Simmons, Michelle

From: Sent: To: Subject: Signed By:

Classification: UNCLASSIFIED Caveats: NONE

Hi Michelle,

I received the email.

Ken Kawabata, CHP White Sands Missile Range 575-678-1168

-----Original Message-----

Kawabata, Ken K CIV USARMY ATEC (US) < ken.k.kawabata.civ@mail.mil >

Wednesday, June 04, 2014 2:30 PM Simmons, Michel le

RE: Deficiency Letter US Army, White Sands Amendment Request (UNCLASSIFIED) ken.k.kawabata@us.army.mil

From: Simmons, Michelle [mailto:Michelle.Simmons@nrc.gov] Sent: Wednesday, June 04, 2014 1:26PM To: Kawabata, Ken K CIV USARMY ATEC (US) Subject: FW: Deficiency Letter US Army, White Sands Amendment Request

-----Original Message----­From: Simmons, Michelle Sent: Wednesday, June 04, 2014 10:25 AM To: 'mary.e.donahue@us.army.mil' Subject: Deficiency Letter US Army, White Sands Amendment R

License # 30-02405-1 0 Docket # 03009345 Mail Control # 583406

Ms. Donahue,

In your letter dated March 3, 2014, you requested that Ken Kawabata be named radiation safety officer for license number 30-02405-10. In order to continue our review of your request, we need a copy of Mr, Kawabata's certificate issued by the American Board of Health Physics (ABHP). We also need the attached form to be completed and submitted to the NRC. Please submit the additional information by June10, 2014. You may submit your response to this letter by email or facsimile . Our fax number is (817) 200 1263. You may respond by email in pdf format. If you have any questions regarding this email, please call me at 817-200-1590. When responding to this email , please include the license, docket and control numbers located at the top of this page.

Thanking you in advance for your cooperation , assistance, and prompt

1

response in this matter.

Michelle Simmons Health Physicist US Nuclear Regulatory Commission 1600 East Lamar Blvd. Arlington, Texas 76011 817-200-1590

Classification: UNCLASSIFIED Caveats: NONE

2

Simmons, Michelle

From: Sent:

Kawabata, Ken K CIV USARMY ATEC (US) <ken.k.kawabata.civ@mail.mil> Thursday, June 05, 2014 7:47 AM

To: Simmons, Michelle Cc: Donahue, Mary E CIV USAF (US)

Subject: Attachments:

RE: Deficiency Letter US Army, White Sands Amendment Request (UNCLASSIFIED) HP Cert.pdf; Preceptor Attestation.pdf; GRF License 2014 Hopewell Amend.pdf

Classification : UNCLASSIFIED Caveats: NONE

Dear Ms. Simmons,

Please find attached a PDF of my Health Physics certification and my preceptor attestation. I also included a copy of our license. Our license is basically for irradiators we use to irradiate electronics and other components. The irradiators are not used for teletherapy or any medical use.

Dr. Roger Sit (CHP) is the RSO for the University of North Carolina Campus and University Hospitals. He can be reached at (919) 962-5711 .

Regards, Ken Kawabata, CHP Office Chief Radiation Protection White Sands Missile Range, NM (575) 678-1168

-----Original Message-----From: Simmons, Michelle [mailto:Michelle.Simmons@nrc.gov] Sent: Wednesday, June 04, 2014 1:26PM To: Kawabata, Ken K CIV USARMY ATEC (US) Subject: FW: Deficiency Letter US Army, White Sands Amendment Request

-----Original Message----­From: Simmons, Michelle Sent: Wednesday, June 04, 2014 10:25 AM To: 'mary.e.donahue@us.army.mil' Subject: Deficiency Letter US Army, White Sands Amendment Request

License # 30-02405-1 0 Docket # 03009345 Mail Control # 583406

Ms. Donahue,

In your letter dated March 3, 2014, you requested that Ken Kawabata be named radiation safety officer for license number 30-02405-10. In order to continue our review of your request, we need a copy of Mr, Kawabata's

1

certificate issued by the American Board of Health Physics (ABHP). We also need the attached form to be completed and submitted to the NRC. Please submit the additional information by June10, 2014. You may submit your response to this letter by email or facsimile. Our fax number is (817) 200 1263. You may respond by email in pdf format. If you have any questions regarding this email, please call me at 817-200-1590. When responding to this email, please include the license, docket and control numbers located at the top of this page.

