U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150--0120 EXPIRES: 05/31/2015

APPLICATION FOR MATERIALS LICENSE

Estimated burden per response to comply with this mandatory collection request: 4.3 hours. Submittal of the application is necessary to detennine that the applicant is qualified and that adequate procedures exist to protect the public health and safety. Send comments regarding burden estimate to the lnfonnation Services Branch (T-5 F53), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail to lnfocollects.Resource@nrc.gov, and to the Desk Officer, Office of lnfonnation and Regulatory Affairs, NEOB-10202, (31 50-0120), Office of Management and Budget, Washington, DC 20503. If a means used to impose an infonnation collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the infonnation collection.

INSTRUCTIONS: SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION. SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW. *AMENDMENTS/RENEWALS THAT INCREASE THE SCOPE OF THE EXISTING LICENSE TO A NEW OR HIGHER FEE CATEGORY WILL REQUIRE A FEE.

APPLICATION FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH:

OFFICE OF FEDERAL & STATE MATERIALS AND ENVIRONMENTAL MANAGEMENT PROGRAMS DIVISION OF MATERIALS SAFETY AND STATE AGREEMENTS U.S. NUCLEAR REGULATORY COMMISSION WASHINGTON, DC 20555-0001

ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS:

IF YOU ARE LOCATED IN:

ALABAMA, CONNECTICUT, DELAWARE, DISTRICT OF COLUMBIA, FLORIDA, GEORGIA, KENTUCKY, MAINE, MARYLAND, MASSACHUSETTS, NEW HAMPSHIRE, NEW JERSEY, NEW YORK, NORTH CAROLINA, PENNSYLVANIA, PUERTO RICO, RljQQ~LSJ,aND, SOUTH CAROLINA, TENNESSEE, VERMONT, VIRGINIA, VIRGIN ISLANDS, c4t~\MRGINIA,

SEND APPLICATIONS TO:

LICENSING ASSISTANCE TEAM DIVISION OF NUCLEAR MATERIALS SAFETY U.S. NUCLEAR REGULATORY COMMISSION. REGION I 2100 RENAISSANCE BOULEVARD. SUITE 100 KING OF PRUSSIA, PA 19406-2713

0 Immediate lit. Normal Rel

IF YOU ARE LOCATED IN:

ILLINOIS, INDIANA, IOWA, MICHIGAN, MINNESOTA, MISSO~ a(&, {f5l Wl([:O~IN~ SEND APPLICATIONS TO : ~ f!g

MATERIALS LICENSING BRANCH U.S. NUCLEAR REGULATORY COMMISSION, REGION II MAR 1 8 2015 2443 WARRENVILLE ROAD, SUITE 210 LISLE, IL 60532-4352

ALASKA, ARIZONA, ARKANSAS, CALIFORNIA, COLORADO, HAWAII, IDA.ONMS.. LOUISIANA, MISSISSIPPI, MONTANA, NEBRASKA, NEVADA, NEW MEXICO, NORTH DAKOTA, OKLAHOMA, OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, TEXAS, UTAH, WASHINGTON, OR WYOMING,

PERSONS LOCATED IN AGREEMENT STATES SEND WPPUCmliJlUI IJ.S. NUCLEAR REGULA TORY COMMISSION ONLY IF THEY S SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION JURISDICTIONS. WISH TO POSSESS AND USE LICENSED MATERIAL I

1. THIS IS AN APPLICATION FOR (Check appropriate item)

[_ ! A. NEW LICENSE

[ __ I B. AMENDMENT TO LICENSE NUMBER

~ c. RENEWAL OF LICENSE NUMBER 2S-27Bo7-o / 3. ADDRESS WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED

l D 'f7 T("~~ bl e.- U. ~. l~ l i Sf e.-1 \ I ;Vt. T s C), D I

2. NAME AND MAILING ADDRESS oi>'APPLICANT (Include ZIP code)

. e*"'j i ~eeri:J 1L.-~~­P.D. Bo" Sts'l ~I is f L-ll1 fr'\ JS~ '\ OJ

4. NAME OF PERSON TO BE CONTACTED ABOUT THIS APPLICATION

l'f{)~)2.57- 0lSIR BUSINESS EMAIL ADDRESS

U'S@>crn. SUBMIT ITEMS 5 THROUGH 11 ON 8-112 X 11" PAPER. TH E TYPE AND SCOPE OF INFORMATION TO B GUIDE.

