WS INITIAL 241 PACKAGE

I-V REVISION

CLARIFICATION

LRN

LRN 6i-1~

LRN-

X&,d,62I941LLICENSEE NAME

LICENSE STATE

CHECK NO:-�y

NUMBER:

CHECK AMO0UNT: VL20

FORWARDED BY: ." d ~

Initial Revisionincludes: Form 241 V 03

Fee V CLicense Copy V/

Clarification

BANK OFAM~fC 98RONAN ENGINEERING CO., KENTUCKYWANRCTE

PH. 606-342-8500 99CNG

DIVISION OF RONAN ENGINEERING CO., INC. WOODLAND HILLS, CA 91371612WOODLAND HILLS, CA

CHECK DATE CHECKNO CEKAUT

04/28/00 89489 $$$$200.00

pay two hundred and (01100 dollars

iPAY US NRC REGION 11TO THE 61 FORSYTH STREET SWORDER OF SUITE 23T85

ATLANTA GA 30303-8931

uO8EiIRRlu i:L??CCCG;IA' ~I. S'52'.

Discount Net Amount

04/28/00 FRI 13:22 FAX 1 606 342 6426 RONAN ENGINEERING 2 002

ISCIFORM2U . a E4R OMISOVA" ff'tl5O"TOtY00N=S

REPORT OF PROPOSED ACTIVITIES INNON-AGREEMENT STATES, AREAS OF EXCLUSIVEFEDERAL JURISDICTION, OR OFFSHORE WATERS

(Rease red the insfntclons beoto, completing this tonn)

ppple VKPM CaUdksd h r t

tnbqp 1~i~i..ts Ilk abu I so tth2 ROWa

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1. )AMSCF ~fl ~nncrrn, o*~~o I~du VaQSS d-obedb~b)2 TYPE OF REPORTRONAN ENGINEERING COMPANY INITIAL 0 REVISION fl] CLARIFICATION

8050 PRODUCTION DRIVE LARRY BAKER , FIELD SERVICEFLORENCE, KY. 41042 GAMEU

606-342800 16406-342-64267. ACTIVITIES TO BE CONDUCTED (JNOERTHE GLANERAL UICENSE MIEN IN la CM isoa

E wtt LOGGING LEAK TES11ING ANOPOR CALIBRATIONS [ TELETKERAPY/IRRAflATOR SERIACE

DPORTABLE GAUGES OTHER (Sp.c4f) met 5 -z4-p 0-F 2 lItvat qq=

URADIOGRAPHY 4'RGSE flAU I A(AW WAP ~ 'L~N$S

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La~snXD 95o SCA.tdwH- d

I OSAW 'SWIC&AJT iE1 amWSAW U~~~~ I 201-260-9 5 K SAnhtt- in Innnlf

IS. CERTWICAMONlJW#MSTBE COAMIFEll BYAPPAICMU

repe - i.ply vtieproi' mu"at byroaduc ma ,o wldat nudw mv tld os ane -m hi aoat4leo f a soff.t#as ,' i~c 12 gea~lficiw or ttit 1~b c12.t "cddttse fl l Rtfiatmitoel'

, IIt.*%ld hI ed~t kteuO~ bytt co'fet . onm na ee1s f a d fdt tw.it

7In caedrrnfU s cp*~o .. o~ndI Tmev.teI a7qc o. r.ndpdtmIiU ln e

04/28/00 FRI 13:22 FAX 1 606 342 6426 RONAN ENGINEERING 0 003

SIZE (mci)ISOTOPE:MODE L#:

CAPSULE TYPE:MFR.:

CERT. DATE:DATE REC. (MFR.):

PRE-SHIP CONTAINER:MFR. P.O.#:

AVAIL. (YIN) /STATUS:

SOURlCE SER.#: 0004/962 0CS- 13 7HEG- 13'7A3015ISOTOPE02 / 01/2 00 002 /15 /2 00 0M17, 2714 599

RONA}I PART It: SRC-PT-C820-X

SHTPPRD(Y/N) :YCUSTOMER: POTLATCH

5.0.4*: ID-200688SHIP DATE: 02/29/2000LICENSE #: 11-27075-02. AM~END 04

SHIPPER: CONWAY CENTRAL EXPRESS$OTJRCEHOLtER: SAl-F37 NOTE:SYSTEM TYPE: X92'PREVIOUS HTSTORY(Y/N) PC DOWN: N

AGREEMENT STATE(Y/N) : N/R4

CUSTOMER ADDRESS

SPECIFIC LOCATION

POTLATCH CORPORATION!DAHA PULP & PAPERBOARDSOS1 MILL ROADLEWISTON, ID 83501ATTN: PAUL E BRIDGESRADIATION SAFETY OFFICERSAME

