NRC FORM 374A U.S. NUCLEAR REGULATORY COMMISSION PAGE 1 of 1 PAGES * , Ucense Number , 22-16447-02 hCY7 MATERIALS LICENSE Docket or Reference Number SUPPLEMENTARY SHEET 030-17370 Amendment No. 04
Serco Laboratories
1931 W. County Road C2 S: int Paul, MN 55113
O (J %qb z A in accordance with NRC Form 314hrtificate of Disposition" dated Au1998, License Number 22-16447-02 is hereby terminate 4 m Q J. ' D ' ik IL . ~ $N ,O s $Y12 :) ,, ' o
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. _ . ..$ FOR THE U.S. NUCLEAR REGULATORY COMMISSION |
AUG 2 4 898 /kbW D:t3 By / o ...s Jar s R. Mullauer, H.S. 9009010094 900824 Ma erials Licensing anch 9 prK'yff | PDR ADOCK 03017370 Region 111 PDR jj p }< C g \ \
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. O* - * . * : (FOR LFMS USE) : INFORMATION FROM LTS BETWEEN: O : ------License Fee Management Branch, ARN Program Code: 03123 and Status Code: 0 Regional Licensing Sections Fee Categorus 3P O I Exp. Date: 20010630 : Fee Comments: * : : : Decon: : : : : : Fin: : : :AssuF~Rei : : : : : : : : :jaT R~~~~~~~~~~ \ O :::::::::::::::: LICENSE FEE TRANSMITTAL A. REGION O 1. APPLICATION ATTACHED Applicant / Licensee SERCO LABORATORIES Received Date 980817 Docket No: O 3017370 d Control No.: 304311 r M As- -> License No. 22-16447-02 '" Action Type: Termination O {~ 2. FEE ATTACHED Anount - ~ ~ ~~ c Check No.: ~ ~~ O 3 3. COMMENTS I ~~ # /f , - h? DaSi nede ______= _ g O . ______m B. LICENSE FEE MANAGEMENT BRANCH (Checi-tr' ' 'e ered /_
1. Fee Category and Anount - - Q _____ . ______2. Correct Fee Paid. # Amendnent ~~~~ /~ ~pplication nay be processed for Renewal O ___ _~ [~ License ______' ' " " ' " O :::::::::::::::::::::::::::::::::: S D 1i ned:::_ 8:) O ? ff:::::::::::::::::::: 9,s---"* A f M EL-. . ------O Chock no:~~ ~- Amount ~~~~~~~~~~~~~ ~~ T~~~~~~~~' Foo Cate0cn[[_ g Type of Foo ___ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~~~~~~~ Date Check Rec'd Date Opmpleted_ h_Yf~~~~~ ~ -By / -- O 7------__=_____ , .. - _ - - ______- - - _ - - _ _ - - _ _ _ _ - _ _ - ______- _ _ - _ _ - - _ _ _ - - - . _ - _ _ - _ _ _ _ _ - _ - _ - ______- _ _ - - _ - _ _ _ _ _ - - - - - _ - - _ _ _ _ - - _ - - _ _ _ - - - - _ _ _ _ , 4 s
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, | NftC FORM 314 U.S. NUCLEAR REGU'.ATORY COMyllSSION APPROVED B7 OMB: NO. 31E,0-0028 EXPIRES: 06/30/98 (646) * le cra Jo.36(c)(1){tv) EsfiMAft0 suRDEN Ptn a sPONst 10 COMPLT WITH TMis MANDATORY wCAMAfl0N CDUECTiON in cra do.42(c)(1)(tv) nfout:1: 30 nenits rins sumerTAt as ust0 sv NaC As PAnr or Tut sAsis ton its 10 CFA 70.38(c)(1)(tv) D[Tinn4NAllON THAL THE f ACRm NAs WIN CitAR[0 0F RA0iOACflVE MAftRIAL Wl0Rf THE f ACam is HElf A310 r0R UNMEsTNCitD USE IDHWARD C0hWINis R[GARWNG BURIif N f siiMAff
CERTIFICATE OF DISPOSITION OF MATERlALS ''L",'",',","^",,,"',"C"', os,"'"'"M,"","'",4",3'4,o "7,=''"; D1500029L OrfICE Of MANAGLA4NT AND BUDidr. WASHiNGioli. DC 20601 AN AGFNCY MAY E0i | INSTRUCTIONS: ALL ITEMS MUST BE COMPLETED - PRINT OR TYPE CONouCT On SPONSOR, AND A PERSON is NOT R[ GLARED TO NSPau TO A CouECDON W SEWD THE COMPLETED CERTIFICATE TO THE NRC OFFICE SPECirlED ON THE REVERSE w 0nuAnn inatss n mAvs A CmNm Auo oms Cumm Nun I.K.[h511 hAME AND ADbfE bb LKJhat huMbtn $ | hMO $s4 $/A 1 7 2 -I4 ilL/7 -02 - CV , w v. (s .h #d " " " " ' " " * " " ' Sst fs.I, ml Win , tfue 3Co kool A, MATERIALS DATA (Check one and complete as necessary) THE LICENSEE OR ANY INDIVIDUAL EXECUTING THIS CERTIFICATE ON BEHALF OF THE LICENSEE CERTIFIES THAT: (Check and/or complete the appropriate stemis) below.) ]1. NO MATERIALS HAVE EVER BEEN PROCURED OR POSSESSED BY THE LICENSEE UNDER THIS LICENSE. OR [2. ALL ACTIVITIES AUTHORIZED BY THE LICENSE HAVE CEASED AND ALL MATERIALS PROCURED AND/OR POSSESSED BY THE , LICENSE NUMBER CITED ABOVE HAVE BEEN DISPOSED OF IN THE FOLLOWING MANNER, I// additiona/ space is needed, use the | reverse side or provide ettechments.)
Describe specific matenal transfer actions and, if there were radioactive wastes generated in terminating this license, the disposal actions including the disposition of low-level radioactive weste, mixed waste, Greater-than-Clase-C waste, and sealed sources, if applicable, ggg hg g[[ gg [cq 4 cc,W// 4 [4g, Ne0sley Ackd h$ d9 tRe, / nw */ %f vh WS A 6,. fem W<. b N , M/mi% y ,,,s,/ ForI transfers, & k t @ specify.S.A di theLWe date 5Bof the files transfer, 7tn the name of the licenso recipient, and the recipient's NRC licerf5e number or Agreementh,W1%/o State name and heense number. Mt : h4 m IWf Neeete # : 07-M70.-w p : hsdeH h/4d Grepuy M|&& JC* If materials were disposed of directly by the licensee rather than transferred to another licensee, licensed disposal site or waste contractor, desenbe the specific disposal procedures (e.g., decayin storspe)
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' | B. OTHER DATA f 1. OUR LICENSE HAS NOT YET EXPIRED: PLEASE TERMINATE IT. I
: 4 3. A RADIATION SURVEY WAS CONDUCTED BY THE LICENSEE TO CONFIRM THE ABSENCE OF LICENSED RADIOACTIVE MATERIALS ! ' ! AND TO DETERMINE WHETHER ANY CONTAMINATION REMAINS ON THE PREMISES COVERED BY THE LICENSE. (Check one)
NO (Attach explanation) , i ,/- YES, THE RESULTS (Check one) y ARE ATTACHED, or ~WERE FORWARDED TO NRC ON (Date) **** i 3. THE PERSON TO BE CONTACTED 2, C ",,"c [ '" REGARDING THE INFORMATION | {gyggg f. [pA/[J f [ PROVIDED ON THIS FORM (N/ [6 " Nh ! 4. Mall ALL FUTURE CORRESPONDENCE REGARDING THIS LICENSE TO
^ ' w scw $.wwnese - e im w. M yn cz- gI B ECEIVED u iN r h wl , md KlO i lie a - ~' CERTIFYING OFFICIAL , I ( g i CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGO!NG IS TRUE AND CORRgTf PMiNTED NAME AND TITL.E ggggg4 slGNAT URE DATL c h -~ %'rrm&. nam {f WARNING: pl'LSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL ANO/OR CRIMINAL PENALTIES Nhc REGULATION 5 REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S C SECTION 1001 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 JURISDICTIONS. nuNitu on ni mu u un a LNuc tokm ne &.ou-Ay ------______. ______. _ _ _ - _ _ - _ , ______- _ . _ - _ _ _ _ _ - _ _ _ _ - _ _ -
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* FILE CERTIFICATES AS FOLLOW 8: IF YOU ARE LOCATED IN: * * , - IF YOU ARE A DISTRIBUTOR OF EXEMPT PRODUCTS, SEND TO: ILLINOls, INDIANA, IOWA, MICHIGAN, MINNESOTA, MISSOURI, OHlO, OR WlSCON88N, SEND APPLICATIONS TO: DIVISION OF INDUSTRIAL AND MEDICAL NUCLEAR SAFETY OFFICE OF NUCLEAR MATERIAL SAFETY AND SAFEGUARDS U.S. NUCLEAR REGULATORY COMMIS$10N MATERIALS LICENSING SECTION U.S. NUCLEAR REGULATORY COMMISSION, REGION 111 WASHINGTON. DC 20566 0001 801 WARRENVILLE ROAD LISLE. IL 60632-4361 ALL OTHERS,IF YOU ARE LOCATED IN: ALASKA, ARIZONA ARKANSAS, CALIFORNIA, COLORADO, . CONNECTICUT, DELAWARE, DISTRICT OF COLUMSIA, MAINE, HAWAll, IDAHO, KANSAS, LOUISLANA, MONTANA NEBRASKA, MARYLAND, MASSACHUSETTS, NEW HAMPSHIRE, NEW NEVADA, NEW MEXICO, NORTH DAKOTA, OKLAHOMA, JERSEY, NEW YORK, PENNSYLVANIA, RHODE ISLAND, OR OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, VERMONT, SEND APPLICATIONS TO: TEXAS, UTAH, WASHINGTON, OR WYOMING, SEND APPLICATIONS TO: LICENSING ASSISTANCE SECTION NUCLEAR MATERIALS SAFETY SRANCH gg ,g g 5. NUCLE AR REGULATORY COMMISSION. REGION i U.S NUCLEAR REGULATORY COMMISSION, REGION IV 011 RYAN PLAZA DRIVE. SUITE 400 KING OF PRUSSIA, PA 19406-1415 ARLINGTON, TX 78011 8064
ALASAMA, FLORIDA, GEORGIA, KENTUCKY, MISSISSIPPI. NORTH CAROLINA, PUERTO RICO, SOUTH CAROLINA, TENNESSEE, VIRGINIA, VIRGIN ISLANDS, OR WEST VIRGINIA, SEND APPLICATIONS TO:
N3 CLEAR MATERIALS SAFETY SECTION U.S. NUCLEAR REGULATORY COMMISSION REGION || 101 fA.tRIETTA STREET NW, SUITE 2900 ATLANTA,3A 30323-0199
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_ - ______* ~~ , MATERIALS LICEN Amendment No. 03 3 % Pursuint t> the At:mic Energy Act of 1954, as (mended, the Energy)teorgnization Act of 1974 (Public Law 93-438), and Title 10, Code of $ g Feberal Regulations Chrpt r I. Parts 30,31. 32,33,34,35. 36. 39,40, and 70, and in reliance on statements2 and representations heretofore made by the licensee, a license is hereby issued authorizing the licen'see to receive, acquire, possess. and transfer3 byproduct. source, and special nuclear | materi:1 designated below; to use such material for the purpose (s) and at the place (s) designated below;E to deliver or transfer such matenal to persons authonzed to receive it in accordance with the regulations of the applicable Part(s). This license shall be deemed to contain the conditions 6 ! f' specified in section 183 of the Atomic Energy Act of 1954, as amended, and is subject to an applicable rules regulations, and orders of the Nucliar Regulatory Commission now or hereafter in effect and to any conditions specified below.~ k ) $ ! I ''C'" e 4 ) In accordance with letter dated $ ' l- October 19 1995 SERCO Laboratories, Inc. 3. License Number, 5 22-16447-02 is renewed in 5 its entirety to read as follows: 3 2. 1931 West County Road C2 e E St. Paul, MN 55113 4. Expiration Date June 30, 2001 E 5. Docket or Reference No. 030-17370 [t 6. Byproduct. Source, and/or E Special Nuclear Material 7. Chemical and/or Physical Form 8. Maximum Amount thatLicensee E May Possess at Any One Time g UnderThis License A. Nickel-63 e A. Foil source *A. 2 sources not (Hewlett-Packard * ( to exceed 15 i Model No. 19235) millicuries each E E E 9. Authorized Uee: E A. s analysis.To be used in a Hewlett-Packard Model 5890 Series gas chromatograph for sample i
. E .. . s CONDITIONS ' ' , 10. Licensed material shall be used only at the licensee's facilities located at 1931 s West County Road C2, St. Paul, Minnesota. 'i
: 11. Licensed material shall be used by, or under the supervision of, Christopher S. Jones, Ph.D. i' ', 12. s The Radiation Safety Officer for this license is Christopher S. Jones, Ph.D. i 13. A. s Sealed sources and detector cells shall be tested for leakage and/or i contamination at intervals not to exceed 6 months or at such other intervals as specified by the certificate of registration referred to in 10 CFR 32.210. ji B. Notwithstanding Paragraph A of this Condition, sealed sources designed to emit s alpha particles shall be tested for leakage and/or contamination at intervals i i not to exceed 3 months. - ~ E 8,
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_.-._._.______._.__._._.______._.m._.m._.~.JC0" ! Pnneed sm verycled paper
_ . _ . . . _ _ _ _ . _ . . _ _ _ _ * NLTC Inductrico, Inc. P. O. Box 1400, N. Tontwende, NY 14120 . Phono 716-693-0550 . TIN 16-1234141 , . * DATE: 5/13/1998 INVOICE NO. 21667
CUSTOMER NUMBER: 10327 PURCHASE ORDER: 9230 CHIP TO: BILL TO: MR CHRIS JONES ACCTS PAYABLE LAB MANAGER LAB MANAGER SERCO LABORATORIES SERCO LABORATORIES 1931 W COUNTY ROAD C2 1931 W COUNTY ROAD C2 ST. PAUL MN 55113 ST. PAUL MN 55113 ...... ______...... ______..______..______o DESCRIPTION * * QUANTITY PRICE * EXTENSION * TOTAL DUE *
NI-63 LEAK TEST 1 s50.00 s50.00
Sales Tax so.00 e50.00 --..__.______-_. __...... __ .....___...____....___ .______. ...______.... * * LEAK TEST CERTIFICATE * * PAY THIS INVOICE NUMBER OF SAMPLES: 3 TEST METHOD: DRY WIPE_. NO STATEMENTWILL BE SENT RADIONUCLIDES AS IDENTIFIED BY CUSTOMER IS NICKEL-63
ANALYSED FOR BETA CONTAMINATION USING WINDOWLESS PROPORTIONAL COUNTER CAMPLES TAKEN BY CUSTOMER ANALYSED BY L KEATING
* * TEST RESULTS * * _...... __...______. ...______. ______...... ___...______.._____.. * + DEVICE ID SAMPLE ID + MICROCURIES/ SAMPLE * PASS / FAIL *
HP s/n F2486 Entrance < 16 x 10E-6 PASS *
HP s/n F2486 Housing < 16 x 10E-6 PASS
HP s/n F2486 Exit < 16 x 10E-6 PASS
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LIMIT IS 5000 x 10E-6 MICR0 CURIES PER DEVICE .... .__..._-___....__...... __.___. ..__.____..___.____...... ___-_-___----_--- - TESTED UNDER NYS DOL LICENSE #2323-3164
DATE: 5/13/1998 SIGNED BY e V -- i HEALTH PHYSICIST [- PAGE l'0F- 1
L . - H3WLETT ' | . - PACKARD * -
- HEYruTThACKARD COMPANY 8% PRODUCT MATERIALS (RAOlOACTIVE) UCENSE VERIFICATION For eschaege of speedc leones for ree.oecove secton capere IEC) detecure (HP t e71SA. HP Gt224A. HP part nurneer 18e0340520. HP 19235 and HP 193031. Anno for retum ter enemange of general hcense doencore (HP 19202. HP 1e233. HP Gt223A. and HP 1es12) for purcnese of conversson into (HP 18742E. HP 1S303. and HP t 82300) for use wem the U S on*y.
INSTRUCT 10NS:
1 Comoete seceon A besow Reed secson 5. and comspees the sopropreto cerencason statement-.eeer 81 for generaliconse or 82 for speede beenee. 2. Include mie form we your renamed doescarte) br enchangeveerviemg. or fem a copy to (302) 8384831.
EC DETECTOR DCHANGE PROGRAA4-EC desociere (HP 19233. HP 19238. HP 18282. HP 1930s. HP 1est a. HP 18713A. HP part numoer s ee0340620. HP G1223A. and HP G1224Al Howtott#eckard we ship a result detecer sueject to me tetowing e The form must be composend property and accompemed by a fup assemb6edy detector (HP 18238. HP t9233. HP 19303. HP 19312. HP 1 e713A. HP 18282. HP part numeer 1800640820. HP G1223A. or HP G1224A). e The program does not apply to any seectonac pere or nonseeneerd hardware. Any such theme reessved we be renamed we the reeudt doencer i e Hewtett#eckard must recewe me used detector before a rep 6acement detector can be shipped. A recuait doesciar will be enopped wein | $ wortung oaye after receipt of me used desactor e A8 doescurs wd be ressmed vs Federal Empreme Prierny 1. e For pnose, cad your local Howtos Packard eases afece, and request me pnce for me appropnem exchange part number shown meiow e F*d out one form for each inspumforW.
When returning a detester ter esehange, t. Determee enchange part nuredber. 2a. Ploes a esses order we your local Hewees#eckard ofees Have your own purchase order nutrear avadeale. Fil in the space for same artier nummer bedser. er 2b. If your metument e under serves contract. cad your local Howtoe#ackard serves department to obtem a emies order number 3. Consult your redesen safety ofesor and me letant revemen of me Code of Federal Reguiseens. Tless to and de (sec.173.a2. t 73 421.t t 73 421). and applicabte local and sente requineens for pachaceg. lateling and shippeg moeucsons. 4. Send me form and me detector dwesey to:
EC Osencer Emchange Program , Hownse#eckard Company-uses Fase Sles 2850 Centerville Road Wilmington DE 19000 1810 Fax: 3024334e12
NOTE: If your doencer e oowerest by werventy. contact your local Howtoe#eckard service engineer before sheppeg your detector %s | ' engineer vnli provide an order number, to be entered on me reverse side, inspied of your purchase order number. In this case you need riot supply a purehene order.
Model No. Detscar No. Enchange Part No. HP Seen Senes HP Q1223A 18t3348578 (gener*4 HP 5e00 Sense HP G1224A 1a n nammen (speedci HP G120sA HP G1223A 1e23848879 (generan HP G120sA HP G1224A 1923848838 (opeedct , 1923840570 (genereQ | HP Ses0 Series HP tease HP 9000 Sense HP 1923e 1steammm gepeedc) HP Sese Sense HP 1930s t800e40800 (specdel HP 5000 Sense MP 1e312 tes124 esso (general) HP part no. t 000640S20 t 80034es20 (specde) i HP 5eeWeteoSenes HP 5700 Senes HP 18713A 1871See001 (aoecdel | 1ste2 e e01 (generoQ | HP 5700 Sense HP intet
A. END USER INPORt4ATION (PtJEASE PRINT OR TYPE)
COMPANY I6(d Co bdofrdBMS ENDUSER Of 8Il$ hMfd ADDRESS Mf W- bnfsr IN Ck CUSTOMER PURCHASE ORDER NO. N4
(A| Ak r Ih h HEWWTT#ACKARD SALES ORDER NO. Nd
TAX STATUS: TAXABL.E S EXEMPT C
TEL.EPHONE NO. Mh bN '7I73
J - B. UCENSE VERIMCATIOWCERTIFICATION
Fedure te compey weih licenoeg reeuvemen^2 con seue's sonous coneeseenees ter your company ans ter Meween-Paceers. Move a see.gnetee scensee reed and comp == the appmoanie carescasen emesment tier.genered beenes ($1) er Mr esecfAc hennes 182) twM
g1, VERIFICATION POR GENERAL UCENSE DETECTOR E)lCHANGE (For esseonge et generei neenes esteemre any New pureness of general Heense EC deemmere reeuves como6eesa of customw cwencemen card a trWormeen ser Generaf beensees (HP puhteesen nummer 1431 Sost sea 7E er MP part numeer Stea 17est. Pteese mescans emecer locesen en the insrument by checheg the opptegness het DETECTOR INSTRUMENT DETECTOR LOCATION SERIAL NO. SER6AL NO(s) BACK FeCNT
HP G1239A EC detector 15 mci M 43 pleend part, general Econes O O EC doencear ter use en HP sees Senes il gas sheenneengraphe r1 W or HP G13eeA- : ; C'lhed eierenteengraphs.