5. RADIOACTIVE MATERIAL

a. Element and mass number, b. chemical and/or physical form; and c. maiximum amount which will be possessed at any one time.

8. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS.

10. RADIATION SAFETY PROGRAM.

12. LICENSE FEES (Fees required only for new applications, with few exceptions') (See 10 CFR 170 and Section 170.31)

6. PURPOSE(S) FOR WHICH LICENSED MATERIAL WILL BE USED.

7. INDIVIDUAL(S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR TRAINING EXPERI ENCE.

9. FACILITIES AND EQUIPMENT.

11 . WASTE MANAGEMENT.

13. CERTIFICATION. (Must be completed by applicant) THE APPLICANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENTATIONS MADE IN THIS APPL/CATION ARE BINDING UPON THE APPLICANT.

THE APPLICANT AND ANY OFFICIAL EXECUTI NG THIS CERTIFICATION ON BEHALF OF THE APPLICANT. NAMED IN ITEM 2, CERTIFY THAT THIS APPLICATION IS PR EPARED IN CONFORMITY WITH TITLE 10, CODE OF FEDERAL REGULATIONS. PARTS 30, 32, 33. 34, 35, 36, 39, AND 40, AND THAT ALL INFORMATION CONTANED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF. . WARNING: 18 U.S.C. SECTION 1001 ACT OF JUNE 25, 1948 62 STAT. 749 MAKES IT AC RIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.

CERTIFYING OFFICER -- TYPED/PRINTED NAME AND TITLE SIGNATURE DATE

TYPE OF FEE FEE LOG AMOUNT RECEIVED CHECK NUMBER COMMENTS

$

APPROVED BY DATE

NRC FORM 313 (03-2013)

th 5 8 6 3 2 4

APPENDIXB

ITEMS 5 AND 6: MATERIALS TO BE POSSESSED AND PROPOSED USES

Yes No Radioisotope Manufacturer or QuantUy Use As Listed Specif}' Other Distributoc Model No. . onSSD Uses Not

Certlftcate Listed on SSD Certificate

Cesium-137 Sealed source manufacturer Not to exceed Yes~ pt.Not or distributor and model either the

Specific applicabl~

number: maximum activity per

description of

source or the gauge use:

:J Uses are: Device manufacturer or maximum t>t ea<u r i.t:J• '

} distributor and model activity per +he. AJ.. . ,.,~ ~Submit safety number: device as JJrDL"7ke< T,,-o ~.l e..r specified in analysis I i.P. 3 tf'1-o1 3 'f 111

Scaled Source Q

supporting safe and Device

tnetf-i!-r{ c.l $ use)

3 2-Lf I Registration

.i-V'l-st"rotet...!.. Certificate

~t;oo

Aniericium- Sealed sourcie manufiicturer Not to exceed YesJ' )31.Not 241 or distributor and inodel either the

Specific applicable

nurnbe6: maximum · activity per description of

. . the gauge use: source or 0 Uses are:

Device manufacturer or maximum

;:r~I ';G di tributor and model activity per .. number: device as (Submit safety

Tf" 'D ">J_ler specified in analysis

~4-lf D, ., fl I I Sealed Source {) supporting safe and Device

lma+~~( 4 use)

3 Z--4 I · · Registration ..

.J-nsf-ro fe..~ · Certificate

3 SoD

B-1 NUREG - 1556, Vol. I , Rev. 1

!ro. 8632 4

APPENDIX B

ITEMS 7 THROUGH 11: TRAINING AND EXPERIENCE, FACILITIES AND EQUIPMENT, RADIATION SAFETY PROGRAM, AND WASTE DISPOSAL

Item No. And Title Suggested Response Yes Alternative Procedures Attached

7. INDIVIDUAL(S) Before obtaining licensed materials. the ~ a RE PONSIBLE FOR proposed RSO wiJI ha\>e successfully RADIATION SAFETY completed one of the training courses PROGRAM AND THEIR described in Criteria in the section entitled

'TRAINING AND · lndividual(s) Responsible for Radiation EXPERIENCE - Safety Program and Their Training and "RADIATION SAFETY Experience - Radiation Safety Officer" in OFFICER NUREG-1556, Vol. 1, Rev. 1, dated

November2001 . ..

Name:S"r~Jte.nR. ~"-<'$ :

8. TRAINING FOR Before using licensed materials. authorized fi1. 0 INDIVIDUALS WORKING users will have successfully completed one of IN OR FREQUENTING the training course described in Criteria in the RESTRICTED AREAS section entitled "Training for Individuals

Working In or Frequenting Restricted Areas" in NUREG-1556, Vol. I , Rev I, dated November 2001.

?. .FACD..ITIES AND No information needs to be subnlitted in · Separate Item 9 EQUIPMENT • response to this 1tefu; key issues are addressed Response

under "R.adiatioD Safety Program - Public Need Not Be Submitied Dose" and '"Radiation Safety Program - Wluj AppllcaUon Operating and Emergency ProcedUtes. •

JO. RADIATION SAFETY The applicant is not required to, and should Need Not Be Submitted PROGRAM - AUDIT not. submit its audit program to NRC for With Application PROGR.\.M review during the licensing phase.

10. RADIATION StU'E.'TY The applicant iS rwt reqiiil-ed to submit a Need Not & ·Submitted PROGRAM - resi)Onse to the termination of activities With Application TERM.INA TJON OF sectioii dUring the initial application. ACTIVITIES Howe\iei; when the license expires when the

licensee <:eases operation, NRC Form 314 · must be submitted.

JO. RADIATION SAFETY We will either possess and use. or have access ~ 0 PROGRAM - SURVEY to and use, a radiation survey merer that meets INSTRUMENTS the Criteria in the section entitled "Radiation

Safety Program - Instruments" in NUREG-1556, Vol. 1, Rev. 1, dated November 200 I.

B-3 NUREG - 1556. Vol. 1. Rev. 1

APPENDIX B

Item No. And Title Suggested Response Yes Alternative Procedures Attached

JO. RADIATION SAFEn' Physical inventories ..,.;11 be conducted at If. 0 PROGRAM - MA TERIAI. intervals not to exceed 6 months. to account RECEIPT AND for all scaled sources and de,ices received ACCOUNTABILITY and possessed under the license.

10. RADIATION SAJo"ET\' Either we will maintain. for inspe~"lion by

"' :J

PROGRAM- NRC. documcnration demonstrating that OCCUPATIONAL unmonitored individuals arc nm likely to I>OSIJ\'IETRY receive a radiation dose in excess of

10 percent of the allowable limits in IO CFR Part 20, or we will provide dosimetry processed and evaluated by an NVLAP-approvcd processor that is exchanged at a frequency recommended by the processor.

IO. RADIATION SAFETY The applicant is not required to submit a Need Not Be Submitted PROGRAM - PUBUC response to the public dose section during the With Application DOSE licensing phase. This matter will be examined

during an inspt.-ction.

10. RADL.\TION SAFETY We will implement and maintain the opt.'Tating ~ ::J PROGRAM - and emergency procedures in Appendix H of OPER.\TING AND NUREG-1556. Vol. I. Rev. I. dated EMERGENCY November 2001. and provide copies of these PROCEDURES procedures to all gauge users and at each job

site.

OR

Operating and emergency procedures will be :1 developed, impkmcnted, and maintained and will meet the t.Titcria in the section enritlcd "Radiation Safety Program - Operating and Emergency Procedures" in NUREG-1556. Vol. I. Rev. I. dated November 2001.

10_ RADIATION SAFETY Leak lcsts will bt: performed at imcrvals " 0 PROGRAM - LEAK TEST approved by NRC or an Agreement Sate and

The specified in the Sealed Source and DeYice

information in Registration Sheet. Leak tests "'ill be AppendlxJ perfonned by an organization authorized by

NRC or an Agreement Stale to provide leak supporting a

testing senices for other licensees or using a ret1uest to

leak test kit supplied by an organization perform leak

authorized by NRC or an Agreement State to testing and

pro..,,ide leak test kils to other licensees and sample

according to the kit supplier's instructions. analysis Is atta<:hed.

NUREG - 1556, VoL I. Rev. I B-4

APPENDIX B

Item No. And Title Suggested Response Yes Alternative Procedures Attached

10. RADIATION SAFETY RoutiM Cli!aning and L11brication PROGRAM- We will implement and maintain procedures ~ MAINTENANCE for routine maintenance of our gauges

according to each manuracrurez-'s recommendations and instruetions.

Non-Routine Mainunance

We will send the gauge to the manufacturer or j). 0 other person authorized by NRC or an

The Agreement State to perform non-routine

information maintenance or repair operations .th t require

listed in the removal of the source or sourceIOd from

AppendlxG the gauge.

supporting a .. request to

perform non-routine maintenance In-house is attached.

