonskid.rErEFHoN€: (860) 794-6915
brera Services Inc.Founders Plazaste}}Trt Hartford Ct 06108
c. ATTENTIoN Mike Plonski
(860) 7e4-691s
2
5
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WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIoNS To THE NRCBE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C. SECTION 1OO1 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT ORREPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
oogNRc FoRM 741 (10-2014)
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DOE/NRC FORM 74{(10-2014) Previous sditions are obsoletaMANDATORY DATA COLLECTIONAUTHORIZED BY 1O CFR 30, 40,50, 70,
72,74,75,150
U. S. DEPARTMENTOF ENERGYAND
U. S. NUCLEAR REGULATORY COTIIIISSION
PubricLawss3-703'e3'438'ss-el NUCLEAR MATERIAL TRANSAcfloN REpoRT
APPROVEDBYOMB: NO.3150{003 EXPIRES: 1013112017
Eslimal€d buden ps rspon66 lo cmply with tis mildatory @ll6lis r€qu6t t h@r and 15 minutes. This informalim i8 required lor IAEA
lnlormalion Coileclions Branch (T-5 t53), U.S. Nuclear Regulatory Commission, Washinglon, DC 20555{001, or by jnbnot o-mail tolnlocollets,Re6ource@nrc,gov, and to the Desk oflic€r, Offce of lnformation and Regulalory Affairs, NEOB-10202, (3150-0003), Ofice ofManagomonl and Budg6t, Washinglon, DC 20503, ll a m€anE used lo impos an informalion ooll@lion doo8 noi display a currently valid
OMB conkol numb€r, lho NRC may nol conducl or sponsor, and a porsm is nol required to roEpond lo, the intormalion colleclion.
IE 3, TRANEACTDN NO, 4, CORRECTIO( NO, i 5. PROCESSINGCODEr.sdtpptRS {S 2. RECENEi'E i
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ffi ;a...xArEAf,DADDREss |b,trcEx8Eio. I oFRECEMR l*:
IO, NO OF OATA LINES 2 11. NATUR€OFTRANSACTTON DETiEUIION OFCOPIES
Cabrera Services Inc.50 Founders Plaza sle 2O7
East Hartford Ct 06108
..ArE|roil: Mike Plonski
d.rELEPHotrE: (860) 794-6915
[:50 Founders Plaza sle 2O7
East Hartford Ct 06108
'^"'ntou'Mike Plonskid.rELEpHoNE: (860) 794-6915
2
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DOE/NRC FORM 741 (10-2014)
DOE'NRC FORiI 74I(10-20'14) PEvious editions are obsoleteMANDATORY DATA COLLECTIONAUTHORIZED BY 1O CFR 30,40, 50,70,72,-t4,75, 150Public Laws 83-703, 93-438, 95-91
iWiNUCLEAR
U. S. DEPARTIENTOF EtrtERGy
u. s. ilucLEAR *rdillro*" "otrrrssror{
MATERIAL TRANSACTION REPORT
APPROVEDBYOi|B: NO.31S0{003 EXp|RES: 10t3112017Eslimalod burden por responoe lo conply wilh this mmdatory @llslim roquest: I hou aM 15 minules. Thi6 informalion is roquired hr IAEAe@unilng ropods lhal show changes in inventdy of nudoar mateilals. Send Mmflls regarding burden slimale lo tro FOti, *ir."i.naInbrmalim collecliore Branch (T-5 F53), U.s- Nuolear Regulatory commission, wahiiglon, DC 20s5s{001, or by intorml mail tolnhmlbcts [email protected], and to lhe Desk olficer, offm ol lnbrmalion aa negulato'ry Affairu, Neoglozoz, tliso{g63j, brf.l
"jMamg€msnl and Budget, Wa8hinoton' Dc 20503, ll a means used to impom an infirmation collelion do€s not aiElay a curiendy vdiaoMB conlrcl numbel, tha NRC may nol conducl or sponsor, and a person is notrequired lo rg8pood lo, lhe inlormalion oolloction,
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] oFREcEIvER ] NO,_.-_ ..,_t Lro. loor olta LNes I 11, NATURE OF TRANSACTION otsIf,taunoN oF coPtEs
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c.ArErrcr: Mike Plonskid.Er€pHoNE: (860) 794-6915
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DOE/NRC FORM 741 -."".""*,," U. S. DEPARTMENTOF ENERGY
1to-20t41 Previous editions ere obsolele g \ .,z/"a ANDi,a4lorioiy orrr coLLEcloN i {ffifi i U. S. NUGLEAR REGULATORY COl,lMlSSlONAUTHORTZED By 10 cFR 30,40,50,70, g"I(5tfJ'72,74,75,',t50PubricLa\ns83703'e3-438's$e'r
NUGLEAR MATERIAL TRANSAciloN REpoRT
APPROVED BY OMB: NO. 3150-0003 EXPIRES: '101311201f
:slimaled burden per rosponso lo comply wilh this mandalory coll4tion roquos| t hour and 15 minutes. This informatis iE required for IAEAtcoounling reports thal show changes in inventory ol nucloar matarials. Send comm6nts rogarding burden estimat€ lo lh6 FOIA, Privacy and
ntormalion Colloctions Branch (T-5 F53), U.S. Nuol€a Rogulatory Commision, Washirgton, DC 20555{001, or by inl6rn6t s-mail lonlocolecls.R*[email protected], and to itE Desk otfcer, Off@ of lnfomalion sd R€gulatoy Alfairs, NEO&10202, (3150{003), Off@ ofUanag€mml and Budgot, Washington, DC 20503. ll a m€ans us6d lo impoEo an infomation collelion doe8 nol display a cutrendy validIMB @nlrol numb€I, th€ NRC may not mf,duct or sponsor, and a person is nol rsquited lo rospond lo, lheinfomalion colloclion.
shtFpER'BRts 2,ReCENER'6R16 3.TnAN6ACTIONNO, 4,6OfiRECTIONNO. S.PROCESSINGCOOE ACTDN CODE 7. D@UMEITAT|ON (Onf td.cumnl ri cti..fi.d SECRE'
ZBV ZBV UNC 1704 ..SHTPPERA b, RECEMEi ..sHlppERM lo.aa"a"a* paGE oF p&Es cofr oF "o",a"]
SEFIES
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LICENSE 9...NAMEAtrDADORESS b.LtsENSENO, OF RECEVEi NO. ro. No oF DArA L|NE62 11, NATURE OF Ti NSACIFT mmBuTbtr oF coPtEs
Cabrera Services Inc.50 Founders Plaza sle 207East Hartford Ct 06108
q.ArENrEri Mike Plonskid.rElEPHoilE, (860) 794-6915
50 F'ounders Plaza sre lu tEast Hartford Ct 06108
c.arENrEN: Mike Plonskid.rELEPrc{E: (t60) 79+6915
3
14. TRANSFER AUTHORITY - CONTRACT, NM DRAFT OR ORDER NUMBER 15, EXPORTOR IMPORT TiANSFERS: LICENSE NO.
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WARNING: FALSE STATEMENTS lN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSTONS TO THE NRCBE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C. SECTION 1OO1 MAKES IT A CRIMINAL OFFENSE TO MAKE A WLLFULLY FALSE STATEMENT ORREPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
DOSNRC FORM 741 (1O-2O14)