NRC FORM 313 US NUCLEAR REGULATORY COMMISSION (4-2008) 10 CFR 30 32 33 34 35 36 39 and 40

APPLICATION FOR MATERIALS LICENSE

APPROVED BY OMB NO 3150-0120 EXPIRES 10312008 Estimated burden per response to comply with this mandatory collection request 44 hours Submittal of the application is necessary to determine that the applicant is ~ualified and that adequate procedures exist to protect the public health and safety

end comments re1arding burden estimate to the Records and FOIAlPrivacy Services Branch (T-5 F53 U Nuclear Regulatory Commission Washington DC 20555-0001 or by internet e-mail to infocollectsnrcov and to the Desk Officer Office of Information and Regulatory Affairs NEOB-1 202 (3150-0120) Office of Management and Budget Washington DC 20503 If a means used to impose an information collection does not display a currenlly valid OMB control number the NRC may not conduct or sponsor and a person is not required to respond to the information 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

APPLICATION FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH

DIVISION OF INDUSTRIAL AND MEDICAL NUCLEAR SAFETY OFFICE OF NUCLEAR MATERIALS SAFETY AND SAFEGUARDS US 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 RHODE ISLAND SOUTH CAROLINA TENNESSEE VERMONT VIRGINIA VIRGIN ISLANDS OR WEST VIRGINIA SEND APPLICATIONS TO

LICENSING ASSISTANCE TEAM DIVISION OF NUCLEAR MATERIALS SAFETY US NUCLEAR REGULATORY COMMISS ION REGION I 475 ALLENDALE ROAD KING OF PRUSSIA PA 19406-1415

IF YOU ARE LOCATED IN

ILLINOIS INDIANA IOWA MICHIGAN MINNESOTA MISSOURI OHIO OR WISCONSIN SEND APPLICATIONS TO

MATERIALS LICENSING BRANCH US NUCLEAR REGULATORY COMMISSION REGION III 2443 WARRENVILLE ROAD SUITE 210 LISLE IL 60532-4352

ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO HAWAII IDAHO KANSAS LOUISIANA MISSISSIPPI MONTANA NEBRASKA NEVADA NEW MEXICO NORTH DAKOTA OKLAHOMA OREGON PACIFIC TRUST TERRITORIES SOUTH DAKOTA TEXAS UTAH WASHINGTON OR WYOMING SEND APPLICATIONS TO

NUCLEAR MATERIALS LICENSING BRANCH US NUCLEAR REGULATORY COMMISSION REGION IV 612 E LAMAR BOULEVARD SUITE 400 ARLINGTON TX 76011-4125

PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE US NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL IN STATES SUBJECT TO USNUCLEAR REGULATORY COMMISSION JURISDICTIONS

1 THIS IS AN APPLICATION FOR (Check appropriate item) 2 NAME AND MAILING ADDRESS OF APPLICANT (Include ZIP code)

A NEW LICENSE Huron Engineering amp Surveying Inc

3205 US-23 South [Z]

B AMENDMENT TO LICENSE NUMBER 0 Alpena Ml 49707

0 C RENEWAL OF LICENSE NUMBER

3 ADDRESS WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED 4 NAME OF PERSON TO BE CONTACTED ABOUT THIS APPLICATION

3205 US-23 South Alpena Mi 49707 Mark Herman- RSO

TELEPHONE NUMBER

(989) 356-6375

SUBMIT ITEMS 5 THROUGH 11 ON 8-1 2 X 11- PAPER THE TYPE AND SCOPE OF INFORMAT ION TO BE PROVIDED IS DESCRIBED IN THE LICENSE APPLICATION GUIDE

5 RADIOACTIVE MATERIAL a Element and mass number b chemical andor physical form and c maiximum amount 6 PURPOSE(S) FOR WHICH LICENSED MATERIAL WILL BE USED

which will be possessed at anyone time

7 INDIVIDUAL(S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR 8 TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS

TRAINING EXPERIENCE

I

9 FACILITIES AND EQUIPMENT 10 RADIATION SAFETY PROGRAM

12 LICENSE FEES (See 10 CFR 170 and Section 17031) 11 WASTE MANAGEMENT

FEE CATEGORY 3P IAMOUNT $ 150000ENCLOSED

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

THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEHALF OF THE APPLICANT NAMED IN ITEM 2 CERTIFY THAT THIS APPLICATION IS PREPARED IN CONFORMITY WITH TITLE 10 CODE OF FEDERAL REGULATIONS PARTS 30 32 33 34 353639 AND 40 AND THAT ALL INFORMATION CONTANED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF

WARNING 18 USC SECTION 1001 ACT OF JUNE 25194862 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 JURIS DICTION

CERTIFYING OFFICER - TYPEDPRINTED NAME AND TITLE SI~ IDATE ~ 2 ~G - 201 ~ FOR NRC lfSE ONLY

Mark Herman - RSO

TYPE OF FEE l FEELOG r EE CATEGORY I~OUNT RECEIVED CHECK NUMBER COMMENTS

APPROVED BY DATE

NRC FORM 313 (4-2008) PRINTED ON RECYCLED PAPER

REC~VED FEBD 8 2013

Attachment to Form 313 Item 3 Address Where Licensed Material Will Be Used And Possessed 3205 US-23 South Alpena Michigan and may be used at temporary job sites of the licensee anywhere in the United States where the US Nuclear Regulatory Commission maintains jurisdiction for regulating the use of licensed material

Item 5 Radioactive Material A Cesium -137 A Sealed sources registered either with NRC under 10 CFR 32210 or with an Agreement State and incorporated in a compatible gauging device A No single source to exceed the maximum activity specified in the certificate of registration issued by NRC or an Agreement State Total possession limit of 40 millicuries

B Americium-241 B Sealed sources registered either with NRC under 10 CFR 32210 or with an Agreement State and incorporated in a compatible gauging device as specified in Item 9 of this license B No single source to exceed the maximum activity specified in the certificate of registration issued by NRC or an Agreement State Total possession limit of 200 millicuries

Item 6 Purpose(s) for which licensed material will be used

A and B Listed above to be used in Troxler Models 3430 3440 and Instrotek 3500 Xplorer moisturedensity gauges for the measurement of moisture and density in construction material

Item 7 Individual(s) Responsible for Radiation Safety Program and Their Training and Experience Mark Herman has completed approved Gauge Safety Certification training HAZMA T and RSO training Mr Herman has practical field experience of using the density gauges for the last 3 years Mr Herman worked closely with the assistant RSO for Wilcox Associates for the last 3 years Mr Herman is a principal in the firm

Item 8 Training for Individuals Working in or Frequenting Restricted Areas ( Instructions to Occupationally Exposed Workers and Ancillary Personnel)

Before using licensed materials (gauges) authorized users will have successfully completed training as described in NUREG 1556 Volume 1

Huron Engineering amp Surveying [nco

Item 9 Facilities and Equipment I have pre-detennined that our storage area will comply to public dose limits and that we are providing sufficient security and control over the gauges These have been calculated and covered in our Radiation Safety Program under Public Dose and also in our Operating and Emergency Procedures

Item 10 Radiation Safety Program Although there is no response required for this item - We have a Radiation Safety program with Emergency Response completed

Item 101 Audit Program Need not be submitted with application

Item 102 Termination of Activities Need not be submitted with application

Item 103 Instruments We will either possess and use or have access to and use a radiation survey meter that

meets the criteria in the section entitled Radiation Safety Program-Instruments in NUREG-1556 Vol 1 Rev 1 Consolidation Guidance about Materials Licenses Program-Specific Guidance about Portable Gauge Licenses dated November 2001 in the event of an incident

Item 104 Material Receipt and Accountability Physical inventories will be conducted at intervals not to exceed 6 months to account for all sealed sources and devices received and possessed under the license

Item 105 Occupational Dosimetry Either we maintain for inspection by NRC documentation demonstrating that unmonitored individuals are not likely to receive in one year a radiation dose in excess of 10 percent ofthe allowable limits in 10CFR Part 20 or we provide dosimetry processed and evaluated by an NVLAP-approved processor that is exchanged at a frequency recommended by the processor

Item 106 Public Dose Need not be submitted with application- Public does calculation have been completed

and are less than all the requirements

Item 107 Operating and Emergency Procedures Operating and Emergency procedures are developed implemented and maintained and

meet the criteria in the section entitled Radiation Safety Program-Operating and Emergency Procedures in NUREG-1556 VoU Revl Consolidated Guidance about Materials Licenses Program-Specific Guidance about Portable Gauge Licenses dated November 2001

Huron Engineering amp Surveying Inc

Item 108 Leak Tests Leak tests will be performed at intervals approved by NRC or an Agreement State and

specified in the Sealed Source and Device Registration Sheet Leak tests will be performed by an organization authorized by NRC or an Agreement State to provide leak testing services to other licensees or using a leak test kit supplied by an organization authorized by NRC or an Agreement State to provide leak test kits to other licensees and according to the kit suppliers instructions

Item 109 Maintenance Routine cleaning and lubrication- We have implemented and maintain procedures for

routine maintenance of our gauges according to each manufactures recommendations and instructions Non-routine maintenance or repair operations that require detaching the source or source rod from the gauge- We send the gauge to the manufacturer or other person authorized by NRC or an Agreement State to perform non-routine maintenance or repair operations that require detaching the source or source rod from the gauge

Item 1010 Transportation Need not be submitted with application- We are familiar with the requirements for

transporting the Density Gauges

Item 11 Waste Management - Gauge Disposal and Transfer Need not be submitted with application- We are familiar with disposal and transfer

methods and options We will always check beforehand that the gauge recipient is authorized to take possession of our gauge type We will keep all disposal and transfer records on file

Huron Engineeling amp Surveying Inc

HURON ENGINEERING amp SURVEYING INC EMERGENCY RESPONSE PROCEDURES

NUCLEAR DENSITY GAUGES

If the source fails to return to the shielded position (eg as a result of being damaged) or if any other emergency or unusual situation arises (eg the gauge is struck by a moving vehicle is dropped or is in a vehicle involved in an accident)

1 Immediately secure the area around the gauge and keep people at least 15 ft away

2 Prevent unauthorized personnel from entering the secured area

3 If heavy equipment is involved detain the equipment and operator until it is determined there is no contamination present

4 Notify Radiation Safety Officer andor Management of situation If local staff is unavailable contact Huron personnel

HURON Home Phone Cell Phone Mark Herman RSO 989-356-0620 989-766-3083 Dan Kibbe 989-657 -098 7 Dale Saranen 989-657-2435

5 Notify Emergency Response Team - as needed (if determined by management) or if no one in Step 4 is available

HAZMAT Team at the Alpena CRTC Contact Number Keith Radabaugh Chief 989-354-6253

6 Follow the directions provided by personnel contacted in Step 4 and Step 5 above

7 Reminder to Licensee Management a Arrange for a survey to be conducted as soon as possible by the HAZMAT Team at the Alpena CRTC b Make necessary notifications to local authorities as well as the NRC as required (Even if not required to do so

you may report ANY incident to the NRC by calling NRCs Emergency Operations Center at 301-816-5100 which is staffed 24 hours a day and accepts collect calls NRC notification is required when gauges containing licensed material are lost or stolen when gauges are damaged or involved in incidents that result in doses in excess of 10 CFR 202203 limits NRCs July 1 1993 memorandum available from your RSO provides additional guidance)

c Timeliness of reports to the NRC needs to be considered d Reporting requirements are found in 10 CFR 20 2201-2203 and 10 CFR 3050

Huron Eng ineering amp Surveying Inc

Procedures for Securing a Portable Gauge in a Vehicle

Licensees commonly use a chain and a padlock to secure a portable gauge in its transportation case to the open bed of a pickup truck while using the vehicle for storage Because the transportation case is portable a theft could occur if the chain is cut and the transportation case with the portable gauge in it is taken If the licensee simply loops the chain through the handles of the transportation case a thief could open the transportation case and take the portable gauge without removing the chain or the case Because the transportation case is also portable it must be protected by two independent physical controls if the portable gauge is inside A lock on the transportation case or a lock on the portable gauge source rod handle would not be sufficient under the proposed requirements because the case and the gauge are portable A vehicle should be used for storage only for a short period of time when a gauge is in transit A portable gauge should only be kept in a vehicle overnight if it is not practicable to provide temporary storage in a permanent structure Under the proposed regulation when a portable gauge is being stored in a vehicle the licensee would be specifically required to use a minimum of two independent physical controls to secure the ga uge Exam pies of two such independent physical controls to secure portable gauges in these situations are-shy

1The locked transportation case containing the portable gauge is physically secured to a vehicle with brackets and a chain or steel cable (attached to the vehicle) is wrapped around the transportation case such that the case can not be opened unless the chain or cable is removed In this example the locked transportation case would count as one control because the brackets would prevent easy removal of the case The chain or cable looped only through the transportation case handle is not acceptable

2 The portable gauge or transportation case containing the portable gauge is stored in a box physically attached to a vehicle and the box is secured with (1) two independent locks (2) two separate chains or steel cables attached independently to the vehicle in such a manner that the box cannot be opened without the removal of the chains or cables or (3) one lock and one chain or steel cable is attached to the vehicle in such a manner that the box cannot be opened without the removal of the chain or cable or

3 The portable gauge or transportation case containing the portable gauge is stored in a locked trunk camper shell van or other similar enclosure and is physically secured to the vehicle by a chain or steel cable in such a manner that one would not be able to open the case or remove the portable gauge without removal of the chain or cable In this example the transportation case would not count as one control because it could be easily removed

Huron Engineering amp Surveying Inc

HURON ENGINEERING amp SURVEYING INC STANDARD OPERATING PROCEDURES

NUCLEAR DENSITY GAUGES

Operating Procedures

1 Before removing the gauge from its place of storage check to make sure that the gauge source rod is in the shielded locked position then lock the transport case if possible

2 Sign the gauge out in the log book including the date(s) of use name(s) of authorized users who will be responsible for the gauge and the temporary jobsite(s) where the gauge will be used

3 Never leave the gauge unattended while in your custody

4 Follow all applicable Department of Transportation (DOT) requirements when transporting the gauge Gauges should be blocked and braced to prevent movement during transportation

5 Do not touch the source rod with your fingers hands or any part of your body and always make sure the source rod is in the shielded position after each measurement is made

6 Always wear your assigned thermoluminescent dosimeter (TLD) or film badge when using the gauge

7 Never wear another persons TLD or film badge

8 Never store your TLD or film badge near the gauge

9 Always keep unauthorized persons away from the area where the gauge is to be used

10 Always maintain constant surveillance and immediate control of the gauge when it is not in storage

11 To assist operators of heavy equipment in seeing the gauges at construction sites always stake and flag each gauge being sure that the flags are tall enough to be seen by heavy equipment operators

12 Never look under the gauge when the source rod is being lowered into the ground

13 After each measurement always return the source to the shielded position and lock it there

14 When the gauge is not in use at a temporary jobsite place the gauge in secured storage location (eg locked in the trunk of a car or locked in a storage shed)

15 Return the gauge to its proper storage location at the end of the work shift

16 When the gauge is returned to storage so indicate in the source log

17 After making changes affecting the gauge storage area (eg changing the location of gauges within the storage area removing shielding adding gauges changing the occupancy of the adjacent areas moving the storage location to a new location) reevaluate compliance with public dose limits and ensure proper security of gauges

Huron Engineering amp Surveying Inc

APNGA Certificate of Achievement

This confirms that

Mark Herman

has successfully completed the APNGA Portable Nuclear Gauge

Radiation Safety Officer Class

on this day

Thursday January 31 2013

Prnerican Portable Nuclear Gauge Association (APNGA) wwwapngacom

Item 9 Facilities and Equipment I have pre-detennined that our storage area will comply to public dose limits and that we are providing sufficient security and control over the gauges These have been calculated and covered in our Radiation Safety Program under Public Dose and also in our Operating and Emergency Procedures

Item 10 Radiation Safety Program Although there is no response required for this item - We have a Radiation Safety program with Emergency Response completed

Item 101 Audit Program Need not be submitted with application

Item 102 Termination of Activities Need not be submitted with application

Item 103 Instruments We will either possess and use or have access to and use a radiation survey meter that

meets the criteria in the section entitled Radiation Safety Program-Instruments in NUREG-1556 Vol 1 Rev 1 Consolidation Guidance about Materials Licenses Program-Specific Guidance about Portable Gauge Licenses dated November 2001 in the event of an incident

Item 104 Material Receipt and Accountability Physical inventories will be conducted at intervals not to exceed 6 months to account for all sealed sources and devices received and possessed under the license

Item 105 Occupational Dosimetry Either we maintain for inspection by NRC documentation demonstrating that unmonitored individuals are not likely to receive in one year a radiation dose in excess of 10 percent ofthe allowable limits in 10CFR Part 20 or we provide dosimetry processed and evaluated by an NVLAP-approved processor that is exchanged at a frequency recommended by the processor

Item 106 Public Dose Need not be submitted with application- Public does calculation have been completed

and are less than all the requirements

Item 107 Operating and Emergency Procedures Operating and Emergency procedures are developed implemented and maintained and

meet the criteria in the section entitled Radiation Safety Program-Operating and Emergency Procedures in NUREG-1556 VoU Revl Consolidated Guidance about Materials Licenses Program-Specific Guidance about Portable Gauge Licenses dated November 2001

Huron Engineering amp Surveying Inc

Item 108 Leak Tests Leak tests will be performed at intervals approved by NRC or an Agreement State and

specified in the Sealed Source and Device Registration Sheet Leak tests will be performed by an organization authorized by NRC or an Agreement State to provide leak testing services to other licensees or using a leak test kit supplied by an organization authorized by NRC or an Agreement State to provide leak test kits to other licensees and according to the kit suppliers instructions

Item 109 Maintenance Routine cleaning and lubrication- We have implemented and maintain procedures for

routine maintenance of our gauges according to each manufactures recommendations and instructions Non-routine maintenance or repair operations that require detaching the source or source rod from the gauge- We send the gauge to the manufacturer or other person authorized by NRC or an Agreement State to perform non-routine maintenance or repair operations that require detaching the source or source rod from the gauge

Item 1010 Transportation Need not be submitted with application- We are familiar with the requirements for

transporting the Density Gauges

Item 11 Waste Management - Gauge Disposal and Transfer Need not be submitted with application- We are familiar with disposal and transfer

methods and options We will always check beforehand that the gauge recipient is authorized to take possession of our gauge type We will keep all disposal and transfer records on file

Huron Engineeling amp Surveying Inc

HURON ENGINEERING amp SURVEYING INC EMERGENCY RESPONSE PROCEDURES

NUCLEAR DENSITY GAUGES

If the source fails to return to the shielded position (eg as a result of being damaged) or if any other emergency or unusual situation arises (eg the gauge is struck by a moving vehicle is dropped or is in a vehicle involved in an accident)

1 Immediately secure the area around the gauge and keep people at least 15 ft away

2 Prevent unauthorized personnel from entering the secured area

3 If heavy equipment is involved detain the equipment and operator until it is determined there is no contamination present

4 Notify Radiation Safety Officer andor Management of situation If local staff is unavailable contact Huron personnel

HURON Home Phone Cell Phone Mark Herman RSO 989-356-0620 989-766-3083 Dan Kibbe 989-657 -098 7 Dale Saranen 989-657-2435

5 Notify Emergency Response Team - as needed (if determined by management) or if no one in Step 4 is available

HAZMAT Team at the Alpena CRTC Contact Number Keith Radabaugh Chief 989-354-6253

6 Follow the directions provided by personnel contacted in Step 4 and Step 5 above

7 Reminder to Licensee Management a Arrange for a survey to be conducted as soon as possible by the HAZMAT Team at the Alpena CRTC b Make necessary notifications to local authorities as well as the NRC as required (Even if not required to do so

you may report ANY incident to the NRC by calling NRCs Emergency Operations Center at 301-816-5100 which is staffed 24 hours a day and accepts collect calls NRC notification is required when gauges containing licensed material are lost or stolen when gauges are damaged or involved in incidents that result in doses in excess of 10 CFR 202203 limits NRCs July 1 1993 memorandum available from your RSO provides additional guidance)

c Timeliness of reports to the NRC needs to be considered d Reporting requirements are found in 10 CFR 20 2201-2203 and 10 CFR 3050

Huron Eng ineering amp Surveying Inc

Procedures for Securing a Portable Gauge in a Vehicle

Licensees commonly use a chain and a padlock to secure a portable gauge in its transportation case to the open bed of a pickup truck while using the vehicle for storage Because the transportation case is portable a theft could occur if the chain is cut and the transportation case with the portable gauge in it is taken If the licensee simply loops the chain through the handles of the transportation case a thief could open the transportation case and take the portable gauge without removing the chain or the case Because the transportation case is also portable it must be protected by two independent physical controls if the portable gauge is inside A lock on the transportation case or a lock on the portable gauge source rod handle would not be sufficient under the proposed requirements because the case and the gauge are portable A vehicle should be used for storage only for a short period of time when a gauge is in transit A portable gauge should only be kept in a vehicle overnight if it is not practicable to provide temporary storage in a permanent structure Under the proposed regulation when a portable gauge is being stored in a vehicle the licensee would be specifically required to use a minimum of two independent physical controls to secure the ga uge Exam pies of two such independent physical controls to secure portable gauges in these situations are-shy

1The locked transportation case containing the portable gauge is physically secured to a vehicle with brackets and a chain or steel cable (attached to the vehicle) is wrapped around the transportation case such that the case can not be opened unless the chain or cable is removed In this example the locked transportation case would count as one control because the brackets would prevent easy removal of the case The chain or cable looped only through the transportation case handle is not acceptable

2 The portable gauge or transportation case containing the portable gauge is stored in a box physically attached to a vehicle and the box is secured with (1) two independent locks (2) two separate chains or steel cables attached independently to the vehicle in such a manner that the box cannot be opened without the removal of the chains or cables or (3) one lock and one chain or steel cable is attached to the vehicle in such a manner that the box cannot be opened without the removal of the chain or cable or

3 The portable gauge or transportation case containing the portable gauge is stored in a locked trunk camper shell van or other similar enclosure and is physically secured to the vehicle by a chain or steel cable in such a manner that one would not be able to open the case or remove the portable gauge without removal of the chain or cable In this example the transportation case would not count as one control because it could be easily removed

Huron Engineering amp Surveying Inc

HURON ENGINEERING amp SURVEYING INC STANDARD OPERATING PROCEDURES

NUCLEAR DENSITY GAUGES

Operating Procedures

1 Before removing the gauge from its place of storage check to make sure that the gauge source rod is in the shielded locked position then lock the transport case if possible

2 Sign the gauge out in the log book including the date(s) of use name(s) of authorized users who will be responsible for the gauge and the temporary jobsite(s) where the gauge will be used

3 Never leave the gauge unattended while in your custody

4 Follow all applicable Department of Transportation (DOT) requirements when transporting the gauge Gauges should be blocked and braced to prevent movement during transportation

5 Do not touch the source rod with your fingers hands or any part of your body and always make sure the source rod is in the shielded position after each measurement is made

6 Always wear your assigned thermoluminescent dosimeter (TLD) or film badge when using the gauge

7 Never wear another persons TLD or film badge

8 Never store your TLD or film badge near the gauge

9 Always keep unauthorized persons away from the area where the gauge is to be used

10 Always maintain constant surveillance and immediate control of the gauge when it is not in storage

11 To assist operators of heavy equipment in seeing the gauges at construction sites always stake and flag each gauge being sure that the flags are tall enough to be seen by heavy equipment operators

12 Never look under the gauge when the source rod is being lowered into the ground

13 After each measurement always return the source to the shielded position and lock it there

14 When the gauge is not in use at a temporary jobsite place the gauge in secured storage location (eg locked in the trunk of a car or locked in a storage shed)

15 Return the gauge to its proper storage location at the end of the work shift

16 When the gauge is returned to storage so indicate in the source log

17 After making changes affecting the gauge storage area (eg changing the location of gauges within the storage area removing shielding adding gauges changing the occupancy of the adjacent areas moving the storage location to a new location) reevaluate compliance with public dose limits and ensure proper security of gauges

Huron Engineering amp Surveying Inc

APNGA Certificate of Achievement

This confirms that

Mark Herman

has successfully completed the APNGA Portable Nuclear Gauge

Radiation Safety Officer Class

on this day

Thursday January 31 2013

Prnerican Portable Nuclear Gauge Association (APNGA) wwwapngacom

Item 108 Leak Tests Leak tests will be performed at intervals approved by NRC or an Agreement State and

specified in the Sealed Source and Device Registration Sheet Leak tests will be performed by an organization authorized by NRC or an Agreement State to provide leak testing services to other licensees or using a leak test kit supplied by an organization authorized by NRC or an Agreement State to provide leak test kits to other licensees and according to the kit suppliers instructions

Item 109 Maintenance Routine cleaning and lubrication- We have implemented and maintain procedures for

routine maintenance of our gauges according to each manufactures recommendations and instructions Non-routine maintenance or repair operations that require detaching the source or source rod from the gauge- We send the gauge to the manufacturer or other person authorized by NRC or an Agreement State to perform non-routine maintenance or repair operations that require detaching the source or source rod from the gauge

Item 1010 Transportation Need not be submitted with application- We are familiar with the requirements for

transporting the Density Gauges

Item 11 Waste Management - Gauge Disposal and Transfer Need not be submitted with application- We are familiar with disposal and transfer

methods and options We will always check beforehand that the gauge recipient is authorized to take possession of our gauge type We will keep all disposal and transfer records on file

Huron Engineeling amp Surveying Inc

HURON ENGINEERING amp SURVEYING INC EMERGENCY RESPONSE PROCEDURES

NUCLEAR DENSITY GAUGES

If the source fails to return to the shielded position (eg as a result of being damaged) or if any other emergency or unusual situation arises (eg the gauge is struck by a moving vehicle is dropped or is in a vehicle involved in an accident)

1 Immediately secure the area around the gauge and keep people at least 15 ft away

2 Prevent unauthorized personnel from entering the secured area

3 If heavy equipment is involved detain the equipment and operator until it is determined there is no contamination present

4 Notify Radiation Safety Officer andor Management of situation If local staff is unavailable contact Huron personnel

HURON Home Phone Cell Phone Mark Herman RSO 989-356-0620 989-766-3083 Dan Kibbe 989-657 -098 7 Dale Saranen 989-657-2435

5 Notify Emergency Response Team - as needed (if determined by management) or if no one in Step 4 is available

HAZMAT Team at the Alpena CRTC Contact Number Keith Radabaugh Chief 989-354-6253

6 Follow the directions provided by personnel contacted in Step 4 and Step 5 above

7 Reminder to Licensee Management a Arrange for a survey to be conducted as soon as possible by the HAZMAT Team at the Alpena CRTC b Make necessary notifications to local authorities as well as the NRC as required (Even if not required to do so

you may report ANY incident to the NRC by calling NRCs Emergency Operations Center at 301-816-5100 which is staffed 24 hours a day and accepts collect calls NRC notification is required when gauges containing licensed material are lost or stolen when gauges are damaged or involved in incidents that result in doses in excess of 10 CFR 202203 limits NRCs July 1 1993 memorandum available from your RSO provides additional guidance)

c Timeliness of reports to the NRC needs to be considered d Reporting requirements are found in 10 CFR 20 2201-2203 and 10 CFR 3050

Huron Eng ineering amp Surveying Inc

Procedures for Securing a Portable Gauge in a Vehicle

Licensees commonly use a chain and a padlock to secure a portable gauge in its transportation case to the open bed of a pickup truck while using the vehicle for storage Because the transportation case is portable a theft could occur if the chain is cut and the transportation case with the portable gauge in it is taken If the licensee simply loops the chain through the handles of the transportation case a thief could open the transportation case and take the portable gauge without removing the chain or the case Because the transportation case is also portable it must be protected by two independent physical controls if the portable gauge is inside A lock on the transportation case or a lock on the portable gauge source rod handle would not be sufficient under the proposed requirements because the case and the gauge are portable A vehicle should be used for storage only for a short period of time when a gauge is in transit A portable gauge should only be kept in a vehicle overnight if it is not practicable to provide temporary storage in a permanent structure Under the proposed regulation when a portable gauge is being stored in a vehicle the licensee would be specifically required to use a minimum of two independent physical controls to secure the ga uge Exam pies of two such independent physical controls to secure portable gauges in these situations are-shy

1The locked transportation case containing the portable gauge is physically secured to a vehicle with brackets and a chain or steel cable (attached to the vehicle) is wrapped around the transportation case such that the case can not be opened unless the chain or cable is removed In this example the locked transportation case would count as one control because the brackets would prevent easy removal of the case The chain or cable looped only through the transportation case handle is not acceptable

2 The portable gauge or transportation case containing the portable gauge is stored in a box physically attached to a vehicle and the box is secured with (1) two independent locks (2) two separate chains or steel cables attached independently to the vehicle in such a manner that the box cannot be opened without the removal of the chains or cables or (3) one lock and one chain or steel cable is attached to the vehicle in such a manner that the box cannot be opened without the removal of the chain or cable or

3 The portable gauge or transportation case containing the portable gauge is stored in a locked trunk camper shell van or other similar enclosure and is physically secured to the vehicle by a chain or steel cable in such a manner that one would not be able to open the case or remove the portable gauge without removal of the chain or cable In this example the transportation case would not count as one control because it could be easily removed

Huron Engineering amp Surveying Inc

HURON ENGINEERING amp SURVEYING INC STANDARD OPERATING PROCEDURES

NUCLEAR DENSITY GAUGES

Operating Procedures

1 Before removing the gauge from its place of storage check to make sure that the gauge source rod is in the shielded locked position then lock the transport case if possible

2 Sign the gauge out in the log book including the date(s) of use name(s) of authorized users who will be responsible for the gauge and the temporary jobsite(s) where the gauge will be used

3 Never leave the gauge unattended while in your custody

4 Follow all applicable Department of Transportation (DOT) requirements when transporting the gauge Gauges should be blocked and braced to prevent movement during transportation

5 Do not touch the source rod with your fingers hands or any part of your body and always make sure the source rod is in the shielded position after each measurement is made

6 Always wear your assigned thermoluminescent dosimeter (TLD) or film badge when using the gauge

7 Never wear another persons TLD or film badge

8 Never store your TLD or film badge near the gauge

9 Always keep unauthorized persons away from the area where the gauge is to be used

10 Always maintain constant surveillance and immediate control of the gauge when it is not in storage

11 To assist operators of heavy equipment in seeing the gauges at construction sites always stake and flag each gauge being sure that the flags are tall enough to be seen by heavy equipment operators

12 Never look under the gauge when the source rod is being lowered into the ground

13 After each measurement always return the source to the shielded position and lock it there

14 When the gauge is not in use at a temporary jobsite place the gauge in secured storage location (eg locked in the trunk of a car or locked in a storage shed)

15 Return the gauge to its proper storage location at the end of the work shift

16 When the gauge is returned to storage so indicate in the source log

17 After making changes affecting the gauge storage area (eg changing the location of gauges within the storage area removing shielding adding gauges changing the occupancy of the adjacent areas moving the storage location to a new location) reevaluate compliance with public dose limits and ensure proper security of gauges

Huron Engineering amp Surveying Inc

APNGA Certificate of Achievement

This confirms that

Mark Herman

has successfully completed the APNGA Portable Nuclear Gauge

Radiation Safety Officer Class

on this day

Thursday January 31 2013

Prnerican Portable Nuclear Gauge Association (APNGA) wwwapngacom

HURON ENGINEERING amp SURVEYING INC EMERGENCY RESPONSE PROCEDURES

NUCLEAR DENSITY GAUGES

If the source fails to return to the shielded position (eg as a result of being damaged) or if any other emergency or unusual situation arises (eg the gauge is struck by a moving vehicle is dropped or is in a vehicle involved in an accident)

1 Immediately secure the area around the gauge and keep people at least 15 ft away

2 Prevent unauthorized personnel from entering the secured area

3 If heavy equipment is involved detain the equipment and operator until it is determined there is no contamination present

4 Notify Radiation Safety Officer andor Management of situation If local staff is unavailable contact Huron personnel

HURON Home Phone Cell Phone Mark Herman RSO 989-356-0620 989-766-3083 Dan Kibbe 989-657 -098 7 Dale Saranen 989-657-2435

5 Notify Emergency Response Team - as needed (if determined by management) or if no one in Step 4 is available

HAZMAT Team at the Alpena CRTC Contact Number Keith Radabaugh Chief 989-354-6253

6 Follow the directions provided by personnel contacted in Step 4 and Step 5 above

7 Reminder to Licensee Management a Arrange for a survey to be conducted as soon as possible by the HAZMAT Team at the Alpena CRTC b Make necessary notifications to local authorities as well as the NRC as required (Even if not required to do so

you may report ANY incident to the NRC by calling NRCs Emergency Operations Center at 301-816-5100 which is staffed 24 hours a day and accepts collect calls NRC notification is required when gauges containing licensed material are lost or stolen when gauges are damaged or involved in incidents that result in doses in excess of 10 CFR 202203 limits NRCs July 1 1993 memorandum available from your RSO provides additional guidance)

c Timeliness of reports to the NRC needs to be considered d Reporting requirements are found in 10 CFR 20 2201-2203 and 10 CFR 3050

Huron Eng ineering amp Surveying Inc

Procedures for Securing a Portable Gauge in a Vehicle

Licensees commonly use a chain and a padlock to secure a portable gauge in its transportation case to the open bed of a pickup truck while using the vehicle for storage Because the transportation case is portable a theft could occur if the chain is cut and the transportation case with the portable gauge in it is taken If the licensee simply loops the chain through the handles of the transportation case a thief could open the transportation case and take the portable gauge without removing the chain or the case Because the transportation case is also portable it must be protected by two independent physical controls if the portable gauge is inside A lock on the transportation case or a lock on the portable gauge source rod handle would not be sufficient under the proposed requirements because the case and the gauge are portable A vehicle should be used for storage only for a short period of time when a gauge is in transit A portable gauge should only be kept in a vehicle overnight if it is not practicable to provide temporary storage in a permanent structure Under the proposed regulation when a portable gauge is being stored in a vehicle the licensee would be specifically required to use a minimum of two independent physical controls to secure the ga uge Exam pies of two such independent physical controls to secure portable gauges in these situations are-shy

1The locked transportation case containing the portable gauge is physically secured to a vehicle with brackets and a chain or steel cable (attached to the vehicle) is wrapped around the transportation case such that the case can not be opened unless the chain or cable is removed In this example the locked transportation case would count as one control because the brackets would prevent easy removal of the case The chain or cable looped only through the transportation case handle is not acceptable

2 The portable gauge or transportation case containing the portable gauge is stored in a box physically attached to a vehicle and the box is secured with (1) two independent locks (2) two separate chains or steel cables attached independently to the vehicle in such a manner that the box cannot be opened without the removal of the chains or cables or (3) one lock and one chain or steel cable is attached to the vehicle in such a manner that the box cannot be opened without the removal of the chain or cable or

3 The portable gauge or transportation case containing the portable gauge is stored in a locked trunk camper shell van or other similar enclosure and is physically secured to the vehicle by a chain or steel cable in such a manner that one would not be able to open the case or remove the portable gauge without removal of the chain or cable In this example the transportation case would not count as one control because it could be easily removed

Huron Engineering amp Surveying Inc

HURON ENGINEERING amp SURVEYING INC STANDARD OPERATING PROCEDURES

NUCLEAR DENSITY GAUGES

Operating Procedures

1 Before removing the gauge from its place of storage check to make sure that the gauge source rod is in the shielded locked position then lock the transport case if possible

2 Sign the gauge out in the log book including the date(s) of use name(s) of authorized users who will be responsible for the gauge and the temporary jobsite(s) where the gauge will be used

3 Never leave the gauge unattended while in your custody

4 Follow all applicable Department of Transportation (DOT) requirements when transporting the gauge Gauges should be blocked and braced to prevent movement during transportation

5 Do not touch the source rod with your fingers hands or any part of your body and always make sure the source rod is in the shielded position after each measurement is made

6 Always wear your assigned thermoluminescent dosimeter (TLD) or film badge when using the gauge

7 Never wear another persons TLD or film badge

8 Never store your TLD or film badge near the gauge

9 Always keep unauthorized persons away from the area where the gauge is to be used

10 Always maintain constant surveillance and immediate control of the gauge when it is not in storage

11 To assist operators of heavy equipment in seeing the gauges at construction sites always stake and flag each gauge being sure that the flags are tall enough to be seen by heavy equipment operators

12 Never look under the gauge when the source rod is being lowered into the ground

13 After each measurement always return the source to the shielded position and lock it there

14 When the gauge is not in use at a temporary jobsite place the gauge in secured storage location (eg locked in the trunk of a car or locked in a storage shed)

15 Return the gauge to its proper storage location at the end of the work shift

16 When the gauge is returned to storage so indicate in the source log

17 After making changes affecting the gauge storage area (eg changing the location of gauges within the storage area removing shielding adding gauges changing the occupancy of the adjacent areas moving the storage location to a new location) reevaluate compliance with public dose limits and ensure proper security of gauges

Huron Engineering amp Surveying Inc

APNGA Certificate of Achievement

This confirms that

Mark Herman

has successfully completed the APNGA Portable Nuclear Gauge

Radiation Safety Officer Class

on this day

Thursday January 31 2013

Prnerican Portable Nuclear Gauge Association (APNGA) wwwapngacom

Procedures for Securing a Portable Gauge in a Vehicle

Licensees commonly use a chain and a padlock to secure a portable gauge in its transportation case to the open bed of a pickup truck while using the vehicle for storage Because the transportation case is portable a theft could occur if the chain is cut and the transportation case with the portable gauge in it is taken If the licensee simply loops the chain through the handles of the transportation case a thief could open the transportation case and take the portable gauge without removing the chain or the case Because the transportation case is also portable it must be protected by two independent physical controls if the portable gauge is inside A lock on the transportation case or a lock on the portable gauge source rod handle would not be sufficient under the proposed requirements because the case and the gauge are portable A vehicle should be used for storage only for a short period of time when a gauge is in transit A portable gauge should only be kept in a vehicle overnight if it is not practicable to provide temporary storage in a permanent structure Under the proposed regulation when a portable gauge is being stored in a vehicle the licensee would be specifically required to use a minimum of two independent physical controls to secure the ga uge Exam pies of two such independent physical controls to secure portable gauges in these situations are-shy

1The locked transportation case containing the portable gauge is physically secured to a vehicle with brackets and a chain or steel cable (attached to the vehicle) is wrapped around the transportation case such that the case can not be opened unless the chain or cable is removed In this example the locked transportation case would count as one control because the brackets would prevent easy removal of the case The chain or cable looped only through the transportation case handle is not acceptable

2 The portable gauge or transportation case containing the portable gauge is stored in a box physically attached to a vehicle and the box is secured with (1) two independent locks (2) two separate chains or steel cables attached independently to the vehicle in such a manner that the box cannot be opened without the removal of the chains or cables or (3) one lock and one chain or steel cable is attached to the vehicle in such a manner that the box cannot be opened without the removal of the chain or cable or

3 The portable gauge or transportation case containing the portable gauge is stored in a locked trunk camper shell van or other similar enclosure and is physically secured to the vehicle by a chain or steel cable in such a manner that one would not be able to open the case or remove the portable gauge without removal of the chain or cable In this example the transportation case would not count as one control because it could be easily removed

Huron Engineering amp Surveying Inc

HURON ENGINEERING amp SURVEYING INC STANDARD OPERATING PROCEDURES

NUCLEAR DENSITY GAUGES

Operating Procedures

1 Before removing the gauge from its place of storage check to make sure that the gauge source rod is in the shielded locked position then lock the transport case if possible

2 Sign the gauge out in the log book including the date(s) of use name(s) of authorized users who will be responsible for the gauge and the temporary jobsite(s) where the gauge will be used

3 Never leave the gauge unattended while in your custody

4 Follow all applicable Department of Transportation (DOT) requirements when transporting the gauge Gauges should be blocked and braced to prevent movement during transportation

5 Do not touch the source rod with your fingers hands or any part of your body and always make sure the source rod is in the shielded position after each measurement is made

6 Always wear your assigned thermoluminescent dosimeter (TLD) or film badge when using the gauge

7 Never wear another persons TLD or film badge

8 Never store your TLD or film badge near the gauge

9 Always keep unauthorized persons away from the area where the gauge is to be used

10 Always maintain constant surveillance and immediate control of the gauge when it is not in storage

11 To assist operators of heavy equipment in seeing the gauges at construction sites always stake and flag each gauge being sure that the flags are tall enough to be seen by heavy equipment operators

12 Never look under the gauge when the source rod is being lowered into the ground

13 After each measurement always return the source to the shielded position and lock it there

14 When the gauge is not in use at a temporary jobsite place the gauge in secured storage location (eg locked in the trunk of a car or locked in a storage shed)

15 Return the gauge to its proper storage location at the end of the work shift

16 When the gauge is returned to storage so indicate in the source log

17 After making changes affecting the gauge storage area (eg changing the location of gauges within the storage area removing shielding adding gauges changing the occupancy of the adjacent areas moving the storage location to a new location) reevaluate compliance with public dose limits and ensure proper security of gauges

Huron Engineering amp Surveying Inc

APNGA Certificate of Achievement

This confirms that

Mark Herman

has successfully completed the APNGA Portable Nuclear Gauge

Radiation Safety Officer Class

on this day

Thursday January 31 2013

Prnerican Portable Nuclear Gauge Association (APNGA) wwwapngacom

HURON ENGINEERING amp SURVEYING INC STANDARD OPERATING PROCEDURES

NUCLEAR DENSITY GAUGES

Operating Procedures

1 Before removing the gauge from its place of storage check to make sure that the gauge source rod is in the shielded locked position then lock the transport case if possible

2 Sign the gauge out in the log book including the date(s) of use name(s) of authorized users who will be responsible for the gauge and the temporary jobsite(s) where the gauge will be used

3 Never leave the gauge unattended while in your custody

4 Follow all applicable Department of Transportation (DOT) requirements when transporting the gauge Gauges should be blocked and braced to prevent movement during transportation

5 Do not touch the source rod with your fingers hands or any part of your body and always make sure the source rod is in the shielded position after each measurement is made

6 Always wear your assigned thermoluminescent dosimeter (TLD) or film badge when using the gauge

7 Never wear another persons TLD or film badge

8 Never store your TLD or film badge near the gauge

9 Always keep unauthorized persons away from the area where the gauge is to be used

10 Always maintain constant surveillance and immediate control of the gauge when it is not in storage

11 To assist operators of heavy equipment in seeing the gauges at construction sites always stake and flag each gauge being sure that the flags are tall enough to be seen by heavy equipment operators

12 Never look under the gauge when the source rod is being lowered into the ground

13 After each measurement always return the source to the shielded position and lock it there

14 When the gauge is not in use at a temporary jobsite place the gauge in secured storage location (eg locked in the trunk of a car or locked in a storage shed)

15 Return the gauge to its proper storage location at the end of the work shift

16 When the gauge is returned to storage so indicate in the source log

17 After making changes affecting the gauge storage area (eg changing the location of gauges within the storage area removing shielding adding gauges changing the occupancy of the adjacent areas moving the storage location to a new location) reevaluate compliance with public dose limits and ensure proper security of gauges

Huron Engineering amp Surveying Inc

APNGA Certificate of Achievement

This confirms that

Mark Herman

has successfully completed the APNGA Portable Nuclear Gauge

Radiation Safety Officer Class

on this day

Thursday January 31 2013

Prnerican Portable Nuclear Gauge Association (APNGA) wwwapngacom

APNGA Certificate of Achievement

This confirms that

Mark Herman

has successfully completed the APNGA Portable Nuclear Gauge

Radiation Safety Officer Class

on this day

Thursday January 31 2013

Prnerican Portable Nuclear Gauge Association (APNGA) wwwapngacom

APNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Mark Herman

Training must be renewed within three years from todays date

Thursday January 31 2013 This course satisfies the training requinnents of 49 CFR 172 Subpart H Including

- General AwarenesslFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOIOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOIOfficiai makes the training and certificate relevant and valid

-HJIO (1b(ed 0 CH~ SJrvtt~IC fl1art v IteflYlQVI mpany N~me Company RSO JOfficial (print)

Ailerican Portable Nuclear Gauge Association (AP NGA) wwwapngacom

APNGA Portable Nuclear Gauge Safety Certification Class

Certificate of Completion to

Mark Herman

Hazmat refresher training is required within 3 years after todays date Thursday May 132010

Course covers training criteria of NUREG 1556 The Agreement States and 49 CFR 172 Subpart H (Includes lATA Requirements) The Company RSO completes the training requirements by familiarizing the employee with

- State specific regulations including introduction to the state regulatory website - The company radiation safety program specifically gauge safety operating and emergency procedures - A tour of storage area with emphasis on security documents and postings - Loading security and transporting gauges in company vehicles - The safety and operating features of the gauge(s) in use by the company - Introduction to gauge safety content on gauge manufacturer website - The RSO must also monitor the employee completing and passing a closed book test of this class material

The RSO signature certifies that the trainee has received the above training requirements

Li I( colt ~1-tJS IO-ilt- SrrVtcv kl4 C---~ Company Na me ~ IfI Signature 01 RSO

ATIerican Portable Nuclear Gauge Association (APNGAJ George E Marshall wwwapngacom AP NGA Director

IIENGINEERING ampSURVEYING INC

BILL OF LADING

Shipper Huron Engineering amp Surveying Inc 3205 US-23 South Alpena MI 49707

Device Nuclear Density Gauge Model No 3430 Serial No 35061

RADIOACTIVE MATERIAL TYPE A PACKAGE SPECIAL FORM FISSILE OR Non-fissile EXCEPTED UN 3332 RQ CLASS 7

CS-137 03 GBq (8 m Ci) Am 241 Be 148 GBq (40 m Ci)

RADIOACTIVE YELLOW II LABEL TI = 03

EMERGENCY CONTACT

TROXLER ELECTRONIC LABORATORIES 24 HOUR EMERGENCY ASSISTANCE 919-549-9539

This is to certify that the above-named materials are properly classified described packaged marked and labeled and are in proper condition for transportation according to the applicable regulations of the Department of Transportation

Shipper (Signature)

CIMy Documents and BackupslNRC- TroxlerlHuron EampS NRC License ApplTroxler Bills of Ladingdoc

II ENGINEERING amp SURVEYING INC

BILL OF LADING

Shipper Huron Engineering amp Surveying Inc 3205 US-23 South Alpena MI 49707

Device Nuclear Density Gauge Model No 3440 Serial No 24534

RADIOACTIVE MATERIAL TYPE A PACKAGE SPECIAL FORM FISSILE OR Non-fissile EXCEPTED UN 3332 RO CLASS 7

CS-137 03 GBq (8 m Ci) Am 241 Be 148 GBq (40 m Ci)

RADIOACTIVE YELLOW I LABEL TI =06

EMERGENCY CONTACT

TROXLER ELECTRONIC LABORATORIES 24 HOUR EMERGENCY ASSISTANCE 919-549-9539

This is to certify that the above-named materials are properly classified described packaged marked and labeled and are in proper condition for transportation according to the applicable regulations of the Department of Transportation

Shipper (Signature)

CWy Documents and BackupslNRC-TroxJerlHuron EampS NRC License ApplTroxler Bills of Ladingdoc

SHP WT 1 LBS DATE 06 FEB 2013

SHIP MATERIALS LICENSING BRANCH TO US NUCLEAR REGULATORY COMMISION REG

STE 210 2443 WARRENVILLE RD

IL 603 9-03 1111111111111111111111111111

ISH 13 00N E2844 36 5V 0112013

a _-JOHIIfIla LWS- _ _-__ ~r- __ -- __bull -_r I4 __ --____I$ __ rIIWot - _ ___ --ary _Ir-

II ENGINEERING amp SURVEYING INC

BILL OF LADING

Shipper Huron Engineering amp Surveying Inc 3205 US-23 South Alpena MI 49707

Device Nuclear Density Gauge Model No 3440 Serial No 24534

RADIOACTIVE MATERIAL TYPE A PACKAGE SPECIAL FORM FISSILE OR Non-fissile EXCEPTED UN 3332 RO CLASS 7

CS-137 03 GBq (8 m Ci) Am 241 Be 148 GBq (40 m Ci)

RADIOACTIVE YELLOW I LABEL TI =06

EMERGENCY CONTACT

TROXLER ELECTRONIC LABORATORIES 24 HOUR EMERGENCY ASSISTANCE 919-549-9539

This is to certify that the above-named materials are properly classified described packaged marked and labeled and are in proper condition for transportation according to the applicable regulations of the Department of Transportation

Shipper (Signature)

CWy Documents and BackupslNRC-TroxJerlHuron EampS NRC License ApplTroxler Bills of Ladingdoc

SHP WT 1 LBS DATE 06 FEB 2013

SHIP MATERIALS LICENSING BRANCH TO US NUCLEAR REGULATORY COMMISION REG

STE 210 2443 WARRENVILLE RD

IL 603 9-03 1111111111111111111111111111

ISH 13 00N E2844 36 5V 0112013

a _-JOHIIfIla LWS- _ _-__ ~r- __ -- __bull -_r I4 __ --____I$ __ rIIWot - _ ___ --ary _Ir-

SHP WT 1 LBS DATE 06 FEB 2013

SHIP MATERIALS LICENSING BRANCH TO US NUCLEAR REGULATORY COMMISION REG

STE 210 2443 WARRENVILLE RD

IL 603 9-03 1111111111111111111111111111

ISH 13 00N E2844 36 5V 0112013

a _-JOHIIfIla LWS- _ _-__ ~r- __ -- __bull -_r I4 __ --____I$ __ rIIWot - _ ___ --ary _Ir-