IO.RADIATION SAFETY The applicant is not required to submit ilS Need Not Be Submitted PROGRAM- response to transportation during the licensing With Application

TRANSPORTATION process. However, this issue will be reviewed during inspection.

11. WASTE MANAGEMENT- The ai)piicant is not required to submit a Need Not Be Submitted GAUGE DISPOSAL' AND resJ)onse to waste management during the With Application TRANSFER licensing process. 'However, the licensee

should deVelop, implement. and maintain gauge transfer and disposal procedures in its · radiation protection program.

B-5 NUREG - 1556, Vol. I. Rev. I

5 8 ,-, 4

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t'.MS US POSTAGE AND FEES PAID

PRIORITY MAIL Mar 16 2015 Mailed from ZIP 59901 Priority Mail Flat Rate Envelope •

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PRIORI TY MAIL 2-DAY CMG CHERYL PO BOX 5159 1097 TRUMBLE CREEK RD KALISPELL MT 59903

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Shipped using PostalMatee Pkg : 110613 I

SHIP TO: USNRD, REGION IV MATERIAL RADIATION PROTECTION SECTION 1600 E LAMAR BLVD ARLINGTON TX 76011-4511

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5 8

NRC FORM 532 U.S. NUCLEAR REGULATORY COMMISSION (1-2012)

DATE

03/24/2015

NAME AND ADDRESS OF APPLICANT AND/OR LICENSEE LICENSE NUMBER

CMG Engineering, Inc. ATTN: Stephen R. Ayers Radiation Safety Officer P.O. Box 5159

25-27807-01

MAIL CONTROL NUMBER

586324

Kalispell, Montana 59903-5159 LICENSING AND/OR TECHNICAL REVIEWER

D [{]

D

CH

This is to acknowledge the receipt of your:

O LETTER and/or [{]APPLICATION DATED: 03/12/2015

The initial processing, which included an administrative review, has been performed.

D AMENDMENT D TERMINATION D NEW LICENSE 0 RENEWAL

There were no administrative omissions identified during our initial review.

This is to acknowledge receipt of your application for renewal of the material(s) license identified above. Your application is deemed timely filed, and accordingly, the license will not expire until final action has been taken by this office.

Your application for a new NRC license did not include your taxpayer identification number. Please fill out NRC Form 531, located at the following link:

http://www.nrc.gov/reading-rm/doc-col lections/forms/nrc531 . pdf

Send the completed NRC Form 531, by facsimile, to the following number: (301) 415-5387

A copy of your action has been emailed to our License Fee and Accounts Receivable Branch, in our Headquarters office in Rockville, MD. You will be contacted separately if there is a fee issue involved.

Your application has been assigned the above listed MAIL CONTROL NUMBER. When calling to inquire about this action, please refer to this control number. Your application has been forwarded to a technical reviewer. Please note that the technical review, which is normally completed within 180 days for a renewal application (90 days for all other requests), may identify additional omissions or require additional information. If you have any questions concerning the processing of your application, our contact information is listed below:

Region IV U.S. Nuclear Regulatory Commission DNMS/NMSB - B 1600 E. Lamar Boulevard Arlington, TX 76011-4511 (817) 200-1103 or (817) 200-1140

NRC FORM 532 (1-2012)

A,6y

BETWEEN:

Accounts Receivable/Payable

and

Regional Licensing Branches

[ FOR ARPB USE ]

INFORMATION FROM WBL

Program Code: 03121 Status Code: Pending Renewal

Fee Category: 3P

Exp. Date:

Fee Comments:

Decom Fin Assur Reqd: N

License Fee Worksheet - License Fee Transmittal

A. REGION

1. APPLICATION ATIACHED Applicant/Licensee: CMG ENGINEERING INC

Received Date: 03/18/2015 Docket Number: 3036909 Mail Control Number: 586324 License Number: 25-27807-01

Action Type: Renewal

2. FEE ATIACHED I ') Q{)

Amount: IJ::, O' {.rY) , ..-

Check No.: -7~C7 ' )

3. COMMENTS

Signed:

Date:

B. LICENSE FEE MANAGEMENT BRANCH (Check when milestone 03 is entered

1. Fee Category and Amount:

2. Correct Fee Paid. Application may be processed for:

Amendment:

Renewal:

License:

Signed:

Date: