NRC FORM 313 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0120 EXPIRES: 06/30/2019 (06-2016) Estimated burden per response to comply with this mandatory collection request: 4.3 hours. Submittal of the 10 CFR 30, 32, 33, 34 35, 36, 37, 39, and 40 application is necessary to determine that the applicant is qualified and that adequate procedures exist to

'c,."J .P.R REGtJl"l'Jo: protect the public health and safety. Send comments regarding burden estimate to the FOIA, Privacy, and

"'" 0 APPLICATION FOR MATERIALS Information Collections Branch (T-5 F53), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001,

a, 71>"" or by e-mai l to lnfocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory I!! " < 0 Affairs, NEOB-10202, (3150-0120), Office of Management and Budget, Washington, DC 20503. If a means ~ : LICENSE ~ tJ' used to impose an information collection does not display a currently valid OMB contro l number, the NRC may

...;..+.., +o~ not conduct or sponsor, and a person is not required to respond to, the information collection.

··**"' INSTRUCTIONS: SEE THE CURRENT VOLUMES OF THE NUREG-1556 TECHNICAL REPORT SERIES ("CONSOLIDATED GUIDANCE ABOUT MATERIALS LICENSES") FOR DETAILED INSTRUCTIONS FOR COMPLETING THIS FORM: http ://www , nrc .gov/readjog-rm/doc-collections/nyregs/staff/sr1~-SEND TWO COPIES OF THE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW.

APPLICATION FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH: IF YOU ARE LOCATED IN:

MATERIALS SAFETY LICENSING BRANCH '"'""· "~"· '°"'· •<•oG.-, w"l'lll-'@"~"~· "'~1· "" DIVISION OF MATERIAL SAFETY, STATE, TRIBAL AND RULEMAKING PROGRAMS APPLICATIONS TO: OFFI CE OF NUCLEAR MATERIALS SAFETY AND SAFEGUARDS U.S. NUCLEAR REGULATORY COMMISSION MATERIALS LICENSING BRANCH WASHINGTON, DC 20555-0001 U.S. NUCLEAR REGULATORY COMMISS REG~f1p 1 8 2017

2443 WARRENVILLE ROAD, SUITE 210 ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS: LISLE, IL 60532-4352

IF YOU ARE LOCATED IN:

ALASKA, ARIZONA, ARKANSAS, CALIFORNIA, COLORADDNMSDAHO, KANSAS, ALABAMA, CONNECTICUT, DELAWARE, DISTRICT OF COLUMBIA, FLORIDA, GEORGIA, KENTUCKY, MAINE, MARYLAND, MASSACHUSEITS, NEW HAMPSHIRE, NEW JERSEY, LOUISIANA, MISSISSIPPI, MONTANA, NEBRASKA, NEVADA, NEW MEXICO, NORTH NEW YORK, NORTH CAROLINA, PENNSYLVANIA, PUERTO RICO, RHODE ISLAND, SOUTH DAKOTA, OKLAHOMA, OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, TEXAS, CAROLINA, TENNESSEE, VERMONT, VIRGINIA, VIRGIN ISLANDS, OR WEST VIRGINIA, UTAH, WASHINGTON, OR WYOMING,

SEND APPLICATIONS TO: SEND APPLICATIONS TO:

LICENSING ASSISTANCE TEAM NUCLEAR MATERIALS LICENSING BRANCH DIVISION OF NUCLEAR MATERIALS SAFETY

U.S. NUCLEAR REGULATORY COMMISSION, REGION I US NUCLEA8-REGULATORY COMMISSION, REGION IV

2100 RENAISSANCE BOULEVARD, SUITE 100 1600 E LAMAR BOULEVARD

KING OF PRUSSIA, PA 19406-2713 ARLINGTON, TX 76011-4511

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

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

D A. NEW LICENSE WORTHINGTON, LENHART & CARPENTER, INC.

[{] B. AMENDMENT TO LICENSE NUMBER 49-27067-01 200 PRONGHORN STREET

D CASPER, WY 82601

C. REN EWAL OF LICENSE NUMBER

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

GREGORY L. BIGGS

200 PRONGHORN STREET, CASPER WY 82601 BUSINESS TELEPHONE NUMBER I BUSINESS CELLULAR TELEPHONE NUMBER

& 307-266-25 307-277-05 1015 HARSHMAN STREET, RAWLINS, WY 82301 BUSINESS EMAIL ADDRESS

GREGB@WLCWYO.CO~ ........ - -SUBMIT ITEMS 5 THROUGH 11ON8-1/2 X 11" PAPER. THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRlljD,. -· ·- ION GUIDE.

