Page 1 of 3 APPROVED BY OMB: NO. 3150-0027 EXPIRES: (11/30/2015) Estimated burden per response to comply with this mandatory collection request: 2.4 hours. This submittal is reviewed to ensure that the applicable statutory. regulatory, and policy considerations are satisfied. Send comments regarding burden estimate to the Infonnation ~~~~;~::~PLICATIONUF::U:::R1::::::~~::::Services Branch (T-5 F53), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by internet e-mail to [email protected], and to the Desk Officer. Office of LICENSE, AMENDME~T, RENEWAL, Infonnation and Regulatory Affairs, NEOB-10202, (3150-0027), Office of Management and OR CONSENT R~IQUEST(S) Budget, Washington, DC 20503. If a means used to impose an infonnation collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a (See Instructions onl~ages 4 and 5) person is not required to respond to, the infonnation collection. PART B. TO BE COMPLETED FokiALL LICENSES, AMENDMENTS, RENEWALS, OR CONSENT REQUESTS (If more space is needed to compl~tr any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.) 1. NAME AND ADDRESS OF APPLICANT/LICENSEE I 1a. NAME OF APPLICANT'S CONTACT 1b. APPLICANT'S REFERENCE NUMBER John Broughton Tucker Energy Services 1c. PHONE NUMBER 1d. FAX NUMBER 12607 E. 60th Street (918) 252-5416 (918) 252-4496 Tulsa, OK 74146-6910 1e. E-MAIL ADDRESS [email protected] 2. TYPE OF ACTION REQUESTED (Check OnJ) CONSENT REQUEST (Parts B, C) EXPORT IMPORT AMENDMENT/RENEWAL D D D Current License Number: (Parts B, C, E) (Parts Bi' D, E) Current License Number: PCB55-03 3. CONTRACT NUMBER(S) 4. FIRST SHIPMENT DATE 5. LAST SHIPMENT DATE 6. PROPOSED EXPIRATION DATE 18-31-2011 8-31-2013 8-31-2015 PART C. TO BE COMPLETED FOR EXPORT LICENSES, AMENDMENTS, OR RENEWALS (If more space is needed to complJte any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.) 7. NAME(S) / ADDRESS(ES) OF SUPPLIERS 8. NAME(S) 1ADDRESS(ES) OF INTERMEDIATE 9. NAME(S) / ADDRESS(ES) OF ULTIMATE AND/OR OTHER PARTIES TO THE EXPORT FOREIGN CONSIGNEE(S) FOREIGN CONSIGNEE(S) Tucker Energy Services See pages 4,5,6 &7 12607 E. 60th Street Tulsa, OK 74146-6910 Tucker Technologies Inc 12607 E. 60th Street Tulsa, OK 74146-6910 7a. FUNCTION(S)PERFORMED/SERVICE(S)PROVIDED 1 8a. INTERMEDIATEUSE(S) 9a. ULTIMATEEND USE(S) Supply and Repair Exploration of Oil and Gas 10. DESCRIPTION OF RADIOACTIVE MATERIALS, SEALED SOURCES, 10a. MAX TOTAL VOLUME I NUCLEAR FACILITIES, EQUIPMENT, OR COMPONENTS; FOR 10b. MAX ENRICHMENT 10c. MAX ISOTOPE ELEMENT WGT (KG), OR NUCLEAR EQUIPMENT INCLUDE TOTAL DOLLAR VALUE OF ORWGT% WGT(KG) TOTAL ACTIVITY (TBq) EQUIPMENT FOR EXPORT see page 3 11. FOREIGN OBLIGATIONS (BY COUNTRY AND BY lERCENTAGE OF MAXIMUM TOTAL VOLUME) NRC FORM7 (11-2012) , . I \ "i f Page 2 of 3 NRC FORM 7 U. S. NUCLEAR REGULATORY COMMISSION (11-2012) 10 CFR 110 I APPLICATION FOR NRC EXPORT OR IMPORT I LICENSE, AMENDMFNT, RENEWAL, OR CONSENT REQUEST(S) (Continued) MB ~CE~~~~~ ., ID;'::~U;~~ ~ : ADAMSACCESSIONNO eR'!6 PUBLIC 01l:. "~N-PU~LlC PART D. TO BE COMPIi.ETED FOR IMPORT LICENSES, AMENDMENTS, OR RENEWALS (If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.) 12. NAME(S) / ADDRESS(ES) OF FOREIGN 13. NAME(S) / ADDRESS(ES) OF INTERMEDIATE 14. NAME(S) / ADDRESS(ES) OF ULTIMATE U. S. SUPPLIERS AND/OR OTHER PARTIES CONSIGNEE(S) CONSIGNEE(S) TO IMPORT See pages 4,5,6,&7 Tucker Energy Services 12607 E. 60th Street Tulsa, OK 74146-6910 Tucker Technologies lnc 12607 E. 60th Street Tulsa, OK 74146-6910 12a. NRC EXPORT LICENSE NUMBER(S) 1 13a. LICENSE NUMBER(S) / EXPIRATION DATE(S) 14a. LICENSE NUMBER(S) / EXPIRATION DATE(S) (if applicable) State of Oklahoma (OK-19815-02) 02/2912018 13b. INTERMEDIATE USE(S) 14b. ULTIMATE END USE(S) 15a. MAX TOTAL VOLUME / 15. DESCRIPTION OF RADIOACTIVE MATERIALS, S~LED SOURCES, 15b. MAX ENRICHMENT 15c. MAX ISOTOPE ELEMENT WGT (KG), OR NUCLEAR FACILITIES ORWGT% WGT(KG) TOTAL ACTIVITY (TBq) See page 3 16. FOREIGN OBLIGATIONS (BY COUNTRY AND BY PERCENTAGE OF MAXIMUM TOTAL VOLUME) PART E. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, RENEWALS OR CONSENT REQUEST(S) 17. ADDITIONAL INFORMATION 17a. COPIES OF RECIPIENTS' PROVIDED ON PAGES 3, 4, [{]YES [{] YES AUTHORIZATIONS PROVIDED? AND/OR ON SEPARATE SHEETS? I, the applicant's authorized official, hereby certify that this application is prepared in conformity 18. CERTIFICATION: with Title10, Code of Federal Regulations, and that all information provided is correct to the best of my knowledge, 18a. PRINT NAME AND TITLE OF AUTHORIZED OFFIQ;IAL 18b. SIGNATURE - AUT.HlZED OFFICIAL 18c. DATE Randy Nitz Radiation Safety Officer NRC FORM 7 (11-2012) . \ Page 3 of 3 NRC FORM 7 U. S. NUCLEAR REGULATORY COMMISSION (11-2012) 10 CFR 110 APPLI ATION FOR NRC EXPORT OR IMPORT LICENSE, AMENDME T, RENEWAL, OR CONSENT REQUEST(S) (Continued) ADDITIONAL INFORMATION (Reference applic ble block numbers from page 1 andlorpage 2 for each entry) Block 10 Page 1 Block 15 Page2 Type Max no of Curies Am24IBe Sealed Sources Category 2 Quartities CS137 Sealed Sources Category 2 Qurtities Cs137 Sealed Sources Exempted Qua tities Am241 Sealed Sources ofless than 10 uCi Am24IBe Sealed Sources ofless than 250 mCi Th232 Approximately 5uCi C060 Strips of less than 10uCi KUT Field Verifier consisting of the follo ing Isotopes K40 Approximately 1.7uCi U238 Approximately 0.23uCi Th232 Approximately 0.17 uCi Block 9 Page 1 Block 12 Page2 Australia, Azerbaijan, Brazil, Canada, Egyr India, Indonesia, Kazakhstan, Mexico Oman, Pakistan, Peru, Poland, Russia, Sau i Arabia. Turkey, Trinidad and Tobago, Ukraine United Arab Emirates, Venezuela NRC FORM 7 (11-2012).