Upload
others
View
8
Download
0
Embed Size (px)
Citation preview
Page 1 of 2
NRC FORM 7(11-2012)10 CFR 110
U. S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0027 EXPIRES: (11/30/2015)Estimcted burden per response to comply with this mandatorycollection request: 2.4 hours. Thissubmittal is reviewed to ensure that the applicable statutory, regulatory, and policyconsiderations are satisfied. Send comments regarding burden estimate to the InformationServices Branch (T-5 F53), U.S. Nuclear RegulatoryCommission,Washington, DC 20555-0001,or by intemet e-mail to [email protected], and to the Desk Officer, Office ofInformation and Regulatory Affairs, NEOB-10202, (3150-0027), Office of Management andBudget, Washington, DC 20503. If a means used to impose an information collection does notdisplay a currently valid OMB control number, the NRC may not conduct or sponsor, and aperson is not required to respond to, the informationcollection.
APPLICATION FOR NRC EXPORT OR IMPORTLICENSE, AMENDMENT, RENEWAL,
OR CONSENT REQUEST(S)(See Instructions on Pages 4 and 5)
PART B. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, RENEWALS, OR CONSENT REQUESTS(If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
1. NAME AND ADDRESS OF APPLICANT/LICENSEE
Source Production & Equipment Co., Inc.113 Teal St.St. Rose, LA70087
2. TYPE OF ACTION REQUESTED (Check One)
EXPORT il IMPORT(Parts S, C, E) L_ (Parts S, D, E)
1a. NAME OF APPLICANT'S CONTACT
Kelley Richardt1b. APPLICANT'S REFERENCE NUMBER
PXB14b.04
464-94711c. PHONE NUMBER
1e. E-MAIL ADDRESS
L AMENDMENT/RENEWALCurrent License Number:
1d. FAX NUMBER
466-9151
DCONSENT REQUEST
(Parts S, C)Current License Number:
3. CONTRACT NUMBER(S)
NA4. FIRST SHIPMENT DATE
Ongoing
PXB14b.04
5. LAST SHIPMENT DATE
Ongoing6. PROPOSED EXPIRATION DATE
09/30/2016
PART C. TO BE COMPLETED FOR EXPORT LICENSES, AMENDMENTS, OR RENEWALS(If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
7. NAME(S) / ADDRESS(ES) OF SUPPLIERS 8. NAME(S) / ADDRESS(ES) OF INTERMEDIATE 9. NAME(S) / ADDRESS(ES) OF ULTIMATEAND/OR OTHER PARTIES TO THE EXPORT FOREIGN CONSIGNEE(S) FOREIGN CONSIGNEE(S)
No change No change No change
7a. FUNCTION(S) PERFORMED/SERVICE(S) PROVIDED
No change
8a. INTERMEDIATE USE(S)
No change
9a. ULTIMATE END USE(S)
No change
10. DESCRIPTION OF RADIOACTIVE MATERIALS, SEALED SOURCES,NUCLEAR FACILITIES, EQUIPMENT, OR COMPONENTS; FORNUCLEAR EQUIPMENT INCLUDE TOTAL DOLLAR VALUE OFEQUIPMENT FOR EXPORT
No change
10a. MAX TOTAL VOLUME /ELEMENT WGT (KG), ORTOTAL ACTIVITY (TBq)
No change
11. FOREIGN OBLIGATIONS (BY COUNTRY AND BY PERCENTAGE OF MAXIMUM TOTAL VOLUME)
No change
10b. MAX ENRICHMENTOR WGT %
10c. MAX ISOTOPEWGT(KG)
NRC FORM 7 (11-2012)
No changeNo change
NRCFORM7 U.S. NUCLEARREGULATORYCOMMISSION(11-2012)10 CFR 110
APPLICATION FOR NRC EXPORT OR IMPORTLICENSE, AMENDMENT, RENEWAL, OR CONSENT REQUEST(S) (Continued)
UC£NSE,:~DOCKET NUMBER ADAMS ACCESSION NUMBER
0PUBLIC OR N·PUBLIC
R PX6.b~ .. 1/00 (.,0 ~<i •. ..
PART D. TO BE COMPLETED FOR IMPORT LICENSES, AMENDMENTS, OR RENEWALS(If morespaceis neededto completeanyof the items,usePages3-4 first, and thenattachadditionalsheets,if necessary.)
12. NAME(S) / ADDRESS(ES) OF FOREIGN13. NAME(S) / ADDRESS(ES) OF INTERMEDIATE 14. NAME(S) / ADDRESS(ES) OF ULTIMATE U. S.SUPPLIERS AND/OR OTHER PARTIES
TO IMPORT CONSIGNEE(S) CONSIGNEE(S)
No change No change No change
12a. NRC EXPORT LICENSE NUMBER(S) 13a. LICENSE NUMBER(S) / EXPIRATION DATE(S) 14a. LICENSE NUMBER(S) / EXPIRATION DATE(S)(if applicable)
No change No changeNo change
13b. INTERMEDIATE USE(S) 14b. ULTIMATE END USE(S)
No change No change
15. DESCRIPTION OF RADIOACTIVE MATERIALS. SEALED SOURCES.15a. MAX TOTAL VOLUME / 15b. MAX ENRICHMENT 15c. MAX ISOTOPE
ELEMENT WGT (KG). ORNUCLEAR FACILITIESTOTAL ACTIVITY (TBq) OR WGT % WGT(KG)
No change No change No change No change
16. FOREIGN OBLIGATIONS (BY COUNTRY AND BY PERCENTAGE OF MAXIMUM TOTAL VOLUME)
NONE
PART E. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, RENEWALS OR CONSENT REQUEST(S)17. ADDITIONALINFORMATION
DYES [Z]NO 17a. COPiESOFRECIPIENTS' DYES [Z] NOPROVIDEDON PAGES3, 4, AUTHORIZATIONSPROVIDED?AND/ORONSEPARATESHEETS?
18. CERTIFICATION:I, the applicant's authorized official, hereby certify that this application is prepared in conformitywith Title10, Code of Federal Regulations, and that all information provided is correct to the bestof my knowledge.
18a. PRINT NAME AND TITLE OF AUTHORIZED OFFICIAL 18b. SIGNATURE -- AUTHORIZED OFFICIAL 18c. DATE
Kelley Richardt
~fdw/ ?kbRegulatory and Quality Manager
Page 2 of 2
NRC FORM 7 (11-2012)