5. RADIOACTIVE MATERIAL 6. PURPOSE(S) FOR WHICH L H EUS§!)

a. Element and mass number; b. chemical and/or physical form; and c. maximum amount 7. INDIVIDUAL(S) RESPONSIB~.OR RAQIAIJGN-S'l':F«Y PROGRAM AND THEIR which will be possessed at any one time . TRAINING AND EXPERIENkffi'l t.i.PUBLIC -

8. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS. 9. FAc1L1T1Es AND Eau1PMENT.Q A.3 sensltlve-Secur1"r "'" ___ 10. RADIATION SAFETY PROGRAM. 11 . WASTE MANAGEMENT. a A.7 sens1uve lllL'1I .....

12. LICENSE FEES (Fees required only for new applications, with few exceptions•) UF~Uow• I AMOUNT $ 1Cf~2[)--t~ (See 10 CFR 170 and Section 170.31) CATEGORY l/'/Ji?_ ENCLfMi: •Amendments/Renewals that increase the scope of the existing license to a new or higher fee category will require a fee. Reviewer: 13. CERTIFICATION. (Must be completed by applicant) THE APPLICANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENT A T/ONS 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, 35, 36, 37, 39, AND 40, AND THAT ALL INFORMATION CONTANED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF. WARNING: 18 U.S.C. SECTION 1001 ACT OF JUNE 25, 1948 62 STAT. 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WI LLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.

CERTI FYING OFFICER - TYPED/PRINTED NAME AND TITLE SIGNATURE DATE

GREGORY L. BIGGS, WLC Treasurer, R.S.O. ~r74,:'P f/!Jj/7 FOR NRC USE ONL 'f' , /"~

TYPE OF FEE I FEE LOG I FEE CATEGORY !$AMOUNT RECEIVED CHECK NUMBER COMMENTS

APPROVED BY DATE

NRC FORM 313 (06-2016)

601057

··-1 c VVI." t:NGJNEt:f.( I NG • S UR ,fFYi1'F3 •PLA N N I NG

...... w ·~· . ·v1 1 r ""'"n ~c· 1 ·1,. ~

September 13, 2017 Licensing Branch US Nuclear Regulatory Commission 611 Ryan Plaza Drive, Suite 400 Arlington, Texas 76011

CASPE R

200 PRON G HORN

CASPE R , WY 826 0 1

P: 3 0 7 - .266 - 2524

RE: Requested Amendment Number 11 to Materials License No. 49-27067-01

To Whom It May Concern:

Worthington, Lenhart & Carpenter, Inc. (WLC) would like to request an amendment of License 49-27067-01. The following is information regarding Worthington, Lenhart and Carpenter, Inc.' s (WLC) request. I have filled out and attached the Information Required for Change of Control and/or Ownership. WLC is requesting that this amendment supersede previous amendments. In short, WLC had one existing owner retire from Worthington, Lenhart and Carpenter, Inc. (WLC). Although Control of Licensed activities has not changed, there have been some minor stock ownership transitions within WLC.

This is being provided as part of Information Required for Change of Control and/or Change of Ownership. Item 1 and item 2.

The Organization (Worthington, Lenhart & Carpenter, Inc.) owns the license. Control has not changed. Gregory L. Biggs is still RSO. Majority Ownership has not changed; owners of the organization have changed as one owner Don A. Davis has retired. Don Davis has provided and WLC has accepted notification of Mr. Davis' intent to retire in September 30, 2017. The information below does not include this as the transition has not happened yet.

This information is being provided so the NRC will have a current list ofWLC owner's. Previous:

Don A. Davis Gregory L. Biggs Jason L. Meyers Shane M. Porter Brad L. Miskimins Douglas A. Boyd

{33.213%) (20.048%) {18.116%) ( 18.116%) ( 7.488%) ( 3.019%)

The highlighted prior owners had a majority share of 66. 787%. Gregory L. Biggs was and still is RSO.

CHEYENNE RAWLINS

DEDICATED TD CLIENTS. DEFINED BY EXCELLENCE.

tb6Q1057

Current:

Gregory L. Biggs Jason L. Meyers Shane M. Porter Brad L. Miskimins Douglas A. Boyd

(30 .018%) (27.125%) (27.125%) (11 .212%) ( 4.521%1

The highlighted current owners have a 100.00% share of ownership. Gregory L. Biggs was and still is RSO.

ITEM 3: ADRESSES

The Storage locations of WLC's portable nuclear density gauges is listed in box 3 of NRC Form 313 . These are the operational facilities of our Engineering and Surveying business and will continue to be the storage facilities. Gauges will be used for the purposes described in their respective SSD Registration Sheets for moisture and density testing for construction projects at temporary job sites throughout Wyoming.

Item 4 - Surveillance Program

The following surveillance program is currently being followed and will continue to be followed after the transference.

A. Survey Instruments We will possess two radiation survey meters, for each location, that meets the criteria in the section entitled, "Radiation Safety Program­Instruments", in NUREG-1556, Vol. 1, Rev. 2, dated May 2012, in the event of an incident.

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

Occupational Dosimetry WLC personnel utilizing nuclear moisture-density gauges will be provided with film badges. The film badges will be collected by the R.S.O. quarterly and sent to the current badge provider, Landauer, Inc., 2 Science Road, Glenwood, Illinois 60425. A copy of a Landauer report "Radiation Dosimetry Report" is attached for your reference.

Either we will maintain, for inspection by NRC, documentation demonstrating that unmonitored individuals are not likely to receive a radiation dose in excess of 10 percent of the allowable limits in 10 CFR Part 20, or we will provide dosimetry processed and evaluated by an

CHEYENNE RAWLINS 601057

DEDICATED TD CLIENTS. DEFINED BY EXCELLENCE.

NVLAP approved processor that is exchanged at a frequency recommended by the processor.

Operating and Emergency Procedures We will implement and maintain the operating and emergency procedures in appendix H ofNUREG-1556, Vol. 1, Rev. 2, dated May 2012, and provide copies of these procedures to all gauge users and at each job site.

Leak Tests Leak tests will be performed at intervals approved by NRC and specified in the Sealed Source and Device Registration Sheet. Leak tests will be performed by an organization authorized by the NRC to provide leak testing services for other licensees or using a leak test kit supplied by an organization authorized by the NRC to provide leak test kits to other licensees and according to the kit supplier's instructions.

Maintenance Routine cleaning and lubrication: We will implement and maintain procedures for routine maintenance of our gauges according to the manufacture's recommendations and instructions.

Non-routine maintenance: We will send the gauges to the manufacturer or other person authorized by the NRC to perform non-routine maintenance or repair operations that require the removal of the source or source rod from the gauge.

B. The surveillance Items # Records: calibrations, leak tests, surveys, inventories, and accountability requirements will be current at the time of transfer.

[YES]

Item 5 - Confirmation of Records Transfer

All records concerning the safety and effective decommissioning (closing) of the Worthington, Lenhart and Carpenter, Pinedale and Gillette, Wyoming locations have been transferred to, Worthington, Lenhart and Carpenter, Inc. Rawlins, Wyoming 82301, or Casper, Wyoming 82601, as appropriate.

CHEYENNE RAWLINS

DEDICATED TD CLIENTS. DEFINED BY EXCELLENCE.

Item 6 - Confirmation of Abiding By All Constraints, Conditions and Requirements

Worthington, Lenhart and Carpenter Inc. will continue to commit to abide by all constraints, conditions, requirements and commitments that we have been or may become subject to .

Thank you for considering this request. If you have any questions please contact me at 307-266-2524.

Respectively Submitted,

~~~ WLC Treasurer, R.S.O.

CHEYENNE RAWLINS

DEDICATED TO CLIENTS. DEFINED BY EXCELLENCE.

APPENDIX E

Licensees must provide full information and obtain NRC's prior written consent before transferring control of the license; some licensees refer to this as "transferring the license." Provide the following information, excerpted from IN 89-25, Rev. 1, "Vnauthorized Transfer of Ownership or Control of Licensed Activities," concerning changes of control by the applicant (transferor and/or transferee, as appropriate). If any items are not applicable, so state.

N(A 1. The new name of the licensed organization. If there is no change, the licensee should so state.

The new licensee contact and telephone number(s) to facilitate communications.

3. Any changes in personnel having control over licensed activities (e.g .• officers of a t owNel(. lti/11t.€O corporation) and any changes in personnel named in the license such as radiation safety IL5,o N" ,NAN?£0fficer, authorized users, or any other persons identified in previous license applications as

responsible for radiation safety or use of licensed material. The licensee should include information concerning the qualifications, training, and responsibilities of nev,.. individuals.

}'£.J 9.

10.

NI-" l l.

An indication of whether the transferor will remain in non-licensed business without the license.

A complete. dear description of the transaction, including any transfer of stocks or assets, mergers, etc., so that legal counsel is able, when necessary, to differentiate between name changes and transferring control.

A complete description of any planned changes in organization. location, facility, equipment. or procedures (i.e., changes in operating or emergency procedures).

A detailed description of any changes in the use, possession, location. or storage of the licensed materials.

Any changes in organization, location, facilities, equipment, procedures. or personnel that would require a license amendment even without transferring control. /'(t"rMC°,o 4'-~e~

An indication of whether aU surveillance items and records (e.g., calibrations, leak tests, surveys, inventories. and accountability requirements) will be current at the time of transfer. Provide a description of the status of all surveillance requirements and records.

Confirmation that aU records concerning the safe and effective decommissioning of the facility (pursuant to IO CFR 30.35(g), 40.36(f), 70.25(g), and 72.30(d)), public dose. and waste disposal by release to sewers, incineration, radioactive material spills, and onsite burials, have been transferred to the new licensee (if licensed activities will continue at the same location) or to NRC for license terminations.

A description of the status of the facility. Specifically, the presence or absence of contamination should be documented. If contamination i.s present, \Vill decontamination occur before transfer? If not, does the successor company agree to assume full liability for the decontamination of the facility or site?

601057

E-1 NUREG-1556, Vol. 16

APPEl'\'OIX E

/l/(A I::!.

U .

N/A 14.

A description of any decontamination plans. including financial assurance arrangements of the transferee. as specified in 10 CFR 30.35. 40.36. and 70.25_ Include information about how the transferee and transferor propose to divide the transferor's assets, and responsibility for any cleanup needed at the time of transfer.

Confirmation that the transferee agrees to abide by all conunitments and representations previously made to !\'RC hy the transferor. These include, but are not limited to maintaining decommissioning records required hy 10 CFR 30.35(g). implementing decontamination acti\'ities and decommissioning of the site. and completing corrective actions for open inspection items and enforcement actions.

\Vith regard to contamination of facilities and equipment, the transferee should confirm, in writing. that it accepts full liability for the site, and should provide evidence of adequate resources to fund decommissioning: or the transferor should provide a conunitment to decontaminate the facility before transferring control.

With regard to open inspection items. etc .. the transferee should confirm, in writing, that it accepts full responsibility for open inspection item<; and/or any resulting enforcement actions: or the transferee proposes alternative measures for meeting the requirements: or the transferor provides a conunitment to close out all such actions with NRC before license transfer.

Documentation that the transferor and transferee agree to transferring control of the licensed material and activity, and the conditions of transfer; and the transferee is made aware of all open inspection items and its responsibility for possible resulting enforcement actions.

15. A commitment by the transferee to abide by all constraints. conditions, requirements, C.O l'>lht i1' 1'11i'N1 represent at ion-.. and commitments identified in the existing license . If not, the transferee AC.lt.€,G.tJ flJ. must provi<lc a description of its program to ensure compliance with the license and

regulations .

NUREG - 1556. Vol. 16 E-2

NRC FORM 313 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0120 EXPIRES: 06/30/2019 (06-2016)

Estimated burden per response to comply with this mandatory collection request: 4.3 hours. Submittal of the 10 CFR 30, 32, 33, 34 35, 36, 37, 39, and 40 application is necessary to determine that the applicant is qualified and that adequate procedures exist to

V"'t~R REGt.1'-f Jo: protect the public health and safety. Send comments regarding burden estimate to the FOIA, Privacy, and

"'" 0 APPLICATION FOR MATERIALS Information Collections Branch (T-5 F53), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, °' · '':""~ or by e-mail to lnfocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory ~ ~

:;; ;.: ~ LICENSE Affairs, NEOB-10202, (3150-0120), Office of Management and Budget, Washington, DC 20503. If a means <;. ii; used to impose an information collection does not display a currently valid OMB contro l number, the NRC may ~-s-.., " o' not conduct or sponsor, and a person is not required to respond to, the information collection. + •• * . ..

INSTRUCTIONS: SEE THE CURRENT VOLUMES OF THE NUREG-1556 TECHNICAL REPORT SERIES ("CONSOLIDATED GUIDANCE ABOUT MATERIALS

LICENSES") FOR DETAILED INSTRUCTIONS FOR COMPLETING THIS FORM: htt11://www.nrc.goY1Nfil!iilg-rm/doc-collections/nuregs/staff/sr1556/. SEND TWO COPIES OF THE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW.

APPLICATION FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH : IF YOU ARE LOCATED IN:

MATERIALS SAFETY LICENSING BRANCH ""~"· ""''"' mw" """""·""!'~'{!Bu~"~· "'jE>I. "" DIVISION OF MATERIAL SAFETY, STATE, TRIBAL AND RULEMAKING PROGRAMS APPLICATIONS TO: OFFICE OF NUCLEAR MATERIALS SAFETY AND SAFEGUARDS U.S. NUCLEAR REGULATORY COMMISSION MATERIALS LICENSING BRANCH WASHINGTON, DC 20555-0001 US. NUCLEAR REGULATORY COMMISS REG~if1p 1 8 2017

2443 WARRENVILLE ROAD, SUITE 210 ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS: LISLE, IL 60532-4352

IF YOU ARE LOCATED IN:

ALASKA, ARIZONA, ARKANSAS, CALIFORNIA, COLORADJ)N.MSDAHO, KANSAS, ALABAMA, CONNECTICUT, DELAWARE, DISTRICT OF COLUMBIA, FLORIDA, GEORGIA, KENTUCKY, MAINE, MARYLAND, MASSACHUSETTS, NEW HAMPSHIRE, NEW JERSEY, LOUISIANA, MISSISSIPPI, MONTANA, NEBRASKA, NEVADA, NEW MEXICO, NORTH NEW YORK, NORTH CAROLINA, PENNSYLVANIA, PUERTO RICO, RHODE ISLAND, SOUTH DAKOTA, OKLAHOMA, OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, TEXAS, CAROLINA, TENNESSEE, VERMONT, VIRGINIA, VIRGIN ISLANDS, OR WEST VIRGINIA, UTAH, WASHINGTON, OR WYOMING,

SEND APPLICATIONS TO: SEND APPLICATIONS TO:

LICENSING ASSISTANCE TEAM DIVI SION OF NUCLEAR MATERIALS SAFETY NUCLEAR MATERIALS LICENSING BRANCH

U.S. NUCLEAR REGULATORY COMMISSION, REGION I US NUCLEAR REGULATORY COMMISSION, REGION IV

2100 RENAISSANCE BOULEVARD, SUITE 100 1600 E LAMAR BOULEVARD

KING OF PRUSSIA, PA 19406-2713 ARLINGTON. TX 76011-4511

PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS

AND USE LICENSED MATERIAL IN STATES SUBJECT TO U .S.NUCLEAR REGULATORY COMMISSION JURISDICTIONS.

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

D A NEW LICENSE WORTHINGTON, LENHART & CARPENTER, INC.

[Z] 8. AMENDMENT TO LICENSE NUMBER 49-27067-01 200 PRONGHORN STREET

D CASPER, WY 82601

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

GREGORY L. BIGGS

200 PRONGHORN STREET, CASPER WY 82601 BUSINESS TELEPHONE NUMBER I BUSINESS CELLULAR TELEPHONE NUMBER

& 307-266-25 307-277-05 1015 HARSHMAN STREET, RAWLINS, WY 82301

BUSINESS EMAIL ADDRESS

GREGB@WLCWYO.COM a1inl

SUBMIT ITEMS 5 THROUGH 11 ON 8-1/2 X 11" PAPER. THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRl1!3D j ·- - . 1IONGUIDE .

5. RADIOACTIVE MATERIAL 6 . PURPOSE(S) FOR WHICH L . _H E USEJ;)

a. Element and mass number; b. chemical and/or physical form; and c. maximum amount 7. INDIVIDUAL(S) RESPONS I B~"""' CANAT.IQN Y PROGRAM AND THEIR which will be possessed at any one time. TRAINING AND EXPER I EN~t.1.PUBLIC

8. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS. 9. FAc1L1T1Es AND Eau1PMENT.Q A.3 Sens1t1ve-securn7 ""1•--

10. RADIATION SAFETY PROGRAM. 11. WASTE MANAGEMENT. a A.7 Sens1uve lnlUlllCll

12. LICENSE FEES (Fees required only for new applications, with few exceptions•) UF~unn (/.,:J_JJ ... f· vi? I AMOUNT $ (See 10 CFR 170 and Section 170.31) CATE RY

ENCL~: 'Amendments/Renewals that increase the scope of the existing license to a new or higher fee category will require a fee. g,.Vl~r:

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

THE APPLICANT AN D 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, 35 , 36, 37, 39, AND 40, AND THAT ALL INFORMATION CONTANED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF. WARNING: 18 U.S.C. SECTION 1001 ACT OF JUNE 25, 1948 62 STAT. 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.

CERTIFYING OFFICER - TYPED/PRINTED NAME AND TITLE SIGNATURE OATE

GREGORY L. BIGGS, WLC Treasurer, R.S.O. ~;,~d4;/'P tf//J;/7 FOR NRC USE ONL y f' f' tY

TYPE OF FEE I FEE LOG I FEE CATEGORY '$AMOUNT RECEIVED CHECK NUMBER COMMENTS

APPROVED BY DATE

NRC FORM 313 (06-2016)

601057

··-1 c VVI." ·r-, NEtJ~INC· • 5URVFYl~~ ··1 • f-'t ANNiNG

September 13, 2017 Licensing Branch US Nuclear Regulatory Commission 611 Ryan Plaza Drive, Suite 400 Arlington, Texas 76011

CASPER

2 00 PRON G HOR N

CASPER, WY 8 2 60 1

P : :30 7·2 66 -2524

RE: Requested Amendment Number 11 to Materials License No. 49-27067-01

To Whom It May Concern:

Worthington, Lenhart & Carpenter, Inc. (WLC) would like to request an amendment of License 49-27067-01 . The following is information regarding Worthington, Lenhart and Carpenter, Inc.' s (WLC) request. I have filled out and attached the Information Required for Change of Control and/or Ownership. WLC is requesting that this amendment supersede previous amendments. In short, WLC had one existing owner retire from Worthington, Lenhart and Carpenter, Inc. (WLC). Although Control of Licensed activities has not changed, there have been some minor stock ownership transitions within WLC.

This is being provided as part of Information Required for Change of Control and/or Change of Ownership. Item 1 and item 2.

The Organization (Worthington, Lenhart & Carpenter, Inc.) owns the license. Control has not changed. Gregory L. Biggs is still RSO. Majority Ownership has not changed; owners of the organization have changed as one owner Don A. Davis has retired. Don Davis has provided and WLC has accepted notification of Mr. Davis' intent to retire in September 30, 201 7. The information below does not include this as the transition has not happened yet.

This information is being provided so the NRC will have a current list of WLC owner's. Previous:

Don A. Davis Gregory L. Biggs Jason L. Meyers Shane M. Porter Brad L. Miskimins Douglas A. Boyd

(33.213%) (20.048%) (18.116%) ( 18.116%) ( 7.488%) ( 3.019%)

The highlighted prior owners had a majority share of 66.787%. Gregory L. Biggs was and still is RSO.

CHEYENNE RAWLINS

DEDICATED TD CLIENTS. DEFINED BY EXCELLENCE.

1'1601057

Current:

Gregory L. Biggs Jason L. Meyers Shane M. Porter Brad L. Miskimins Douglas A. Boyd

(30 .018%) (27.125%) (27.125%) (11 .212%) ( 4.521 %

The highlighted current owners have a 100.00% share of ownership. Gregory L. Biggs was and still is RSO.

ITEM 3: ADRESSES

The Storage locations of WLC's portable nuclear density gauges is listed in box 3 of NRC Form 313. These are the operational facilities of our Engineering and Surveying business and will continue to be the storage facilities. Gauges will be used for the purposes described in their respective SSD Registration Sheets for moisture and density testing for construction projects at temporary job sites throughout Wyoming.

Item 4- Surveillance Program

The following surveillance program is currently being followed and will continue to be followed after the transference.

A. Survey Instruments We will possess two radiation survey meters, for each location, that meets the criteria in the section entitled, "Radiation Safety Pro!:,rram­Instruments", in NUREG-1556, Vol. 1, Rev. 2, dated May 2012, in the event of an incident.

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

Occupational Dosimetry WLC personnel utilizing nuclear moisture-density gauges will be provided with film badges. The film badges will be collected by the R.S.O. quarterly and sent to the current badge provider, Landauer, Inc., 2 Science Road, Glenwood, Illinois 60425. A copy of a Landauer report "Radiation Dosimetry Report" is attached for your reference.

Either we will maintain, for inspection by NRC, documentation demonstrating that unmonitored individuals are not likely to receive a radiation dose in excess of 10 percent of the allowable limits in 10 CPR Part 20, or we will provide dosimetry processed and evaluated by an

CHEYENNE RAWLINS '601057

DEDICATED TO CLIENTS. DEFINED BY EXCELLENCE.

NVLAP approved processor that is exchanged at a frequency recommended by the processor.

Operating and Emergency Procedures We will implement and maintain the operating and emergency procedures in appendix H ofNUREG-1556, Vol. 1, Rev. 2, dated May 2012, and provide copies of these procedures to all gauge users and at each job site.

Leak Tests Leak tests will be performed at intervals approved by NRC and specified in the Sealed Source and Device Registration Sheet. Leak tests will be performed by an organization authorized by the NRC to provide leak testing services for other licensees or using a leak test kit supplied by an organization authorized by the NRC to provide leak test kits to other licensees and according to the kit supplier's instructions.

Maintenance Routine cleaning and lubrication: We will implement and maintain procedures for routine maintenance of our gauges according to the manufacture's recommendations and instructions.

Non-routine maintenance: We will send the gauges to the manufacturer or other person authorized by the NRC to perform non-routine maintenance or repair operations that require the removal of the source or source rod from the gauge.

B. The surveillance Items # Records: calibrations, leak tests, surveys, inventories, and accountability requirements will be current at the time of transfer.

[YES]

Item 5 - Confirmation of Records Transfer

All records concerning the safety and effective decommissioning (closing) of the Worthington, Lenhart and Carpenter, Pinedale and Gillette, Wyoming locations have been transferred to, Worthington, Lenhart and Carpenter, Inc. Rawlins, Wyoming 82301, or Casper, Wyoming 82601, as appropriate.

CHEYENNE RAWLINS

DEDICATED TD CLIENTS. DEFINED BY EXCELLENCE.

Item 6 - Confirmation of Abiding By All Constraints, Conditions and Requirements

Worthington, Lenhart and Carpenter Inc. will continue to commit to abide by all constraints, conditions, requirements and commitments that we have been or may become subject to .

Thank you for considering this request. If you have any questions please contact me at 307-266-2524.

Respectively Submitted,

~s~~ WLC Treasurer, R.S.O.

CHEYENNE RAWLINS

DEDICATED TD CLIENTS. DEFINED BY EXCELLENCE.

APPENDIX E

Licensees must provide full information and obtain NRC's prior written consent before transferring control of the license; some licensees refer to this as "transferring the license." Provide the following information, excerpted from IN 89-25, Rev. 1, "V nauthorized Transfer of Ownership or Control of Licensed Activities," concerning changes of control by the applicant (transferor and/or transferee, as appropriate). If any items are not applicable, so state .

N(A 1.

N/A 2.

The new name of the licensed organization. If there is no change, the licensee should so state.

The new licensee contact and telephone number(s) to facilitate communications.

3. Any changes in personnel having control over licensed activities (e.g., officers of a t o vvNcl(. ltiTt1ttE"0 corporation) and any changes in personnel named in the license such as radiacion safety ILS,o /Vt> ,rM~fficer, authorized users, or any other persons identified in previous license applicacions as

responsible for radiation safety or use of licensed material. The licensee should include information concerning the qualifications, training, and responsibilities of nev.: individuals.

}'6J 9.

10.

NIA 11.

An indication of whether the transferor will remain in non-licensed business without the license.

A complete, clear description of the transaction, including any transfer of stocks or assets, mergers, etc., so that legal counsel is able, when necessary, to differentiate between name changes and transferring control.

A complete description of any planned changes in organization. location, facility, equipment. or procedures (i .e., changes in operating or emergency procedures).

A detailed description of any changes in the use, possession, location. or storage of the licensed materials.

Any changes in organization, location, facilities, equipment, procedures. or personnel that would require a license amendment even without transferring control. /fcvAJ°.o "'-~~~

An indication of whether all surveillance items and records (e.g ., calibrations. leak tests, surveys, inventories, and accountability requirements) will be current at the time of transfer. Provide a description of the status of all surveillance requirements and records .

Confirmation that all records concerning the safe and effective decommissioning of the facility (pursuant to IO CFR 30.35(g), 40.36(f), 70.25(g), and 72.30(d)), public dose. and waste disposal by release to sewers, incineration, radioactive material spills, and onsite burials, have been transferred to the new licensee (if licensed activities will continue at the same location) or to NRC for license terminations.

A description of the status of the facility. Specifically, the presence or absence of contamination should be documented. If contamination is present, \i,.'ill decontamination occur before transfer? If not, does the successor company agree to assume full liability for the decontamination of the facility or site?

6 0 1 0 5 7

E-1 NUREG-1556, Vol. 16

APPEl'\OIX E

I~. 11/(A

U.

N/,lf 14.

A description of any decontamination plan.s, including financial assurance arrangements of the transferee. as specified in 10 CFR 30.35. 40.36. and 70.25. Include information about how the transferee and transferor propose to divide the transferor's assets, and responsibility for any cleanup needed at the time of transfer.

Confirmation that the transferee agrees to abide by all commitments and representations previously made to l\'RC by the transferor. These include, but are not limited to maintaining decommissioning records required hy l 0 CFR 30.35(g). implementing decontamination acti\'i ties and decommissioning of the site, and completing corrective actions for open inspection items and enforcement actions.

With regard to contamination of facilities and equipment, the transferee should confirm, in writing. that it accepts full liability for the site, and should provide evidence of adequate resources to fund decommissioning: or the transferor should provide a commitment to decontaminate the facility before transferring control.

\Vith regard to open inspection items. etc .. the transferee should confirm, in writing, that it accepts full responsibility for open inspection item-; and/or any resulting enforcement actions: or the transferee proposes alternative measures for meeting the requirements; or the transferor provides a conunitrnent to close out all such actions with NRC before license transfer.

Documentation that the transferor and transferee agree to transferring control of the licensed material and activity, and the conditions of transfer; and the transferee is made aware of all open inspection items and its responsibility for possible resulting enforcement actions.

15. A commitment by the transferee to abide by all constraints. conditions, requirements, C-0 l">lnt rrhl£N1 representation .... and commitments identified in the existing license. If not, the transferee A?ttlE,elJ flJ. must provide a description of its program to ensure compliance with the license and

regulations.

~UREG - 1556. Vol. 16 E-2

NRC FORM 532 U.S. NUCLEAR REGULATORY COMMISSION (05-2016) .::,(,,"-V"-llll"Ot1<-f_.

_+ , %. ; ~ ACKNOWLEDGEMENT - RECEIPT OF CORRESPONDENCE '; ~ : '!I . ~ ~ ~ +.., ~o .......

Name and Address of Applicant and/or Licensee Date

I 09/26/2017 I License Number(s)

Gregory L. Biggs, Radiation Safety Officer I 49-27067-01 I Worthington, Lenhart & Carpenter, Inc.

Mail Control Number(s) 200 Pronghorn Street Casper, Wyoming 82601 I 601057 I

Licensing and/or Technical Reviewer or Branch

CH ill

This is to acknowledge receipt of your: D Letter and/or 0 Application Dated : 09/13/2017

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

0 Amendment D Termination D New License D Renewal

D There were no administrative omissions identified during our initial review.

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

D Your application for a new NRC license did not include your taxpayer identification number. Please complete and submit NRC Form 531, Request for Taxpayer Identification Number, located at the following link: http_://www..nrc.gov/reading-rm/doc-collections/forms/nrc531,pdf

Follow the instructions on the form for submission.

D The following administrative omissions have been identified :

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

Region IV U. S. Nuclear Regulatory Commission DNMS/NMSB - B 1600 E. Lamar Boulevard Arlington, TX 7601 1-4511 (817) 200-1209 or (817) 200-1140

NRC FORM 532 (05-2016)

/r1~vfr7

BETWEEN:

Accounts Receivable/Payable and

Regional Licensing Branches

[ FOR ARPB USE l INFORMATION FROM WBL

Program Code: 03121 Status Code: Pending Amendment Fee Category:3P Exp. Date: 07/31/2021 Fee Comments: Decom Fin Assur Reqd: N

License Fee Worksheet - License Fee Transmittal A. REGION

1. APPLICATION ATTACHED ApplicanULicensee: Worthington, Lenhart & Carpenter, Inc.

Received Date: 09/18/2017 Docket Number: 3032144 Mail Control Number: 601057 License Number: 49-27067-01

Action Type: Amendment

2. FEE ATTACHED

Amount:

Check No.:

3. COMMENTS

Signed:

Date:

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

1. Fee Category and Amount: ~~~~~~~~~~~~~~~~~-

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

Amendment:

Renewal:

License:

Signed:

Date: