11111 111111 11111 IIII III II 1111111 1111111 IIII liiiI IIIIII 1111111 IIIII 111111 IIII IIIIII III IIII IIIGL-702385-19

10/27/2014

NRC FORM 664

02 - 2004

10 CFR 31.5

SECTION 1

PAGE 1 of 2U.S. NUCLEAR REGULATORY COMMISSION

GENERAL LICENSEE REGISTRATION

APPROVED BY OMB: NO. 3150-0198 EXPIRES: 03/31/2010Estimated burden per response to comply with this mandatory collection request: 20 minutes. NRC will use this information to track general licensees and their devices to ensure a higherlevel of device accountability. Send comments regarding burden estimate to the Records and FOIA/Privacy Services Branch (T-5 F52), U. S. Nuclear Regulatory Commission, Washington,DC 20555-0001, or by internet e-mail to infocollects@nrc.gov to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0000). Office of Management andBudget, Washington, DC 20503. If a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and aoerson is not reouired to reseond to. the information collecthon.

Complete all six sections of this registration form. If any of the preprinted information is incorrect, provide thechanges in the applicable boxes. USE CAPITAL LETTERS.

General LicenseRegistration NumberGL-702385-19

SECTION 1 - GENERAL LICENSEE INFORMATION

Enter the company name and the street address/physical location of use for your device(s). Forportable devices, specify the primary storage location. Do not use a P.O. Box address.

Company Name: LITWAR PROCESSING CO

Department: LITWAR PREP PLANT

Address Line 1: STATE ROUTE 1/5 @ LITWAR

Address Line 2: AT MOUTH OF WARBRANCH

I ty: I IAEICity: IAEGER

State: WV Zip Code: 24844 -

Cateciorv: 7F---

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10/27/2014

IIIIIH III iii 111111 IIIII II HII IIISECTION 1

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: BOWMAN

First Name: WILLIAM Middle Initial: T

DTelephone: (304) 938-5700 Extension:

Title: 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: LITWAR PREP PLANT

Address Line 1: P.O. BOX 727

Address Line 2:

City: IAEGER

State: WV L Zip Code: 24844- 1I .1111 " [hi ll

]

]

]

]I

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11I11111 11111 1111 1111111 I IIIIIII IIIII1111 1111111I IIIII 111111 111111111 11111111GL-702385-19

10/27/2014 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SEC

Our records indicate that you have these devices. Please update the information as necessary. PAG

NRC Device Key 390959 (Internal Control Number)

Distributor/Distributed By: BSI INSTRUMENTS

Distributor License Number: 37-21226-02G

Manufacturer Name: BSI INSTRUMENTS

Device Model (Not Source Model): LB 330

Device Serial Number: 504-2-92

Transfer Date (Receipt Date): 05/15/1992SNot in possession of device (Also

complete Section 4.)

MM DD YYYY

1111I1IIIII,TION 2;E 1 of 8

Isotope (e.g. AM241)

1 C060

2

3

4

5

6

Activity (e.g. 100)

5.000000000

Unit (e.g. mCi)

mCi

DIDEDIDliiEEJZ

A A

1111 111111IIII 111111II III IIII III II11111111 11111111IIII 11111 11111 IIIlIIII IIII 11111 11111111IIIGL-702385-19

10/27/2014 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2

Our records indicate that you have these devices. Please update the information as necessary. PAGE 2 of 8

NRC Device Key 298861 (Internal Control Number)

Distributor/Distributed By: KAY-RAY/SENSALL, INC.

Distributor License Number: IL-01010-02

Manufacturer Name: KAY-RAY/SENSALL, INC.

Device Model (Not Source Model): 3660

Device Serial Number: 26747

Transfer Date (Receipt Date): 05/15/1989Not in possession of device (Also

E- complete Section 4.)

MM DD YYYY

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

1 CS137 100.000000000 mCi

2

3

4

5

6

,iiilI

WiLIEZEE'liiiWEDinDin

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I 1IIIII IIIII 11111 111II 11I1I 1I 111 1111111I III IIII IIIII 111I1 III III lIi IIIIII IllI IIIIIIGL-702385-19

10/27/2014 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECOur records indicate that you have these devices. Please update the information as necessary. PAC

NRC Device Key 299364 (Internal Control Number)

Distributor/Distributed By: TN TECHNOLOGIES, INC.

Distributor License Number: L01105I I I I -I I I IManufacturer Name: TN TECHNOLOGIES, INC.

Device Model (Not Source Model): 5201

Device Serial Number: B2151

Transfer Date (Receipt Date): 05/15/1993Not in possession of device (Also

'I complete Section 4.)

MM DD YYYY

,TION 2E 3 of 8

Isotope (e.g. AM241)

1 CS137

II L if I2

3

4

5

6 LI tIIJII

Activity (e.g. 100)

100.000000000

Unit (e.g. mCi)

mCiELDDinDIDDinDin_DiD

A A

1111 IIIII 1111111 11111111 IIII III III III IIIIIHI III IIII IIII 111 111111111 IGL-702385-19

10/27/2014 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SE(Our records indicate that you have these devices. Please update the information as necessary. PAG

NRC Device Key 546613 (Internal Control Number)

Distributor/Distributed By: KAY-RAY/SENSALL, INC.

Distributor License Number: IL-01010-02

Manufacturer Name: KAY-RAY/SENSALL, INC.

Device Model (Not Source Model): 7062B

Device Serial Number: $95J2201

Transfer Date (Receipt Date): 08/15/1995'Voot in possession of device (Also

E_41 complete Section 4.)

MM DD YYYY

11111IIIIITION 2E 4 of 8

Isotope (e.g. AM241)

1 CS137

2

3

4

5

6

Activity (e.g. 100)

100.000000000

Unit (e.g. mCi)

mCi

1IDDIIJDILIZDIII

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ii 11111111I IIIIII II IIIIII II I IIII111111111111 11111 UIIIIIIII IIII WII IHIII IIGL-702385-19

10/27/2014 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2

Our records indicate that you have these devices. Please update the information as necessary. PAGE 5 of 8

NRC Device Key 546614 (Internal Control Number)

Distributor/Distributed By: KAY-RAY/SENSALL, INC.

Distributor License Number: IL-01010-02

Manufacturer Name: KAY-RAY/SENSALL, INC.

Device Model (Not Source Model): 7062B

Device Serial Number: $95J2202

Transfer Date (Receipt Date): 08/15/1995Ajloot in possession of device (Alsow in complete Section 4.)

MM DD YYYY

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

1 CS137 100.000000000 mCi

2

3

4

5

6

DII"

DIII]DID

1111 11111I 1111111 11111II 11111 11111 lIIIIIIIM IIIIIIIII IIII~ iili 11 11111 1111 11111111IGL-702385-19

10/27/2014 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SEC

Our records indicate that you have these devices. Please update the information as necessary. PAG

NRC Device Key 608525 (Internal Control Number)

Distributor/Distributed By: TN TECHNOLOGIES, INC.

Distributor License Number: L01105

Manufacturer Name: TN TECHNOLOGIES, INC.

Device Model (Not Source Model): 5038

Device Serial Number: B179

Transfer Date (Receipt Date): 06/28/2000A 1._Not in possession of device (Also

W LI LZII_ ilfl ,J• complete Section 4.)

MM DD YYYY

11111IIIITION 2

E 6 of 8

Isotope (e.g. AM241)

1 CS137

2

3

4

5

6 LiJLIE2Z_

Activity (e.g. 100)

200.000000000

Unit (e.g. mCi)

mCi

A A

GL-702385-19

10/27/2014 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SE(Our records indicate that you have these devices. Please update the information as necessary. PAG

NRC Device Key 625274 (Internal Control Number)

Distributor/Distributed By: THERMO FISCHER SCIENTIFIC

Distributor License Number: L03524

I I I I I I I I I I IManufacturer Name: THERMO MEASURETECH

1 11 1 1 I-Tl I I 1 -T F l IDevice Model (Not Source Model): 5038

Device Serial Number: B181

Transfer Date (Receipt Date): 11/16/2000,,ot in possession of device (AlsoD ILII Di complete Section 4.)

MM DD YYYY

I11111113TION 2

E 7 of 8

.Isotope (e.g. AM241)

1 CS137

2

3

4

5

6 'Di ii

Activity (e.g. 100)

200.000000000

Unit (e.g. mCi)

mCi

A A

IIIIIIIIIIIIIIII 0111 li I I111 II IIIII11 IIII 11111111 11111 III IIII IIIIIIIGL-702385-19

10/27/2014 SECTION 2 - DEVICES SUBJECT TO REGISTRATION

Our records indicate that you have these devices. Please update the information as necessary.

NRC Device Key 681666 (Internal Control Number)

Distributor/Distributed By: KAY-RAY/SENSALL, INC.

Distributor License Number: IL-01010-02

Manufacturer Name: KAY-RAY/SENSALL, INC.

Device Model (Not Source Model): 7062P

Device Serial Number: 13215

Transfer Date (Receipt Date): 02/10/1982Not in possession of devic

El complete Section 4.)

MM DD YYYY

1I11I lIIII IIII IIIISECTION 2PAGE 8 of 8

I

ID:e (Also

Isotope (e.g. AM241)

1 CS137

2

3

4

5

6

Activity (e.g. 100)

100.000000000

Unit (e.g. mCi)

mCi

EDIZ

A A

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10/27/2014 SECTION 3SECTION 3 - ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1

Provide information about other devices you have that are subject to registration. Do not report specifically licensed devices.

Manufacturer Name

Initial Transferor Name

Initial Transferor License Number (if known)

Device Model Number (Not Source Model)

Device Serial Number

]I

]

0 Manufacturer/Initial Transferor listed aboveHow acquired and date (e.g.,from a distributor/manufacturer, 0 Other General Licensee Date Transferred: 111111 i ii!other licensee, other source)? I I I..

U Other Source (Received) -MM DD YYYY

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Isotope (e g AM241)

LZIIIJIJIEIZLZLIJIJILIIIDEIJIDLIIIIILZZIZLZEJIJIflDEZEIJEZLIlIiIflLZLIILZEZLIJIJIflELII Jill

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

IZILI~

EL

. . . . . . . . . . .

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IIIIIH IIIIIIIIIIIII IlWI11111111111 IIIII111111 01I1I IIII II 10 IIII II I 1 M11 liii 111 iiiI IlIIGL-702385-19 SECTION 4 - NOT IN POSSESSION OF DEVICE SECTION 410/27/2014Provide information about devices listed in Section 2 or 6, but no longer in your possession. PAGE 1 of e5-

Part I Transfer Date:

NRC Device Key: 131q 10 IQl 9 11 11 [q(from Section 2 or 6)

MM DD YYYYLocation of the Device:

o Whereabouts Unknown (complete Part 1 only) 0 Transferred to another general licensee (complete Parts 2 and 3)

o Never Possessed the Device (complete Part 1 only) 0 Transferred to a Specific Licensee (Not the manufacturer)

o Returned to Manufacturer (complete Part 1 only) (complete Part 2)

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

Company Name:

IDea r-mMIeFIn t hIl: 1 c1 1 Il 1 41, I, I IDepartment:

11 11111 Il 1 11111 11II11 I llAddress Line 1:

1 1411 0 I G I I, Ill I, I• In1oa lm 1 IL~n.I I I I. I I I IAddress Line 2:

City:

State: Zip Code: Y 6-j4- I I IJIJIPart 3 Enter the name of the individual responsible for this device:

Last Name:

First Name: Middle Initial:I I I I [ I [ I I'11:Telephone Number: EIILII I I Extension: [L E DTitle:

A A

GL-702385-19 SECTION 4 - NOT IN POSSESSION OF DEVICE SECTION 410/27/2014

Provide information about devices listed in Section 2 or 6, but no longer in your possession. PAGE +o1"• o fs

Part 1 Transfer Date:

NRC Device Key: 15 41l6 1 l/ 1 1311(from Section 2 or 6)

MM DD YYYYLocation of the Device:

o Whereabouts Unknown (complete Part 1 only) 0 Transferred to another general licensee (complete Parts 2 and 3)

o Never Possessed the Device (complete Part 1 only) pQTransferred to a Specific Licensee (Not the manufacturer)

O Returned to Manufacturer (complete Part 1 only) (complete Part 2)

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

IL.o I3sCompany Name:

Department:

I I I II II I I 1 III!1 I 1 1 1 1 1 11I I I IAddress Line 1:

I11 1 1 1 IlllllIII lFl- loWc ILm W Ial l III I I I II IAddress Line 2:

J I Ir I I I I I I I I I I I I 1i r: 1ICity:

l- qI I a I r L nState: Zip Code: 0-. 1 4IZI _

Part 3 Enter the name of the individual responsible for this device:

Last Name:

First Name: Middle Initial:

I .r 1-l 1 I I I T rl/FTelephone Number: ZIIZ ~ jExtension: Z IJIIITitle:

A A

I IIIIIII IIIII 111111 11II 11 11111 11111 11111 11111 11IIII 11II 111M IIII iiiII I IIIIIIII IIII 11111 JIlI lIII IIIIGL-702385-19 SECTION 4 - NOT IN POSSESSION OF DEVICE SECTION 410/27/2014

Provide information about devices listed in Section 2 or 6, but no longer in your possession. PAGE--of-

Part 1 Transfer Date:

NRC Device Key: I I/A/

(from Section 2 or 6)MM DD YYYY

Location of the Device:

O Whereabouts Unknown (complete Part 1 only) 0, Transferred to another general licensee (complete Parts 2 and 3)

O Never Possessed the Device (complete Part 1 only) A Transferred to a Specific Licensee (Not the manufacturer)

o Returned to Manufacturer (complete Part 1 only) (complete Part 2)

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

IL-Ol31S 1 lql I I I ICompany Name:

IId hle ,--I,•ol~l~l Is hle~l IsIIch I lle l, 1 W 1l, I CI I 1 1-IDepartment:

Address Line 1:1•1 14 1 ol A I IlIl Il, In l .oll IW al I I I I I I 1 1-IAddress Line 2.I

I I I .I II I I I I I I I I I I I I I I I I I ICity:

LK'l lalIr I I Ll c?,I lodI I I I I I I I I- I I I I I I I 1 I-State: Zip Code: I 8r 41 1 1-E K E D FPart 3 Enter the name of the individual responsible for this device:

Last Name:

I 1 1 I1 1 1 I 1 -T 1 1 I I I 1 1 1 1 1 I I 1 1 -1First Name: Middle Initial:

I III I I I I I F ITelephone Number: El EI LLIII Extension:[I ]I ]ITitle:

I I I I I I I I II I I I III III I I III

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GL-702385-1 9

10/27/2014 SECTION 4 - NOT IN POSSESSION OF DEVICE SECTION 4

Provide information about devices listed in Section 2 or 6, but no longer in your possession. PAGE 4-ef"

Part I Transfer Date: 4.04'SNRC Device Key: .192 lc 1; • ,5, 16: 1,•

(from Section 2 or 6)MM DD YYYY

Location of the Device:

o Whereabouts Unknown (complete Part 1 only) 0 Transferred to another general licensee (complete Parts 2 and 3)

o Never Possessed the Device (complete Part 1 only) X Transferred to a Specific Licensee (Not the manufacturer)

o Returned to Manufacturer (complete Part 1 only) (complete Part 2)

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

ILl0j3 5 Qlql I I l lI ICompany Name:

ITIh I m • I5Io I cI, h I ele14 1, 411, lCJ I JIDepartment:

Address Line 1:111411I 11 A ~ , I I 11.1 l I.l l l IW al I I I I I I 1 1-1Address Line 2:

City:I- l . l r I I L l l l l I c? nI1 IIIIState: ifZip Code: k- 6- 11I EPart 3 Enter the name of the individual responsible for this device:

Last Name:

I I I I I I I I I I I lI I J I I I -FTI-JI 1:First Name: Middle Initial:

Telephone Number: I I IIJ I I Extension:Title:

A A

GL-702385-19 SECTION 4 - NOT IN POSSESSION OF DEVICE SECTION 410/27/2014

Provide information about devices listed in Section 2 or 6, but no longer in your possession. PAGE I-e+-

Part I Transfer Date:

NRC Device Key: 7 j_7 I2.3 .(from Section 2 or 6)

MM DD YYYYLocation of the Device:

o Whereabouts Unknown (complete Part 1 only) 0 Transferred to another general licensee (complete Parts 2 and 3)

o Never Possessed the Device (complete Part 1 only) @ Transferred to a Specific Licensee (Not the manufacturer)

o Returned to Manufacturer (complete Part 1 only) (complete Part 2)

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

Company Name:

I-l h I el -I, ol I F I s el rl 1c1Q I I lt 1 It 1-l IC I I 1 1Department:

A ddr sI I I II:I I I I I I I I I I I

Address Line 1:I1•1 14 1 1 I ITllll l -- l- .I IL-n ý m I W l I IT ] I I I IF.IAddress Line 2.

1 1 1 1 1 I FII II I I I I I I I I I I I II1 1City:IX'ý u l Irl ILIQInIdI I I I I I I I I- I I I I I I I I IState: Zi oek8-W l

Part 3 Enter the name of the individual responsible for this device:

Last Name:

1 1 1 1 1I H I 1 1 11 1 I [ I I T I II I I I I I I

First Name: Middle Initial:I I I I II I I I I I I IFTelephone Number: Extension:

Title:

I III I II I I I I I I I

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I11111111111 111111111111IIIHill II III 11111III 11111I11111III 11111111 IIIIII 111111111II 11111II II IIGL-702385-19 SECTION 5 - CERTIFICATION SECTION 510/27/2014 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 applicable regulations may be viewed at the NRC website at:

http://www.nrc.gov/reading-rm/doc-collections/cfr)

A/•&-. &,at= /21A/ISIGNATURE - 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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lii IIIIIIII II1 IIII 111111 11111 11111 III1111II IIII III lIIIIII IIIIII IIIIIII III I111I1 11 IIIIII IIIIGL-702385-1910/27/2014 SECTION 6 - DEVICES NOT SUBJECT TO REGISTRATION SECTION 6

PAGE 1 of 1

NRC Device Key: Manufacturer License No:

Manufacturer Name:

Model Number: Serial #: Transfer Date: