8
Hill, Carol From: Sent: Davis, Gurvis Jr CIV (US) <[email protected]> Thursday, March 13, 2014 6:17 PM To: Hill, Carol Cc: Davis, Gurvis Jr CIV (US) Subject: Attachments: Amendment Request for NRC License 30-02405-10 (UNCLASSIFIED) WSMR AMEND 30-2405-10 RSO (7 Mar 14).pdf Importance: High Classification: UNCLASSIFIED Caveats: NONE Ms. Hill, D MAR 7 4 20 14 DNMs 1. Attached is the amendment request for NRC License 30-02405-10 requesting a change in RSO. 2. Please contact Mr. Ken Kawabata at 575-678-1168 should you have any questions. Very respectfully, Gurvis Davis ATEC Radiation Safety Staff Officer (443) 861 - 9705 DSN 848 88 (443) 910-0489 Fax : (443) 861- 9965 "Truth In Testing" Classification: UNCLASSIFIED Caveats: NONE 1 PUBLIC 0 Immediate Release ;12-Normal Release NON-PUBLIC 0 A.3 Sensitive-Security Related 0 A.7 Sensitive Internal 0 Other: · ------ Reviewer: - 1?tt:l. -- Date: 3-r 1- -!'f llo. 5 833 57

Department of the Army; White Sands Missile Range ... · department of the army white sands test center u.s. army white sands missile range 100 headquarters avenue white sands missile

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Hill, Carol

From: Sent:

Davis, Gurvis Jr CIV (US) <[email protected]> Thursday, March 13, 2014 6:17 PM

To: Hill, Carol Cc: Davis, Gurvis Jr CIV (US) Subject: Attachments:

Amendment Request for NRC License 30-02405-10 (UNCLASSIFIED) WSMR AMEND 30-2405-10 RSO (7 Mar 14).pdf

Importance: High

Classification: UNCLASSIFIED Caveats: NONE

Ms. Hill,

D

MAR 7 4 2014

DNMs

1. Attached is the amendment request for NRC License 30-02405-10 requesting a change in RSO.

2. Please contact Mr. Ken Kawabata at 575-678-1168 should you have any questions.

Very respectfully,

Gurvis Davis ATEC Radiation Safety Staff Officer (443) 861- 9705 DSN 848 88 (443) 910-0489 Fax : (443) 861- 9965 "Truth In Testing"

Classification: UNCLASSIFIED Caveats: NONE

1

PUBLIC 0 Immediate Release

;12-Normal Release

NON-PUBLIC 0 A.3 Sensitive-Security Related 0 A.7 Sensitive Internal 0 Other: ·------

Reviewer: -1?tt:l.-- Date: 3-r 1- -!'f

llo. 5 833 57

DEPARTMENT OF THE ARMY WHITE SANDS TEST CENTER

U.S. ARMY WHITE SANDS MISSILE RANGE 100 Headquarters Avenue

WHITE SANDS MISSILE RANGE, NEW MEXICO 88002-5000

REPlY TO A n EP<liOil O f :::t­

'­~

TEDT-WS-ISO @; G 3 MAR 20i4

~

MEMORANDUM0HRU Commander, U.S. Army Test and Evaluation Command (CSTE-OP/Gurvi Davis), 2202 Aberdeen Boulevard, Aberdeen Proving Ground. MD 21005-5001

FOR U.S. Nuclear Regulatory Commission, Region IV, ATTN: License Assistant, ·160Q East Lamar Boulevard, Arlington, TX 76011-4125

~UBjECT: Reque::;l fu1 A(1it:ndrne1,t to NRC Matarla!s Ucc:-:~e Nc. 30-02405-10

t : Reference page 2 Materials License No. 30-2405-10 CONDITIONS Item 11.B, Radiation Safety Officer.

2. The White Sands Missile Range requests the approval of Mr. Ken K. Kawabata as the Radiation Safety Officer for the Radioactive Material License No. 30-02405-10. Mr. Kawabata's resume' is provided as an enclosure to this memorandum.

3. Ms. Mary E. Donahue has been the authorized Radiation Safety Officer for the license since December 12. 2011 (amendment no. 23)

4. Upon approval . Mr. Kawabata will replace Ms. Donahue as the primary radiation safety person for the Radioactive Material License No. 30-02404-10.

5. The point of contact for this request is Ken Kawabata, C

Encl as

575-678-1168.

Jh 5 833 57

APPENDIX A

U.S NUCLEAR REGULATORY COMMISSION

TRAINING AN D EXPERIENCE BROAD SCOPE RADIATION SAFETY OFFICER

1. NAME OF RSO: Ken K. Kawabata 2. EDUCATION: B.S. Chemistry

3. CERTIFICATION

SPECIALITY BOARD CATEGORY MONTH AND YEAR CERTIFIED

American Board of Hea lth CHP 11/2005 Physics (ABHP)

4. TRAIN ING RECEIVED IN BASIC RADiOiSOTOPE HANDLiNG TECHNiQUES

CLOCK HOURS CLOCK HOURS IN LECTURE/ OF

FIELD OF TRAINING LOCATION AND DATE OF TRAINING LABORATORY SUPERVISED ON-THE-JOB EXPERIENCE

1) t.t.uu l!tand U.toa' Zl1opy4"d Va ep Ct.. >3.:)0 ""'· , .:mn•s

A RADIATION PHYSICS AND 19a5-19'Y.l

INSTRUMENTATION 2 ) V/osh~S-e tf:r•ocd ~.,, R•-:hland \\'/, 1900~1994

3) uS De~a1mcr1 ot Er«9'/. R ch'"""' w;.. 199-:-19')(;

•:) SIMford Ur'll\'l!'Sd'Y Mef'IQ P .. d ., CA 1999·20:0

!>) Flu~ J-1;-)rto~d. R<n~-d WA 2000..200'\ &I We,~-"~g."l :>uso. RrcN.ooo. V..'A : CG3 7) UnrvtYs•:)' c1 Nort, Cov.ol~.r .. 1 Cn.1po H1J

NC tcO<-?CC5 61 ( n.or;ysoiu• o"'s SJ!t L:tlo.~ C•l)' ur

2005·1:xl7 9) ECC. Lakewood, CO :2007 -200<! 101 USF.P/, l as Vcqos "''V 2003-: 0<Y.J 11 ) Goosyr:ec, IPCh IAala y>.a 2CG-2012 12) V'.~to Sn"'ds 1.'\Jss/ ft Rango 2~;2·P•tsc'"t

B. RADIATION PROTECTION 1 2 J,.:S, ti l ~.~~011 1 7 "'300 tv s >O:COC r.: s

c MATHEMATICS PERTAINING TO 1 1 3 .! 5 G,7 8 9 ~ 0 t1 1 :' .. '300 rvs :-.!QCO t-· !.

THE USE AND MEASUREMENT OF RADIOACTIVITY

D RADIATION BIOLOGY 1.2 3.45 6/,69 10 '1 .1? >300 N !> .. ..1QOO tY~

E RADIOPHARMACEUTICAL --· ·$:> r,, ~ ·o!»JI" ~ ..

CHEMISTRY

5. EXPERIENCE WITH RADIOISOTOPES

ISOTOPE Ci USED AT ONE LOCATION CLOCK HOURS TYP[ OF USE TIME

A-·7.: 1 ·c ~1 Pu· to-'i • :! ' .:. ~.f>9 1C' 1' ·300 C~ tn'C""~~ .. ··•u

~'~- ~·-...-.J c~. !37 ~00~ ' -J:J~ T • • .f" tr• lC o~•a~

==·r-···· ~ · -r-s 1 s · :!OC \'/;J) :c o.:s.rox:

c,.s;c t.:.: OC<I 12 !oC Ec;. ;v"lc-· l e>'>

6. EXPERIENCE SUPERVISING USE OF RADIOISOTOPES

ISOTOPE MAXIMUM ACTIVITY LOCATION CLOCK HOURS TYPE OF USE

Cs 137 Sr·~.O 1'·32. l(>J MC• 1 >JOO r.rs Rc:.c.J•Ch .1f"V: \1\I'IJ (..)I Uso rl-j C- 1~ 1· 131 1·12~

T c -~om

Co.ro. Cs.-13/, T"''230 V-238 Pu 2.% M"' ,_ . 'uC•

1,23', t ~689, t i) 1i 12 "-}00 r'.(S C.Jt bt ~t;on ll~ C"'IO(.io; S~c.oo;

OJ.:I.OC '.OWW:S

7. PRACTICAL EXPERIENCE

ACTIVITY LOCATION EXPLANATION

PERFORMED SAf-ETY EVALUAT IONS OF FACILI TIES 2.3 ·· ~

Pe1C:TOd :l'.X:!! 5. il'l:l OIJ noe1~ar safe:)' tCYlCN fa USO~ SAfb . Sr\RP:.

AND EQUIPMENT OF PROPOSED USES. ~nd CD~c;;n fi)ltr ... ~.

EVALUATED QUALIFICATIONS OF AUTHORIZeD 7 E ... alo;JtCO ~u.:hfi:.nt.on ct rcst:ardwrs and Ia:>) ,nor 1c subrr.1~ 131 ot

USERS AND INDIVIDUALS WORKING UNDER THE au:not•.:C<S \JS~r ;,;,:>'ea' on to RSC

SUPERVISION OF AUTHORIZED USERS FOR PROPOSED USES

CONDUCTED A LABORATORY AUDIT PROGRAM. 2 3 . 5.7 Po·fon->~d tJlKM::i ::.ntJ !:.\1\IOtiL'lor.cs of ta::-QiatOI'IoQS af'ld taollhM

¢ RESEARCH AND DEVELOPMENT LABS ¢ MEDICAL LABS • NUCLEAR MEDICINE. ONCOLOGY. ETC.

MAINTAINED PERSONNEL MONITORING PROGRAM 7 ts 1: ',',1n.:)~ed C d CC'n.."lJ do-SoltTV>try and .:..tARA pt'<>'_Y:l."ns

FOR DETERMINING EXTERNAL EXPOSURE ¢ SELECT APPROPRIATE

DEVICES ¢ MONITORED EXPOSURE RECORDS

¢ ESTABLISHED EXPOSURE INVESTIGATIVE LEVELS

MAINTAINED A BIOASSAY PROGRAM FOR 7B M.l·rt:;'l:"'IC'd "-'~<>'0 DoaJ COU'"I~t..ot .1na b<OJ:~~y :,')(Q9ilff\ Pc-·•~"'0 11"1-!ur ..,al

DETERMINING INTERNAL EXPOSURE dc ... :me:ry cab./a t ons basoc upon o. o.o'l '>~1y rosuf:~

<> DETERMINED METHOD· IN-VIVO AND IN-VITRO

¢ ESTABLISHED ACTION LEVELS ¢ EMERGENCY FOLLOW-UP

ACTIONS

CALCULATED INTERNAL AND EXTERNAL 76 PrOVIde ~'oun .. , tlon fOt NRC !orrn $

RADIATION DOSES.

MONITORED AND MAINTAINED ABSOLUTE AND ~ 2,J..: !>6.i ,89.10,1 1 , , M.Y."lOe-d t:tf~u~n1 reiO.lX! OC'OQra.--n IO 1n;Juda ~.~cr ~~ SI<!I""S Stile,...

OTHER SPECIAL FILTER SYSTEM ASSOCIATED mot"J"Ot•"'J . :tncs aft.•a me. .. 'Oti!YJ of ctt!\..ent,

WITH THE USE. STORAGE. OR DISPOSAL OF RADIOACTIVE MATERIAL

EVALUATED. SELECTED. DESIGNED. AND 1 3 10 1\:a~-.,tf'(J •n roo ... l...\:t:t:(a:o.)· C:O!!-t":l'l

SUPERVISED MAINTENANCE OF PROCESS CONTROL AND CONFINEMENT SYSTEMS. SUCH AS

GLOVE BOXES AND HOODS

PERFORMED SHIELDING EVALUATIONS. '2.:/ 5 7 X·tar ,~ ::es1~;n ~ '·eo C.t:>ert ~"\0 ~,c·-:.nQ to ~up:>Ofl Yo?t•

INCLUDING DETERMINATION OF TYPE AND AMOUNT NEEDED

B. 10 • 1 C/,LCULATED RADIOACTIVE DECAY. BUILDUP. AND

Rl~ ..,"""~ n..,:~';11C.1' do'N~ "'.:l ' ·oo ;;aM •..c:n..• 'Y.ItC "'. "T''Qrl~=-"' ' 1'\1) SECULAR AND TRANSIEN f EQUILIBRIUM.

Jb 58 33 57

ACTIVITY LOCATION EXPLANATION

EVALUATED. SELECTED. 11/IAINTAINED. AND , ? 5.~ . 10 " St''CC':oo a"'d us" o rr'-r ·:1''Y! f"-:'-:rr-~r~ !o- .... ~ .. ~nc ~)'lr.r"lC)

EFFECTIVELY USED RESPIRATORY PROTECTIVE r~:t'O"''~O

EQUIPMENT

MAINTAINEO A CONTAMINATION CONTROL PROGRAM ,,3,< 56789 1011 \~ M J"l:l:;na Ot f'0 '1Cf '"'.f!ot' St.:r'Jtl'i !. IU ~u;;:,.:,t ' ('Uf"" ~.t '':'Hn.)'IO""l ccr:~oi iiM

0 AMBIENT RADIATION SURVEYS ·o.: ~I en -.ot'•tOt r q P'O':;f.lr'S

0 CONTAMINATION SURVEYS 0 AIR SAMPLING PROGRAM

0 SEALED SOURCE LEAK TESTING 0 SAMPLE ANALYSIS

Pv1'01r-•o s"'•os: ';.11<41 ot t~iJ.J..lC!o , & ~ 1, oY"-d ~sorrd CC'A"'..lM~J'•on

INVESTIGATIONS 1 3!!7 c~trts

0 OVEREXPOSURES 0 ACCIDENTS. SPILLS. LOSSES THEFTS

0 UNAUTHORIZED RECEIPTS. USES. TRANSFERS. DISPOSALS 0 MISADMINISTRA TIONS

l •ili t..-d it.rJ-c.n:.~ u~"f ano ~..J~·~ pror: ~'s!.Or~ ...... ,.d~r:.

CONDUCTED RADIATION PROTECTION TRAINING 76

FOR FACILITY PERSONNEL. 0 AUTHORIZED USEHS ANU t.AB 'vVORi\ERS

0 ANIMAL CARETAKERS 0 NURSING STAFF

0 INCINERATOR OPERATORS 0 ANCILLARY STAFF

• SECURITY 0 WASTE PROCESSORS/HANDLERS

DEVELOPED RADIATION SAFETY MANUALS .: , 7 11 Oc..---vc10()Cc1 fbd•:'t'On Ptotcct:on Pl<n!i ana Ef'tvt·or¥r~al Mcr.:ouYJ Plans

SELECTED INSTRUMENTATION ASSOCIATED WITH Setoc: flod ar-.d put~"'<:.C-d rx•aflcr rr~J SU:'l:l!Q .n~Ul.n'ltr:t.1~•on aM :v'\C:fl..a-y

THE MEASUREMENT OF RADIATION 1 2 3 4 5 G.7 6.9 10. 11 12 ~tng ..,,:r..,.-nef\!.J' on

0 SURVEY INSTRUMENTS (GM. ION CHAMBER. SCINTILLATION

0 COUNTING EQUIPMENT 0 SPECIAL EQUIPMENT (DOSE CALIBRATOR. DIRECT READING

DOSIMETER. AIR SAMPLER) Ca :>ra:cc OO"':aboe ono bCN:I"'II:H>oratory r»:a'IO'' r'NI\UI'~ lf'~t\K"'I(tf11)

PERFORMED INSTRUMENT CALIBRATIONS ~ i.8 11

Pet1tv·ned m••Sf' func.t•CI"U f et UNC Ho:~l:lls COORDINATED MATERIAL INVENTORY AND 7

ACCOUNTABILITY PROGRAM <> MONITORED RECEIPT. USE.

DECAY. TRANSFER. AND DISPOSAL

COORDINATED RADIOACTIVE WASTE DISPOSAL M~•''--"';OC w;,Sh! C1 Spo~;,l :>'01;~\!""l

PROGRAM .: 6 7 9 I I 0 EFFLUENT MONITORING

0 COLLECTION 0 TREATMENT <> PACKAGING 0 DISPOSAL

PREPARED RADIOACTIVE PACKAGES FOR ; u

TRANSPORTATION.

ACTIVITY LOCATION EXPLANATION

DEVELOPED t,ND MAINTAINED A FACILITY 123.4.5 6 ":8,3 1011 ~ 2 .:.u :.'ltJ·ol~>eJ '"'ll~Var f~JCJ1t t.l':; 1 v.~~ ... ~ at n.ld ."tn c ··,er::cne) ;x<>n ' Cf

EMERGENCY PLAN FOR RESPONDING TO tC~")O(K: r.p tO !~" tMi".IW (.I r3":: 0.1C: VO T :Jl r'""()l

RELEASE OF RADIOACTIVE MATERIAL

DETERMINED NEED FOR FINANCIAL ASSURANCE ; 10 ~;*" ..... :::Cf•• ' tur·t•on o~ re~ttJ· ;f", b\;1 ~- -v:~ ¥!'J l.)QOI:i::YIO!:

FOR DECOMMISSIONING.

DEVELOPED AND MAINTAINED 7 U 0'\'1'1''• ' y ~;l"t!l.!'"'c..,: :o ).UpOCrt -::c:::..,,.. ... oOf" r; 'U"\CCn.'l

DECOMMISSIONING FINANCIAL ASSURANCE FUNDING PLAN.

8. PROFESSIONAL ORGANIZATIONS

Health Phys•cs Soc•ety

9. AWARDS, SCIENTIFIC PRESENTATIONS AND PUBLICATIONS

10. SIGNATURE AND CERTIFICATION

I cert1fy that. to the best of my knowledge and belief. all of my statement is true. correct. complete. and made in good faith .

SIGNATURE DATE SIGNED (Month. day. year)

'((,\V//dJ,;l," .. f<.FN i( 1 1 7J3 _, .... _ . ~ · .............. April 6. 2012

Ken K Kawabata GS·IIO ·- .. , .... ..

·~: 5 8 3 3 5 7

NRC FORM 532 (1 -2012)

U. S. NUCLEAR REGULATORY COMMISSION

DATE

03/14/2014

NAME AND ADDRESS OF APPLICANT AND/OR LICENSEE LICENSE NUMBER

Department of the Army 30-02405- 10

Commander, White Sands M issile Range A TIN: Mary E. Donahue

MAIL CONTROL NUMBER

583357 Radiation Safety Officer

BLDG 21225 TEDT-WS-SV-P LICENSING AND/OR TECHNICAL REVIEWER

ch White Sands Missile Range, NM 88002-5158

D D

0

This is to acknowledge the receipt of your:

[Z] LETTER and/or D APPLICATION DATED: 03/ 13/20 14

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

[{] AMENDMENT 0 TERMINATION 0 NEW LICENSE 0 RENEWAL

There were no administrative omissions identified during our initial review.

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.

Your application for a new NRC license did not include your taxpayer identification number. Please fill out NRC Form 531, located at the following link:

http :1/www. nrc .gov /read ing-rm/doc-collections/forms/n rc531 . pdf

Send the completed NRC Form 531, by facsimile, to the following number: (301) 415-5387

A copy of your action has been emailed to our License Fee and Accounts Receivable Branch, in our Headquarters office in Rockville, MD. You will be contacted separately if there is a fee issue involved.

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, wh ich 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 76011 -4511 (817) 200-1103 or (817) 200-1 140

NRC F0::4M 53 (1-2012)

3/1{

BETWEEN:

Accounts Receivable/Payable and

Regional Licensing Branches

[ FOR ARPB USE ]

INFORMATION FROM WBL . . . .

Program Code: 03521 Status Code: Pending Amendment

Fee Category: 2B 3G Exp. Date: Fee Comments: 170.11(A)(5)

Decem Fin Assur Reqd: Y

License Fee Worksheet - License Fee Transmittal

A. REGION

1. APPLICATION ATIACHED ApplicanULicensee: ARMY, DEPARTMENT OF THE

Received Date: 0311412014 Docket Number: 3009345 Mail Control Number: 583357 License Number: 30-02405-10

Action Type: Amendment

2. FEE ATIACHED

Amount:

Check No.:

3. COMMENTS

Signed:

Date:

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

1. Fee Category and Amount:

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

Amendment:

Renewal:

License:

3. OTHER ----------------

Signed:

Date: