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01152013 1448 5173712013 C2AE PAGE 0110
bull I
I bull
i2E PrudCtt 51 ~C L3npoundlr)g i11l4E9j5middot S~5 15 3923middot 517 ~1 12JO cee ~ ~~ 371 20l-f~)( ~ C3~~on
January 16 2013
Ms_ Jennifer Bishop Materials Licensing Branch US Nuclear Regulatory Commission Region III 2443 Warrenville Road Suite 210 Lisle IL 60532-4351
RE Renewal to Material License Number 21-24979-01 Control No 578100
Dear Ms Bishop
Please find enclosed our Application for Material License Renewal with the appropriate attachments This was originally submitted on August 13 2012 with the required License Fee and is being resubmitted in its entirety per the Conversation Record dated January 9 2013 between you and me
Item A The application has been revised per NUREG 1556 Vol 1 Rev1 and is attached The gauges and models we currently possess are as follows
bull Troxler Model No 3440 Serial No 27020 bull Troxler Model No_ 3440 Serial No 18434 bull Troxler Model No- 3440 Serial No 20973 bull Troxler Model No_ 3440 Serial No 20054 bull Troxler Model No_ 3440 Serial No 14771 bull Troxler Model No_ 3430 Serial No 21728
Item B Paul L Risberg is the Radiation Safety Officerfor Capital Consultants Inc (db_a C2AE) His Radiation Safety Officer Training Certificate and Delegation of Authority is attached_
Item C The listing of Troxler gauges Model Nos 4640 and 3241 on the August 13 2012 Material License Application was made in error We do not possess these gauges nor have we possessed these gauges in the past Refer to Item A above
01152013 1448 5173712013 C2AE PAGE 02 10
Ms Jennifer Bishop Materials Licensing Branch US Nuclear Regulatory Commission Region III January 16 2013 Page 2
Item D The legal corporation name of the Applicant is Capital Consultants Inc Cd ba C2AE) This does not reflect a change in ownership of the company
If you have any questions please contact me
Very truly yours
CAPITAL CONSULTANTS INC (dba C2AE)
~famp Chief Executive Officer
nrcPLR2012Renewal
Attachments
C2AE PAGE 031001152013 1448 5173712013
NRC FORM 313 US NUCLEAR REGULATORY COMMISSION APPROVaJ BY OMS NO 3150-0120 EXPIRES (051312015) 105-2012) Esli1l1allld burnan per response 10 corT4)ly Min this mandalOf) collec~on request 43 lair SubmllWl 01 10 CFR 30 32 33
Ihe appllCllUon i$ ncw-sary to dalsrmna Ihet Ihe sppIcpnl ~ quallfld iIIld that ltXJeqUaIe procedUIBS exisl34 31 J6 3g a~d 40 10 protect the publiC hellIt~ SNI ~Qly Send commanls raga((llng bulIlen oslm~la Ie tha Information
APPLICAliON FOR MATERIALS LICENSE 5etvieos Branch (T-5 F53) US NUClear Reg~~lOry Commlssioo Washklglon DC 20~~~middotOOOl 0( by Internlll amp-msll to InlocolJoelsRosounemlOv and to the De$~ Ollllter Off1ca of InformatOn and Rogui)(Ory Affiirs NEOB-l0202 (3150-0120) OffiCa of M~agement and BOOge~ WasnlnglOn DC 20503 II a ~lIltlllS used to Imposa an InformaOon eolOClion does nat display cunanty valid OMB control numbsr the NRC may not conducl or sponsor and a person Is flOt re(luireltj 10 rnspond Ill the InIormatlon
collOcllon
INSTRUCrlONS SfEE THE APP~OPRlATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION SEND TWO COPIES O~ THE EIIfIRE COMPLETED APPLICATION ro THE NRC OFFICE SPECIFIED BELOW
APPUCAI10N FOR DISTRIBUTION OF ~lMPT FRODUCTS FILE APPLICAllONS WIlli IF YOU ARE IOCATED IN
OFFICE OF FEDERAl STAYE MATERIALS AND IlliNOIS INDIANA IOWA MICHICOAN MINNESOTA MISSOO~I 01110 OR WISCONSIN ENVIRONMENTAL MANAGEMENT PROGRAMS SEND AlllICAl1ON3 TO DIVISION O~ MATERiAlS SAFETY AND STAn AfiREEMENTS L1S NUCLEAR REGULATORY COMMISSION MA~ERIA~S LICEN51NG BRANCH WASHINI3ION DC 20555-0001 US NUC~EAR REGULATORY COMMISSION REGION III
ALI OntER PERSONS FILE APPLICATIONS AS FOLlOW5 244J WARRENVILLE ROAD SUITE 210 LISLE IL 60532-4352
I~ YOU ARE LOCATED IN
ALASAMA CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA AlASKAARlONA ARKANSAS CALIFORNIA COLOAADO HAWAIIIDAHO KANSAS NNTUCKY MAIN MAIltYLAND IoASSACtiUSEnS New HAMPSHIRE NEW JERSEY LOUISIANA MISSISSIPPI MONTANA NE6RAiKA NEVADA NEW MEXICO NORTli NEW YORK NORTH CAROUNA PENNSYLVANIA PUERTO RICO RHODE ISLANO $OUTli DAKOTA OKLAtiOMA OREGON PACIFIC TRUST TERRITORIES SOUTI1 DAKOTA TEXAS CAROLINA TENNESSEE V~RMONT VIRGINIA VIRGIN ISLANDS OR WST VIRGINIA UTAll WASHINGTON OR WYOMING
SEND APFLICA TlONS TO SlNtgt APPLICATION5 TO
LlCENSINlt ASSISTANCt TlaquoAIA NUCLEAR MAi1iRIALS UCENSING BRANCH DIIilGION OF NUCLEAR MA TpoundRIAlS SAFETY US NUCLEAR REGULATORY COMMISSION REGION IV US NUCLEAR RIGULATORVCOMMIS310N REGION I 1Soo E LAMAR BOULEVARD 2100 RENAISSANCE eoll~ARD SUfTE 100 ARLINGTON TX 76011-4511 KING OF PRUSSIA FA 19406-271~
PERSONS LOCA1ED IN AGREEMENT SrATEs SEND APPLICATIONS TO THe US NUCLeAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MA TERIAL IN STArES SUBJECT TO US NUCLEAR REGULATORY COMMISSION JURISDICfIONS
1 THIS IS AN APPLICATION FOR (Chock ~PPIOJJrf9re 1eltTl) 2 NAMe AND MAILING ADDRESS Of AP~ICANT (lncliJde ZIP clode)
D A NEW UCtNSE Capital Consultants Tnc
D dba C2AE 8 AMINDklEN~ 10 LICENSE NUMBER
725 Prudden Strect --- shy0 C F~NEWAL OF UCENSE NUMBeR 21-24979-0 I Lansing M1 48906
3 AOORess WHERE LlCENSD MAT~RIAl WIll BE USEO O~ POgtSESSED 4 NAt1E OF PER50N TO BE CONTACTED ABOUT THIS APPUCATION
At Capital Consultants Inc bull 725 Prudden Street Lansing MJ Paul L Risberg
48906 Capital Consultants Inc 123 W Main St Gaylord MJ BUSINESS TELEJOHONE NUMBER IBuSINESS CELLULAR TELEPloONE NUMseR
49735 and at temporary job sites throughout the US where the (517) 371-1200 (517) 719-5484 US oNuclear RegUlatory Commission maintains jurisdiction over BUSINESS EMAI~ADORE65
the use of by-product material paulrisbergc2ae_com SUBMIT ITEMS 5 THROUGH 11 ON B112 X 11 PAPER THE TYPE AND seogte OF INFORMATION TO BE PROvlDEO IS DESCRIBED IN THE LlCEN6E APPLICATION GUIDt
~ RADIOACTIVE MATeRIAL R Elamenl and M wnbcr b ~amlcal alldlo( phy1lc11 lorm Qfd C mallltirnum meum 6 PURPOSEIS) FOR WHICH LlCSNSED MATERiAl WILL B~ USED
wIieII w~ be pcw~ed 8t anyone lime
7 INDIVIDUAl(S) RESPONSIBLE FOR RADIATION SA~Erv P~OGRAM AND T11EIR B mAJNING FOR INDIVIDUALS WORKING IN OR FR~OUENTING RESTRICTED AR~AStRAINING EXPERIENCG
9 ~ACllITIS AND EQUIPMENY 10 RADIATION SAFETY PROGRAM
12 LICENSE FES fSec 10 CfR 170 a~d SOltIan 17031) WA6TE MANAGEMENT ltMOUN
FEE CATEGORY 3P ENCLOSED s 150000
1S CERTIFICATION (Mull be GOO7plttca oy applictJrtl) TloI APJO~ICNT UNDERSTANDS HAT ALL STATEMENTS AND flEPRESENTATIONS MAD IN HIS AFPUCATION APE fJlNOING IWON THE APPLICAN
THE APPLICANT AND ANY OFRCIAL EXCUTING THIS CERTI~ICATION ON BEMALF OF IHE APPLICANT NAMtD IN 11111 2 CERTIFY THAT TS AfgtILICATION IS FREPARED IN CONFOIIMITY WITH TITLE 0 COD~ OF FEDERAL REGU~TION8 PARTS 303133 a-4 35 3S~ AND 40 ANDYHAT ALL INFORMATION CONTANED HEREIN 15 TRUE AND COMECT 10 THe eEST OF HtEIR KNOwEDGE AND BELIEF WARNING 16 USC SECTION 1001 IgtIr OF JUNE ~~ 194862 STAT 749 MA)ltI$ IT A CRIMINAl OFFENSe 0 MAKE A WILLFUllY FASE STATEMENT OR REPRESENrAI10N TO ANY DEPARTMENT OR AGENCY OF THE UNIIO STATES AS TO ANY MATTER WITHIN ITS JURISOICnON
CEIlTIFVING OFFICER TYPEDPRINTED NAME AND flY SI~NATURE dL DAn
William J Kimble Prcsident and CEO cUlf I shy I (~113 FOR NRC USE ONLY -TYPE O~ ~E~ I FEE LOG [feE CATEGORY I MOINT RECEIVED ceCK NUMBER COMMENTS -shy
bullshyAP~ROVED BY DAT~
NRC FORM 313 ~2012)
01152013 1448 5173712013 C2AE PAGE 0410
APPE)1DIXB
ITEMS 5 AND 6 MATERIALS TO BE POSSESSED AND PROPOSED USES
CcsiUlTI-137x
x
