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04/05/2017

NRC FORM 664

07- 2015

10 CFR 31.5

APPROVED BY OMB: NO. 3150-0198

SECTION 1

PAGE 1of2 U.S. NUCLEAR REGULATORY COMMISSION

GENERAL LICENSEE REGISTRATION

EXPIRES: 04/30/2016

Estimated 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 higher level of device accountability. Send comments regarding burden estimate to the FOIA, Privacy, and Information Collections Branch (T-5 F53), U. S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail to [email protected], and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0198), Office of Management and Budget, 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 a person is not required to respond to, the information collection.

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

General License

Registration Number GL-3849-21

SECTION 1 - GENERAL LICENSEE INFORMATION

Enter the company name and the street address/physical location of use for your device(s). For

portable devices, specify the primary storage location. Do not use a P.O. Box address.

Company Name: BOARD OF MUNICIPAL UTILITIES

I I I I I I I I I I I I I Department: SIKESTON POWER STATION

I I I I I I I I I I I I I I I Address Line 1: 1551 W WAKEFIELD

I I I I I I I I I I Address Line 2: PO BOX 370

I I I I I I I I I I I I I I City: SIKESTON

I I I I I I I I I I I I I I I

State: MO rn Zip Code: 63801 - I I I - I I I I . I

11111111 11111111111111111111111111111 llll 1111111111111111111 I llllllll llll lllll llll lllllll Ill llll llll <: . · GL-3849-21

' 04/05/2017

SECTION 1 - GENERAL LICENSEE INFORMATION (Continued)

SECTION 1

PAGE 2of2 .

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

,.,. , ·. ·. Last Name: TURNBOW

I I I I I I I I I I I I I I I I I I I I I I I First Name: STEVE Middle Initial: D

1111111111· I I I D ··. ··.Telephone: (573) 475-3127 Extension:

... 1 I I 11 I I 11 I I I I I I I I I I ·' Title: RADIATION SAFETY OFFICER

I I I I I I I I I I I I I I I I I I I I I I I

' 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: SIKESTON POWER STATION

· I I I I I I I I I I I I I I I I I I I I I I I . Address Line 1: 1551 W WAKEFIELD

I,::: I I I I I I I I I I I I I I I I I I 1, . . . .. · Address Line 2: PO BOX 370

;:·;<<·.I I I I I I I I I 1· I I I I I I I I I I I I I City: SIKESTON

···. I I I I I . I I I I I I I I I I I I I I I I I I I . .. state: MO []] Zip Code: 63801 - I I I I I I - I I I I I

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.. · ... · 041os12017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 ·. · , Our records indicate that you have these devices. Please update the information as necessary. PAGE 1 of 34 .. · · •. '.:·:

. · NRC Device Key 48577 (Internal Control Number)

. . Distributor/Distributed By: TN TECHNOLOGIES, INC.

~; ··-I · I I I I I I I I I I I I I I I I I I I I I I I . Distributor License Number: L01105

_: I . I I I I I I I I I I I I I : ::,, ~-•·•Manufacturer Name: TN TECHNOLOGIES, INC.

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· ...•. ·:: ·NRC Device Key 48578 (Internal Control Number)

. .. Distributor/Distributed By: TN TECHNOLOGIES, INC.

+·1 ··· I I I I I I I I I I I I I I I I I I I I I I . I · . Distributor License Number: L01105

.::1 I I I I I I I I I I I I I . < Manufacturer Name: TN TECHNOLOGIES, INC.

.·\·:1 I I I I I I I I I I I I I I I I I I I I I I I · ' ·,.· Device Model (Not Source Model): 5197

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0410512011 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 .. · ·· .·. Our records indicate that you have these devices. Please update the information as necessary. PAGE 3 of 34 ·

NRC Device Key 48579 · · (Internal Control Number) ·.I

··.;I··· .. I I I I I I I I I I I I I I I I I I I I I ·I I :11

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. .. . . 04/05/2017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 ' Our records indicate that you have these devices. Please update the information as necessary. PAGE 4 of 34

· , NRC Device Key 48580 (Internal Control Number)


',I · I I I I I I I I I I I I I I I I I I I. I I I I .· · Distributor License Number: L01105

• '. :.1 . I I I I I I I I I I I I I .. :·Manufacturer Name: TN TECHNOLOGIES, INC.

