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* i�.UNITED STATES

NUCLEAR REGULATORY COMMISSION REGION I

475 ALLENDALE ROAD KING OF PRUSSIA, PA 19406-1415

May 29, 2001

Ms. Susan F. Dean, President Construction Materials Testing, Inc. 152 Littleton Road Whitefield, NH

SUBJECT:

NH-419

APPROVAL OF PROPOSED ACTIVITIES IN NON-AGREEMENT STATES (NRC FORM 241) FOR CALENDAR YEAR 2001

Dear Ms. Dean:

This acknowledges receipt of NRC Form 241 dated May 24, 2001, and the $1,200 filing fee, which you submitted to report proposed activities in Non-Agreement States under the authority of the general license pursuant to 10 CFR 150.20.

In the future, please use the NRC Form 241 and mark the appropriate box for submitting revisions and clarifications. Please fax your revision or clarification and a copy of the appropriate fee to (610) 337-5269.

The NRC Form 241 must include specific changes, such as locations, dates of work and personnel. Work locations are subject to NRC inspection in accordance with requirements for a general license.

The total days of usage/storage through this reciprocity request is 64 days. If you have any questions, please call Sheryl Villar (610) 337-5239 or Rebecca J. Brown (610) 337-5260. Your cooperation is appreciated.

Sincerely,

3) John D irea ,Chief

Nuclear Materials Safety Branch Division of Nuclear Materials Safety

Enclosure: NRC Form 241

cc: State of Vermont

DOCUMENT NAME: G:XLAS\2001Approva1241 LtrConstruction.wpd To receive a copy of this document, indicate in the box: "C" = Copy without attachment/enclosure "E" Copy with attachment/enclosure "N" = No copy

HNAME 'Svillar/ j in ner•r. JDATE 105/29101 J-\In/mn i'

*FROM Conr' tr'ictiori Materials :in.. PHONE NO0. 5 03 8ý37 93-Y5 May. 24 2001 11:23PM P3 NVRC FORM;241 U.S,. NUCLEAR REGULATORY COMMISSION APPROVEi5BY(0M8; NO. 315O-0073 ~ Q/ Entimatad burden per responsto comply ith this M*ndakrycoffei~o reqluest: 15 minutes. Tb is rotiication is rvoujred'So that NRC me Schedule fmqpection of the acrvtvlesc to onsture ihat they nre cc--z.- : r2ktOfe-4 with requirements tor Protection 91 the public hptli an.

R~EPORT OF PROPOSED ACTIVITE INcm saey Sena 00mulatorregmmssin iiiES iN"Af saey Send omnsr ri burden estimate to the Aeftrdi Mn'N-AGREEMENT STATES, AREAS OF F" 4 (U 1A'ati1ntor DCO e-01lft b-Isrner e-rria orirosfignc~rgo

rxb~~~m:zlr A (3f-fo,~rlrs.qm~ n Wsi0 DC 20503, ItSr merel 10s tomPt0g, an informatizon oo ýo~ n dc~i 110 diePtay a 4.urrently valid OM B conftol number, the (P~a~s rad heifltrJ~rnsbofrecompleting rhiS form) NRC ryay u ondc 'P. Spnor. .rd ;5 perscii rio reauired 10 lAME F ~.~iIBE ~ ~ f~~i ~,po~;g ;nrc~ij~or~ Ccr',,,3 GC~ hao~ircspond to. th~ifraincletr Construction Material$ Testing, Inc. 2. TYPE OF REPORT

X: INI-IIIAL __ REIi. ' 1-52 'Littleton Road

4 IESCIlTA.3JDTL iWhitefield, NH Susan F, Dean/President

ST7lCPHONE NUIV2ER a FAC$ML M~ 017clude Area Cale) ""r A~ A'KCde (603) 837-9332 (603) 837-9335 7. ACTIViT-lzs To 2S CONDUCT7D UNDER T14E GENERAL LICENSE GJIVEN !IV 10t CFR 150.20