Sealcd SOUTCr manufacturer Not to exceed Or distributor and model either the
number madmulU
Troxler - 3400 Series activity per
Device manufactuJel or distributor and model number Troxler - 34403430
sourct Or
maximum activity per device as specified io Seltlled Source and Device Registration Certificate
YesN
Specific description of the gauge use
To be used in
Troxler
3400 seIies
gauges for measurement
of physical
properties of
materials
DlNot applicable
o Uses are
(Submit satety analysis supporting safe use)
B-1 NURBG 1556 Vol 1 Rev I
01152013 1448 5173712013 C2AE PAGE 0510
APPENDIXB
o Not applicable
o USeS are Device manufacturer or distributor and model number
Sealed source manufacturer 252 Californium-x
or distributor and model number
Not to exceed either the maximum activity per source or maximwn activity per device as specified in Sealed Source and Device Registration Certificate
Yes 0
Specific description of the gauge use
(Submit safety analysis suppc)I1il1g safe use)
NUREG-lj56 VoL 1Revl B-2
C2AE PAGE 051001152013 1448 5173712013
APPENDIXB
ITEMS 7 THROUGH 11 TRAINING AND EXPERIENCE FACILITIES AND EQUIPMENT RADIATION SAFETY PROGRAM AND WASTE DISPOSAL
INDlVroOALS WORKING IN OR FREQUENTING RESTRICrEO AREAS
8
Item No And Title
TRAINING FOR
1o RADIATION SAFETY PROGRAM shy SURVEY INSTROMENTS
Suggested Re~ponse
Before using licensed materials authorized 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 in NUREG-1556 Vol 1 Rev 1 dated November 2001
Yes Alternlltive Procedures
Attached
We will either possess and use or have access to and use a radiation survey meter that meets the Criteria in the section entitled Radiation Safety Program - Instruments in NUREG-1556 Vol I Rev_ 1 dated November 2001
o
o
B-3 NUREG - 1556 Vol 1 Rev 1
01162013 1448 5173712013 C2AE PAGE 0710
APPENDTXB
Item No Alld Title
10 RADIATION SAFETY
Suggested Response
Either we wilJ maintain for inspection by
Yes Alternative Procedures Attached
o PROGRAMshyOCCUPATIONAL DOSIMETRY
NRC documentation demonstrating that unmonitored individuals are n01likely 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 ltIna evaluated by an NVLAP-approved pCOCeSsor that is exchanged at a frequency recommended by the processor
10 RADIATION SAFE1Y We wiil implement and maintain the operating o PROGRAMshyOPERATING AND EMERGENCY PROCEDURES
and emergency proceduns in AppendixH of NUREG-1556 Vol 1 Rev 1 dated November 2001 and provide copies ofthese procedures to all gauge tlserS and at each job site
OR
Operating and emergency procedu~es will be developed implcmmted md maintained and will meet the criteria in the section entitled Radiation Safety Program - Operating and Emergency Procedures in NUREG-1556 VoL 1 Rev 1 dated November 2001
0
NUREGmiddot 1556 Vol 1 Rev 1 8middot4
C2AE PAGE 08 100115 2013 1448 5173712013
APPENDIXB
Item No And Title
~
I
Suggested Response Yes Alternative Procedures Attached
i
lORADIATION SAFETY The applicant is not required to submit its Need Not Be Submitted PROGRAMshy response to tTansportation during the licensing Witll AI)Igtlication
TRANSPORTATION process However this issue will be reyjewed during inspection
B-5 NUREG - 1556 Vol J Rev 1
01
(SI I- W
I- p
p
(S) I- shyI-
shy10
Professional SelVice Industries Inc OJ
tJl I- ~ W
I-
~~ ~ i ~ f~ ~ ~~~~~- J ~ WRADIATION SAFETY TRAINING PROG-RAMmiddot ~
FOR
RADIATION SAFETY OFFICERS FOR
()lIOISTURE DENSITY GAUGES 10 Jgt
[TlTHIS IS TO CERT[FY THAT
PAUL RISBERG
Has Successfully Completed the Approved Corporate Radiation Safety Training Program for Radiation Safety OfficersInstructors
Subjects Induded in the course were as follows
REGULAT10NS RADIATION SAFETY 1 Security and Control 1 Principles of Radiation Safety 2 License Conditions 2 Radiation Dosage CalculatIons 3 Records 3 Radiation Detection and Measurement 4 Transportation - 4 Biological Effects middot
~nnel TrainQln 5 Emergency Proceduresg) A _ ~~gt- 110690
-u Jgt
~ (S) LD shyI- (S)
01152013 1448 5173712013 C2AE PAGE 1010
~ 725 Prudden Street
~ l1lnsingMI48906c2aeit P ~173711200 Memo ~ F 0173712013 _ olovtlog hllman Qchlovumunl WWWC2aecom
To Paul L Risberg Radiation Safety Officer
From William J Kimble PE Chief Executive Officer
Date January 11 2013
Re Delegation of Authority Radiation Safety Officer
As of January 11 2013 you Paul L Risberg have been appointed Radiation Safety Officer for C2AE and are responsible for ensuring the safe use of radiation within the company
You are responsible for managing the Radiation Protection Program identifying radiation protection problems initiating recommending or providing corrective actions verifying implementation of corrective actions stopping unsafe activities and ensuring compliance with regulations
You are hereby delegated the authority necessary to meet those responsibilities including prohibiting the use of byproduct material by employees who do not meet the necessary requirements and shutting down operations where justified to maintain radiation safety You are required to notify management if staff does not cooperate and does not address radiation safety issues In addition you are free to raise issues with the Nuclear Regulatory Commission at any time It is estimated that you will spend 6 hours per week conducting radiation protection activities
Date
I accept the above responsibilities
cc NRC License ile Business Unit Leaders and Directors
01152013 1448 5173712013 C2AE PAGE 02 10
Ms Jennifer Bishop Materials Licensing Branch US Nuclear Regulatory Commission Region III January 16 2013 Page 2
Item D The legal corporation name of the Applicant is Capital Consultants Inc Cd ba C2AE) This does not reflect a change in ownership of the company
If you have any questions please contact me
Very truly yours
CAPITAL CONSULTANTS INC (dba C2AE)
~famp Chief Executive Officer
nrcPLR2012Renewal
Attachments
C2AE PAGE 031001152013 1448 5173712013
NRC FORM 313 US NUCLEAR REGULATORY COMMISSION APPROVaJ BY OMS NO 3150-0120 EXPIRES (051312015) 105-2012) Esli1l1allld burnan per response 10 corT4)ly Min this mandalOf) collec~on request 43 lair SubmllWl 01 10 CFR 30 32 33
Ihe appllCllUon i$ ncw-sary to dalsrmna Ihet Ihe sppIcpnl ~ quallfld iIIld that ltXJeqUaIe procedUIBS exisl34 31 J6 3g a~d 40 10 protect the publiC hellIt~ SNI ~Qly Send commanls raga((llng bulIlen oslm~la Ie tha Information
APPLICAliON FOR MATERIALS LICENSE 5etvieos Branch (T-5 F53) US NUClear Reg~~lOry Commlssioo Washklglon DC 20~~~middotOOOl 0( by Internlll amp-msll to InlocolJoelsRosounemlOv and to the De$~ Ollllter Off1ca of InformatOn and Rogui)(Ory Affiirs NEOB-l0202 (3150-0120) OffiCa of M~agement and BOOge~ WasnlnglOn DC 20503 II a ~lIltlllS used to Imposa an InformaOon eolOClion does nat display cunanty valid OMB control numbsr the NRC may not conducl or sponsor and a person Is flOt re(luireltj 10 rnspond Ill the InIormatlon
collOcllon
INSTRUCrlONS SfEE THE APP~OPRlATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION SEND TWO COPIES O~ THE EIIfIRE COMPLETED APPLICATION ro THE NRC OFFICE SPECIFIED BELOW
APPUCAI10N FOR DISTRIBUTION OF ~lMPT FRODUCTS FILE APPLICAllONS WIlli IF YOU ARE IOCATED IN
OFFICE OF FEDERAl STAYE MATERIALS AND IlliNOIS INDIANA IOWA MICHICOAN MINNESOTA MISSOO~I 01110 OR WISCONSIN ENVIRONMENTAL MANAGEMENT PROGRAMS SEND AlllICAl1ON3 TO DIVISION O~ MATERiAlS SAFETY AND STAn AfiREEMENTS L1S NUCLEAR REGULATORY COMMISSION MA~ERIA~S LICEN51NG BRANCH WASHINI3ION DC 20555-0001 US NUC~EAR REGULATORY COMMISSION REGION III
ALI OntER PERSONS FILE APPLICATIONS AS FOLlOW5 244J WARRENVILLE ROAD SUITE 210 LISLE IL 60532-4352
I~ YOU ARE LOCATED IN
ALASAMA CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA AlASKAARlONA ARKANSAS CALIFORNIA COLOAADO HAWAIIIDAHO KANSAS NNTUCKY MAIN MAIltYLAND IoASSACtiUSEnS New HAMPSHIRE NEW JERSEY LOUISIANA MISSISSIPPI MONTANA NE6RAiKA NEVADA NEW MEXICO NORTli NEW YORK NORTH CAROUNA PENNSYLVANIA PUERTO RICO RHODE ISLANO $OUTli DAKOTA OKLAtiOMA OREGON PACIFIC TRUST TERRITORIES SOUTI1 DAKOTA TEXAS CAROLINA TENNESSEE V~RMONT VIRGINIA VIRGIN ISLANDS OR WST VIRGINIA UTAll WASHINGTON OR WYOMING
SEND APFLICA TlONS TO SlNtgt APPLICATION5 TO
LlCENSINlt ASSISTANCt TlaquoAIA NUCLEAR MAi1iRIALS UCENSING BRANCH DIIilGION OF NUCLEAR MA TpoundRIAlS SAFETY US NUCLEAR REGULATORY COMMISSION REGION IV US NUCLEAR RIGULATORVCOMMIS310N REGION I 1Soo E LAMAR BOULEVARD 2100 RENAISSANCE eoll~ARD SUfTE 100 ARLINGTON TX 76011-4511 KING OF PRUSSIA FA 19406-271~
PERSONS LOCA1ED IN AGREEMENT SrATEs SEND APPLICATIONS TO THe US NUCLeAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MA TERIAL IN STArES SUBJECT TO US NUCLEAR REGULATORY COMMISSION JURISDICfIONS
1 THIS IS AN APPLICATION FOR (Chock ~PPIOJJrf9re 1eltTl) 2 NAMe AND MAILING ADDRESS Of AP~ICANT (lncliJde ZIP clode)
D A NEW UCtNSE Capital Consultants Tnc
D dba C2AE 8 AMINDklEN~ 10 LICENSE NUMBER
725 Prudden Strect --- shy0 C F~NEWAL OF UCENSE NUMBeR 21-24979-0 I Lansing M1 48906
3 AOORess WHERE LlCENSD MAT~RIAl WIll BE USEO O~ POgtSESSED 4 NAt1E OF PER50N TO BE CONTACTED ABOUT THIS APPUCATION
At Capital Consultants Inc bull 725 Prudden Street Lansing MJ Paul L Risberg
48906 Capital Consultants Inc 123 W Main St Gaylord MJ BUSINESS TELEJOHONE NUMBER IBuSINESS CELLULAR TELEPloONE NUMseR
49735 and at temporary job sites throughout the US where the (517) 371-1200 (517) 719-5484 US oNuclear RegUlatory Commission maintains jurisdiction over BUSINESS EMAI~ADORE65
the use of by-product material paulrisbergc2ae_com SUBMIT ITEMS 5 THROUGH 11 ON B112 X 11 PAPER THE TYPE AND seogte OF INFORMATION TO BE PROvlDEO IS DESCRIBED IN THE LlCEN6E APPLICATION GUIDt
~ RADIOACTIVE MATeRIAL R Elamenl and M wnbcr b ~amlcal alldlo( phy1lc11 lorm Qfd C mallltirnum meum 6 PURPOSEIS) FOR WHICH LlCSNSED MATERiAl WILL B~ USED
wIieII w~ be pcw~ed 8t anyone lime
7 INDIVIDUAl(S) RESPONSIBLE FOR RADIATION SA~Erv P~OGRAM AND T11EIR B mAJNING FOR INDIVIDUALS WORKING IN OR FR~OUENTING RESTRICTED AR~AStRAINING EXPERIENCG
9 ~ACllITIS AND EQUIPMENY 10 RADIATION SAFETY PROGRAM
12 LICENSE FES fSec 10 CfR 170 a~d SOltIan 17031) WA6TE MANAGEMENT ltMOUN
FEE CATEGORY 3P ENCLOSED s 150000
1S CERTIFICATION (Mull be GOO7plttca oy applictJrtl) TloI APJO~ICNT UNDERSTANDS HAT ALL STATEMENTS AND flEPRESENTATIONS MAD IN HIS AFPUCATION APE fJlNOING IWON THE APPLICAN
THE APPLICANT AND ANY OFRCIAL EXCUTING THIS CERTI~ICATION ON BEMALF OF IHE APPLICANT NAMtD IN 11111 2 CERTIFY THAT TS AfgtILICATION IS FREPARED IN CONFOIIMITY WITH TITLE 0 COD~ OF FEDERAL REGU~TION8 PARTS 303133 a-4 35 3S~ AND 40 ANDYHAT ALL INFORMATION CONTANED HEREIN 15 TRUE AND COMECT 10 THe eEST OF HtEIR KNOwEDGE AND BELIEF WARNING 16 USC SECTION 1001 IgtIr OF JUNE ~~ 194862 STAT 749 MA)ltI$ IT A CRIMINAl OFFENSe 0 MAKE A WILLFUllY FASE STATEMENT OR REPRESENrAI10N TO ANY DEPARTMENT OR AGENCY OF THE UNIIO STATES AS TO ANY MATTER WITHIN ITS JURISOICnON
CEIlTIFVING OFFICER TYPEDPRINTED NAME AND flY SI~NATURE dL DAn
William J Kimble Prcsident and CEO cUlf I shy I (~113 FOR NRC USE ONLY -TYPE O~ ~E~ I FEE LOG [feE CATEGORY I MOINT RECEIVED ceCK NUMBER COMMENTS -shy
bullshyAP~ROVED BY DAT~
NRC FORM 313 ~2012)
01152013 1448 5173712013 C2AE PAGE 0410
APPE)1DIXB
ITEMS 5 AND 6 MATERIALS TO BE POSSESSED AND PROPOSED USES
CcsiUlTI-137x
x
Sealcd SOUTCr manufacturer Not to exceed Or distributor and model either the
number madmulU
Troxler - 3400 Series activity per
Device manufactuJel or distributor and model number Troxler - 34403430
sourct Or
maximum activity per device as specified io Seltlled Source and Device Registration Certificate
YesN
Specific description of the gauge use
To be used in
Troxler
3400 seIies
gauges for measurement
of physical
properties of
materials
DlNot applicable
o Uses are
(Submit satety analysis supporting safe use)
B-1 NURBG 1556 Vol 1 Rev I
01152013 1448 5173712013 C2AE PAGE 0510
APPENDIXB
o Not applicable
o USeS are Device manufacturer or distributor and model number
Sealed source manufacturer 252 Californium-x
or distributor and model number
Not to exceed either the maximum activity per source or maximwn activity per device as specified in Sealed Source and Device Registration Certificate
Yes 0
Specific description of the gauge use
(Submit safety analysis suppc)I1il1g safe use)
NUREG-lj56 VoL 1Revl B-2
C2AE PAGE 051001152013 1448 5173712013
APPENDIXB
ITEMS 7 THROUGH 11 TRAINING AND EXPERIENCE FACILITIES AND EQUIPMENT RADIATION SAFETY PROGRAM AND WASTE DISPOSAL
INDlVroOALS WORKING IN OR FREQUENTING RESTRICrEO AREAS
8
Item No And Title
TRAINING FOR
1o RADIATION SAFETY PROGRAM shy SURVEY INSTROMENTS
Suggested Re~ponse
Before using licensed materials authorized 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 in NUREG-1556 Vol 1 Rev 1 dated November 2001
Yes Alternlltive Procedures
Attached
We will either possess and use or have access to and use a radiation survey meter that meets the Criteria in the section entitled Radiation Safety Program - Instruments in NUREG-1556 Vol I Rev_ 1 dated November 2001
o
o
B-3 NUREG - 1556 Vol 1 Rev 1
01162013 1448 5173712013 C2AE PAGE 0710
APPENDTXB
Item No Alld Title
10 RADIATION SAFETY
Suggested Response
Either we wilJ maintain for inspection by
Yes Alternative Procedures Attached
o PROGRAMshyOCCUPATIONAL DOSIMETRY
NRC documentation demonstrating that unmonitored individuals are n01likely 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 ltIna evaluated by an NVLAP-approved pCOCeSsor that is exchanged at a frequency recommended by the processor
10 RADIATION SAFE1Y We wiil implement and maintain the operating o PROGRAMshyOPERATING AND EMERGENCY PROCEDURES
and emergency proceduns in AppendixH of NUREG-1556 Vol 1 Rev 1 dated November 2001 and provide copies ofthese procedures to all gauge tlserS and at each job site
OR
Operating and emergency procedu~es will be developed implcmmted md maintained and will meet the criteria in the section entitled Radiation Safety Program - Operating and Emergency Procedures in NUREG-1556 VoL 1 Rev 1 dated November 2001
0
NUREGmiddot 1556 Vol 1 Rev 1 8middot4
C2AE PAGE 08 100115 2013 1448 5173712013
APPENDIXB
Item No And Title
~
I
Suggested Response Yes Alternative Procedures Attached
i
lORADIATION SAFETY The applicant is not required to submit its Need Not Be Submitted PROGRAMshy response to tTansportation during the licensing Witll AI)Igtlication
TRANSPORTATION process However this issue will be reyjewed during inspection
B-5 NUREG - 1556 Vol J Rev 1
01
(SI I- W
I- p
p
(S) I- shyI-
shy10
Professional SelVice Industries Inc OJ
tJl I- ~ W
I-
~~ ~ i ~ f~ ~ ~~~~~- J ~ WRADIATION SAFETY TRAINING PROG-RAMmiddot ~
FOR
RADIATION SAFETY OFFICERS FOR
()lIOISTURE DENSITY GAUGES 10 Jgt
[TlTHIS IS TO CERT[FY THAT
PAUL RISBERG
Has Successfully Completed the Approved Corporate Radiation Safety Training Program for Radiation Safety OfficersInstructors
Subjects Induded in the course were as follows
REGULAT10NS RADIATION SAFETY 1 Security and Control 1 Principles of Radiation Safety 2 License Conditions 2 Radiation Dosage CalculatIons 3 Records 3 Radiation Detection and Measurement 4 Transportation - 4 Biological Effects middot
~nnel TrainQln 5 Emergency Proceduresg) A _ ~~gt- 110690
-u Jgt
~ (S) LD shyI- (S)
01152013 1448 5173712013 C2AE PAGE 1010
~ 725 Prudden Street
~ l1lnsingMI48906c2aeit P ~173711200 Memo ~ F 0173712013 _ olovtlog hllman Qchlovumunl WWWC2aecom
To Paul L Risberg Radiation Safety Officer
From William J Kimble PE Chief Executive Officer
Date January 11 2013
Re Delegation of Authority Radiation Safety Officer
As of January 11 2013 you Paul L Risberg have been appointed Radiation Safety Officer for C2AE and are responsible for ensuring the safe use of radiation within the company
You are responsible for managing the Radiation Protection Program identifying radiation protection problems initiating recommending or providing corrective actions verifying implementation of corrective actions stopping unsafe activities and ensuring compliance with regulations
You are hereby delegated the authority necessary to meet those responsibilities including prohibiting the use of byproduct material by employees who do not meet the necessary requirements and shutting down operations where justified to maintain radiation safety You are required to notify management if staff does not cooperate and does not address radiation safety issues In addition you are free to raise issues with the Nuclear Regulatory Commission at any time It is estimated that you will spend 6 hours per week conducting radiation protection activities
Date
I accept the above responsibilities
cc NRC License ile Business Unit Leaders and Directors
C2AE PAGE 031001152013 1448 5173712013
NRC FORM 313 US NUCLEAR REGULATORY COMMISSION APPROVaJ BY OMS NO 3150-0120 EXPIRES (051312015) 105-2012) Esli1l1allld burnan per response 10 corT4)ly Min this mandalOf) collec~on request 43 lair SubmllWl 01 10 CFR 30 32 33
Ihe appllCllUon i$ ncw-sary to dalsrmna Ihet Ihe sppIcpnl ~ quallfld iIIld that ltXJeqUaIe procedUIBS exisl34 31 J6 3g a~d 40 10 protect the publiC hellIt~ SNI ~Qly Send commanls raga((llng bulIlen oslm~la Ie tha Information
APPLICAliON FOR MATERIALS LICENSE 5etvieos Branch (T-5 F53) US NUClear Reg~~lOry Commlssioo Washklglon DC 20~~~middotOOOl 0( by Internlll amp-msll to InlocolJoelsRosounemlOv and to the De$~ Ollllter Off1ca of InformatOn and Rogui)(Ory Affiirs NEOB-l0202 (3150-0120) OffiCa of M~agement and BOOge~ WasnlnglOn DC 20503 II a ~lIltlllS used to Imposa an InformaOon eolOClion does nat display cunanty valid OMB control numbsr the NRC may not conducl or sponsor and a person Is flOt re(luireltj 10 rnspond Ill the InIormatlon
collOcllon
INSTRUCrlONS SfEE THE APP~OPRlATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION SEND TWO COPIES O~ THE EIIfIRE COMPLETED APPLICATION ro THE NRC OFFICE SPECIFIED BELOW
APPUCAI10N FOR DISTRIBUTION OF ~lMPT FRODUCTS FILE APPLICAllONS WIlli IF YOU ARE IOCATED IN
OFFICE OF FEDERAl STAYE MATERIALS AND IlliNOIS INDIANA IOWA MICHICOAN MINNESOTA MISSOO~I 01110 OR WISCONSIN ENVIRONMENTAL MANAGEMENT PROGRAMS SEND AlllICAl1ON3 TO DIVISION O~ MATERiAlS SAFETY AND STAn AfiREEMENTS L1S NUCLEAR REGULATORY COMMISSION MA~ERIA~S LICEN51NG BRANCH WASHINI3ION DC 20555-0001 US NUC~EAR REGULATORY COMMISSION REGION III
ALI OntER PERSONS FILE APPLICATIONS AS FOLlOW5 244J WARRENVILLE ROAD SUITE 210 LISLE IL 60532-4352
I~ YOU ARE LOCATED IN
ALASAMA CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA AlASKAARlONA ARKANSAS CALIFORNIA COLOAADO HAWAIIIDAHO KANSAS NNTUCKY MAIN MAIltYLAND IoASSACtiUSEnS New HAMPSHIRE NEW JERSEY LOUISIANA MISSISSIPPI MONTANA NE6RAiKA NEVADA NEW MEXICO NORTli NEW YORK NORTH CAROUNA PENNSYLVANIA PUERTO RICO RHODE ISLANO $OUTli DAKOTA OKLAtiOMA OREGON PACIFIC TRUST TERRITORIES SOUTI1 DAKOTA TEXAS CAROLINA TENNESSEE V~RMONT VIRGINIA VIRGIN ISLANDS OR WST VIRGINIA UTAll WASHINGTON OR WYOMING
SEND APFLICA TlONS TO SlNtgt APPLICATION5 TO
LlCENSINlt ASSISTANCt TlaquoAIA NUCLEAR MAi1iRIALS UCENSING BRANCH DIIilGION OF NUCLEAR MA TpoundRIAlS SAFETY US NUCLEAR REGULATORY COMMISSION REGION IV US NUCLEAR RIGULATORVCOMMIS310N REGION I 1Soo E LAMAR BOULEVARD 2100 RENAISSANCE eoll~ARD SUfTE 100 ARLINGTON TX 76011-4511 KING OF PRUSSIA FA 19406-271~
PERSONS LOCA1ED IN AGREEMENT SrATEs SEND APPLICATIONS TO THe US NUCLeAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MA TERIAL IN STArES SUBJECT TO US NUCLEAR REGULATORY COMMISSION JURISDICfIONS
1 THIS IS AN APPLICATION FOR (Chock ~PPIOJJrf9re 1eltTl) 2 NAMe AND MAILING ADDRESS Of AP~ICANT (lncliJde ZIP clode)
D A NEW UCtNSE Capital Consultants Tnc
D dba C2AE 8 AMINDklEN~ 10 LICENSE NUMBER
725 Prudden Strect --- shy0 C F~NEWAL OF UCENSE NUMBeR 21-24979-0 I Lansing M1 48906
3 AOORess WHERE LlCENSD MAT~RIAl WIll BE USEO O~ POgtSESSED 4 NAt1E OF PER50N TO BE CONTACTED ABOUT THIS APPUCATION
At Capital Consultants Inc bull 725 Prudden Street Lansing MJ Paul L Risberg
48906 Capital Consultants Inc 123 W Main St Gaylord MJ BUSINESS TELEJOHONE NUMBER IBuSINESS CELLULAR TELEPloONE NUMseR
49735 and at temporary job sites throughout the US where the (517) 371-1200 (517) 719-5484 US oNuclear RegUlatory Commission maintains jurisdiction over BUSINESS EMAI~ADORE65
the use of by-product material paulrisbergc2ae_com SUBMIT ITEMS 5 THROUGH 11 ON B112 X 11 PAPER THE TYPE AND seogte OF INFORMATION TO BE PROvlDEO IS DESCRIBED IN THE LlCEN6E APPLICATION GUIDt
~ RADIOACTIVE MATeRIAL R Elamenl and M wnbcr b ~amlcal alldlo( phy1lc11 lorm Qfd C mallltirnum meum 6 PURPOSEIS) FOR WHICH LlCSNSED MATERiAl WILL B~ USED
wIieII w~ be pcw~ed 8t anyone lime
7 INDIVIDUAl(S) RESPONSIBLE FOR RADIATION SA~Erv P~OGRAM AND T11EIR B mAJNING FOR INDIVIDUALS WORKING IN OR FR~OUENTING RESTRICTED AR~AStRAINING EXPERIENCG
9 ~ACllITIS AND EQUIPMENY 10 RADIATION SAFETY PROGRAM
12 LICENSE FES fSec 10 CfR 170 a~d SOltIan 17031) WA6TE MANAGEMENT ltMOUN
FEE CATEGORY 3P ENCLOSED s 150000
1S CERTIFICATION (Mull be GOO7plttca oy applictJrtl) TloI APJO~ICNT UNDERSTANDS HAT ALL STATEMENTS AND flEPRESENTATIONS MAD IN HIS AFPUCATION APE fJlNOING IWON THE APPLICAN
THE APPLICANT AND ANY OFRCIAL EXCUTING THIS CERTI~ICATION ON BEMALF OF IHE APPLICANT NAMtD IN 11111 2 CERTIFY THAT TS AfgtILICATION IS FREPARED IN CONFOIIMITY WITH TITLE 0 COD~ OF FEDERAL REGU~TION8 PARTS 303133 a-4 35 3S~ AND 40 ANDYHAT ALL INFORMATION CONTANED HEREIN 15 TRUE AND COMECT 10 THe eEST OF HtEIR KNOwEDGE AND BELIEF WARNING 16 USC SECTION 1001 IgtIr OF JUNE ~~ 194862 STAT 749 MA)ltI$ IT A CRIMINAl OFFENSe 0 MAKE A WILLFUllY FASE STATEMENT OR REPRESENrAI10N TO ANY DEPARTMENT OR AGENCY OF THE UNIIO STATES AS TO ANY MATTER WITHIN ITS JURISOICnON
CEIlTIFVING OFFICER TYPEDPRINTED NAME AND flY SI~NATURE dL DAn
William J Kimble Prcsident and CEO cUlf I shy I (~113 FOR NRC USE ONLY -TYPE O~ ~E~ I FEE LOG [feE CATEGORY I MOINT RECEIVED ceCK NUMBER COMMENTS -shy
bullshyAP~ROVED BY DAT~
NRC FORM 313 ~2012)
01152013 1448 5173712013 C2AE PAGE 0410
APPE)1DIXB
ITEMS 5 AND 6 MATERIALS TO BE POSSESSED AND PROPOSED USES
CcsiUlTI-137x
x
Sealcd SOUTCr manufacturer Not to exceed Or distributor and model either the
number madmulU
Troxler - 3400 Series activity per
Device manufactuJel or distributor and model number Troxler - 34403430
sourct Or
maximum activity per device as specified io Seltlled Source and Device Registration Certificate
YesN
Specific description of the gauge use
To be used in
Troxler
3400 seIies
gauges for measurement
of physical
properties of
materials
DlNot applicable
o Uses are
(Submit satety analysis supporting safe use)
B-1 NURBG 1556 Vol 1 Rev I
01152013 1448 5173712013 C2AE PAGE 0510
APPENDIXB
o Not applicable
o USeS are Device manufacturer or distributor and model number
Sealed source manufacturer 252 Californium-x
or distributor and model number
Not to exceed either the maximum activity per source or maximwn activity per device as specified in Sealed Source and Device Registration Certificate
Yes 0
Specific description of the gauge use
(Submit safety analysis suppc)I1il1g safe use)
NUREG-lj56 VoL 1Revl B-2
C2AE PAGE 051001152013 1448 5173712013
APPENDIXB
ITEMS 7 THROUGH 11 TRAINING AND EXPERIENCE FACILITIES AND EQUIPMENT RADIATION SAFETY PROGRAM AND WASTE DISPOSAL
INDlVroOALS WORKING IN OR FREQUENTING RESTRICrEO AREAS
8
Item No And Title
TRAINING FOR
1o RADIATION SAFETY PROGRAM shy SURVEY INSTROMENTS
Suggested Re~ponse
Before using licensed materials authorized 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 in NUREG-1556 Vol 1 Rev 1 dated November 2001
Yes Alternlltive Procedures
Attached
We will either possess and use or have access to and use a radiation survey meter that meets the Criteria in the section entitled Radiation Safety Program - Instruments in NUREG-1556 Vol I Rev_ 1 dated November 2001
o
o
B-3 NUREG - 1556 Vol 1 Rev 1
01162013 1448 5173712013 C2AE PAGE 0710
APPENDTXB
Item No Alld Title
10 RADIATION SAFETY
Suggested Response
Either we wilJ maintain for inspection by
Yes Alternative Procedures Attached
o PROGRAMshyOCCUPATIONAL DOSIMETRY
NRC documentation demonstrating that unmonitored individuals are n01likely 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 ltIna evaluated by an NVLAP-approved pCOCeSsor that is exchanged at a frequency recommended by the processor
10 RADIATION SAFE1Y We wiil implement and maintain the operating o PROGRAMshyOPERATING AND EMERGENCY PROCEDURES
and emergency proceduns in AppendixH of NUREG-1556 Vol 1 Rev 1 dated November 2001 and provide copies ofthese procedures to all gauge tlserS and at each job site
OR
Operating and emergency procedu~es will be developed implcmmted md maintained and will meet the criteria in the section entitled Radiation Safety Program - Operating and Emergency Procedures in NUREG-1556 VoL 1 Rev 1 dated November 2001
0
NUREGmiddot 1556 Vol 1 Rev 1 8middot4
C2AE PAGE 08 100115 2013 1448 5173712013
APPENDIXB
Item No And Title
~
I
Suggested Response Yes Alternative Procedures Attached
i
lORADIATION SAFETY The applicant is not required to submit its Need Not Be Submitted PROGRAMshy response to tTansportation during the licensing Witll AI)Igtlication
TRANSPORTATION process However this issue will be reyjewed during inspection
B-5 NUREG - 1556 Vol J Rev 1
01
(SI I- W
I- p
p
(S) I- shyI-
shy10
Professional SelVice Industries Inc OJ
tJl I- ~ W
I-
~~ ~ i ~ f~ ~ ~~~~~- J ~ WRADIATION SAFETY TRAINING PROG-RAMmiddot ~
FOR
RADIATION SAFETY OFFICERS FOR
()lIOISTURE DENSITY GAUGES 10 Jgt
[TlTHIS IS TO CERT[FY THAT
PAUL RISBERG
Has Successfully Completed the Approved Corporate Radiation Safety Training Program for Radiation Safety OfficersInstructors
Subjects Induded in the course were as follows
REGULAT10NS RADIATION SAFETY 1 Security and Control 1 Principles of Radiation Safety 2 License Conditions 2 Radiation Dosage CalculatIons 3 Records 3 Radiation Detection and Measurement 4 Transportation - 4 Biological Effects middot
~nnel TrainQln 5 Emergency Proceduresg) A _ ~~gt- 110690
-u Jgt
~ (S) LD shyI- (S)
01152013 1448 5173712013 C2AE PAGE 1010
~ 725 Prudden Street
~ l1lnsingMI48906c2aeit P ~173711200 Memo ~ F 0173712013 _ olovtlog hllman Qchlovumunl WWWC2aecom
To Paul L Risberg Radiation Safety Officer
From William J Kimble PE Chief Executive Officer
Date January 11 2013
Re Delegation of Authority Radiation Safety Officer
As of January 11 2013 you Paul L Risberg have been appointed Radiation Safety Officer for C2AE and are responsible for ensuring the safe use of radiation within the company
You are responsible for managing the Radiation Protection Program identifying radiation protection problems initiating recommending or providing corrective actions verifying implementation of corrective actions stopping unsafe activities and ensuring compliance with regulations
You are hereby delegated the authority necessary to meet those responsibilities including prohibiting the use of byproduct material by employees who do not meet the necessary requirements and shutting down operations where justified to maintain radiation safety You are required to notify management if staff does not cooperate and does not address radiation safety issues In addition you are free to raise issues with the Nuclear Regulatory Commission at any time It is estimated that you will spend 6 hours per week conducting radiation protection activities
Date
I accept the above responsibilities
cc NRC License ile Business Unit Leaders and Directors
01152013 1448 5173712013 C2AE PAGE 0410
APPE)1DIXB
ITEMS 5 AND 6 MATERIALS TO BE POSSESSED AND PROPOSED USES
CcsiUlTI-137x
x
Sealcd SOUTCr manufacturer Not to exceed Or distributor and model either the
number madmulU
Troxler - 3400 Series activity per
Device manufactuJel or distributor and model number Troxler - 34403430
sourct Or
maximum activity per device as specified io Seltlled Source and Device Registration Certificate
YesN
Specific description of the gauge use
To be used in
Troxler
3400 seIies
gauges for measurement
of physical
properties of
materials
DlNot applicable
o Uses are
(Submit satety analysis supporting safe use)
B-1 NURBG 1556 Vol 1 Rev I
01152013 1448 5173712013 C2AE PAGE 0510
APPENDIXB
o Not applicable
o USeS are Device manufacturer or distributor and model number
Sealed source manufacturer 252 Californium-x
or distributor and model number
Not to exceed either the maximum activity per source or maximwn activity per device as specified in Sealed Source and Device Registration Certificate
Yes 0
Specific description of the gauge use
(Submit safety analysis suppc)I1il1g safe use)
NUREG-lj56 VoL 1Revl B-2
C2AE PAGE 051001152013 1448 5173712013
APPENDIXB
ITEMS 7 THROUGH 11 TRAINING AND EXPERIENCE FACILITIES AND EQUIPMENT RADIATION SAFETY PROGRAM AND WASTE DISPOSAL
INDlVroOALS WORKING IN OR FREQUENTING RESTRICrEO AREAS
8
Item No And Title
TRAINING FOR
1o RADIATION SAFETY PROGRAM shy SURVEY INSTROMENTS
Suggested Re~ponse
Before using licensed materials authorized 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 in NUREG-1556 Vol 1 Rev 1 dated November 2001
Yes Alternlltive Procedures
Attached
We will either possess and use or have access to and use a radiation survey meter that meets the Criteria in the section entitled Radiation Safety Program - Instruments in NUREG-1556 Vol I Rev_ 1 dated November 2001
o
o
B-3 NUREG - 1556 Vol 1 Rev 1
01162013 1448 5173712013 C2AE PAGE 0710
APPENDTXB
Item No Alld Title
10 RADIATION SAFETY
Suggested Response
Either we wilJ maintain for inspection by
Yes Alternative Procedures Attached
o PROGRAMshyOCCUPATIONAL DOSIMETRY
NRC documentation demonstrating that unmonitored individuals are n01likely 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 ltIna evaluated by an NVLAP-approved pCOCeSsor that is exchanged at a frequency recommended by the processor
10 RADIATION SAFE1Y We wiil implement and maintain the operating o PROGRAMshyOPERATING AND EMERGENCY PROCEDURES
and emergency proceduns in AppendixH of NUREG-1556 Vol 1 Rev 1 dated November 2001 and provide copies ofthese procedures to all gauge tlserS and at each job site
OR
Operating and emergency procedu~es will be developed implcmmted md maintained and will meet the criteria in the section entitled Radiation Safety Program - Operating and Emergency Procedures in NUREG-1556 VoL 1 Rev 1 dated November 2001
0
NUREGmiddot 1556 Vol 1 Rev 1 8middot4
C2AE PAGE 08 100115 2013 1448 5173712013
APPENDIXB
Item No And Title
~
I
Suggested Response Yes Alternative Procedures Attached
i
lORADIATION SAFETY The applicant is not required to submit its Need Not Be Submitted PROGRAMshy response to tTansportation during the licensing Witll AI)Igtlication
TRANSPORTATION process However this issue will be reyjewed during inspection
B-5 NUREG - 1556 Vol J Rev 1
01
(SI I- W
I- p
p
(S) I- shyI-
shy10
Professional SelVice Industries Inc OJ
tJl I- ~ W
I-
~~ ~ i ~ f~ ~ ~~~~~- J ~ WRADIATION SAFETY TRAINING PROG-RAMmiddot ~
FOR
RADIATION SAFETY OFFICERS FOR
()lIOISTURE DENSITY GAUGES 10 Jgt
[TlTHIS IS TO CERT[FY THAT
PAUL RISBERG
Has Successfully Completed the Approved Corporate Radiation Safety Training Program for Radiation Safety OfficersInstructors
Subjects Induded in the course were as follows
REGULAT10NS RADIATION SAFETY 1 Security and Control 1 Principles of Radiation Safety 2 License Conditions 2 Radiation Dosage CalculatIons 3 Records 3 Radiation Detection and Measurement 4 Transportation - 4 Biological Effects middot
~nnel TrainQln 5 Emergency Proceduresg) A _ ~~gt- 110690
-u Jgt
~ (S) LD shyI- (S)
01152013 1448 5173712013 C2AE PAGE 1010
~ 725 Prudden Street
~ l1lnsingMI48906c2aeit P ~173711200 Memo ~ F 0173712013 _ olovtlog hllman Qchlovumunl WWWC2aecom
To Paul L Risberg Radiation Safety Officer
From William J Kimble PE Chief Executive Officer
Date January 11 2013
Re Delegation of Authority Radiation Safety Officer
As of January 11 2013 you Paul L Risberg have been appointed Radiation Safety Officer for C2AE and are responsible for ensuring the safe use of radiation within the company
You are responsible for managing the Radiation Protection Program identifying radiation protection problems initiating recommending or providing corrective actions verifying implementation of corrective actions stopping unsafe activities and ensuring compliance with regulations
You are hereby delegated the authority necessary to meet those responsibilities including prohibiting the use of byproduct material by employees who do not meet the necessary requirements and shutting down operations where justified to maintain radiation safety You are required to notify management if staff does not cooperate and does not address radiation safety issues In addition you are free to raise issues with the Nuclear Regulatory Commission at any time It is estimated that you will spend 6 hours per week conducting radiation protection activities
Date
I accept the above responsibilities
cc NRC License ile Business Unit Leaders and Directors
01152013 1448 5173712013 C2AE PAGE 0510
APPENDIXB
o Not applicable
o USeS are Device manufacturer or distributor and model number
Sealed source manufacturer 252 Californium-x
or distributor and model number
Not to exceed either the maximum activity per source or maximwn activity per device as specified in Sealed Source and Device Registration Certificate
Yes 0
Specific description of the gauge use
(Submit safety analysis suppc)I1il1g safe use)
NUREG-lj56 VoL 1Revl B-2
C2AE PAGE 051001152013 1448 5173712013
APPENDIXB
ITEMS 7 THROUGH 11 TRAINING AND EXPERIENCE FACILITIES AND EQUIPMENT RADIATION SAFETY PROGRAM AND WASTE DISPOSAL
INDlVroOALS WORKING IN OR FREQUENTING RESTRICrEO AREAS
8
Item No And Title
TRAINING FOR
1o RADIATION SAFETY PROGRAM shy SURVEY INSTROMENTS
Suggested Re~ponse
Before using licensed materials authorized 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 in NUREG-1556 Vol 1 Rev 1 dated November 2001
Yes Alternlltive Procedures
Attached
We will either possess and use or have access to and use a radiation survey meter that meets the Criteria in the section entitled Radiation Safety Program - Instruments in NUREG-1556 Vol I Rev_ 1 dated November 2001
o
o
B-3 NUREG - 1556 Vol 1 Rev 1
01162013 1448 5173712013 C2AE PAGE 0710
APPENDTXB
Item No Alld Title
10 RADIATION SAFETY
Suggested Response
Either we wilJ maintain for inspection by
Yes Alternative Procedures Attached
o PROGRAMshyOCCUPATIONAL DOSIMETRY
NRC documentation demonstrating that unmonitored individuals are n01likely 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 ltIna evaluated by an NVLAP-approved pCOCeSsor that is exchanged at a frequency recommended by the processor
10 RADIATION SAFE1Y We wiil implement and maintain the operating o PROGRAMshyOPERATING AND EMERGENCY PROCEDURES
and emergency proceduns in AppendixH of NUREG-1556 Vol 1 Rev 1 dated November 2001 and provide copies ofthese procedures to all gauge tlserS and at each job site
OR
Operating and emergency procedu~es will be developed implcmmted md maintained and will meet the criteria in the section entitled Radiation Safety Program - Operating and Emergency Procedures in NUREG-1556 VoL 1 Rev 1 dated November 2001
0
NUREGmiddot 1556 Vol 1 Rev 1 8middot4
C2AE PAGE 08 100115 2013 1448 5173712013
APPENDIXB
Item No And Title
~
I
Suggested Response Yes Alternative Procedures Attached
i
lORADIATION SAFETY The applicant is not required to submit its Need Not Be Submitted PROGRAMshy response to tTansportation during the licensing Witll AI)Igtlication
TRANSPORTATION process However this issue will be reyjewed during inspection
B-5 NUREG - 1556 Vol J Rev 1
01
(SI I- W
I- p
p
(S) I- shyI-
shy10
Professional SelVice Industries Inc OJ
tJl I- ~ W
I-
~~ ~ i ~ f~ ~ ~~~~~- J ~ WRADIATION SAFETY TRAINING PROG-RAMmiddot ~
FOR
RADIATION SAFETY OFFICERS FOR
()lIOISTURE DENSITY GAUGES 10 Jgt
[TlTHIS IS TO CERT[FY THAT
PAUL RISBERG
Has Successfully Completed the Approved Corporate Radiation Safety Training Program for Radiation Safety OfficersInstructors
Subjects Induded in the course were as follows
REGULAT10NS RADIATION SAFETY 1 Security and Control 1 Principles of Radiation Safety 2 License Conditions 2 Radiation Dosage CalculatIons 3 Records 3 Radiation Detection and Measurement 4 Transportation - 4 Biological Effects middot
~nnel TrainQln 5 Emergency Proceduresg) A _ ~~gt- 110690
-u Jgt
~ (S) LD shyI- (S)
01152013 1448 5173712013 C2AE PAGE 1010
~ 725 Prudden Street
~ l1lnsingMI48906c2aeit P ~173711200 Memo ~ F 0173712013 _ olovtlog hllman Qchlovumunl WWWC2aecom
To Paul L Risberg Radiation Safety Officer
From William J Kimble PE Chief Executive Officer
Date January 11 2013
Re Delegation of Authority Radiation Safety Officer
As of January 11 2013 you Paul L Risberg have been appointed Radiation Safety Officer for C2AE and are responsible for ensuring the safe use of radiation within the company
You are responsible for managing the Radiation Protection Program identifying radiation protection problems initiating recommending or providing corrective actions verifying implementation of corrective actions stopping unsafe activities and ensuring compliance with regulations
You are hereby delegated the authority necessary to meet those responsibilities including prohibiting the use of byproduct material by employees who do not meet the necessary requirements and shutting down operations where justified to maintain radiation safety You are required to notify management if staff does not cooperate and does not address radiation safety issues In addition you are free to raise issues with the Nuclear Regulatory Commission at any time It is estimated that you will spend 6 hours per week conducting radiation protection activities
Date
I accept the above responsibilities
cc NRC License ile Business Unit Leaders and Directors
C2AE PAGE 051001152013 1448 5173712013
APPENDIXB
ITEMS 7 THROUGH 11 TRAINING AND EXPERIENCE FACILITIES AND EQUIPMENT RADIATION SAFETY PROGRAM AND WASTE DISPOSAL
INDlVroOALS WORKING IN OR FREQUENTING RESTRICrEO AREAS
8
Item No And Title
TRAINING FOR
1o RADIATION SAFETY PROGRAM shy SURVEY INSTROMENTS
Suggested Re~ponse
Before using licensed materials authorized 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 in NUREG-1556 Vol 1 Rev 1 dated November 2001
Yes Alternlltive Procedures
Attached
We will either possess and use or have access to and use a radiation survey meter that meets the Criteria in the section entitled Radiation Safety Program - Instruments in NUREG-1556 Vol I Rev_ 1 dated November 2001
o
o
B-3 NUREG - 1556 Vol 1 Rev 1
01162013 1448 5173712013 C2AE PAGE 0710
APPENDTXB
Item No Alld Title
10 RADIATION SAFETY
Suggested Response
Either we wilJ maintain for inspection by
Yes Alternative Procedures Attached
o PROGRAMshyOCCUPATIONAL DOSIMETRY
NRC documentation demonstrating that unmonitored individuals are n01likely 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 ltIna evaluated by an NVLAP-approved pCOCeSsor that is exchanged at a frequency recommended by the processor
10 RADIATION SAFE1Y We wiil implement and maintain the operating o PROGRAMshyOPERATING AND EMERGENCY PROCEDURES
and emergency proceduns in AppendixH of NUREG-1556 Vol 1 Rev 1 dated November 2001 and provide copies ofthese procedures to all gauge tlserS and at each job site
OR
Operating and emergency procedu~es will be developed implcmmted md maintained and will meet the criteria in the section entitled Radiation Safety Program - Operating and Emergency Procedures in NUREG-1556 VoL 1 Rev 1 dated November 2001
0
NUREGmiddot 1556 Vol 1 Rev 1 8middot4
C2AE PAGE 08 100115 2013 1448 5173712013
APPENDIXB
Item No And Title
~
I
Suggested Response Yes Alternative Procedures Attached
i
lORADIATION SAFETY The applicant is not required to submit its Need Not Be Submitted PROGRAMshy response to tTansportation during the licensing Witll AI)Igtlication
TRANSPORTATION process However this issue will be reyjewed during inspection
B-5 NUREG - 1556 Vol J Rev 1
01
(SI I- W
I- p
p
(S) I- shyI-
shy10
Professional SelVice Industries Inc OJ
tJl I- ~ W
I-
~~ ~ i ~ f~ ~ ~~~~~- J ~ WRADIATION SAFETY TRAINING PROG-RAMmiddot ~
FOR
RADIATION SAFETY OFFICERS FOR
()lIOISTURE DENSITY GAUGES 10 Jgt
[TlTHIS IS TO CERT[FY THAT
PAUL RISBERG
Has Successfully Completed the Approved Corporate Radiation Safety Training Program for Radiation Safety OfficersInstructors
Subjects Induded in the course were as follows
REGULAT10NS RADIATION SAFETY 1 Security and Control 1 Principles of Radiation Safety 2 License Conditions 2 Radiation Dosage CalculatIons 3 Records 3 Radiation Detection and Measurement 4 Transportation - 4 Biological Effects middot
~nnel TrainQln 5 Emergency Proceduresg) A _ ~~gt- 110690
-u Jgt
~ (S) LD shyI- (S)
01152013 1448 5173712013 C2AE PAGE 1010
~ 725 Prudden Street
~ l1lnsingMI48906c2aeit P ~173711200 Memo ~ F 0173712013 _ olovtlog hllman Qchlovumunl WWWC2aecom
To Paul L Risberg Radiation Safety Officer
From William J Kimble PE Chief Executive Officer
Date January 11 2013
Re Delegation of Authority Radiation Safety Officer
As of January 11 2013 you Paul L Risberg have been appointed Radiation Safety Officer for C2AE and are responsible for ensuring the safe use of radiation within the company
You are responsible for managing the Radiation Protection Program identifying radiation protection problems initiating recommending or providing corrective actions verifying implementation of corrective actions stopping unsafe activities and ensuring compliance with regulations
You are hereby delegated the authority necessary to meet those responsibilities including prohibiting the use of byproduct material by employees who do not meet the necessary requirements and shutting down operations where justified to maintain radiation safety You are required to notify management if staff does not cooperate and does not address radiation safety issues In addition you are free to raise issues with the Nuclear Regulatory Commission at any time It is estimated that you will spend 6 hours per week conducting radiation protection activities
Date
I accept the above responsibilities
cc NRC License ile Business Unit Leaders and Directors
01162013 1448 5173712013 C2AE PAGE 0710
APPENDTXB
Item No Alld Title
10 RADIATION SAFETY
Suggested Response
Either we wilJ maintain for inspection by
Yes Alternative Procedures Attached
o PROGRAMshyOCCUPATIONAL DOSIMETRY
NRC documentation demonstrating that unmonitored individuals are n01likely 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 ltIna evaluated by an NVLAP-approved pCOCeSsor that is exchanged at a frequency recommended by the processor
10 RADIATION SAFE1Y We wiil implement and maintain the operating o PROGRAMshyOPERATING AND EMERGENCY PROCEDURES
and emergency proceduns in AppendixH of NUREG-1556 Vol 1 Rev 1 dated November 2001 and provide copies ofthese procedures to all gauge tlserS and at each job site
OR
Operating and emergency procedu~es will be developed implcmmted md maintained and will meet the criteria in the section entitled Radiation Safety Program - Operating and Emergency Procedures in NUREG-1556 VoL 1 Rev 1 dated November 2001
0
NUREGmiddot 1556 Vol 1 Rev 1 8middot4
C2AE PAGE 08 100115 2013 1448 5173712013
APPENDIXB
Item No And Title
~
I
Suggested Response Yes Alternative Procedures Attached
i
lORADIATION SAFETY The applicant is not required to submit its Need Not Be Submitted PROGRAMshy response to tTansportation during the licensing Witll AI)Igtlication
TRANSPORTATION process However this issue will be reyjewed during inspection
B-5 NUREG - 1556 Vol J Rev 1
01
(SI I- W
I- p
p
(S) I- shyI-
shy10
Professional SelVice Industries Inc OJ
tJl I- ~ W
I-
~~ ~ i ~ f~ ~ ~~~~~- J ~ WRADIATION SAFETY TRAINING PROG-RAMmiddot ~
FOR
RADIATION SAFETY OFFICERS FOR
()lIOISTURE DENSITY GAUGES 10 Jgt
[TlTHIS IS TO CERT[FY THAT
PAUL RISBERG
Has Successfully Completed the Approved Corporate Radiation Safety Training Program for Radiation Safety OfficersInstructors
Subjects Induded in the course were as follows
REGULAT10NS RADIATION SAFETY 1 Security and Control 1 Principles of Radiation Safety 2 License Conditions 2 Radiation Dosage CalculatIons 3 Records 3 Radiation Detection and Measurement 4 Transportation - 4 Biological Effects middot
~nnel TrainQln 5 Emergency Proceduresg) A _ ~~gt- 110690
-u Jgt
~ (S) LD shyI- (S)
01152013 1448 5173712013 C2AE PAGE 1010
~ 725 Prudden Street
~ l1lnsingMI48906c2aeit P ~173711200 Memo ~ F 0173712013 _ olovtlog hllman Qchlovumunl WWWC2aecom
To Paul L Risberg Radiation Safety Officer
From William J Kimble PE Chief Executive Officer
Date January 11 2013
Re Delegation of Authority Radiation Safety Officer
As of January 11 2013 you Paul L Risberg have been appointed Radiation Safety Officer for C2AE and are responsible for ensuring the safe use of radiation within the company
You are responsible for managing the Radiation Protection Program identifying radiation protection problems initiating recommending or providing corrective actions verifying implementation of corrective actions stopping unsafe activities and ensuring compliance with regulations
You are hereby delegated the authority necessary to meet those responsibilities including prohibiting the use of byproduct material by employees who do not meet the necessary requirements and shutting down operations where justified to maintain radiation safety You are required to notify management if staff does not cooperate and does not address radiation safety issues In addition you are free to raise issues with the Nuclear Regulatory Commission at any time It is estimated that you will spend 6 hours per week conducting radiation protection activities
Date
I accept the above responsibilities
cc NRC License ile Business Unit Leaders and Directors
C2AE PAGE 08 100115 2013 1448 5173712013
APPENDIXB
Item No And Title
~
I
Suggested Response Yes Alternative Procedures Attached
i
lORADIATION SAFETY The applicant is not required to submit its Need Not Be Submitted PROGRAMshy response to tTansportation during the licensing Witll AI)Igtlication
TRANSPORTATION process However this issue will be reyjewed during inspection
B-5 NUREG - 1556 Vol J Rev 1
01
(SI I- W
I- p
p
(S) I- shyI-
shy10
Professional SelVice Industries Inc OJ
tJl I- ~ W
I-
~~ ~ i ~ f~ ~ ~~~~~- J ~ WRADIATION SAFETY TRAINING PROG-RAMmiddot ~
FOR
RADIATION SAFETY OFFICERS FOR
()lIOISTURE DENSITY GAUGES 10 Jgt
[TlTHIS IS TO CERT[FY THAT
PAUL RISBERG
Has Successfully Completed the Approved Corporate Radiation Safety Training Program for Radiation Safety OfficersInstructors
Subjects Induded in the course were as follows
REGULAT10NS RADIATION SAFETY 1 Security and Control 1 Principles of Radiation Safety 2 License Conditions 2 Radiation Dosage CalculatIons 3 Records 3 Radiation Detection and Measurement 4 Transportation - 4 Biological Effects middot
~nnel TrainQln 5 Emergency Proceduresg) A _ ~~gt- 110690
-u Jgt
~ (S) LD shyI- (S)
01152013 1448 5173712013 C2AE PAGE 1010
~ 725 Prudden Street
~ l1lnsingMI48906c2aeit P ~173711200 Memo ~ F 0173712013 _ olovtlog hllman Qchlovumunl WWWC2aecom
To Paul L Risberg Radiation Safety Officer
From William J Kimble PE Chief Executive Officer
Date January 11 2013
Re Delegation of Authority Radiation Safety Officer
As of January 11 2013 you Paul L Risberg have been appointed Radiation Safety Officer for C2AE and are responsible for ensuring the safe use of radiation within the company
You are responsible for managing the Radiation Protection Program identifying radiation protection problems initiating recommending or providing corrective actions verifying implementation of corrective actions stopping unsafe activities and ensuring compliance with regulations
You are hereby delegated the authority necessary to meet those responsibilities including prohibiting the use of byproduct material by employees who do not meet the necessary requirements and shutting down operations where justified to maintain radiation safety You are required to notify management if staff does not cooperate and does not address radiation safety issues In addition you are free to raise issues with the Nuclear Regulatory Commission at any time It is estimated that you will spend 6 hours per week conducting radiation protection activities
Date
I accept the above responsibilities
cc NRC License ile Business Unit Leaders and Directors
01
(SI I- W
I- p
p
(S) I- shyI-
shy10
Professional SelVice Industries Inc OJ
tJl I- ~ W
I-
~~ ~ i ~ f~ ~ ~~~~~- J ~ WRADIATION SAFETY TRAINING PROG-RAMmiddot ~
FOR
RADIATION SAFETY OFFICERS FOR
()lIOISTURE DENSITY GAUGES 10 Jgt
[TlTHIS IS TO CERT[FY THAT
PAUL RISBERG
Has Successfully Completed the Approved Corporate Radiation Safety Training Program for Radiation Safety OfficersInstructors
Subjects Induded in the course were as follows
REGULAT10NS RADIATION SAFETY 1 Security and Control 1 Principles of Radiation Safety 2 License Conditions 2 Radiation Dosage CalculatIons 3 Records 3 Radiation Detection and Measurement 4 Transportation - 4 Biological Effects middot
~nnel TrainQln 5 Emergency Proceduresg) A _ ~~gt- 110690
-u Jgt
~ (S) LD shyI- (S)
01152013 1448 5173712013 C2AE PAGE 1010
~ 725 Prudden Street
~ l1lnsingMI48906c2aeit P ~173711200 Memo ~ F 0173712013 _ olovtlog hllman Qchlovumunl WWWC2aecom
To Paul L Risberg Radiation Safety Officer
From William J Kimble PE Chief Executive Officer
Date January 11 2013
Re Delegation of Authority Radiation Safety Officer
As of January 11 2013 you Paul L Risberg have been appointed Radiation Safety Officer for C2AE and are responsible for ensuring the safe use of radiation within the company
You are responsible for managing the Radiation Protection Program identifying radiation protection problems initiating recommending or providing corrective actions verifying implementation of corrective actions stopping unsafe activities and ensuring compliance with regulations
You are hereby delegated the authority necessary to meet those responsibilities including prohibiting the use of byproduct material by employees who do not meet the necessary requirements and shutting down operations where justified to maintain radiation safety You are required to notify management if staff does not cooperate and does not address radiation safety issues In addition you are free to raise issues with the Nuclear Regulatory Commission at any time It is estimated that you will spend 6 hours per week conducting radiation protection activities
Date
I accept the above responsibilities
cc NRC License ile Business Unit Leaders and Directors
01152013 1448 5173712013 C2AE PAGE 1010
~ 725 Prudden Street
~ l1lnsingMI48906c2aeit P ~173711200 Memo ~ F 0173712013 _ olovtlog hllman Qchlovumunl WWWC2aecom
To Paul L Risberg Radiation Safety Officer
From William J Kimble PE Chief Executive Officer
Date January 11 2013
Re Delegation of Authority Radiation Safety Officer
As of January 11 2013 you Paul L Risberg have been appointed Radiation Safety Officer for C2AE and are responsible for ensuring the safe use of radiation within the company
You are responsible for managing the Radiation Protection Program identifying radiation protection problems initiating recommending or providing corrective actions verifying implementation of corrective actions stopping unsafe activities and ensuring compliance with regulations
You are hereby delegated the authority necessary to meet those responsibilities including prohibiting the use of byproduct material by employees who do not meet the necessary requirements and shutting down operations where justified to maintain radiation safety You are required to notify management if staff does not cooperate and does not address radiation safety issues In addition you are free to raise issues with the Nuclear Regulatory Commission at any time It is estimated that you will spend 6 hours per week conducting radiation protection activities
Date
I accept the above responsibilities
cc NRC License ile Business Unit Leaders and Directors
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