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: ,· NRC Device Key 48581 (Internal Control Number) . ·.,.. .

.. ·• ·. Distributor/Distributed By: TN TECHNOLOGIES, INC .

.. I I I I I I I I I I I I I I I I I I I I I I I I · /-Distributorlicense Number: L01105

·. -I I I I I I I I I I I I I I <'.: ·,Manufacturer Name: TN TECHNOLOGIES, INC.

:·,<} ·I I I I I I I I I I I I I I I I I I I I I I I '.''·.·

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· · 0410512011 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 .

.; Our records indicate that you have these devices. Please update the information as necessary. PAGE 6 of 34

··• : ·· ••.. NRC Device Key 48582 (Internal Control Number) .. ; :t .

. - ; Distributor/Distributed By: TN TECHNOLOGIES, INC.

·<I . I I I I I I I I I I I I I I I I I I I I I I I .• ·. •· Distributor License Number: LO 1105

<I I I I I I I I I I I I I I • '.Manufacturer Name: TN TECHNOLOGIES, INC .

. -">I I I I I I I I I I I I I I I I I I I I I I I I : ; · Device Model (Not Source Model): 5197

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· : . 041os12011 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 . · .. · . Our records indicate that you have these devices. Please update the information as necessary. PAGE 7 of 34 ·.

,,,. '

Y NRC Device Key 48583 (Internal Control Number)


·:'_ I · I I I I I I I I I I I I I I I I I I I I I I I · · · · · ... ·. Distributor License Number: L01105

-J ·. I I I I I I I I I I I I · ->'.Manufacturer Name: TN TECHNOLOGIES, INC.

:: .I I I I I I I I I I I I I I I I I I I I I I I I • i /

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:· 1 I · 1 I I I I I I I I I I I I I I I I I I I I I . ·• Device Serial Number: 8438

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''.-

. ·. NRC Device Key 48584 (Internal Control Number)

.~··) D.istributor/Distributed By: TN TECHNOLOGIES, INC .

. ::::I I I I I I I I I I I I I I 1 · I I I I I I I I I · .. Distributor License Number: L01105

. I I I I I I I I I I I I I I . Manufacturer Name: TN TECHNOLOGIES, INC.

·::.I · I I I I I I I I I I I I I . I I I I I I I I I I · . <Device Model (Not Source Model): 5197

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.. > 04/05/2017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 . , ". · Our records indicate that you have these devices. Please update the information as necessary. PAGE g of 34

· •·· .· N·Rc Device Key 48585 (Internal Control Number)

.. ,\Distributor/Distributed By: TN TECHNOLOGIES, INC. .

; .. -":l I I I I I I I I I I I I I I I I I I I I I I I :': '· Distributor License Number: L01105

-"·· I I I I I I I I I I I I I I .. Manufacturer Name: TN TECHNOLOGIES, INC.

<ti I I I I I I I I I I I I I I I I I I I I I I ! .: ·. Device Model (Not Source Model): 5197

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·' ··.:.

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0410512011 SECTION ·2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 .

, · · Our records indicate that you have these devices. Please update the information as necessary. PAGE 1 Q of 34

·._ · > NRC Device Key 48586 (Internal Control Number)

<'.Distributor/Distributed By: TN TECHNOLOGIES, INC.

· ! I I I I I I I I I I I I I I I I I I I I I I 1 · I , : : Distributor License Number: L01105

>l I I I I I I I I I I I I I :.Manufacturer Name: TN TECHNOLOGIES, INC.

-<I ·I I I I I I I I I I I I I I I I I I . I I I I I :/ ·Device rylodel (Not Source Model): 5197

·f I I I I I I I I I I I I I I I I I I I I I I I ·. :•·)·Device Serial Number: 8441

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:;>•rnrn1 I I I ' MM DD YYYY

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04/05/2017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 : , : - Our records indicate that you have these devices. Please update the information as necessary. PAGE 11 of 34

: '. NRC Device Key 48587 (Internal Control Number)

<. Distributor/Distributed By: TN TECHNOLOGIES, INC.