Thanking you in advance for your cooperation, assistance, and prompt response in this matter.

Michelle Simmons Health Physicist US Nuclear Regulatory Commission 1600 East Lamar Blvd. Arlington, Texas 76011 817-200-1590

Classification: UNCLASSIFIED Caveats: NONE

2

~ -:::-; -:: ..

··.

~-~~->

" . .....___ .. __ ._.,. _

et\.cat\ "Board

~~ of Health P~Jy8 •

Be it known that · .. ~(l~

Ken K. Kawabata has satisfactorily met the professional standards established by the

erican Board of Health Physics and is hereby certified in ~: '

~ibt~ a__;h~~

{:/'~ Vice-Chairman

the comprehensive practice of

HEALTH PHYSICS and is entitled to be identified as a Diplomate

of the American Board of Health Physi

November 2005 1 Chairman, Panel of Examiners

Date

'--------- ... --·-·---------

NRC FORM 313A {RSO) (3-2009)

U.S. NUCLEAR REGULATORY COMMISSION

RADIATION SAFETY OFFICER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION

APPROVED BY OMB: NO. 3150-0120 EXPIRES: 3/3112012

[1 0 CFR 35.50] Name of Proposed Radiation Safety Officer

____ JL~ _j~-~-:1o~---- ----------------~---------~-------- ------------ ----- ---------------- -- ---- -- -------Requested Authorization(s) The license authorizes the following medical uses (check all that apply):

[] 35.100 0 35.200 D 35.300 ll 35.400 [] 35.500 [] 35.600 (remote afterloader)

[] 35.600 (teletherapy) 0 35.600 (gamma stereotactic radiosurgery) [J 35.1000 ( ) ----------...

PART I --TRAINING AND EXPERIENCE (Select one of the four methods below)

*Training and Experience, including board certification, must have been obtained within the 7 years preceding the date of application or the individual must have obtained related continuing education and experience since the required training and experience was completed. Provide dates. duration, and description of continuing education and experience related to the uses checked above.

if,. Board Certification

a. Provide a copy of the board certification.

b. Use Table 3.c. to describe training in radiation safety, regulatory issues, and emergency procedures for all types of medical use on the license.

c. Skip to and complete Part II Preceptor Attestation.

OR 0 2. Current Radiation Safety Officer Seeking Authorization to Be Recognized as a Radiation Safety

Officer for the Additional Medical Uses Checked Above

a. Use the table in section 3.c. to describe training in radiation safety, regulatory issues, and emergency procedures for the additional types of medical use for which recognition as RSO is sought.

b. Skip to and complete Part II Preceptor Attestation .

OR [ ] 3. Structured Educational Program for Proposed Radiation Safety Officer

a. Classroom and Laboratory Training ............. ~~~~~~~~-~;-~~~~~in_g _____ ..;:..__ ___ L_o_c_a-ti~;o_f_T_r-ai-ni-n~------·-- ---cloc-k -- ---·-oa~e~---or··· l

-----------------·--- ... . ....... ___ t:!ours __ Tram1ng~--! Radiation physics and instrumentation i

I -----·------------·----······--------·-----------------r------------------------------------------.......... ........ ... ........ ............ ....... ............. , Radiation protection

I I

1

_. __ ,_,. ..... --.-.. --•-••-·-•--··------·-r-------- --··----.·•··-- --- ·---·-·-----·-·oo"""•i•-•"•""· ............... ., ...... .-....... . ,. ,.. ,,. ,.,,.,._. • ••· '"' Mathematics pertaining to the

I use and measurement of , radioactivity

II __________ , ______________ __________________________ ________ ···-···------ --- ---- .. ---- -- ... .. .. -····------ ---------------1------- -- ··- .... .. Radiation biology

I ,-R;diatio~-do_s_i_m_e-tr-y------1--------------------· ·--··-·--------·-···------···· ---·---------------·-·-····· ---·-· ...... .............. .

I 1---------------·-·---------------------- --------------------- ---------~-------- -· · ·· · ···- -- · ·· · ·· · ................ ... . ... . ! L. ----

Total Hours of Training:

NRC FORM 313A (RSO) 13-2009) PRINTED ON RECYCLED PAPER PAGE 1

NRC FORM 313A (RSO) U.S. NUCLEAR REGULATORY COMMISSION (3-2009)

RADIATION SAFETY OFFICER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION {ccntinued)

3. Structured Educational Program for Proposed Radiation Safety Officer (continued)

b. Supervised Radiation Safety Experience (If more than one supervising individual is necessary to document supervised work experience, provide multiple copies of this section.)

··- ..... _ ... --~---~--------·--·-·------·---J----------------·-------,---------~

Descnptlon of Expenence License or Permit Number of Facility Training* . . . Location of Training/ I Dates of I

'Shipping: receiving ,"and performing related- __ ______ ___ .. __________ . ·---- --------------- -1 radiation surveys I

Osln9.aii<Tpeiforrmn9-ctie'Ci<s t'arP'rope;:·----- ... - ------ ·--·-·-----------·------------·---operation of instruments used to determine the activity of dosages, survey meters, and instruments used to measure radionuclides

------~ i I I

I

i Securing -and contrOiiing·-;--b-y-pr_o_d:-u-c,....t -m-a7te- r--:-ia-lc- ----·---- -- .. --.---------... ------·-----·--·-------------------1 I I I

I

L I I

·-- .-........................... ...... .. --------.-- ....................... -- - - - - -- - ... ---·-·-------·--......... ............................................. ........... _ ... _ ....... _.11 Using administrative controls to avoid J

material · I i I

mistakes in administrat~oh of byproduct _

1

1

!'

i ~-U-~i~g--p~~;-ed~-;~-;t~p-;.-~;~t-or mini~~;-- ,-· -----------~-----·--~ 1 radioactive contamination and using proper I 1

1

i I

l decontamination procedures

1

J

· ·usin~9 -emer9encyp.rciced'ures-t6· -c;c;n-fror ···~·- ------------------------·-----............. .

1

byproduct material r --, I I I I I I I

·-· ............ _______________________ _____ ~--------------------------------- ----..--... -t----- --- 1,. Disposing of byproduct material I

...................................... __ ., _____ ,. ____ , __ ,.._. ........ ----r------------------·~-----·-----................ ... ··- .. ·- ----!--- - - ---Licensed Material Used (e.g., 35.100, · 35.200, etc.)+

--- ------------------

..... _ _____________ _ ._ ______________ , ____ ....,..1 _____ --j

+ Choose all applicable sections of 10 CFR Part 35 to describe radioisotopes and quantities used : 35 .100, 35.200, 35 .300, 35.400, 35.500, 35 .600 remote afterloader units, 35.600 teletherapy units, 35 .600 gamma stereotactic radiosurgery units, emerging technologies (provide list of devices).

PAGE 2

NRC FORM 313A (RSO) (3-2009)

U.S. NUCLEAR REGULATORY COMMISSION

RADIATION SAFETY OFFICER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (cmtinued)

3. Structured Educational Program for Proposed Radiation Safety Officer (continued)

b. Supervised Radiation Safety Experience (continued)

(If more than one supervising individual is necessary to document supervised work experience, provide multiple copies of this section.)

bing Individual ! license/Permit Number listing supervi~ing individual a;-~---·· ··]

' Radiation Safety Officer I , I .... ·- -... . . ·-· ······ ...... ..... ..... ..... ....... ...... ---.... .... ·-- ... ............. --.-. .. -··- - - - - ~-- ......... ····-........... ··- ·· -.... ... ... . ··-.. .... ...... .. .. .. ....... ...... . ·· • · ... -- --- -----· ·· ... ········. -- .. .

, Th1s license authorizes the following medical uses:

icJ 35.1 oo o 35.200 o 35.300 o 35.4oo

!!"'.:..] 35.500 D 35.600 (remote afterloader) 0 35.600 (teletherapy)

i(:::l 35 .600 (gam~a stereotactic radiosurgery) [J 35 .1000 ( ) j • 0

'•' _,. ,,_.,...,~-·--•·••noY.'- Oo••>"'--··~ · •

l·--··- ··• ·· •·----··· · · --~---~·~-----·-·------· ··""---•-------~~--·· .. ·• •·-•~-·a.__, -~··--······ · '-·~ ..... ---- - ·-· -""· •·----- --- ·--· · - - - --·-- - -·.--. ...... •••·••· .. ·-·~-. , ..

c. Describe training in radiation safety, regulatory issues , and emergency procedures for all types of medical use on the license.

r- --------------- ----- - ------·---r-------·--------1 Description of Training Training Provided By i

Dates of Training*

IRadiati~_n_s_a-fe--t-y-, -re-g--u-la_t_o-ry-is-s-ue_s_,_a_n_d--- +-- -------------- --------- ------ -· - - - -- -----i

emergency procedures for 35.100, 35.200, fl--- ~ /f 1

·i> k . .!)/ LH-,.0 Jj 'ZAJ' 4r .- 11;

and 35.500 uses I._., y - I 7/1A1cX i

~-------------·---------- - --- ------ ··- --------··- - ·-··--·-·-----·---·-··------- .... ................. ······-··· ·-·· . ..... i Radiation safety, regulatory issues, and I emergency procedures for 35.300 uses ( f

(\

Radi-at-io_n_s~-fe_t_y_, r __ e_g_u-la-t--o-ry_i_s-su_e_s_,_a __ n_d----+1-- - - -------- --- - -------·--------·-·-·---

emergency procedures for 35.400 uses I I I I I

R_a_d_i_a-tio_n_s_a_f_e-ty_,_r_e_g-ul-a-to_r_y-is_s_u_e_s_, -a-nd---t-

11

1! - - ---------------- ---- - ---------··-·-- -·

emergency procedures for 35.600 - t 1 f1. teletherapy uses

----·-·--·. ..... .... ... . .. ---···-··--···---·-··-----·-·-···------ -- ----··-·"··"•"""' ·-·--·-- ... 1........... . ... .............. .. .... ........ .. ........ ... -.......................... '""" ..... ·-- ........... -·-- ------ -- .... - - --- ·-·-·· --- -- -- ·- ........ .. Radiation safety, regulatory issues, and emergency procedures for 35.600 - remote afterloader uses lA ( \

------··--·--- -- - ------ ----· ·--·-----· - -·--------------·-----·----------··--------·-·---·--·--·-- ··-------· ·-·--------·-- ---·-·---- --· Radiation safety, regulatory issues, and emergency procedures for 35.600 - gamma stereotactic radiosurgery uses

·--·- -·--·-----·-- ------- --------- - --·-- ------ ----------- ------------- ----- ·- ---·---------·-· .............. -·-·----·---· .... ... . .......... j Radiation safety, regulatory issues, and i emergency procedures for 35.1000, specify L ! use(s): 1

I

---- -- - ----- ---·--- . ·- -·- -------·---------.. J PAGE 3

NRC FORM 313A (RSO) (J-2009)

U.S. NUCLEAR REGULATORY COMMISSION

RADIATION SAFETY OFFICER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (ccntinued)

3. Structured Educational Program for Proposed Radiation Safety Officer (continued)

c. Training in radiation safety, regulatory issues, and emergency procedures for all types of medical use on the license (continued)

s·u-periiiSTng TndTVTdua(-if-tr-a-in-in·g--w-as-p-~-ov-id_e_d_b_y_su-p-erv-1-.SI-.n-g ---,j:-L-ic_e_n_s_e __ /P_e_r_m·~-N-um-b~~-lis_t_ln-g -su_p_e~;;-~glndiV;d~;I··---- ·-·- - --

RSO, AU, AMP, or ANP. (If more than one supervising individual is : r ( iL A- \ necessary to document supervised training, provide multiple copies of ' ~1.1 '¥. -e !>&~- ~ C, 8 ' 0 2-1 .,.. -this page.) ! () (p 'i ~ O..rb S: -A \

\Q.o, l2f S _. t-" : () & tj - o l- 14- I . ····· ··· ·········· ····· .. . ............................ .... ......... ..L. .... ~ .. t,.K ~ ... o .. 2 ... 1.4---""-J ........... .... ............... ...... ............... . .

License/Permit lists supervising individual as:

[~adiation Safety Officer [] Authorized User 0 Authorized Nuclear Pharmacist

[ ] Authorized Medical Physicist

Authorized as RSO, AU, ANP, or AMP for the following medical uses:

[ if351 00 rns.200 [:gt35.300 ~5.400 [g"35.500 [ Ps.6oo (remote afterloader) 0 35.600 (teletherapy)

r-~5.600 (gamma stereotactic radiosurgery) [ ] 35.1000 ( )

d. Skip to and complete Part II Preceptor Attestation.

[J 4.

OR

Authorized User, Authorized Medical Physicist, or Authorized Nuclear Pharmacist identified on the licensee's license

a. Provide license number.

b. Use the table in section 3.c. to describe training in radiation safety, regulatory issues, and emergency procedures for all types of medical use on the license.

c Skip to and complete Part II Preceptor Attestation.

PART II- PRECEPTOR ATTESTATION

Note: This part must be completed by the individual's preceptor. The preceptor does not have to be the supervising individual as long as the preceptor provides, directs, or verifies training and experience required . If more than one preceptor is necessary to document experience, obtain a separate preceptor statement from each.

First Section Check one of the following:

~ 1. Board Certification

[;::{! attest that -~"'" \4_\.Jt-v~~-"'"------- has satisfactorily completed the requirements in Name of Proposed Radiation Safety Officer

(!{f CFR 35.~a)c@r 35.50 (a)(2)(i) and (a)(2)(ii); or 35.50(c)(1).

OR

r:::J 2. Structured Educational Program for Proposed Radiation Safety Officers

[] I attest that - -:-.---:-=----.--:=--::-::--:·--·-::-c:--­

Name of Proposed Radiation Safety Officer

has satisfactorily completed a structural educational

program consisting of both 200 hours of classroom and laboratory training and one year of full-time radiation safety experience as required by 10 CFR 35.50(b)(1).

OR PAGE4

NRC FORM 313A (RSO) U.S. NUCLEAR REGULATORY COMMISSION (3-2009)

RADIATION SAFETY OFFICER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (cmtinued)

Preceptor Attestation (continued)

First Section (continued) Check one of the following:

0 3. Additional Authorization as Radiation Safety Officer

[] I attest that is an - - --------··----·---- --

Name of Proposed Radiation Safety Officer

[] Authorized User 0 Authorized Nuclear Pharmacist

[] Authorized Medical Physicist

identified on the Licensees license and has experience with the radiation safety aspects of similar type of use of byproduct material for which the individual has Radiation Safety Officer responsibilities

--~---------------------------------------------------------AND

Second Section Complete for all (check all that apply):

~attest that ------~~~ - l-~~0-~----- has training in the radiation safety, regulatory issues, and Name of ProposedRadiation Safety Officer

emergency procedures for the following types of use:

[9'35.100

[913',5.200

L£35.3oo

[~5.300

~300

[gi5.300

~5400 ~ 500 ~.600 1~ 35.6oo

r-v:::-,_Y.l 35.600

[ ] 35.1000

oral administration of less than or equal to 33 millicuries of sodium iodide 1-131, for which a written directive is required

oral administration of greater than 33 millicuries of sodium iodide 1-131

parenteral administration of any beta-emitter, or a photon-emitting radionuclide with a photon energy less than 150 keV for which a written directive is required

parenteral administration of any other radionuclide for which a written directive is required

remote afterloader units

teletherapy units

gamma stereotactic radiosurgery units

emerging technologies, including:

PAGE 5

NRC FORM 313A (RSO) U.S. NUCLEAR REGULATORY COMMISSION (3·2009)

RADIATION SAFETY OFFICER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (cootinued)

Thi rd Section Complete for ALL

AND

[3'1 attest that ~-1~~~------ has achieved a level of radiation safety knowledge Name of Proposed Radiation Safety Officer

sufficient to function independently as a Radiation Safety Officer for a medical use licensee.

~------------------------~----~-----------------------------

Fourth Section Complete the following for Preceptor Attestation and signature

I am the Radiation Safety Officer for -~-~3-:C6 __ &~~ r K,_ ~0 ( Jw.... 4 C~~-~(--~-

Name of Facility

License/Permit Number:

PAGES