'.VE LL L0Gj c; G LEAK TESTING ANIXOP CALIBRATION.5 TELETHERAFIYIPFAD,IA1.Q-F. EV

X PORTABLE GAUGES OTHER tspectf,} ==F

F(AIQ0GRAPHY U> L;; OF PAC1<AGiNc (CERTIFICATES; CF! OVPLIANCer NUMAZEESS

= rMýXDRE ITtC'j~y STATEr 7:pcýt7 9. A T.Al. PHYSCOAL ADO~rzSOF WORK LOCATIONl SI Crou , 11u'Ii~~cro ri- SnIts -plot..-.,,,, .~ P-O. Box 909 (333 Citizens Road) tMarshfield, VT Water StOrage Reservoi Newport, VT 05855 Marshfi~eld, VT

10 CLIENT TELFPWlglr-JPMSER iWlI CAIT.S-'*.?:se'Z r'"13C1 4 - 5 2 2 .5 oesm NIC (80) 34-7169 12. DATES SCHEDULED' 13 NUMBER OF 14, 15. 01 OCTO TWORK DAYS ADD DELETE RFR(C UBP

TO N'JMBE TO EE MAYO4 2001 AJtlly't 31, 20 1 35 c I7

LIST ADDITIONAL WORK SITES ON SEPARATE SHEET(S) To INCLUt E ALL INFORMATION CONTAiNED IN ITEMS 9-16 ABOVE 17 LIST RADIOACTIVE MATERIAL,, WHICH WILL 5E FOSSESSED, USED. INSTALLED, SERVICED, Oft TI25TED r oxi1e r 3 4 40 S eri±e s lbier,.,d d~cr'etlon of Zype an flar~n edlt", fAtertar *realOSourcezs or Oiewtes tO be Used.) Portable density/mroisture gauge SrnCI-Cesiurt 137, Amer~cium 241, Beryllium 4 0 r,

1P EHMEANT STAT- SPECIFIC LICEtiiSE VfNHCk AlTHO11iZES TIJEOn5ýq T ODC IEIF U2FSAT XI~;I AEV~E wec ~ HESMEECEPT FOR LOC, TIC-,t Op USe. AS 19C;I IJIEM1 A S O E d o r o d s f h e ~ d ~ c li a r r o , m sta c cO m o -sn Y M e in itia l A fR C F o rmn 7 2 4 1 .) 4 1 9 N H 4 / 3 0 / 0 *THr: UNDERSIGNED. HERESY CERTIFY THAT:CRIIAIN M.T O PET YAPIAT

a. Air informationrinI this report (s ltrueand complete. I have read and understand the provision, of the generai license 10 CPR I SO.20 reprinted on the instructions ot tnit form: .no I undar'orio~ tha~tI 7,n required to com~ply with theste provisions as to alt byproduct, lource, or specIal nuctc.,r material whic~h I Posse&$ and use in norl.Aareement Satetr' Ci. offshore waters under the general license for which, thIS relport is filed Will) the U.S. Nuclear Regulatory CO~mlmi~in, I Urldtft~ald that aCtiVitles, incIudln0 storage. COndustiqd in n~rn-Agrevient States under general llcense 10 CFR 160.20 are limited to a, lrttl t 1790 dnv! in calendar year. With the exceptifon of Wont conducted in off-ZhOre waters, which is auttlorl~cd for an unlimited period of timre in the oslenvar yeir I understand that I maily be inSpected by NRC itt the abov* listed work site toosations and at the Licensee home dfficc adores& Yce activities ceriormeo ;,non.Agreement Statet or offshore Waters. I cinaerstand that Conduct of any activitieS not dencribili above!. including conduct of EICVtlvtes on dlates or locations~fern f'm zh~escr~ccn above~ gr withiout NRC outhorizatlon. may subject me to enforcement action, including civil or criminaI penaittes. PTF'-~ ~FIC~ .RSO or Manageen..r Repraseep.'me Alme ace rI..) sir2NATU~,/r.[ Susan F, Dpan/Radiation SO % A ?t\. V1ARNING. False statemyents In this certi71cate may be subject to 6ii an" rimna ii, n~alties. '1JRC regulations rquir tha fomisSIOns 0o

-le NRC be complote and arcurate in all material respects. 18 U.S.C. Section 1001, maetaciial offense to rnak.i w1fj~ ,l .atarment Or rooresen tation to any department or aqeilcy of the United States as to arty rM-atter Within itS ui.Iftediction.

JSE ONLYI !2 > ~ j

FROM Construction Materials Testing PHONE NO. :603 8937 9335 May.- 25 2001 05:16PM P3 IPAt PORM 241 ILUCLEAR REGULATORY COIMMISSION APPC' 'I BY CMB; No. 3190-oO13 EXPIRES: 37i1r.0C Estirya urden er roe~noneto compij Ivth hitsetand*jya~tycckeci

ruot- minuteas, i' notficeton is 1SUreduisdo that NRC niq =cadl lnripwcion of the actmaior to unsure Thot they are ccdu; ~accordance with requIremenlats (or protection of the 'pualic healtt a a- POPOED ~.,nuI~ INsafety.'Sand comrmonts ir~qrcingq burden astimate Jo the Rft-wgi L *.%" . PR P~sED CTIVTIE INInfw~oeneOron,? Tt~ El). .SNucear PeqIawwon, Conrmiasor N)"IN-AGREEMENT STATES. .14REAS OF E'!li"%n~ ~55.~1 '!' I hm0- -. ? IflIrn~~~ha to oj1isenc.gov s

%..Suw, ut Mainaqemenz Ono Sud,.

rt1`-:Jkr<AL JUXIbjUIi I JUN, OR OFFSHORE WA IX r- washinglD 2053 If 3mcns usea o dmose a nl; (Please read the instructions b efora cornpiorjn6 this fori I NRC may Fiat conduct o ____.r

?IAM6 ~ ~ ~ ~ ~ ~ ~ ~ ~~- "'/ L;resoýeo r&,,,px~ 0co ullk7Z7:=tond to, the informa, ion collecrion.

Construction Materials Testing, Inc. 2.JTA TYP EViOF REPORT ICAI

15 2 L it tIe t on Road ;exa, e a -1 4i~CENSSS CONTrACT AND IL

WhiefildNHSu~all F. Dean/President

S TELEPHONE NUM8ER 8 ~SML ~ri (b701.iO. A.-So C00i.) drci.ArS1"Ea .Ut3Ei

(6o~l)837932 (603)8837-9335 7. CTIITIS O B CODUCEDUNDR TlEGENERAL LIC ENSIE GIVEN IN I KF 150.2.0

'VELL LCGG:NG LEAK( 7STING ANOIOR CALI8RATiCNS TELETHERAPV/IRRAOIATCR.Se.%VIC;T

X PORTABLE GAUGES OTHER , Specify) z#

RADOIOGRAPH-Y ;WISER- AS USER 0; PACXAG:N0 (CERTIFICATES.OF COMPLIANCE NUMBER$M

8 CU~4T IA~c*. D~SSc'~YCC~trV ~~9. ACTUAL P14YSICAL ,ADDRESS OF WORK LOCATIONive 03 c01717131 an7 actI'P97 G/6,Oateocui±fl 3z I

V1- 0 .'t3 L- '0. CLIENT TELEPHONE NUMSER 11. WOR -'.CATION TEL;-! PHNENVIVSER J(Inclucjo Alen C~ooo,

FROm

Nay 2Y, 2001

LI ST.!7, LjS7 RADIOACTIVE MATERIAL., WHICH WILL 8r2 POSSESSED. USEO, INSTALLED. SERVICED, OR TESTED f 3xr 'ý!¶CILIUV cesna,401onr ot 1yo. ari OcjanmOrjr 1,diaclv~he material. zostod sourcesa. orctavicox to vo uved..c.J

tortab le d ens ity/moisture gauge 8mCi -Ce~sium 137 , Am'sric ium 241 , Beryllium~ 40

'0 ?GREEYýIT STATE SP6CiFj&IUC.ENse WCH AVYJTRIZES rNE UNO AS:G?.J5TO CONDUCT LiCNS NUOE AU11J1.~r.S'/IHCH AR.E! Tqr .mGEPC1T';R LOCATION OF USZ.APS PEO StDINIT~ ABOVE (Four COD149S Of the S~eCi,7C 11cenSO most OccOfflanye the initial NIRC Forn 241.141;TATE jEXVIR

4 9v.zýA

13. CERTIFICATION (MUST BE COMPLETED QlYAPPLICANT) THE UNDERSIGNED. HERESY rER7IFY THAT;

Ali information in this report Is truo and cemplite. I have read and understand the provision of the general license 10 CFR 160.20 reprinted on the ingiruCCcons of this form: a~nd I underntano ra In1 * required to comply with these provisions as to all byproduct. source. or special nuclear material whilch Ipossess anid use fin non-Aqrelimont Stnsa;e offsnore Waters undet The general license for Which TiT~s repast Is filed with the U.S. Nucleir Rogulatary CommIss-ton.

C I unidersatnd that activities, including storage. conducted~ Inon-Agreement States undarganeral lIcenso 10 CFR 190.20 are limited to acl ~Ct43If'0 d:vs in czlendlar year, WItri the exception of work Cccnducted in off-shore waitirc. which Is sLuttiorized for 3n un~limIted iperiod of timne in tile c.alendar vaea' 'j I understand thait I maw b insaec,.tei b~ N*. R-. --- -

non-Agreemenit States or Offshtore waters.sehon fl8Acesfr2tile errma

oIundervitand t3itj conducl 0>1 any XC~vtlvme not dleSCribec atove. including conduct Of aCtiVIties On 114tas Or locations 0lttoreng item -hose decz;Ocixt above or without NRC authOrtZatlan. m3Y subject Me go enfor-cment, aton-5i. cl,, IIt ivil 0. 1, .r'~t, ýFCý .RCV o a~ 0 ,n 4,-0eEI~~ AJ.,,7 * Tilie) SIGNATURE

.l. . ..ý ~ -EEj~ -U RSCi OFllg M3M290Mnai penaisies.b~ WLJ4,( reuaIn :ýreqietatg; ~ SI

JSE ONLY I ~ ~ fSIJ/~~~i6

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'le NRC be complete andi accurate In all material resPects. 13 U.S.C. Section 14301 mnakes it a criminal offense to makce ai willfully *.Ie tatem.Žnr or f eoresentailon to any department or agency of the United States as to any rnatrro wr1ithin5 i...J;.- ; -

FROM :Construction materials Testing PHONE NO. :603 837 9335 UsJ ~ V4J.U.1~5 .ýAX F 1xi IND F gul

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FROM : Construction Materials Testing PHONE NO. : 603 837 9335 May. 29 2001 02:17PM P2

5-29-20• 12 ,23,1i 'POM NH PAD HEALTH G03 225 2325 "" "

STATE OF NEW HAMPSI-RE

DEPARTMENT OF HEALTH AND HUMAN SERVICES

OFFICE OF COMMUNITY & PUBLIC HEALTH e HAZEN DExVE, CONCOAD, NH 0301.6527

603-271-4,501 1-800-552434, E&r-. 4601 TDD A•ees: I-SOW-7356-Z64

Donald L Shucaway CoaWm~sonier

KAthleen A. Duna S~COPY

March 30, 2001

Construction Materials Testing, Inc, ATTN, Susan F. Dean 152 Littleton Road Whitefield, New Hampshire 0359S

RE: Log No. 200103045 Gentlemen:

This is to acknowledge receipt of your request dated March 28, 2001, for renewal of Radioactive Material License No, 4 19R. Since this application was received in a timely manner, you are hereby authorized, under the provisions of New Hampshlre .ples for the Control of Ra\dditon He-P 4030.12, to continue to operate under the authorizations of your present license during th, interim reviow process until final action has been taken, or until April ^0, 2002, by which time tha Agency should have completed action on your request.

This letter should be retained in your files as verifoation that your licen!;e remains valid until an

amendment exending the license is issued, or the request is denied.

Sincerely,

original signed by DENNIS P. O'DOWD Dennis P. O'Dcwd, Supervisor Radioactive Material Section Bureau of Radiological Health

DPO/ineJ

FROM :. Construction Materials Testing PHONE NO. : 603 837 9335

FORM BRH-2B

May. 25 2001 05: 16PM P2

AUDIT R N° 20000 20 21

PAGE I of I PAGE

STAT7 '•'•HIRE

DEPARTMENT OF HEALTH AND HUMAN SERVICES

OFFICE OF COMMUNITY & PUBLIC HEALTH

BUREAU OF RADIOLOGICAL HEALTH

RADIOACTIVE MATERIAL LICENSE

Pursuant to the State of New Hampshire, Department of Health and Human Services' Bureau of Radiological Heaith

regulations and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued

authorizing the licensee to receive, acquire, own, possess. and transfer radioactive material listed below: and to use such

radioactive material for the purpose(s) and at the place(s) designated below, This license is subject to all applicable rules,

regulations, and orders of the Department of Health and Human Services' Bureau of Radiological Health now or hereafter in

effect and to any conditions specified below.

LICENSEE 3. LICENSE NO. 419R. Amendment No. 6

1 NAME Coi,,Srtiction Matcrials "rcstinm. Inc, 4. EXPIRATION DATE April 30, 2001

2. ADDRESS 152 littleron Road 5. FILE NUMBER

Whitefield. New Hahmpshire 03598

6.RADIOACTIVE MATERIAL (ELEMENT AND 7. CHEMICAL AND/OR PHYSICAL FORM 8. MAXIMUM AMOUNT OF

MASS NUMBER) RADIOACTIVITY WHICH LICENSEE MAY POSSESS AT ONE TIME

9. AUTHORIZED USE

CONDITIONS

!In uccordainc with application dated February 23, 2000, signed by Susan F. Dcan.New Hampshire RadioactiVc 'VMtcri-ii I.iccisc No. 41 9R Is hereby amended to extend the expiration date to that noted in Condition 4 above,

FOR THE DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF COMMUNITY & PUBLIC HEALTH

DATE CF ISSUANCE March 8, 2000- -

DIANE E. TEFFT. ADMINISTRATOR BUREAU OF RADIOLOGICAL HEALTH

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Construction Materials Testing, Inc. cr) Customer Contact List LL

February 28, 2W0 Custorw lo~CoI ~It

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Construction Materials Testing, Inc. Customer Contact List

February 28, 2000

Dale Bingham

Carroll Avery

Cwstaw er Pike Indu j, In. United Conslucfn

The Gernan Group

Engineers Consu'icejn, Inc, SupeiOrCortrelj Company

EvereNJ, Prescot, In:.

Lamoure Cfostruc.jo, Inc. Rivendell nlrdwste School Dkbrict Char'will Construction Compa"y Rlchlrd Varo

WE to Pike ndu*es, P.O. Box 180 LowWatesmdoi, " 0r848 UaftedConstrucon P.O.Box43 NeipAo•RNH 073"-3 The Gorman Group 564 Hayes Road E Burke, VT M,,32 Engineers Construction, Inc, P.O. Box 2187 S. Budinglon, VT 05407

Supelor Concrete Company 982 Minot Avenue Auburn, ME 04210 EverottJ. Prescot4 bc. 2318Airport Road Bafre,VT 05841 LaIoiIle Construcion, Inc. RO. Box ?9 Morrisvil3e,VT 05661 Rivendell Interstate School Distr PK0, Box 153 Orford, NH 03777 C•harmi Condstcton Comlpany P.O. Box 889 Meredit, H 03253

%603 2794538

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