'·'1 - I I I I I I I I I I I I I I I I I I I I I I I · ·_ '.-': Distributor License Number: L01105

. '.·:I - I I I I I I I I I I I I I :::;; . M'anufacturer Name: TN TECHNOLOGIES, INC. ,···,_~~~~~~~~~~~~

-_./I I I I I I I I I I I I I I I I I I I I I I I I .. , :Device Model (Not Source Model): 5197

I I I I I I I I I I I I I I I I I I I I I I I I •_ /' Device Serial Number: 8442

\;~l 1 I I I I I I I I I I I I I I I I I I I I I I I ~. Transfer Date (Receipt Date): 08/15/1979

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04/05/2017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 ; : Our records indicate that you have these devices. Please update the information as necessary. PAGE 12 of 34

. •; ·: : NRC Device Key 48588 (Internal Control Number)

·.·•··.,Distributor/Distributed By: TN TECHNOLOGIES, INC.

: · 1 I I I I I I I I I I I I I I I I I I I I I . I I · ·•.·Distributor License Number: L01105

: ·1 I I I I I I I I I I I I I . •.·.·:'·Manufacturer Name: TN TECHNOLOGIES, INC.

·.I I I I I I I I I I I I I I I I I I I I I I I ; . · D,evice Model (Not Source Model): 5197

r1 I I I I I I I I I I I I I I I I I I I I I I I ;.·.

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: ·I · I I I I I I I I I I I I I I I I I I I I I I I I I .. '····

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. ···Transfer Date (Receipt Date): 08/15/1979

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' ·. .. 04/05/2017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 · : · Our records indicate that you have these devices. Please update the information as necessary. PAGE 13 of 34 · ..

: ·: NRC Device Key 48589 (Internal Control Number)

. ; : ·Distributor/Distributed By: TN TECHNOLOGIES, INC.

·./I-· I I I I I I I I I I I I I I I I I I I I I I I ··_:·1·-

· •···· Distributor License Number: L01105

:<J · I I I I I I I I I I I I I ..•. Manufacturer Name: TN TECHNOLOGIES, INC.

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· > NRC Device Key 48590 (Internal Control Number)

: : Distributor/Distributed By: TN TECHNOLOGIES, INC .

. I I I I I I I I I I I I I I I I I I I I I I I I ·: .. :···Distributor License Number: L01105

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< : 0410512011 SECTION 2 - DEVICES SUBJl:CT TO REGISTRATION SECTION 2 : :· Our records indicate that you have these devices. Please update the information as necessary. PAGE 15 of 34 ,' > NRC Device Key 48591 (Internal Control Number) · .... : ..

. : . Distributor/Distributed By: TN TECHNOLOGIES, INC.

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48592 (Internal Control Number)

: }iDistributor/Distributed By: TN TECHNOLOGIES, INC.

· :·1 I I I I I I I I I I I I I I I I I I I I I I I .•; Distributor License Number: L01105

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· · 0410512011 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 . . · > Our records indicate that you have these devices. Please update the information as necessary. PAGE 17 of 34

·:. · NRC Device Key 665377 (Internal Control Number)

. '; , Distributor/Distributed By: TN TECHNOLOGIES, INC.

· .:1 I I I I I I I I I I I I I I I I I I I I I I I • ·Distributor License Number: L01105

·:::<:1 I I I I I I I I I I I I I · Manufacturer Name: TN TECHNOLOGIES, INC.

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. · .· · 0410512011 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 \ : Our records indicate that you have these devices. Please update the information as necessary. · PAGE 18 of 34

· · · NRC Device Key 665378 (Internal Control Number)

<~Distributor/Distributed By: TN TECHNOLOGIES, INC.

;'.:rl I I I I I I I I I I I I I I I I I I I I I I I ·;· ..

·· Distributor License Number: LO 1105

: ·::1 I I I I I I I I I I I I I :··<Manufacturer Name: TN TECHNOLOGIES, INC.

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> Our records indicate that you have these devices. Please update the information as necessary. PAGE 19 of 34 ·. ·


. : Distributor/Distributed By: TN TECHNOLOGIES, INC.

<·I· 1 · I I I I I I I I I I I I I I I I I I I I I I ·· •· . Distributor License Number: L01105 ·

. :_,~J I I I I I I I I I I I I I ·Manufacturer Name: TN TECHNOLOGIES, INC.

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.· . 041os12011 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 . ; ·: ,.,

' .·' Our records indicate that you have these devices. Please update the information as necessary. PAGE 20 of 34 . · .··

, ·. NRC Device Key 665380 (Internal Control Number)

.... · .. ·Distributor/Distributed By: TN TECHNOLOGIES, INC.

: ] . I I I I I I I I I I I I I I I I I I I I I I I ·. _:: Distributor License Number: L01105

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·, · · 041os12011 SECTION 2. - DEVICES SUBJECT TO REGISTRATION SECTION 2 . · > ·' Our records indicate that you have these devices. Please update the information as necessary. PAGE 21 of 34

·. · .. · NRC Device Key 665381 (Internal Control Number)

·.··•,Distributor/Distributed By: TN TECHNOLOGIES, INC.

. .>:I. I I I I I I I I I I I I I I · I I I I I I I I I .·: > Distributor License Number: L01105

, I . I I I I I I I I I I I I I : Manufacturer Name: TN TECHNOLOGIES, INC.

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04/05/2017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2

1

. ; Our records indicate that you have these devices. Please update the information as necessary. PAGE 22 of 34 · . •• •.

~ .. ·· . NRC Device Key 665382 (Internal Control Number)

·•· . ··Distributor/Distributed By: TN TECHNOLOGIES, INC.

·.1 I I I I I I I I I I I I I I I I I I I I I I I ' I

·':: Distributor License Number: L01105 · .. · · '. I

>)I I I I I I I I I I I I I I ~·J Manufacturer Name: TN TECHNOLOGIES, INC .

. fl I I I I I I I I I I I I I. I I I I I I I I I I ··. ·· Device Model (Not Source Model): 5219

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' ' 04/05/2017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 • .=· Our records indicate that you have these devices. Please update the information as necessary. PAGE 23 of 34

.. <· NRC Device Key 665383 (Internal Control Number)

.,' '. Distributor/Distributed By: TN TECHNOLOGIES, INC.

1.:_ 1 I I I I I I I I . I I I I I I I I I I I I I I I I

i · Distributor License Number: L01105

'<JI I I I I I I I I I I I I -;,:;: Manufacturer Name: TN TECHNOLOGIES, INC.

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:<·! I I I I I I I I I I I I I I I I I I I I I I : ; Device Serial Number: 870

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,, ; 0410512011 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 · : · Our records indicate that you have these devices. Please update the information as necessary. PAGE 24 of 34 . :

; < . NRC Device Key 665384 (Internal Control Number)

... Distributor/Distributed By: TN TECHNOLOGIES, INC.

: I I I I I I I I I I I I I I I I I I I I I I I I · : Distributor License Number: L01105

:. :~ I I I I I I I I I I I I I I .· Manufacturer Name: TN TECHNOLOGIES, INC. ·

::· J · I I I I I I I I I I I I I I I I I I I I I I I .. · .Device Model (Not Source Model): 5219

. I I I I I I I I I I I I I I I I I I I I I I I I ·. · Device Serial Number: 871

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. NRC Device Key 665385 (Internal Control Number)

, > Distributor/Distributed By: TN TECHNOLOGIES, INC.

· :- ~ ::J . . I I I I I I I I I . I I I I I I I I I I I I I I .,·

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·:.::}·1 I I I . I I I I I . I I I · 1 I , ·.·. Manufacturer Name: TN TECHNOLOGIES, INC.

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<_; NRC Device Key 665386 (Internal Control Number) ...

'· . Distributor/Distributed By: TN TECHNOLOGIES, INC .

. ·>·I I I I I I I I I I I I I I I I I I I I I I I I · • ···. Distributor License Number: L01105

·:·1.· I I I I I I I I I I I I I 0 Manufacturer Name: TN TECHNOLOGIES, INC.

··,· ..

