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Q AhD : STATUS CODE: 0_ _ G I 0 t[A L L_I C E N S I N G _S E,C T I _0_N S __

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: EAP. CATE: 19970731O F6E CC4MENTS: ______,________,

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1. APPLICATIGN ATTACHE 0Q APPLICANT / LICENSEE: HALEY, CHISHDLM L MORRIS,'INC.

RECEIVED DATE: 921104~

~ DCC KE T ' NO: 3029702Q CONTRCL hD.: 255016

LICEN$E AD.: 45-24867-01ACTION TYPE: TERMINATION

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cERTIFICAT E OF DISPOSITION OF MATERIAL.S R.1",0,',',oM*,afgggy ,8,gg,( g,gquNtip r iai y 8 povettan etGAAtome cowwsseog.M & DetNQ T Dh. DC MA % . A4 TO THf PDt h wep t.

INSTRUCTION $ $f ND THE COMPLETE D CERTIFICATE TO T HE fA4lt#'r:s A'4/$rld co'arle'ev- ettvetitN *no.e:t tai 6m si,kc 2%nossics ce wAhaag.h'4 NT A'*D sup00 n AS* i~37C N.NHC Of F tCL SP!CIFit0 ON THE REVE RLE priatortafel

pctssts N AWt AND st;a gg,3 m~st hyv$tst

llaley, Chisholm & Marris. Inc. 45-24887-01P.O. Dox 7807

m ustt o-a.tio' oaveCharlottesville. Virginia 22906

July 31, 1997

THE (10EN1f 2 On ANv INDIVIDUAL ExFCUllNO THis CSRT r!CATE ON 9Iw AL8 C4 Twl UcEN$EE CERTitlE S THAT.rcms e*+r nme ne use awse:en nea s mein n

A. MA T F RI At S D A1 A /CP,et& ene and t->mo'e e es ne<er.e yl

] 1, t.O M ATE ulALS WAVE E VE 84 DEE N Fl!OCURED on P05SEstED 8v THE llCENME UNota twi$ ticENSICR

] 2. ALL M ATE PI ALS f'HOCURED ANDf0M POSSEt$ED BY THE LtC!NSE E UNDE R THE L'CEN$E NUVBIR CITlO A90VI N AVI tilN D'$POSID C8IN Teil F O LLOMN3 M ANNE R. //'ewws/ ste, ts ne**a. m i9 ee.v p tve e* pawar ewav'ai

one w uni 4 m.m .i v.vc eme inu ree wee resc.m. wnin s,-vcee in temir etro im, unw te, o..nw ew.. iere is,e lgaos,teon of love levg| rgdcsttrvt Wett9. en af f wettt. Ortettt than C|30t.C W3He, and tuled FMeet, if 3pDhteth

The self contained sealed Troxler Nuclear Density Gauge-Model #3411B S/N 14001C5-137 S/N 50-2189 and AM-241 S/N 479358r n t#i'et w.e or nr of r, treen'n, ts, nrn, et t* nuns.o e,orvt ers ee reop ent i N AC keen netm or Ameen et sme rem, andoacenu net.c

11-4-92 E.O. Gooch 6 Associates Lic. No. 45-25189-01 (Copy Attached)H mesa. i wee emne of o rectN u e,i ce ni rere t*.a e ve ee ta. net v nnw.. twise d ooi.i et, or n.ite coae : tor, cie.ent4 thes:.e: f t emw preteere. to s.. emv os orxsw

0. OTHE R DAT/.

[ 1. OV A L PCIN$E H A3 NOT YE T (XF;RE D, P E ASE T5 RNtlN AT E 17.L

2 W AS A R Ab! ATiON $UmvEY CON 0VCitp TO CONFlR481NE AB$ENCE OF LICENSE D R ADICACTIVE M ATE AIALS AND TO DE TERVINE WHETHER

{Y CONTAM!NAT|ON PtMAINS ON THE PREM'SES COVE RE D BY THE L10EN$Elry...:e e ne;

No to,m ew." Self Contained Unit - However, a wipe test was performed_M YES. TH1 RISVLT$ Icane enet Md Sent to TroXIer for analysis - results will be on file.

ARE ATTACHE D. o._

W E R I PC D A Ah DID TO N A0 ON (frei

3 TM5 timSON 70 el CONTACTE D R$C ARO'NG TNE INFORVAllON F %**.46H)1*6#+ 0"Naut

liLULIVLU UT L.t-1) Q L |v- (804) 978-1000nteeNthvue.m

Michael T. Bogns. Vice President, p_,

4 MAIL ALL SJfvAL CORP 45PONDENCE HEG ARplNG THis LICENSE ' d t' (. f.4 / )/g

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Italey, Chisholm 6 Morris. Inc.

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22906Charlottesville, VA h . 4 &Bongs , Vice( l'rds'it10 Tit"" g # ' - >*g ('*,m'

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At t n: Mr. Michael T.

CEHilFYING OF FICIAL / '

I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREQQiNO l$ THUE AND CORRECT=

81N A T ve t gagg,

' November 4, 1992..us , t - . . 3 , a a y

MicLael T. Bongs..Vice PresidentWARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUWECT TO civil AND/OR CHIMINAL PENALTIES. NRCREGULATIONS REQUIRE THAT SUDMISSIONS TO THE NRC BE COVFLETE AND ACCURATE IN ALL MATERIAL RESPECTS.

,

Id U.S C $ECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATIONTO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.

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SFECIAL FORM RAD 10 ACTIVE SOURCE CER1IFICATE k* *

ORIGINAL*=

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I.THIS DOCUMENT hUST DE RETAINED BY lHE REC 1PIENT UNTIL SUCH TIME THAT THE iMATERIAL IS TRANSFERRED INTO THE POSSESSION OF ANOTHER LICENSEE. A COPY OFTHIS DOCUMENT MUS1 DE KEPT WITH THE GAUGE UHILE DEING TRANSPORTED ON PUDLICHICHUAYS IN THE UNITED STALES. INTlRNATIONAL USERS SHOULD CONTACT THE LOCALREGULATORY AGENCY TO DElERMINE THE DOCUMENTATIOr4 REQUlkEMENTS.

SEALEb SOURCi-- -- . .-

SE ALED SOUT:CE_ _ . . _ . - - . _

rT-137 RAD 10 ACTIVE MATERIAL Ah24i:DE50 ?iD? SOUPCE SERIAu NUNDER 47 7350

.30 GI Q ( L . 0fiC I ) ACTIVIIY i.40 GDO( 40tiCI )NEUlRON OUTPUT (NPS) 7.3 XiO' 4

20 i Ei., 19b0 DATE UF MEASUREMENT 21 MAY, 1(706102312 T R O X L E F. DRAUING NUMBER LO2451

GF/140/r cPECIAL FORM CENTIFICATE GD/7/SC64444 ANSI SPECIFICATION C64544

04 nAR, 19L7 ***nDATE OF LEAN TEST **** 04 MAR, 1907

SOURCC(S> ARE CONI AltiED IN TROXLER HDDEL 3411 SERIAL. 1400$TRANfiEERRED ON 04 M (, R , 1707 SALLJ ORDER NUMDER 15404

* Ton * * FR0rl =''OE 693600(-

ENSE:45-24007-01 3:1-102-1,ar :HALET CHISHOLM L M0r;RI S TROXLER ELECT. LADORATORIES,1NC,

ROUTE 743 F. D. DOX 12057RESEARCH TRIANGLE PARN, NC 27709EARLYSVILLE, VA 22937 I

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RADIATION SAFETY DEf% THENT

ean SfECIAL FORM, PACKAGE 6 TRANSPORT INFORMATION ***

A ., SPECIAL FORM- RADIDACTIVE hATEF.IAL USED IN THIS GAUGE HAS DEEN TESlED BYTHE SOURCE hANUFACTURER 10 MEET THE REQUIREMENTS AS SPECIAL FORM M ATER--IAL. THE ADOVE REFERENCEb SPECIAL FORM CERTIFICATE HAS DEEN ISSUED DY ANINTERNATIONALLY RECOGNIZED ' COMPETENT AUTHORITY'. THE ADOVE REFERENCEDLEAL TEST REVCALED THE REMOVAELE ACTIVITY TO DE LESS THAN O.005 HICRO-CURIE. A RECOMMENDED WORNING LIFE FOR THIS SOURCE IS 15 YEARS. THIS ISDASED DN TOXICITY, HALF-LIFE, INITIAL ACTIVITY, C APSULE DESIGN AND OPER--ATIONAL EXPERIENCE.

D. PACKAGE CLASSIFICATION- THE ADOVE LISTED NUCLEAR DAUGE HAS DEEN TESTEDAND hEET.S THE REQUIREMENTS OF US D01 6 IAEA REGULATIONS AS A ' TYPE A'PACNAGE. THE GAUGE MUST ALUAYS DE TRANSPORTED IN ITS ACCOMTANYING TRANS-

,

PORT CASE TO ENSURE COMPLIANCE WITH THE LADELING REQUIREMENTS. A REPORTOF TES1ING AND EVALUATION TO AFFIRH THAT THE GAUGE IS SHIPPED AS A USDOT '

7A TYTE A PACKAGE IS MAINTAINED ON FILE AT TROXLER ELECTRONIC LADS. INC.RESC ARCH TRI ANGLE PARD, 'NC 27709.

P DILL OF LADING: '

RADIDACTIVi. MATERIAL-

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SPECIAL FORM-N,0.S. UN2974-

T1PE A IACKAGEPADIO'CTIVC YELLOU II

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TROXLER ELECTRONIC LABOP.ATORIES, INC.P.O. BOX 12057, CORWALLIS ROAD

RESTARCH TRIANGLE PARK, NORTH CAROLINA 27709, U.S.A.Telephone 919/549-8661, Cable Troxelee, Telex 6844902

.

TYPE A PACXACE CEFTIFICATION

Troxler Electronic Laboratories, Inc. certifies that their models 1255,1257, 1351, 1352, 2226, 2376, 2400 Series, 3205, 3216, 3200 Series, 3300Series , 3400 Series , 3241, 3565 and 4640 contat'n Type A quantities ofspecial form radioactive caterials and are packed for shipment inSpecification 7A Type A containers.

These containers meet the requirements of United States Department ofTransportation CFR 173.24 and-are designed and constructed to meet thestandards as specified in C7R 173.403 and 173.465. These containers arecarked and labeled in conformance with CFR 173.444. These regulations

;are in agreement with the Regulations for the Safe Transport of,

, , , ,

Radioactive Materials (Safety Series No. 6) of the ' International AtomicEnergy Agency as A= ended.

A copy of this Certification must remain on file as required by CFR173.415(a).

TROXLER ELECTRONIC LABORATORIES, INC.

!' Vh hSu |G.,Kennech Brown, Jr.Radi$ tion Safety Of ficer

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U.s. NUCLE AQ HEGULATORY Commission O' NSq pt.ee) g ; )-,

f MATERIALS UCENSE I I|4 >g Pursuant to the Atomic Energy Act of 1954, as arnended, the Energy Reorganization Act of 1971 (Public 1.aw 93-438), an' Title 10, pd ,

( Ccde of federal Regulations, Chapter 1. Parts 30,31,32,33,34,35,39,40 and 70, and in reliance on statements and representations heretofore p'

4: made by the licensee, a license is hereby issued authorising the licensee to receive, acquire, possess, and transfer bypmduct, source, and special >4 nuclear material designated l< low; to use such material for the purpose (s) and at the place (s) designated below; to deliver or transfer such material h4 to persorts authorized to receive it in accordance with the regulations of the applicable Part(s). This license shall t< deemed to contain the conditions I

f{ specified in Section 183 of the Atomic Energy Act of 1954, as amended. and is subject to all applicabic rules, regulations and orders of the Nuclearf4 Regulatory Commission now or hereafter in effect and to any conditions specified below, f4,

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% g, E. O. Gooch and Associates 3. Ucense number 45 25189-01 >|'

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(' 4 Expiration date March 31,1997 pjq Charlottesville, Virgirda 22403 p|

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4 6. Dyproduct, source, and/or 7. Chemical and/or physical 6. Maximum amount that licensee fs -

4! special nucleu material form may possess at any one time k'

i under this license h4j h4 A Cesium 137 A. Scaled source registered A. 50 mi!!icuries total, no source to >-

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; pursuant to 10 CFR 32.210 exceed 10 rnillicuries,j 'or an equivalent Agreement

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[% #)L ented neutron source D. 250 millicurie's total, no source toD Americiurn 241 o D. S

registered pursuant . to exceed 50 millicuries F'

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C. Californium 252 C.. Scaled neutron source C. - 330 microcuries, no single source'

i registered pursuant to to exceed 66 microcuries>Idi '/ 10 CFR 32.210 or an

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g/ F|9. Authori7ed Use: i

>M A. Scaled source (s) contained in Troxler Electronics 12boratories model 4640 Series and 3400 Series portable4 gauging devices (registered pursuant to 10 CFR 32.210 or an equivalent Agreement State Regulation) for - y

mqasuring properties of materials. p

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4 D. Scaled source (s) contained in Troxler Electronics Laboratories model 3400 Series and model 3216 portable p

4 gauging devices (registered pursuant to 10 CFR 32.210 or an equivalent Agreement State Regulation) for _ 14 measuring properties of materials. 4H h*

4 C. ' Scaled sourec(s) contained in Troxler El:etronics laboratories model 340D Series portable gauging devices d-f (registered pursuant to 10 CFR 32.210 or an equivalent Agreement State Regulation) for measuring hqi properties of materials. p'4 ' h!i 4

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>ff(l10. Licensed material may be used at the licensee's facilities at Suite 5,1111 Rose Hill Drive, Charlottesville, Virginia

and at temporary job sites of the licensee anphere in the United States where the U.S. Nuclear Regulatory pCommission rnaintains jurisdiction for regulating the use oflicensed material, y

'g!1 NM 11. The Radiation Protection Officer for this license is John Y. Gooch. IJA >

1: 12. Licensed material shall be used ~ or under the supenision and in the physical presence of, John Y. Gooch orh'f individuals who have satisfactorily completed the desice manufacturer's training program for safe use of portable p

g gauging desices and have been trained in the licensee's operating and emergency procedures. The licensee shall p1 maintain records of persons designated as users,

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p 13. Scaled sources containing licensed material shall not be opened or removed from the gauging desice by the flicensee.,,

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14. A.(1) The source (s) specified in item 7, shall be tested for leakage 'and/or contamination at intervals not to py exceed 6 months. Any source received from another person which is not accompanied by a certificate b)4 indicating that a test was performed within 6 months before the transfer shall not be put into use until It% tested. .

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. hf (2) Notwithstanding the periodic leak test required by this condition, any licensed scaled source is exempt from'! such leak tests when the source contains 100 microcuries or less of beta and/or gamma emitting material p|F

[| or 10 microcuries or less of alpha emitting material. bj~

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I H. Any source in storage and not being used need not be' tested. When the source is removed from storage f$h for use or transfer to another person, it shall be tested before use orttransfer, g

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t - pi/ C. The test shall be capable of detecting the presence of 0.005 microcurie of radioactive material on the test 11M sample. If the test reveals the presence of 0.005 microcurie or more of removable contamination, the F!% source shall be removed from senice and decontaminated, repaired, or disposed of in accordance with >

$ Commission regulations. A report shall be filed within 5 days of the date the leak test result is known with ff the U. S. Nuclear Regulatory Commission, Region !!, Division of Radiation Safety and Safeguards, Nuclear y/ hiaterial Safety Section,101 h1arietta Street, Suite 2900, Atlanta, Georgia 30323. The report shall specify p

g| the source involved, the test results, and corrective action taken. Records ofleak test results shall be kept h|,j in units of microcuries and shall be maintained for inspection by the Commission. Records may be F

i disposed of following Commission inspection. bi Fi 6y D. The licensee is authorized to collect leak test samples for analysis by Troxler Electronics Laboratories or p

g%a.tests for leakage and/or contamination shall be performed by persons specifically licensed by the

#(Commission or an Agreement State to perform such services. |>>

The licensee may transport licensed materialin accordance with the provisions k>f;10 CFR Part 71, * Packaging andf15.

g Transportation of Radioactive blaterial? g/ b/ 16. The licensee shall conduct a physical inventory every 6 months to account for all sources and/or devices received p

M and possessed under this license. Records of inventories shall be maintained for 2 years from the date of each bl,

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If Ig 17. The licenste shall inaintain record 3 ofinformation impottant ta safe and eIfective decoinmissior.ing at the location ff' in Condition 10 pursuant to the provisions of 10 Cllt 3035(g) until this license is terminated by the Commission. p

i F)k 18. Except as yecifically provided otherwhe in this license, the licensee shall conduct its program in accordance with h% the st atement <., representations, and procedurcsyontained in the documents including any enclosures, listed below, ff The Nuclear 1(egulatory Commission's regulations shall govern unicss the statements, representations and g --

i procedures in the licensce's application and correspondence are enore restrictive than the regulations. p4

il *i F|,4 A. Application dated January 16,1992 - la.-

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