GL-642159-1804/08/2014

NRC FORM 6402-200410 CFR 31.5

SECTION 1PAGE lof2

UA NUCLEA REGULATORYCONS WO

A iE REwG1TATIONNPPROV0 D BY OHS: NO. 3150-OIOS EXWA&. 03110"J"We leud bw~i per remponusel cmply wWg Ibis nu~dMW cdteeaim utuo": 2D nai& NR K wil.W Uds oftloSIMI "ftigswU lieromuaml ful claftes looseshfowlod ~d~moai fla. 6uaxwont a"%& wgdm*Wndbf Raor end F0IPvtvWSurcm S'uld~( FW), U. & Nulear R49WWV Cawimssm Wmt*VW,DC 2015-OO1. or by trisivi .oWb bedl u edsvgommf o theD"d OUWo, Q41c. ofbnwdm and tapiewy Alll.. NE0U-1MZ (25O@0O4. Q01as~of muapurtorkc

~~Wuiiqý C202.Imeswe kaeanidevwwalla calcisnclmow no deply *enwfuyvol OW 9Sam"alftaw,@ ftNC nv apnoowuct orsporaff. andmut, nt ra~e ~ hbondto ek~~a~edlci

CoupleftusuHs~eaftweloif E Ils bou~m 10ft 11"Yetlf Pi pmpebif MOOemdlsm I lcor"t*prlde Owlchange. In ihe applsAb boxes. U11 CAPITAL LEfTMES

GenAel Lkiens-LR ist-8ber

GL4421 P-S

SiCTIO I - GMEE LICENSEE IO--T-OW

Ernr Oew cqw~my ons and the street addeme/Plyslcalls of wwlor your dc.Is. Forpo imtbalk dve, e vspedft Prim. imnp Icakwi*n Do M me a P.O. ox addes.

Company Name: HOLLY FRONTIER LLC

A? i £1-cDepebment 300 MORRIE AVE

Address Line 1: 2700 EAST 5TH STREET

Address Li 2:1 1'' 1 1i _ " 1 .... 1 i 1 1l 1 1! 1 1 1 1i11 1 1 1 -CRY: roi, 4.71" T E

I I I I I I I I I I 1 1. 1 1 1 1 1 1 1 1 1 1 1 1

s=t,: WY Zip Cof: 32007 - EF-I 4IEI d II7. VIA.4

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11111111111111 II IIIIII II III I IIII Ul 1111111 1 IIIII I I IIIIII IIII IIII III IIIIIII iiiI IIII I I11111111111111 iiGL-642159-18 SECTION 104/08/2014

PAGE 2 of 2SECTION 1 - GENERAL LICENSEE INFORMATION (Continued)

Enter the name, telelphone number and title of the person who is the responsible individual for the device(s).

Last Name: INGRAHAMI I I I I I I I I I I I III Il I I I I I I I IFirst Name: WILLIAM Middle Initial: F

I I I I I I II I I I ITelephone: (307) 771-8823 Extension: 8823

DI fIIII I 1 EllFlllTitle: CURRENT SAFETY OFFICER

Enter the mailing address where correspondence regarding your device(s) should be sent.This address should be specific to the use or storage location of your device(s).

Department: SAFETY DEPARTMENT

Address Line 1: 300 MORRIE AVE

I I -I I 1 !H I I I 1 I-- 1 .- --- I- .J- - _ I JAddress Line 2: P.O. BOX 1588

City: CHEYENNE

State: VVY [L Zip Code: 82007 -1734 - EII J

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I 11NIII~tIlll II IIIIIIII EWH I iII.tH:HIWIiIMt flI! 1111II11!lii ! III Ji,~ll l liiiGL-642159-18

04/08/2014 SECTION _240 E, IG E S:U B.J-(-T'.iT•,•RFEG [,.T•JLTION -SECTIO1N 2Our. records.:indicate that you have eje qdvicesp,,., lease update the information as necessary. {PAGE 1 of 1

NRC Device Key 757411 (Internal Control Number)..

DistributorlDistriluted By:; THERMO SCIENWIFIC PORTABLE ANALYT;ICAL INSTR

Distributor License Number:. .53-03.88,.;• .... .... .. r , . , , ' .'• ' " . "* , . ' " . .. . .. . t:, Z-"

i i i : i i 1 ; '1 i t • i:'- ... . , ..... . ....

Manufacturer Name: NITON CORPOFaTION

• * • - •,.. .:1... *.. . .

Device Modeil (Not Source Model): XLP 818

Device Serial Number: 14035

Transfer Date (Receipt Date); 02/22/2007 ... .. Not in pos ession of device'

. . . .. U] (Also 6omplete Section 4.)

MM DD Y ,YYY •. .....

Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi)

1 AM241 - 30,00000000 0 mCi. . . . . I' I T-il I I [ 12

3 ..

I IIlE D I I ... I.. I I I I I II I I EI'4

6 , . . . ...5 ... " 1 " ,: " .... i " i ; i6: ,"

I IHIR~HIII,* .* , I EUREE!GL-642159-18 ~ oms~gwSECTtMt 404/0812014

Provide information abovulfmifs li fti lSCUMo rti o no b p IO PaMO . PAGE Of 1

Part I Transfer Date:

NRC Device Key:57 /// r 1;- [f(from Section 2 or 6) .

MM DD YYYYLocation of the Device:

o Whereabouts Unknown (complete Part I only) 0 Transferred to another general licensee (complete Parts 2 and 3)o Never Possessed the Device (complete Part i only) • Transferred to a Specific Licensee (Not the manufacturer)o Returned to Manufacturer (comptlet Pat I only) (complete Part 2)

Part 2 License Number of Recipient (if transferred to a specific licensee):

Company Name:

Department _

Address Line 1:

Address Line 2:I" i I I ! 1:111 1 i-•I II1 t1i1-t'l-11i11i111..1'City: _ _

State: ZipCode: '-[.]

Padt 3 EnWOr Un nem 40010 OIdWuM IMgopSile fpIIlOMhWIIIýLast Name:

First Me: Middle Irlif:.

Telephone Number. 6 S2 719 I~i Extnson LI -RTite:

L I I 1.- ... 11 L I 11L,.1 1 1... .1 1 . ... ... 1

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• lImIB IhEII~iM ilI IHlItlgII I..IGL-642159-18e2o159 •SECTI 4 -.NOT IN POSSESSION OF DEVICE

04P08=2r14

Provide Information about devices Noted In Section. 2 or 6, but no longer In your possession.

"1l1I'SECTION 4

PAGE 1 of I

Part INRCDevice= . 71 5 b Key:(from Section 2 or 6)

Transfer Date:

M

GL-642159-18 SECTION 5 - CERTIFICATION SECTION 504/08/2014 PAGE 1 of 1

I hereby certify that:

A. All information contained in this registration is true and complete to the best of my knowledge and belief.

B. A physical inventory of the devices subject to registration has been completed, and the device information on

this form has been checked against the device labeling.

C. I am aware of the requirements of the general license, provided in 10 CFR 31.5.

(Copies of applicabl re lations may be viewed at the NRC website at:

hftp://www.nc. g in -r /doc-collections/cfr)/

SIGNATURE - RESPONSIBLE INDIVIDUAL (Listed in Section 1) DATE

WARNING: FALSE STATEMENTS MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC

REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL

MATERIAL ASPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY

WRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED

STATES AS TO ANY MATTER IN ITS JURISDICTION.

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I III1I11 111111 1111 IIII IIIII 11111 11111II III III 111111 11111 iiiI iiiI I 111II1I1 iiiI 1111111 111I IIIIIIGL-642159-1804/08/2014 SECTION 6 - DEVICES NOT SUBJECT TO REGISTRATION SECTION 6

PAGE 1 of 1

NRC Device Key: 670565

Manufacturer Name: NITON CORPORATION

Model Number: 841S S

Isotope: CD109 Activity: 50.0000000O

Isotope: FE55 Activity: 20.0000000I

Manufacturer License No: 3G-105-02

erial #: U32956387L Transfer Date: 12/27/2001

0000

Unit: mCi

Unit: mCi