current device ~e~~i# mci

GENERAL MILLS

July 11, 2016

Director, Office of Nuclear Material Safety and Safeguards ATTN:GLTS U.S. Nuclear Regulatory Commission Washington, DC 20555-001

Re: Transfer of Ownership (Disposal Transfer) GL-705013-19 (NRC Materials License 13-1883-01) General Mills 707 Pillsbury Lane New Albany, IN 47150

Dear Sir/ Madam:

MARIE PUCKET, CSP Safety Manager

This letter serves as notification that, General Mills (license holder), has disposed of fifteen (15) nuclear gauges listed below to RAM Services, Inc (Two Rivers WI) on 6/27/16.

Device ~e~~I# Current

·r.,,~n~f.ltiifet' · mCi Leak·T~st Model · 18838-A 5 2/4/16 Kay-Ray 7062BP 18838-B 5 2/4/16 Kay-Ray 7062BP 18838-F 5 2/4/16 Kay-Ray 7062BP 18838-1 5 2/4/16 Kay-Ray 7062BP 18838-P 5 2/4/16 Kay-Ray 7062BP 20397 5 2/4/16 Kay-Ray 7062BP 26709A 5 2/4/16 Kay-Ray 7062BP 267098 5 2/4/16 Kay-Ray 7062BP 26709C 5 2/4/16 Kay-Ray 7062BP 267090 5 2/4/16 Kay-Ray 7062BP 26709E 5 2/4/16 Kay-Ray 7062BP 26710 10 2/4/16 Kay-Ray 7062BP 26711 5 2/4/16 Kay-Ray 7062BP 27570 10 6/28/16 Kay-Ray 7062BP S94C3102 5 2/4/16 Kay-Ray 7062BP

The licensee contact person/ site RSO is Marie Puckett at the contact information below.

We are decommissioning this facility over the course of the next three (3) months. The plan is as follows:

• As equipment is taken out of service, any identified K-Ray associated with this equipment will be removed and placed into storage. Our specific device license allows us to do this. We will survey the device and equipment area before and after its removal from the equipment.

• The storage cabinet has always been surveyed on a regular basis and will continue to do so. Once the radiation levels for the stored devices reaches close but not over SmR/hr at the closed cabinet door, we will call RAM Services, Inc to arrange for pick up.

• We conduct leak tests and surveys right before they are picked up by RAM to ensure there are no leaks.

• Page2 J~ly 11', 2016

• After all devices are removed I will alert your office and the Region Ill office of the termination of the license.

• I have attached all the relevant paperwork to this letter (RAM's receipt of materia;ls letter; shipping ddcuments and leak test certificates.) ; , . . ' · .

Please contact me if you have any questions regarding this information.

Sincerely;

~/1~- -~~ 1r77~-vr~ .

Marie Pu~kett, CSP Safety Manager Radiation Safety Officer

General Mills, 707 Pillsbury Lane, New Albany, IN 47150 812-941-4293 [email protected]

..

FORM 540 tu\11'1 ~c ,INC 5. SHIPPER· NAME ANO FACILITY SHIPPER 1.0. NUMBER 7, NRC FORM 540 AND S40A PAGE 1 OF 1 PAGE(S) IB. MANIFEST NUMBER

RAM Services, Inc. FOR NRCFOR.M 5-41 AND S41A -,-PAGE(S) (Use this numbor on an continualion pages)

UNIFORM LOW-LEVEL RADIOACTIVE General Miiis 47150 NRC FORM 542 AND 542A -,- PAGE(S)

707 Pillsbury Lane ADDmoNAL INFORMATION 1 PAGE(S) 2016-0098 WASTE MANIFEST New Albany IN 47150 .__ COLLECTOR

PROCESSOR

SHIPPING PAPER USER PERMIT NUMBER 1 SHIPMENT NUMBER x GENERATOR TYPE 9. CONSIGNEE - Name end Faciity Address CONTACT

1. EMERGENCY TELEPHONE NUMBER (Include Area Code) 2016..0098 IND I RAM Services, Inc. JERRYWIZA, RPT

800-424-93000 CONTACT TELEPHONE NUMBER TELEPHONE NUMBER (Include Aroo Code)

ORGANIZA TlON Marie Puckett or Jerry Wiza 812 941-4293 510 COUNTY HIGHWAYV CHEMTREC (for RAM SERVICES CONTRACT 210964) 6. CARRIER· Namo ond AddteH TWO RIVERS WI 54241

1-920-6864889

2. IS THIS AN "EXCLUSIVE USE"' SHIPMENT? 3. TOTAL NUMBER OF RAM Services, Inc. EPA 1.D. NUMBER SIG't' ut · """'°"''j'."'""'" •oi<nowl•d,,,.g w••I• rooelpl 01 Ju1..'{ L•I'(. w YES 510 COUNlY HIGHWAYV r,1._......_ ~

PACKAGES IDENTIREO 1 NA .. - ... NO ON THIS MANIFEST TWO RIVERS WI 64241 SHIPPING DATE 10.CEH'lll"ICATION

==--> !his ts to certify ltl:tt tho herein-named rnateriats are proper\)' clo.Hlfied, dct&cnbed.. packn;•d, marked, nnd labeled 131'1d ara

EPA MANIFEST NUMBER CONTACT TELEPHONE NUM6ER in proper conlitlon for trtll'Lsportatlon KC:Otding to !he oppticnble regulations oftM Department of Trllnsportatlon. Thill also

4. DOES EPA REGULATED D YES JERRYWIZA, RPT (lncludo Area Code) certifies that fhe materials arc clauHied, p;,ckaged, marked, and labeled and nre in propar condition tot transportitioo and

WASTE REQUIRING A NOT APPLICABLE - disposal as described in accordance'W1th !he applicoble requirements of 10 CFR Parts. 2D mid 61, or eq\llvalent stole

MANIFEST ACCOMPANY []] SIGNArt:7;:'FiE'"w'"'"""'

920-686-3889 regulations.,• NO

THIS SHIPMENT? Jri:Jfi)~~ A11..1 Hl"llWI/- Sf 1~AT'fE It- l~e/lAn DrJ/;;71 fi, --> -vnr .. ~ tf-Ves,'" provide Manifest Number==== -r~

11. U.S. DEPARTMENT OF TRANSPORTATION DESCRIPTION 12. -.;£3 ~ ~ 1•. 15. ll 16.TOTAL 17. 18."fOTAL WEIGHT 19. IDENTIFICATION

(Including UN 10 number, proper shipping name, hazard class, OOTLABEL S~ORT PHYSICAL ANO INOMOUAL PACKAGEACTMTY LSNSCO OR VOLUME NUMBER OF and anv addltlonal Information) "RADIOACTIVE" INDEX CHEMICAL FORM RADIONUCLIOES IN SI UNITS CLASS (U38 appropriate uni/$) PACKAGE

UN2915, Radioactive material, type A package, 7

o.I SOLID Cs-137 mCI I MBq 260.11 Kg

Yellow II NONE 575.0 Lbs RPK-1208

OXIDE 3.90E+01 1.44E+03 < 7.5 FT3

«

-

. "

FOR CONSIGNEE USE ONl.Y

Record Waste Description Inadequate

Contamination or Leakage Detected

Unexpected Exposure Rates Detected

Labels, Markings, ate. Inadequate ;

Container Integrity Inadequate ~

Other

No Violations Detected on this Shipment

FORM 541 RAM SERVICES, INC.t-!Jl'llm!1!'7l~T""-----.-----,--1-._MAN_IF_ES_T_T_o_T-::A=LS=:::-==='."".:'===-=------12. MANIFEST NUMBER SPECIAL NUCLEAR MATERIAL (grams) 2016-0098

5.

UNIFORM LOW-LEVEL RADIOACTIVE WASTE MANIFEST

CONTAINER AND WASTE DESCRIPTION

Additional Nuclear (:\egulat_ory Co~mlsslon (NRC) Requirements for Cont~ol,,

Transfer and Olsposal of Radioactive Waste

CONTAJNER ICENTIFlCATION

NUMBER/ GENERATOR ID

NUMSER(SI

6.

CONTAINER OESCRlPTION

(Seo Note 1)

7. 8. .. WASTE SURFACE

VOLUME .A.NO RADIATION CONTAINER LEVEL

10. SURFACE CONT~INATION

~ WEIGHT ........ J:'l.~09{!9_q~;, __ ,_.m .. .._ ,_, ..... -.~R--.-...... -'!!~L... ... __ ,~,,,,-~ ~ lb mremlhr I BETA-

ALPHA GAMMA

0.2124 260.82

PACKAGES/ DISPOSAL

CONTAINERS

NET WASTE VOLUME

NET WASTE V'o'EIGHT

!!!~ .. --. .!~···- ~.~-·-~~~:~~-···

U-233

NP

U-235 Pu TOTAL 3. PAGE

NP NP l-----..L..ft3 ___ &_.6_3_..1.lb;;;_ __ s2_0=...,.i,----.,...,,.,..---'------'------+-------i4' SHIPPER NAME

OF

ACTIVITY (MBq/mCQ

ALL NUCLIDES TRITIUM C-14 Tc:-99 ~129 SOURCE RAM Services, Inc.

1---"_.s_o _ _,. __ 1_ •• _•e_•_o_3_+-__ N_P __ +-__ N_P __ -+---NP---1---N_P __ _,._k• ____ N_P-ISHIPPER ID NUMBER mCI 3.90E+01 NP NP NP NP lb NP 47150

PHYSICAL DESCRIPTION

11. 12. 13. APPROXlMAlE

WASTE WASTE SOR BENT DESCRIP· VOLU~.E{S) IN SOLIDIFICATION

TOR CONTAJNER STABILIZATION (~eN01o:Z). MEDIA

.:....-~.~:_ __ (SoeNoto3)

14. CHEWJCAL DESCRIPTION

CHEMICAL. FORM/ CHELATING AGENT

WEIGHT ... CHELATING

AGENT IF>0.1'A

15. RADIOLOGICAL DESCRIPTION

IN OM DUAL RADIONUCUDES, ACllVITY, CONCENTRATION, ANO CONTAINER TOTAL ACTMlY

RAOIONUCUDES pC4.lgm MBq (mCtl

0,16 100 SOLID OXIDE 1.GSE+OS 1.44E+03 3.90E+o1

16. WASTE

CLASSlFlCATION

AS-Cl.,.A Stablo

AU-Class A Unstable B-Cla99 B C-Cl::i1s.C

RPK-1208 /47150

4 .. -·-·- a.OJ T.-r <3,6E-6 <3.6E-5

36 NP 1--------t---+----1t----1AS-Class A 7.5

.. -.. -··-

........... ~ ..

NOTE 1: Container Description Codes. For Containers/Waste requiring disposal in approved structuraJ ovoipacks, the

numerical code must befollo'Mld by"-0P:

1 Wooden Box or Crate

2 MctGI Box 3 PlasticOrumorPail 4 Met~ Orum or Pail

5 Mata!TanlcorUner 6 Concrete Tank or Wnet 7 Polyothylene T<inJc or Liner

8 Fibl!!rglass Tonk or Liner

9 Oemlnerafizet •. 10 Ga~ Cylinder 11 Bulk, Unpackaged W.nto

12 Unpud<tlgod Componentu

13 High lnt~rity Container 19 Other. Describe in Item 6,

or additional page.

576 <220 <2200 5,63 100

·-... -...... --- ---c:; ........ - ..... ---·+------!

.... --.. ·-·--.. ·+------1

...... -----·---1------1

.. ........ - .............. +------!

NOTE 2: Waste Descriptor Co dos (Choose up to three Yd'llch predominate by volume.)

20. Charcoal 21. Incinerator Ash

22. Soil 23. Gas 24. Oil 25, AqUdOUa Liquid

29. Oomoition Rub~e 30. Cation Ion-Exchange Media

31. Anlo_n lon-EXctlange Modia 32. Mlx•d Bed lon.Exchan~ Media 33. Contaminated Equipment

3a Evaporator Bottoma/Sludges/CotlC9ntrat«r.1 39. Ccmpa~blo Trash 40. Noncompactible Trath

41. Animal Carcaa• 42. Bloll)Qieal Material (m:C(lpl animal carcass) .-3. Activated Material

NONE SUBTOTAL 1.44E+03 3.90E+o1

NOTE 3: For stiidifiea11on media that meot disposal site strudural S1abilrty reQuirtments, Ute numencal codo mt111 be follo'M.!d by•-s•, Forailaclicificaticn medili, the-vondor (manufocturor) and bland nismo must also be ldenlified In item 13,

Code too= NON REQUIRED.

Sorptlon SoUdificaUon 60. SpeediDli 67.RorcoX 75. Petloset II 90, Cement 61.Celetom SS.Solid A Serb 76.Aquaaet 91,Concrete 62.AoorDiy/ 69.Ct\emd30 77. Aquaaet U (EncapstAation)

26. FilterMeda

34. Ori,µnic Uq~id (except oil)

35, Gtass....we or LatMoro 59. othor, Oescribo ln Hem 11, or oddi1ional page Superfine 70. Chomsi so 89. Other. Describa In 92.Bitumen 27. Mechanical Ater 36. Scaled Source/Oevlco 63.HIOd 71. Chemsil 3030 item 13, or adcitional 93. Vinyl Chloride 28. EPA or State Haurdoua 37. PainlorPla!lng 64. Sare T Serb n. Oicopert HP200 page 94. Vinyl Ester Styrene

65.SafeNCri 73. Oicapert HPSOO 66.FJoreo 74. Petroset

FORM 542

4. GENERATOR

IDENTIFICATION NUMBER

47150

I ·RAM SERVICES, INC •. ~1.-;.:::::::-----w_A_S_T_E_c_o_LLE;;;;_cc.T_o_Rl_P'-R'-oc~Ers_s_o_R ________ -....,...,,.,.,..-=.v----------l-2-.MA-N_1..:FE..:s..:T_N_u_M..:sER::..:. __ J....I _______ _ Name ER USE ONLY ..

UNIFORM LOW-LEVEL RADIOACTIVE

WASTE MANIFEST MANIFEST INDEX AND REGION COMPACT TABULATION

List all original "PROCESSED WASTE" generators (if any) before "COLLECTED WASTE" generators.

s. 6. GENERATOR NAME GENERATOR' . •A.

AND TELEPHONE FACILITY WASTE OESCRIPTION

NUMBER ADDRESS (NOMENCLATURE)

General Millso 707 Pillsbury Laneo Sealed 812 941-4293 New Albany,IN 47150 So~rcelbevlce

RAM Services, Inc.

IDENTIFICATION NUMBER ,54241

7 Shipping Dale

.. 7. PREPROCESSED NUMBER(S) 9.

, WASTE., UNOERWHICH (OR MATERIAL) WASTE,(OR' WASTE CODE

VOLUME MATERIAL) Po: PROCESSED (m3} (ll3) RECEIVED AND C • COLLECTEO

na.re OF RECEIPT

0.212376 7.50 c

• ... ~ '

TOTALS OF ALL _PAGES( FORMS 542 AND 542A)

2016-0098

Page 1 of1

10. 11. AS PROCESSED/COLLECTED TOTAL

ORIGINATING A SOURCE COMPACT MATER

0

IAL C.ACTJ\llTY D.VOLUME

B.SNM E. WE1GHT REGION

OR STATE (kg) Qb) (g)

(MBq) (mCQ (m3) (ft3) ~·>

IN 0 0 0 1.44E+03 3.90E+01 ~.212 7.50 575.00

"'

" . O.OOE+OO O.OOE+oO O.OOE+OO 1.44E+03 3.90E+01 2.12E.01 7.SOE+OO S.75E+02

('

F. MAXIMUM PACKAGE

RAC!ATION LEVEL

(mrem/hr)

I

510 County Highway V Two Riven;, Wl 54241 Voice +1-920-686-3889 Fax +1-920-686-3899

STATE OF WISCONSIN RADIOACTIVE MATERIALS LICENSE 071-1234-01

SEALED SOURCE LEAK TEST CERTIFICATE RAM ACCESSION NO. 135848

GENERAL MILLS - NEW ALBANY

LOCATION 47150 - INDIANA

CONTACT PERSON MARIE PUCKETT I PHONE 812-941-4293

GENERAL MILLS NEW ALBANY 707 PILLSURY LANE

NEW ALBANY, INDIANA 47150 United States of America

LEAK TEST ANALYSIS I EQUIPMENT NO. DEVICE/TOOL NUMBER

MODEL# 7062BP MANUFACTURER Kay-Ray

SOURCE SERIAL NO. 18838-A MANUFACTURER S/N ·-ISOTOPE Cs-137 SOURCE ORIGINAL ACTIVITY 5mCi

0.185 GBq

DATE SOURCE WIPED 30 Jan 2016 REASON FOR TEST PERIODIC

ANALYSIS DATE 04 Feb 2016 ANALYTICAL METHOD Liquid Scintillation Counting

GROSS SAMPLE COUNT 10 cpm INSTRUMENT Perkin Elmer Tri-Carb 3110TR 130414

BACKGROUND 22cpm COUNTING EFFICIENCY 95%

NET SAMPLE COUNT -11.3684 dpm MINIMUM DETECTABLE 1.18E-05 µCl ACTIVITY 0.44 Bq

SAMPLE ANALYSIS ACTIVITY -1E-05 µCl PASS/FAIL CRITERION 0.005 µCl -0.21053 Bq 185 Bq

SOURCE PASSES TEST ACTION LEVEL 0.001 µCl

37 Bq

ANALYST Virginia Parlato th I • • f~ .vr--NOTES:

ADDITIONAL SOURCE DESCRIPTION: CFL GLUTEN HI LEVEL, B2

I

510 County Highway Y Two Rivers, WI 54241 Voice +1-92G-686-38S9 Fax +1-920-686-3899








LEAK TEST.ANALYSIS I EQUIPMENT NO. DEVICE/TOOL NUMBER


SOURCE SERIAL NO. 18838-B MANUFACTURER S/N

ISOTOPE Cs-137 SOURCE ORIGINAL ACTIVITY 5mCi 0.185 GBq


ANALYSIS DATE 04 Feb 20.1!3. ANALYTICAL METHOD Liquid Scintillation Counting


-BACKGROUND 22 cpm COUNTING EFFICIENCY 95%

NET SAMPLE COUNT -5.81053 dpm .. MINIMUM DETECTABLE 1. 18E-05 µCl ACTIVITY 0.44 Bq

SAMPLE ANALYSIS ACTIVITY 0 µCl PASS/FAIL CRITERION 0.005 µCl -0.10526 Bq 185 Bq


37Bq

ANALYST Virgi~ia Parlato th , .. f~ ~ NOTES:

ADDITIONAL SOURCE DESCRIPTION: PriL GLUTEN HI LEVEL, A2

I

510 County Highway V Two Riveni, WI 54241 Voice +1-9.W-686-3889 Fax +1..gio-686-3899


-



LOCATION 47150- INDIANA


GENERAL MILLS NEW ALBANY I

707 PILLSURY LANE


LEAK TEST ANALYSIS I EQUIPMENT NO. DEVICErfOOL NUMBER


SOURCE SERIAL NO. . 18838-F MANUFACTURER S/N -ISOTOPE Cs-137 SOURCE ORIGINAL ACTIVITY 5mCi

0.185 GBq



GROSS SAMPLE COUNT 20 cpm ' INSTRUMENT Perkin· Elmer Tri-Garb ' 3110TR 130414


NET SAMPLE COUNT "2.04211 dpm MINIMUM DETECTABLE 1.18E-05 µCl ACTIVITY 0.44 Bq

SAMPLE ANALYSIS ACTIVITY 0 µCl PASS/FAIL CRITERION 0.005 µCl -0.03509 Bq. 185 Bq


37 Bq

ANALYST Virginia Parlato [/~~ f~

NOTES:

ADDITIONAL SOURCE DESCRIPTION: PIZZA GLUTEN LO LEVEL, A1

I

SlO County Highway V -Two 'Rh•ers, \VI 54241 Voice +1-920-686-3889 Fax +l-920-686-3899










SOURCE SERIAL NO. 18838-1 ~

MANUFACTURER S/N

ISOTOPE Cs-137 · SOURCE ORIGINAL ACTIVITY 5mCi 0.185 GBq

DATE SOURCE WIPED 30 Jan 2016- REASOflJ FOR TEST PERIODIC

ANALYSIS.DATE 04 Feb 201~ ANALYTICAL METHOD Liquid Scintillation Counting

GROSS SAMPLECOUNT 9 cpm INSTRUMENT Perkin Elmer Tri-Garb 3110TR 130414

BACKGROUND 2,2 cpm COUNTING EFFICIENCY 95%

NET SAMPLE COUNT -11.7.'684 dpm MINIMUM DETECTABLE . 1.18E-05 µCl ACTIVITY 0.44 Bq


SOURCE PASSES TEST

" ACTION LEVEL 0.001 µCl

37 Bq

ANALYST Virginia Parlato lhr f~ NOTES:

ADDITIONAL SOURCE DESCRIPTION: PHL GLUTEN HI LEVEL, A1

..

I

510 County Highway V Two Rivm, WI 54241 Voice +1-92G.6S6-s889 Fax +1-920-686-3899










SOURCE SERIAL NO. 18838-P MANUFACTURER S/N









37 Bq

ANALYST Virginia Parlato v.; / .. fadaf ~

NOTES:

ADDITIONAL SOURCE DESCRIPTION: CFL GLUTEN HI LEVEL, B1

•,

I

510 Counf¥ Highway V Two Ri\'ers, Wt 54241 Voice +1-920-686-3889 Fax +H>Z0-686-3899


SEALED SOURCE LEAK TEST CERTIFICATE RAM ACCESSION NO, 135865






LEAK TEST ANALYSIS I EQUIPMENT NO. NA DEVICEfTOOL NUMBER


SOURCE SERIAL NO, 20397 MANUFACTURER S/N




GROSS SAMPLE COUNT 11 cpm INSTRUMENT Perkin Elmer Tri-Garb 3110TR 130414


NET SAMPLE COUNT -10.0737 dpm MINIMUM DETECTABLE 1.18E-05 µCl ACTIVITY OA4Bq

SAMPLE ANALYSIS ACTIVITY -1 E-05 µCl PASS/FAIL CRITERION 0.005 µCl -0.19298 Bq 185 Bq


37 Bq

ANALYST Virginia Parlato th ; .. f~ ~ NOTES:

ADDITIONAL SOURCE DESCRIPTION: Pizza Gluten One Batch Level - A1

I

510 County Higmvay V Two Rivers, Wl 54241 Voice +1-920-686-3889 Fax +t-920-686-3899










SOURCE SERIAL NO. 26709A MANUFACTURER S/N -ISOTOPE Cs-137 SOURCE ORIGINAL ACTIVITY 5mCi

0.185 GBq








37 Bq

ANALYST Virginia Parlato ~; .. fwld' ~ NOTES:

ADDITIONAL SOURCE DESCRIPTION: Bread Line Sapp Bin Low Level

·-

I

510 County Highway V Two Rivers, WI 54241 Voice +1-920-686-3889 Fax +1-gzo-686-3899



GENERAL MILLS • NEW ALBANY


CONTACT PERSON MARIE PUCKETI I PHONE 812-941-4293



LEAK TEST ANALYSIS I EQUIPMENT NO. DEVICEfTOOL NUMBER


SOURCE SERIAL NO. 26709B MANUFACTURER S/N -ISOTOPE Cs-137 SOURCE ORIGINAL ACTIVITY 5mCi

0.185 GBq








37 Bq

ANALYST Virginia Parlato v.: I ._ f~ ~ NOTES:

ADDITIONAL SOURCE DESCRIPTION: Bread Line Soda Bin Low Level

I

510 Counf¥ Highway V. Two Rivers, WI s4241 Voice +1-920-686-3889 Fax +l-920-686-3899


SEALED SOURCE LE;AK TEST CERTIFICATE RAM ACCESSION NO. 135874


LOCATION 47150 c INDIANA






SOURCE SERIAL NO. 26709C '

MANUFACTURER S/N -ISOTOPE Cs-137 SOURCE ORIGINAL ACTIVITY 5mCi

0.185 GBq


ANALYSIS DATE. 04 Feb·2016 ANALYTICAL METHOD Liquid Scintillation Counting

GROSS SAMPLE COUNT 14cpm INSTRUMENT Perkin Elmer Tri-Carb 3110TR 130414

BACKGROUND 22 cpm . COUNTING EFFICIENCY 95%


SAMPLE ANALYSIS ACTIVITY 0 µCl PASS/FAIL CRITERION 0.005 µCl -0.14035 Bq 185 Bq.


37 Bq

ANALYST Virginia Parlato ~; '. f~ ~ NOTES:

ADDITIONAL SOURCE DESCRIPTION: Bread Line Salp Bin Low Level •'.

I

510 Counfy Highway V Two Rivers, wr 54241 Voice +1-920-686-3889 Fax +1-920-686-3899



GENERAL MILLS • NEW ALBANY





LEAK TEST ANALYSIS I EQUIPMENT NO. DEVICErfOOL NUMBER


SOURCE SERIAL NO. 1§_709.R MANUFACTURER S/N




GROSS SAMPLE COUNT 10cpm INSTRUMENT Perkin Elmer Tri-Garb 3110TR 130414





37 Bq

ANALYST Virginia Parlato

th+~ f~ NOTES:

ADDITIONAL SOURCE DESCRIPTION: Bread Line B-1 Preblend One Batch Level

I

510 County Higln""!)' V Two Rivers, W1 54241 Voice +1-920-686-3889 Fax +1-920-686-3899










SOURCE SERIAL NO. 26709E MANUFACTURER S/N -· ISOTOPE Cs-137 SOURCE ORIGINAL ACTIVITY 5mCi

0.185 GBq


ANALYSIS DATE 04 Feb 2016 ANALYTICAL, METHOD Liquid Scintillation. Counting

GROSS SAMPLE COUNT 6 cpm. INSTRUMENT Perkin Elmer Tri-Garb 3110TR 130414





37 Bq

ANALYST Virginia Parlato v.: , ' . f~ ~ NOTES:

ADDITIONAL SOURCE DESCRIPTION: Bread Line B-2 Preblend One Batch Level

,_ '

I

510 Coun~ Highway V Two Rh•ers, Wl 54241 Voice +1-920-686-3889 Fax +1-920-686-3899





CONTACT PERSON · MARIE PUCKETI I PHONE 812-941-4293




MODEL# 7062BP MANUFACTURER Kax-Ray

SOURCE SERIAL NO. 26710 MANUFACTURER S/N ----ISOTOPE Cs-137 SOURCE ORIGINAL ACTIVITY 10 mCi

0.37 GBq




BACKGROUND 22cpm COUNTING .EFFICIENCY 95%




37 Bq

ANALYST Virginia Parlato ~+2.;_ f~

NOTES:

ADDITIONAL SOURCE DESCRIPTION: Bulk Batching Unenriched Flour Bin High Level

I

510 County Highway V Two Ri\•ers, WI 54241 Voice +t-920-686-3889 Fax +l-920-686-3899










SOURCE SERIAL NO. 26711 MANUFACTURER S/N

ISOTOPE Cs-137 SOURCE ORIGINAL ACTIVITY 5mCi' 0.185 GBq

DATE SOURCE WIPED 31 Jan .2016 - REASON FOR TEST PERIODIC

ANALYSIS DATE 04 Feb 2016 ANALYTICAL METHOD Liquid Scintillation. Counting

GROSS SAMPLE COUNT _23 cpm INSTRUMEf'JT Perkin E;:lmer Tri-Garb 3110TR 130414

BACKGROUND 22 cpm. COUNTING EFFICIENCY 95%

NET SAMPLE COUNT 0.957895 dpm MINIMUM DETECTABLE 1.18E-05 µCl ACTIVITY 0.44 Bq

SAMPLE ANALYSIS ACTIVITY 0 µCl PASS/FAIL CRITERION . 0.005 µCl 0.01754 Bq 185 Bq


37 Bq

ANALYST Virginia Parlato ~, .. f~ ~

NOTES:

ADDITIONAL SOURCE DESCRIPTION: Bulk Batching Unenriched Flour Bin High Level

,_ .

I

510 County Highway V Two Rivers, Wl 54241 Voice +1-920-685-38Sg Fax +1-920-685-3899







NEW ALBANY, INDIANA 47150 UNITED STATES



SOURCE SERIAL NO. 27570 MANUFACTURER S/N --ISOTOPE Cs-137 SOURCE 'ORIGINAL ACTIVITY 1 mCi

0.037 GBq

DATE SOURCE WIPED 26 Jun 2016 REASON FOR TEST PERIODIC

ANALYSIS DATE 28 Jun 2016 ANALYTIC.AL METHOD Liquid Scintillation Counting


BACKGROUND 21 cpm COUNTING EFFICIENCY 95%


'SAMPLE ANALYSIS ACTIVITY 0 µCl PASS/FAIL CRITERION 0.005 µCl -0.17544 Bq, 185 Bq

SOURGE PASSES TEST ACTION LEVEL 0.001 µCl

37Bq

ANALYST Virginia Parlato v:: I • • fadd ~ NOTES:

ADDITIONAL SOURCE DESCRIPTION:

I

510 County Highway V Two Rivers, Wt 54241 Voice +1-920-686-3889 Fax +1-920-686-3899










SOURCE SERIAL NO. S94C3102 MANUFACTURER S/N




GROSS SAMPLE COUNT 23cpm INSTRUMENT Perkin Elmer Tri-Garb 3110TR 130414


NET SAMPLE COUNT 0.957895 dpm MINIMUM DETECTABLE 1.18E-05 µCl ACTIVITY 0.44 Bq

SAMPLE ANALYSIS ACTIVITY 0 µCl PASS/FAIL CRITERION 0.005 µCl 0.01754 Bq 185 Bq


37Bq

ANALYST Virginia Parlato v::I,. f,;vjd ~

NOTES:

ADDITIONAL SOURCE DESCRIPTION: Bread Corn Sugar Low Level

current device ~e~~i# mci

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