HP tette EC doesseer. t5 mCl M eseessed part, general Esenes EC deessest ter use en HP sete Sedes gas afwomeengraphs.
HP teelt EC desseest. t 5 MCI M es,inese part, general leones C EC desseest ter use en HP esse sedes ges seweeneengraphe O HP ttses EC desseter.15 MCI M eseisend part, general noones O EC desseest ter use en HP e78e and HP e788 Sedes see ehrenseengraphs. SIGNATURE OF AUTHORIZED OPPICER OR UCENSED USER This le to serefy sist i een in sempeones sad underetend the rogueseens governing see general seense EC doenster desented in Anfamoselen for General Useneses (w puhuesten number (as) ese14ea7E w HP pen anseher 80881788). .
DATE Neen: it is eensatte ter you a rnese a sepy for your reeeres.
St. VERIFICATION POR SPECIPIC UCENSE DETECTOR E)dCMANSE The Nucteer Reguinary Commenen requienre reguse Homens#eekent e have venAseten of your NRC Econes en Sie (or steen heense et you live n en ' Agreement * sinusi toeste shqppeg your doescar. This nennee enuet he surrent. and it rnuet apply to the type. euensey. and term bemg pureissed on the seove returenced ereer. (See CAF Ties 10. NRC form at 3 and Reguheery Gumie 10.7 ter tiennemg etermosen
DETEC'Ce INSTRUMENT DETECTOR LOCAfiCN SERIAL NO. SERIAL NO(el BACK FsCM
HP G122dA EC desmeter. t5 mCl M es,isend part, for uso en C w esse Sen. a gas ehreemographe O O HP totse EC dessener 15 rnCI M esgesund part, ter uso en O O w see A S.n= ga shre meg"P"' O O HP t eses EC dessesor, is MCI M ESigleted part, ter use en HP esse Sedes ges ehromelegraphs [ [ EC deemster, HP pen number 1eesseeste. t 5 MCI M eseiosed O O p=i. =r == en w asse,see. S.n= g ehreem gre,he O HP 18713A EC deemster.15 mCl M esetated part, for use en 'f"""fS- " C HP 97ee and HP e780 Sedes gas ehrometsgraphs.
UCENSE NUMSER )) 'b "Ob SIONATURE OF AUTHORIZED OPPICER OR UCENSED USER Tltio le a eenNy ihet my NRC or Agreement Stoes Usense is cureont iSSulNG AGENCY (4 % dao ensi pte me e reeeeve seg type, guenely, and form of recieacove meannele seeisee speessed desented eteve. EXPtRATION DATE la f 3 8 f 7061 h MW _
DATE f[ Nees: Copy et liennes e requsrest: areer we be Mesd us wrtnowt Pe ft e seveemde ter you a mese a espy for your receres
Primead la USA 1012 Pinhuandes No. i43n 509I noa5E Port No. 19333 90760 . .- .
. SERCO Laboratories 1931 West County Road C2 Phone (651) 636 7173 St. Paul, Minnesota 55113 Fax (651) 636-7178
August 13,1998
Hewlett Packard ECD Exchange Program Little Falls Site 2850 Centerville Road Wilmington Delaware 19606-1610
Dear Sirs:
Enclosed is a model G1224A electron capture detector cell, serial number F2486. I no longer possess the gas chromatograph on which this cell was used and I now wish only to dispose of the electron capture cell. I do not wish to exchange this detector for another.
Also included here are the HP License Verification form, the latest leak check form, and a copy of our materials license.
Should you have any questions about these matters, please contact me at (651) 636-7173.
Sincerely, i
. 4 9/L / / w Christopher S. Jones [ ] Radiation Safety Officer i
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. SERCO Laboratories
1931 West County Road C2 Phone (651) 636-7173 St. Paul, Minnesota 55113 Fax (651) 636-7178
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August 13,1998
Minnesota Department of Health Division of Environmental Health Section of Radiation Control 121 East Seventh Place P.O. Box 64975 St. Paul, MN 55164-0975
Dear sir / madam:
This letter is to inform you that SERCO Laboratories no longer possesses any sources ofionizing radiation. Enclosed is a Certificate of Dispostion of Materials and other paperwork relating to the dispensing of the one source that we had.
In addition, we have applied to the Nuclear Regulatory Commission to terminate our license. Our current NRC license number is 2216447 02. Our Mmnesota Department of Health Registration number is 62- 04328.
If you have any questions regarding this matter, please contact me at 636-7173.
Sincerely,
Christopher ones Radiation Safety Oflicer
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"#0 UNITED STATES ' %**, .+ . NUCLEAR RESULATORY COMMISSION ,, REGION 111 G , 801 WARRENVILLE ROAD ' * USLE, ILUNolS 605324351 ..... O I4 M
Christopher S. Jones, Ph.D. Radiation Safety Officer Serco Laboratories 1931 W. County Road C2 Saint Paul, MN 55113
Dear Dr. Jones:
Enclosed is Amendment No. 04 which terminates your NRC Material License No. 22-16447-02 in accordance with your request.
If you have any questions or require clarification on any of the information stated above, you may contact us at (630) 829-9887.
Sincerely,
- Original signed by James R. Mullauer, M.H.S. Health Physicist Materials Ucensing Branch ,
License No. 22-16447-02 Docket No. 030-17370
Enclosure: Amendment No. 04
i- To tooelve a copy of this document, indicate in the box: "C" = Copy without ettschment/ enclosure "E" = Copy with enschmenuenciosure "w" = No copy | | OFFICE DI)llplSfil_1 | DNMS/Rlli | | | NAME J441[p6erf DATE P M 96 " ~ OFFICIAL RECORD COPY
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# '' " ' ' ' ' ' ' ' " ~ # "4o - 8 * NUCLEAR REGULATORY COMMISSION $ REGION til h 801 WARRENVILLE ROAD * LISLE. ILUNOIS 605324351
'\'' *****/ AUGUST 19,1998 I
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Christopher S. Jones, Ph.D.
, Rad! stim Safety Officer ' Serco Laboratories 1931 West Country Road C2 ,St. Paul, MN 55113
SUBJECT: ' ACKNOWLEDGEMENT OF CORRESPONDENCE (Application Dated August 13,1998)
Dear Licensee:
In response to your request, we have completed the initial processing, which is an administrative . review of your application for a(n):
._ New License _ Amendment _ Renewal' ~. X. Termination _ Auth User (Amendment not required) __, Other
, No administrative deficiencieswere identified d'uring this initial review. However, P Pould be noted that a technical review may identify omissions in the submitted information.
It appears that your request is routine (see 1-3 below, as applicable).
1. New and ' amendment actions are normally completed within 90 days, unless we find major deficiencies, or policy issues requiring central program office assistancem You are required to provide your taxpayeridentification number to our Fees Department. Please fill out the | - enclosed NRC Form 531. ;
2. Renewal actions are~normally completed within 180 days, however, under timely filing ! . (before expiration), you may continue to operate under your existing license, j
3. Termination actions are norrnally completed within 90 days, unless confirmatory surveys { following decontamination / decommissioning activities are involved.
~ A copy of your correspondence has been forwarded to our Licensing Fee and Debt Collection Branch (301/415-6097) for approval of the fee category and amount, if required.
We will try to complete your request as soon'as practicable. - Any correspondence about this request should reference the control number. Please direct any questions concoming your request . to the Materials Licensing Branch at (630) 829-9887.
Materials Support Branch
; Mail Control No. 304311 License No. 22-16447-02
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