HISTORY

04/28/00 FRI 13:23 FAX 1 606 342 6426 RONAN ENGINEERING 0 004

SIZE (mCi)ISOTOPE:MODEL#:

2APSULE TYPE!MFR.:

CERT. DATE:DATE REC. (MFR.)Z

PRE-SHIP CONTAINER:MFR. P.O.#;

AVAIL. (Y/N) /SrATUS:

SOURCE SER.#: 000619820CS- 13 7HEG-137A3Q015ISOTOPE02 / 01/2 00 002/ 15/2 000M17, 0814599N

RONAN PART #: SRC-PT-CS-20-X

SHIPPED (YIN) ; YCUSTOMER: POTLATCH

S.0.4~: TD-200688SHI1P DATE: 02/29/2000LICENSE #: 11-27075-01 AM4END 04

SHIPPER; CONWAY CENTRAL EXPRESSSOURCEHCLUER: SAl-F37 NOTE:SYSTEM TYPE: X92PREVIOUS HISTORY(Y/N) PC DOWN: N

ACREEMSNT STATE (YIN) : N/R4

CUSTOMER ADDRESS

SPECIFIC LOCATION

POTLATCH CORPORATIONIDAHA PULP & PAPERBOARD803 MILL ROADLEWISTON, ID 83501ATTNt PAUL E BRIDGESRADIATION SAFETY OFFICERSAME

HISTORY

0 4/28 /00 FRI 13:23 FAX 1 606 342 6426 RON.AN ENGINEERING I0 O05

SIZE (mci)ISOTOPE:MODELft:

CAPSULES TYPE:NFR.:

CSRT. DATE:DATE REC. CMFR.)z

PRS-SH4IP CONTAINER:MFR. P.O.#:

AVAIL. (YIN) /STATUS:

SOURCE SER.#: 0009/9820CS5137HEG- 137A3 015ISOTOPE02 / 0 27200 002/1E/2000M17, 2514599N

RONAN PART #: SRC-PT-CS-20~-X

SH{IPP~D(Y/N) : YCTISTOMER: POTLATCH

S.O.#: ID-200688SHITP DATE: 02/29/2000LICENSE #: 11-27075-01 AME1ND 04

SHIPPER: CQNWAY CENTRAL EXPRESSSOURCEHOLDER: 8AI--F37 NOTE:SYSTEM TYPE: X92PREVIOUS HISTORY(Y/N) PG DOWN: N

AGREEMENT STATE(Y/N) : N/R4

CUSTOMER ADDlRESS

SPECIFIC LOCATION4

POTLJATCH CORPORATIONIDAHA PULP & PAPERBOARD803 MILL ROADLEWISTON, ID 33501,ATTN: PAUL E BRIDGESRADIATION SAFETY OFFICERSAME

HISTORY

04/28/00 FRI 13:23 FAX 1 606 342 6426 RONAN EINGINEERING 10006

SIZE (mci)ISOTOPE:MODE L#:

CAPSULE TYPE:MFR.:

CERT. DATE:DATE REC. (MFR.)!

PRE-SHIP CONTAINER!MFR. P.O,#:

AVAIL. (YIN) /STATUS:

SOURCE SER.#: 0010/982 0,CS- 13 7HEC- 137AS 015TSOTOPE02 / 01/ 2 0 0002 /15 /2 00 0M17, 2314 59 9N

RONAN PART #: SRC-PT-CS-20-X

SH-IPPED(Y/N): YCUSTOMER: POTLATCH

S.G.#z TfD-200688SHIP DATn: 02/29/2000LICENSE #: 11-27075-01 AMEND 04

SHIPPER: CONWAY CENTRAL EXPRESSSOURCEHOLDER: SA1-F37 NOTE:SYSTEM TYPE: X92PREVIOUS HISTQRY(Y/N) PC DOWN: N

AGREEMENT STATE(Y/N); N/T4

CUSTOMER ADDRESS

SPECIFIC LOCATION

POTLATCH CORPORATIONTDAHA PULP & PAPERBOARD803 MILL ROADLEWISTON, ID 83301ATTN~ PAUL E BRIDGESRADIATION SAFETY OFFICERSAME

HISqTORY

04/28/00 FRI 13:23 FAX 1 606 342 6426 RONAN ENGINEERING Z 007

SIZE (mci) ::SOTOPE:MOD EL*:

CAPSULE TYPE:MFR.!

CERT. DATE:DATE REC. (MFR.):

PRE-SHjIP CONTAINER:MPR. P.O.4f:

AVAIL.-(Y/N) /STATUS!

