.,

Pr1ntpack inc. U.S. Flexibles Division P.O. BOX 110 • 600 GRANTHAM LANE• NEW CASTLE, DE 19720 PHONE 302-323-4000 •FAX 302-323-1698

August 4, 2016

U.S. NRC-Region I 2100 Renaissance Blvd . Suite 100 Renaissance Park King of Prussia, PA. 19406 (610) 331-5000 (800) 432-1156

Dear Sir or Madam,

This is to advise you that on September 30, 2016, we have received one Generally Licensed device from our 600 Grantham Lane, New Castle, DE 19720 facility. The manufacturer, Thermo­Fisher Scientific (Thermo EGS Gauging, Inc.) distributes gauges/sources containing radioactive sources under Massachusetts License 20-6751 . We received the following device source:

Device Model ACS-185

Device S/N KA2101

Part# NER-588

Isotope Kr-85 Gas

Activity 1250mCi; 46.25GBq

If you have any questions, contact me at (302)323-0900 ext. 4050. My e-mail address is mdoss@printpack.com.

Sincerely,

11~/J~ Michael W. Doss Environmental Coordinator/RSO

Member Flexible Packaging Association f.} Printed on Recycled Paper

Sh• Ch kl• f Source lfoJease Must _.:.;S:..;0:..;U::.:r:..:C:..:C _ __.Ip_m_e_n_f __ . e_c __ IS ____________ Be-Aut! :o_nze_d _

1-General

Company Printpack

Address 600 Grantham Lane

... · - · · __ 6J ..... _, -- -- • _...,.

SO# 73003 ---- - -----· ·-·-··-·---·

2 - Sensor/Device Data

Source Model ___:_.N_E_R_--'--58_8 ____ _

Contact

Telephone

n.; ............. +

FAX

Date: July 28th 2016

Michael Doss

e-mail mdoss@printpack.com

Source Date: 4/25/16

Sensor Model _A_S_C_-1_8_5 ____ _

Source Serial Nwnber KA2101

Sensor Serial Number KA2101 Sensor Date: _4-'/-"-2.::.:5/-=1.cc.6_:__ o...,.._,..._ C't,.; __ .;_,.. 1'T,..._;o\ 0 .... ..1:,.. ....... .....: .... . ...... ,,.,.._,..,,....:,..1 ,.,,.,,, .............. 4 n .... ,.1 ... ,..-. ... - - -r-- ---.rr-.. o - . _ .... _ -. ... --.•v-- .. -• ....... -.-...... -.. _, .-,) , ... - --- .-. __ ...... _,,_ Radio Nuclide Kr-85 Class or Division 7 UN Number UN-2915

Activity 1250 - - --- mCi 46.25 ,GBq

3 - Packaging

Check all that apply: _lf_ Capsule Only Source Housing __ Outer Pack Required __ Reportable Quantity

Label Yellow Il Transport Index 0.4 Surface Measurement 22.3 mR/hr mSv/hr

4 - Pre-shipment Tasks Performed (check all that apply, attach survey report)

_lf_ Dose Rate Report _ Housing I Capsule Swipe _ Shipping P~kage Swipe _Paperwork to Relieve Inventory

5 - Documents Required to Accompany Shipment (Check all that apply or indicate quantity required. For licensing purposes some documents may be sent ahead of source)

x Shipper's Certification of Radioactive Materials

7525-V Shipper's Export Declaration

X Radioactive Packing List ---- ---

NAFTA Certificate of Origin

Known Shipper's Certificate

Pro-Forma Commercial Invoice

x FedEx Airbill Straight Bill of Lading - Short Form

Dose Rate Leak Test Report ---Shipper's Declaration for Dangerous Goods ----x

__ x__ Material Safety Datasheet x Shipping Container Certification

Soecial Form Certificate Packaging and Closing Instruction/Procedure

Certificate of Radioactive Device ---RAM Licensing Information Sheet ---- x EGS RAM License 20-0751 ------- Source Recovery Commitment Letter

.... _..... .. . .. ... - ... ~ -.,~ .............. • 1 ..,..,"' ... ·-- ................. ~ .... •• ~ - -~ ·- · ·

6 - Materials for Replacement and Returning Sources (indicate quantity required)

4 New Source Data Plates (list in item 8) Return Shipping Papers

D"~ .......... rr~...,,..+,,,.._,....,1 C',.. ..... -""'M"lo "C" .... -- UV'JO'lOl\'l ....... _.__.... ..... .., ........ ~ ....................... __ ..... ..._ __ .& .................. --..... --~""-----

.• •·- .••• .... •' • l\. . ........ ,,..,. - •

7 - Source Caution/Data Plates and Labels (list part number and quantity)

Source Housing Detector Housing Frame Mmmt

2 1

Reference Procedure: RP1024 Shipping Radioactive Devices

Form HX393396 Change 9 4 November 2008

Source Shipment Checklist ---------------·------·---- ---- ·-·---- ----·--

Form Fields:

1 - General: Self-explanatory.

'? _ ~Pn~l\>"ffiPvirP n<>t<>• Tn hP rnm.'.'IPtPrl h~r thP P <:y) nr ,t,,.,;~<>tP 'Qpfpr tn thP <>nnrnnn<>tP <:Prtlnn nf thP rPl<>tPn nrnrPnrn·p fnr <> . . description of the information required.

Source Model: Source manufacturer's model number. For example the source used in the CIMLine Kr-85 sensor is NER-588.

:;uurc.:t: uwr::. LJdLC u1c ::.uwvc vC1JJMllC w= ;i::.::.c1uu1cu.

Source Serial Number: Serial number of the source capsule/holder. I Sensor Model: Thermo EGS Model number in which the source capsule/holder is used. For example the CIMLine Kr- .5 sensor model number ASC-185. When a sensor is shipped, tlris is the model number that goes on the shipping papers - not th source model number.

Sensor Date: Date the source was loaded into the Thermo EGS sensor.

Serial Number: Source or Device serial number.

Proper Shipping Name: Kr-85 sources = Radioactive Material, Type A Package; Am-241 and Sr-90 = Radioactive Mal i:,rial, Type A Package, Special Fom1. This means that the devices must be identical in source type and activity.

Radio Nuclide: Kr-85, Sr-90, Am-241 etc.

Class or Division: Always 7.

Activity: Source strength.

3 - Packaging: Check all that apply. For example, is the package Type A or B? Is the source a capsule without a housing? Is the . .. ,. . . -

,:)VUl\..r\,.o jJl UVU;:)il15 1.UVu.tJ.LVU. lV a ,:)\;QJ.Ul\ . .. 1 .l.l.<l.J.U\J Vl J.U. a .::uuppu15 \.IU.lU.4.U1\ .. •.l \VVAJ 1 ..1i) Ul"-'.1'-' a..u VUl\..ol .1 a\,,.I\. \_Vial'"') U.'.)tr.,..U. !

Number of Packages: If more than one source is being shipped and the source and packaging are identical, then this fo 1 is used for all packages. If there are any differences, then a separate form is used for each package.

Label: Almost always Yellow il.

Transport Index: Refer to the appropriate section of the related procedure for a description of the information required.

('.,,,,.r/'fron Alfnrr("11.,..nn'ln»f · Uloht>ct reu3Ainn ~t tho. f'V.lf'lr-:\<r~ n1rt~ro. lnrln~lntY tho. Mttnm ...., ...... . - -

4 - Pre-Shipment Tasks Performed: Check all that apply.

5 - Documents Required to Accompany Shipment: Documents lis}ed here shall go with each package to a customer site.

6 - Materials for Replacement and Returning Sources: 1f sources are being returned to Thenno EGS for replacement and/or disposal, indicate what items need to accompany the shipment.

7 - Source Caution/Data Plates or Labels - For replacement sources, list requirements for source housing, detector housin and trame mount

IMPORTANT NOTE

Releasing New Sources as Service Replacements: The Materials Manager, or other persons specifically designated by the Wlaterials Manager, must authorize new source capsules for Customer Service replacements.