_,:;~I ~I ~I ~I ~I ~I ~I ~I ~I ~l~l~l~l~l~l~l~\~\~\~l~l~\~I

· Device Model (Not Source Model): 5219

.<I I I I I I I I I I I I I I I I I I I I I I I ; ... :>.Device Serial Number: 873

:···:~;I . I I I I I . I I I I I I I I I I I I I I I I I I i ••.. ;

~· . '·. ·. Transfer Date (Receipt Date): 08/15/1979

1;·:;·rnrn1111 :< · MM DD YYYY !- . '

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50.000000000

\ \ I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I

I I I I I I I I


Unit (e.g. mCi)

mCi

I I I I I I I I I I I I I I I I I I I I I I I I ...


: ·, ' I lllllll llllll II llllll lllll lllll lllll llll llllll lllll llll llll I llllllll llll lllll llll llll llll ' ' ' < . , GL-3849-21

:' . . 041os12011 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 '. ) Our records indicate that you have these devices. Please update the information as necessary. PAGE 27 of 34 · ·

; i ,._ I

,: > NRC Device Key 665387 (Internal Control Number) · I

' .. ··. Distributor/Distributed By: THERMO FISCHER SCIENTIFIC

.-:: I I I I I I I I I I I I I I I I I I I I I I I I ·' ·~ .

. ). : Distributor License Number: L03524

.> I · I I I I I I I I I I I I I : '< Manufacturer Name: THERMO MEASURETECH

-·".I l I I I I I I l I l I l I l I l l l I I l l I ' ·!.· •''

.·· > Device Model (Not Source Model): 7062P

.' >l l I I , I I I I I l l I l I l l l l l l l l I · · ·.· .. •. 'Device Serial Nu_mber: 10089

'.·/_.:1 ··. I I I I I I I I I I I I I I I I I I I I I I •.;/:Transfer Date (Receipt Date): 08/15/1979

·<.:,.:::rnrn1 I I I MM DD yyyy

D No~in possession of device (Also complete Section 4.)

!•.------------------' '' ' · Isotope (e.g. AM241)

:· 1 CS137

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· ,>: I I I •'6

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50.000000000


I l I I I I I I I I I I I


l l l l l I I I I I I I I

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mCi

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,: :". GL-3849-21

. . . 0410512011 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 . · < · Our records indicate that you have these devices. Please update the information as necessary. PAGE 28 of 34 . · ··

.. · .· NRC Device Key 665388 (Internal Control Number)

· ':, .. ·.Distributor/Distributed By: T.HERMO FISCHER SCIENTIFIC

·,I I I I I I I I I I I I I I I I I I I I I I I I •. ; : Distributor License Number: L03524

·· ··:1 · I I I I I I I I I I I I I . ;;._;·'Manufacturer Name: THERMO MEASURETECH

/~~1 I I I I I I I I I I I I I I I I I I I I I I I : : :, Device Model (Not Source Model): 7062P

: I I I I I I I I I I I I I I I I I I I I I I /",, Device Serial Number: 10090

,.,:.,I · I I I I I I I I I I I I I I I I I I I I I I .·•· Transfer Date (Receipt Date): 08/15/1979

.:/CDCDI I I I <.i

·.' MM DD yyyy

.: Isotope (e.g. AM241)

, 1 CS137

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50. 000000000

I I I I

I I I I

I I I

I I I


Unit (e.g. mCi)

mCi

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I I I I I I I I I I I I I I

. '

. I

., t

•• 1

I. ,1

< : .111111111111111111111111111111111111111111111111111111111111 111111111111111111111111111111 •. •. : . GL-3849-21

04/05/2017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 ' · ...•• Our records indicate that you have these devices. Please update the information as necessary. PAGE 29 of 34


Distributor/Distributed By: THERMO FISCHER SCIENTIFIC

.··::1 I I I I I I I I -I I I I I I I I I I I I I I I •· :: . ' Distributor License Number: L03524

>·J I I I I I. I I I I I I I I :···.,:., .

/<'(Manufacturer Name: THERMO MEASURETECH

:; ·I I I I I I I I I I I I I I I · I I I l l l l l I Device Model (Not Source Model): 7062P

)I I I· I I I i · I I I I I I I I I I I I I I I I .· •. ·· Device Serial Number: 10091

.· I I I I I I I I I I I I I I I I I I I I I I I I , •• •. Transfer Date (Receipt Date): 08/15/1979

:: .. ~:~:rn rn I I I I ;,· •.·,

·\· MM DD YYYY

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> 1 CS137

.> . I I I I I I 2

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50.000000000



Unit (e.g. mCi)

mCi

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. " . ' .

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('. .

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..

. ' . • I •

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. : :~ . . ' .

. . 04/05/2017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 . ·,; Our records indicate that you have these devices. Please update the.information as necessary. PAGE 30 of 34 . · ::

.· . NRC Device Key 665390 (Internal Control Number)

i · .. Distributor/Distributed By: THERMO FISCHER SCIENTIFIC

.;;:I I I I I I I I I I I I I I I I I I I I I I I I . '·• Distributor License Number: L03524

. '• .

'..·~~Manufacturer Name: THERMO MEASURETECH

· · ~. ·I I I I I I I I I I I I I I I I I I I I I I 1

• • Device Model (Not Source Model): 7062P

: I I I I I I I I I I I I . I I I I I I I I . I I I I . . : Device Serial Number: 10092

?.:··] I I I I I I I I I I I I I I I I I I I I I I I I 1 •••

. : : Transfer Date (Receipt Date): 08/15/1979

'"ITJITJI I I I .·.,.· ... MM DD YYYY


. ;·. -----------=--------· Isotope (e.g. AM241)

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. 3

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50.000000000


I I I I I I I I I I I I I I I I I I I I I I I I

Unit (e.g. mCi)

mCi

I I I

I I I I I I I I

I I I I I I I I

I I I

I lllllll llllll II llllll lllll lllll lllll llll llllll lllll llll llll I llllllll llll lllll llll llll llll . • . ' . . . GL-3849-21 .. ,

. . 04/05/2017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 . . ~ •, .

·.·.• . Our records indicate that you have these devices. Please update the information as necessary. PAGE 31 of 34 ·. ' ··;

: ; · NRC Device Key 665391 · (Internal Control Number) ··~

.· .. ··• Distributor/Distributed By: THERMO FISCHER SCIENTIFIC

::J I I I I I I I I I I I I I I I I I I I I I I I •·-···Distributor License Number: L03524

).:J I I I I I I I I I I I I. I ; , : Manufacturer Name: THERMO MEASURETECH

· :,:.I I I I I I I I I I I I I I I I I I I I I I I I . :•

· · Device Model (Not Source Model): 7062P

·.LI I I I I I I I I I I I I I I I I I I I I I · · .. Device Serial Number: 10093

-':J . I I I I I I I I I I I I I I I I I I I I I I . '. : Transfer Date (Receipt Date): 08/15/1979

'<·OJ[IJI I I I . -· ... •. MM DD YYYY


!.'·.•----· ---------------1 •••

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I I I I I . ::2

'J r---1 ~I l~l~I : 3 _...... r---1 ~I ~I l~l~I

. A

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r---1 .----.---1 1.---.----,

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

50.000000000 mCi

I I I I I I I I I I I I I .---\ 1,-----,1-----.1

I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I l l l l l l l l l l I I I I I I I I I I I I I I I I I I I

I I I I I I I I I I I I I I . ''• .

. !

': '..

' ' ),;'

' -.·_ I lllllll llllll II llllll lllll lllll lllll llll llllll lllll llll llll I llllllll llll lllll llll llll llll -. ' ·:::: GL-3849-21

- --: - 0410512017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 .. ·, :: ·our records indicate that you have these devices. Please update the information as necessary. PAGE 32 of 34 . : · : .. ·

-:_ .- NRC Device Key 665393 (Internal Control Number)

-_ -Distributor/Distributed By: THERMO FISCHER SCIENTIFIC

:· __ J I I I I I I - I I I I I I I I I I I I I I I I I ,'l', ·.

- Distributor License Number: . L03524

--_,J I I I I I I I I I I I I I ·</Manufacturer Name: THERMO MEASURETECH

;\:~:-1 . I I I I I I I I I I I I I I I I I I I I I · I I · · . -·--• Device Model (Not Source Model): 7062P

>I I I I _ I I I I I I I I I I I I I I I I I I I I / Device Serial Number: 10095

:<~1 · I I I I I I . I I I I I I I I I I I I I I I I I I . \·:·:

} _'Transfer Date (Receipt Date): 08/15/1979 •' ··'

/;-rnrn1 I I I . MM DD YYYY


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

-- ' 1 CS137 50.000000000 mCi

I I I I I I I I I \I I I I I '

I I I I I - -.;.,.

r·o:.

2 "

I I I I I I I I I I I I I I I I I I I I "

3

I I I I I I I I I I I I I I I I I ·.·, ;

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; -4 ·~-:.:

I I I I I I I I I I I I I I I I I I I I I I

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I I I I I I I I I I I I I I I I I I I I

' -

; ,,

~ . ... ; - '

111111111111111111111111111111111111111111111111111111111111 111111111111111111111111111111 ' . GL-3849-21

·. 04/05/2017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2 . : ' ·. · Our records indicate that you have these devices. Please.,µpdate the information as necessary. PAGE 33 of 34

. · : NRC Device Key ,, ·.


> Distributor/Distributed By: THERMO FISCHER SCIENTIFIC

: I I I I I I . I I I I ·1 I I I I I I I I I I I I I .· : 'Distributor License Number: L03524

. ··I . I I I I I I I I I I I I . I ··. _ Manufacturer Name: THERMO MEASURETECH

-·· ;·1 I I I I I I I I I I I I I I I I I I I I I I I ,·,

· ' . Device Model (Not Source Model): 7062P

<-I I I I I I I I I I I I I I I . I I I I I I I I 1.

· · · Device Serial Number: 10096

-. · I. I I I I I I I I I I I I I I I I I I I I I I I I ·' ···.-Transfer Date (Receipt Date): 08/15/1979

·<.·:.OJ ITJ I I I I MM DD YYYY

D Not in possession of device (Also complete Section. 4.)

,,.---------------'. < Isotope (e.g. AM241) ..

· . 1 CS137

:: I I I I I I .· -_.-.. · ' ':2

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Activity (e.g. 100)

50.000000000




I ! ! ! ! ! ! I ! ! ! !

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mCi

I I I I

I I I

I I I I

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I

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.. "

I lllllll llllll II llllll lllll 111111111111111111111111111111111 111111111111111111111111111111 .. .. · GL-3849-21

: 04/05/2017 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2. · · · Our records indicate that you have these devices. Please update the information as necessary. PAGE 34 of 34 · .

·.. NRC Device Key 665395 (Internal Control Number) .

. . · Distributor/Distributed By: THERMO FISCHER SCIENTIFIC

:J I I I I I I I I I I I I I I I I I I I I I I I . ·.;:,:· .

· ... ··'.Distributor License Number: L03524

:· 1 I I I I I I I I I I I I I ::_:·..:.

1• : Manufacturer Name: THERMO MEASURETECH

.. : I. I I I. I I · 1 I I I I I I I I I I I . I I I I I I < Device Model (Not Source Model): 7062P

.. ::·I I I I .1 I I I I I I I I I I l l l l l I ! ! l ·':Device Serial NLimber: 10097

·\J · I I I I I I I I I I I I I I I I I I I I I I I I I ; •

1

• Transfer Date (Receipt Date): 08/15/1979 . . ~ . ; rn rn 1~1~1~1~

MM DD YYYY


·. '':1 CS137

< :·· . ,.---.---1,----,11-1.------.1 : . 2

I I 3

.· .---I r-1 ~, 1-1-1 · .. 4

. . .. .---, ,__, ~, ,-,.------.,

I I I I .·. 6


Activity (e.g. 100)

50.000000000


I I I I I I I I I I




Unit (e.g. mCi)

mCi

I I I I

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. I

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I I I I I I I I I I I I I I I I I I . ,

. ~ · ..

111111111111111111111111111111111111111111111111111111111111 GL-3849-21

04/05/2017

111111111111111111111111111111

SECTION 3 SECTION 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

I I I I I I I I I I I I I I I I I I I I I I I I I · ·. Initial Transferor Name

· : .. _ I I I I I I I I I I I I I 1 · I I I I I I I I I I I I· · · Initial Transferor License Number (if known)

-. · I I I I I I I I I I I I I Device Model Number (Not Source Model)

I I I I I I I I I I I I I I I I I I I I I I I I 1 · Device Serial Number

.. --·. .___I ..___I ..___I _,___I _.___I _.__I __.__I -'--I --'--I --'--I __.__I --'--I ---'-I ---'-I _,__J _.._I --L-1----'--l --'-l--'-l ---'-l----'-l---'l---'l---'l'----'I ···: .: .. :

I I I I 0 Manufacturer/Initial Transferor listed above

How acquired and date (e.g., ' ,· .· from a distributor/manufacturer, 0 Other General Licensee Date Transferred: rn rn I , . other licensee, other source)? . · ··· 0 Other Source (Received) MM DD yyyy

Isotope (e.g. AM241) Activ"ty(eg. 100) Unit (e.g mCi)

1 . I I •.. ·•·••• 2.

I .• ,·

I •.

3.

5.

. . ~

'' 6.

7. I I . ·. 8 . I I

'9. I I "

I I ·. 10.

. ' .

----- ---- ---------,;-------------------

--. . I lllllll llllll II llllll lllll 111111111111111111111111111111111 111111111111111111111111111111 ; _-·. GL-3849-21

' ' : 04/05/2017 SECTION 4 - NOT IN POSSESSION OF DEVICE

··. '. : -__ Provide information about devices listed in Section 2 or 6, but no longer in your possession. : ·,:

- " Part 1 Transfer Date:

ITJITJI 111 ·. ~ .

MM DD YYYY . _ . Location of the Device:

SECTION 4 ·.

PAGE 1of1 .

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

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

•· : __ .;.· 0 Returned to Manufacturer (complete Part 1 only) (complete Part 2)

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

I I I -1 I I I I I I I I I I Company Name:

,. I I I I I I I I I I I I I I· I I I I I I I I I I I I I : : _ : · Department:

I J I I I I I I I I I I I I I I I I I I I I I I I . · ' Address Line 1: . '-: ~

I I I I I I I I I I I I I I I I I I I I I I I I I I Address Line 2:

:I I I I I I I I I I I I I I I I I I I I I I I I I I -· -.. . City: .. . . . . ... --· r---1 ,----,I lr---r---1 .,.--I .,.--I .,.--I -.---I -.---I -.---I -.---I ~I ~I -.---I -.---I -.---I -.---I ~I ~I -.---I ~I ~I ~I ~I ~I ~l ~l I

State: rn Zip Code: I I · I I I I -I I I I I Part 3 Enter the name of the individual responsible for this device:

· Last Name:

: __ -· 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I First Name: Middle Initial:

>::· -1 I I I I I I I I I I I I I D , _: Telephone Number: I I I I I I I I r---1 ~I l~I Extension: ,----,I ,~,~l~l~I _1'1

.·. , ·Title:

- I I I I I I I I I I I I I I I I 1 ·

.. ·.

.. '.:·

.. · . :~ ...

: : ~' ;-. . , ::·

I lllllll llllll II llllll lllll lllll lllll llll llllll lllll llll llll GL-3849-21

04/05/2017

I hereby certify that:

SECTION 5 - CERTIFICATION

I llllllll llll lllll llll llll llll SECTION 5 PAGE 1of1

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/rea i -rm/doc-collections/cfr)

SIGNATURE - RESPONSIBLE INDIVIDUAL (Listed in Section 1) DATE

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

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

MATERIALASPECTS. 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.

.! '

,·,,

'.

: . I lllllll llllll II llllll lllll lllll lllll llll llllll lllll llll llll I llllllll llll lllll llll llll llll . . . · .. · .. ·. GL-3849-21

. . ... ·.. 04/05/2017

.· ···. · .·. NRC Device Key: .:_; . · · Manufacturer Name:

Model Number:

·:·-·:' . . . . ·. . .

. , _'._.:

...

I

.. ··.··.:

: ~ '. . ·'

... ·. '·

_:··>'·; . :.. ;

SECTION 6 - DEVICES NOT SUBJECT TO REGISTRATION SECTION 6 • .

Manufacturer License No:

Serial#:

I j

PAGE 1of1

Transfer Date:

' I ' '

·'

,· ·. 1

I

' : i '. '

. '·i

GL Registration from Board of Municipal Utilities. · I I. I -. '" . ..... ,·: 'J;:', .... ·. ·...

Documents

Transcript of GL Registration from Board of Municipal Utilities. · I I. I -. '" . ..... ,·: 'J;:', .... ·. ·...