SOURCE SER.#; 00it3/~82 0CS- 137HEC- 137A3015ISOTCPEO2 /0ol/2 o0O002 /15/2 00 0M17, 2014599N

RONPAN PART #: SRC-PT-CS-20-X

SHIPPED (Y/N) : YCUSTOMEk: POTLATCH

SO.0.: ID-200688SHIP DATE: 02/29/2000LICENSE #: 11-27075-0J. AMEND 04

SHIPPER: CONWAY CENTRAL EXPRESSSOURCEHOLDER: SAl-P37 NOTE:SYSTEM TYPE: X92PREVIOUS KISTORY(Y/N) PO DOWN: N

AGREEMENT STATE ('/N) : N/R4

CUSTOMER ADDRESS

SPECIFIC LOCATION

POTLATCA4 CORPORATITONIDAHA PULP & PAPER9OARD803 MILL ROADLEWISTQN, ID 83501ATTN: PAUL B BRIDGESRADIATION SAFETY OFFICERSAME

HISTORY

04/ 28/0 0FRI 13:23 FAX 1 606 342 6420 RONAN ENGINEERING la 008

IZE (mCi) : 2'ISOTOPE: C~

MODEL#: HICAPSULE TYPE; A

MFPR.: ICERT. DATE: C

DATE REC. (MFR.) : .0PRE-SHIP CONTAINER: M

NER. P.O.#: 1AVAIL- (Y/N) /STATUS: N

DURCE SERZ.#: 0017/980S-137EG -1S~3015sSOTOPE2/01/20C02/ 15/200017, 144 59 9

RONAN PART #t SRC-PT-CS-20-X

SH{IPPEDCY/N)! YCUSTOMER: POTLATCH

S.C.#; ID-200688SHiIP DATE: 02/29/2000LICENSE t4: 11-27075-01 AMVENn 04

SHIPPER: CONWAY CENTRAL EXPRESSSOURCEHOLDER: SAl-FS7 NOTE:SYSTEM TYPE: X92PREVIOUS FIlSTORY(Y/N) PG DQOWN: N

AGREEMENT STATE (YIN); N/R4

CUSTOM'ER ADlDRESS

SPECIFIC LOCATION

POTLATCH CORPORATIONTDAEA PULP & PAPERBOARD803 MILL ROADLEWISTON, ID S3501ATTŽTh PAUL F BRIDGESRADIATION SAFETY OFFICERSAME

HISTORY

04/28/00 FRI 13:23 FAX 1 606 342 6426 RONAN ENGINEERING ~1009

SIZE CmC±)ISOTOPE;MODEL#*Z

CAPSULE TYPE:MFR.t

CERT. DATE:DATE REQ. (MFR.):

PRE-SHIP CONTAINER:MFR P.O.#:

AVAIL. (Y/N) /STATUS:

SOURCE SER.#: 0018/982 0CS - 13 7142G-137A3015ISOTOPE02/01/200002/15/2000M17, 2614599N

RONAN PART #: SRC-PT-CS-20-X

SHI PPED (YIN) : YCUSTOME~R: POTLATCH4

S.O.4: ID-200688SHIP DATE: 02/29/2000LICENSE #: 11-27075-01 AMEND 04

SHIPPER: CONWAY CENTRAL EXPRESSSO{JRCEHOLDER: SAl-F37 NOTE:SYSTEM TYPE: X92PREVIOUS HISTORY(Y/N) PO DOWN: N

AGREEMENT STATE (Y/N): N/R4

CUSTOMER ADDRESS

SPECIFIC LOCATION

POTLATCH CORPORATIONIDAHA PULP & PAPERBOARD203 MILL ROADLEWISTON, ID 83501ATTN: PAUL E BRIflGESRADIATION $AFETY OFFICERSAME

HI STORY

SIZE (mCi): 20ISOTOPE: CS-IS?MODRL#: HEG-137

CAPSULE TyPez~ A3015MFR.: ISOTOPE

CERT. DATE: 02/01/2000DATE REC. (MFR.); 02/15/2000

PRE-SHIP CONTAINER: 1417, 28MFR, P.O.4*: 14599

AVAIL. (YIN) /STATTYS: N

RONAN PART ft: SRC-PT-CS-20-X

SHIPPED(Y/N): YCUSTOMER: POTLATCH

S.C.#: ID-200688SHIP DATE: 02/29/2000LICENSE t*: 11-21075-01 ANENDl 04

SHIPPER: CONWAY CENTRAL EXPRESSSOURCEHOLIDER: SAl-F37 NOTE:SYSTEM TYPE: X,92PREVIOUS RISTORY(Y/N) PC DOWN: N

AGR22MENT STATE (YIN) : N/R4

CUSTOMER ADDRESS POTLATCH CORPORATIONIDAHA PULP & PAPERBOARD803 MILL ROADLEWTSTON, ID 83501ATTN: PAUL E BRIDGESRADIATION SAFETY OFFICER

SPECIFIC LOCATION SAME

HIlSTORY

04/28/00 FRI 13:24 FAX 1 606 342 6428 RONAN ENGINEERING a oil

SIZE (mci)ISOTOPE:M4ODEL#:

CAPSULE TYPE:MFR.:

CERT. DATE:DATE REC. (Mn.):

PRE-SHIP CONTAINER:mrt loi

AVAIL. (YIN) /STATUS:

SOURCE SER.#: 0021/982 0

HEG-137AS 015ISOTOPE02/01/200002/15/20 001417, 1114 599N

RONAN PART #: SRC-PT-CS-20-X

SHIPPED (Y/N): Y'CUSTOMBR: POTLATCH

SO0#: TD-200688SNIP DATE: 02/29/2000LICE.NSE 4*: 11-27075-0l AMEND 04

SHIPPER: CONWAY CENTRAL EXFRE~SSOURCE1HOLDER: SA1-F37 NOTE:SYSTEM TYPE: X92PREVIOUS I4TSTORY(Y/N) PG DOWN: N

AGREEMENT STATE (YIN); N/R4

CUSTOMER ADDRESS

SPECIFIC LOCATION

POTLATCH CORPORATIONiDAHA PULP & PAPERBOARD803 MILL ROADLEWISTON, TD S3501ATTN: PAUL F BRIDGESRADIATION SAFETY O'FFCERhSAME

HISTORY

04/28/00 FRI 13:24 FAX 1 606 342 6426 RONANJ ENGINEERING la012

SIZE rnC±)ISOTOPE:MODEL#:

CAPSULE TYPE:MFR.:

CERT. DATE:DATE REC. (MPR.)!

PRE-SHIP CONTAINER:MFR. P.o.4:

AVAIL. (Y/N) /S~tTUS:

SOURCE SER.#*: RR-8172 0CS-1s,HSO-137A30 15ISOTOPE;02/0 1/2 00 0o2/i5 000M17, 1714599N

RONAN PART #: SRC-2T-CS-20-X

SHIPPED YN;YCUSTOMER: POTLATCH

S-O.#: ID-200688SHIP DATE; 02/29/2000LICENSE #4: 11-27075-01 AMEND 04

SHIPPER; CONWAY CENTRAL EXPRESSSOURCEliOLDER: SAl1S37 NOTE;SYSTEM TYPE: X92pREVIOUS HISTORY(Y/N) PO DOWN! N

AGREEMENT STATE (Y/N) : N/R4

CUSTOMER ADDRESS

SPECIFIC LOCATION

POTLATCH CORPORATIONID2U{A PULP & PAPERROARD802 MILL ROADLEWISTON, ID 83501ATTN- PAUL BRPIDGESRADIATTON SAFETY OFFICERSAME

HI STORY

To: NRCAttention: Diane Heimfax Number: 404 562 4955Subject: Request for Reciprocity

RONAN ENGINEERING COMPANYMEASUREMENTS DIVISION

8050 Production Dr, Florence Ky. 41042 USA(606) 342-8500 FAX (606) 342-6426

From: Tom ChildsDate: 04/28/00 01:20 PMNumber of Pages: 1 of 12Merindian Gold

FAX

05/01/00 M1ON 09:32 FAX 1 606 342 6426 RONAN ENGINEERING 0 002

Reference

POTLATCH

Check#89489

Date

04/28/00Date

04/28/00

DbscriptkMt

RECrPROGITY POTLATCHAmount'

200,00

~GrossIS -> 0,9

Discount

0.00

o [scouint

Net Amount

200.00

Check Amount200.00role

RONAN ENGINEERING.CO.. KENTUCKYPH. 606-S42-8500

DIVISION OF RONAN ENGINEERING CO~, INC.WOODLAND KILLS; CA

* BAJWARPN EF

39!WOODLAND HII

CHECK DATE04128/00

NKorFAMEaIeA 89S

.LCA 91307 le~s-f-ZN ZC

CHECK NO. CHECKAMOdUNT 7

89489 $S$2O(f

Pay two hundred and 00/1 00 dollars

PAYTO THECORER OF

US NRC REGION 1161 FORSYTH STREET SWSUITE 23T85ATLANTA GA 30303-8931

1: I2 2COCOP II:

Reference

POTLATCH

Date

04/28/00

Description Amount D1scount Net Amount

20000QRECIPROCITY PCTL-ATCHCheck 4 Date89489 04/28/00

VendorUS NRC REGION 1I

200.00

Gross200~00

Pisnount Check Amount~ 0 200~00

I I 11,

II . I

rLI~rIIAI CCMPMY 6O,a3,I 36

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