APPENDIX A

NRC FORM 313 U S NUCLEAR REGULATORY COMMISSION

(8-ampIll) 10 CFI1 30 32 33shy34 3536 39 and 40

APPLICATION FOR MATERIAL LICENSE

EXPIRES0Sl31f(OO2APPROVED BY OM6 NO 0020

Estlmatad burden per rltllsponu to comply with this mandatory information eotlfCtfon request 14 hout$ Submittal 0 the application 1$ neenuty to c$~terrmne th~t the applicanl ~s qUaII(Hd aM thaI adequate pro~dlJ(u eJUSf 0 piotbct Ite p1Jblic heanh and ut Send eomlTI~n~ regarding burden utimate to the Records Managemsnt Branch (fe EeL US Nycleat ReQulatory CommisSlon WuhJn01on OC 2055$CXJ01 Of by intrnt e_mail to b51nrc OY and to the Dult Offlce( Office ofnlormation and Regulatory Mfain NE08-10202 l15()Ol~Dl Office at Managmtnt and Budget Washington DC 20503 11 a mUMS used to impose an ifltormatlon colle(tion dOles not display 11 cutTently valid OMB contlot numbet NRC may not conduct Of sponsor and a pef50n iamp not required to respond to the infofmati(m collelttion

INSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW

APPLICATION FOR OlSTRI8UTtON OF EXEMPT PRODUCTS FllE APPLICATIONS WITH

DIVISION OF INOUSTRIAL AND MEDICAL NUCLEAR SAFETY OFrJCE OF NUGUAR MATERIALS SAFETY ANO SAFpoundGUAR()S US NUCLEAR REGULATORY COMMISSION WASHINGTON DC 2055gt--OOO1

ALL OTHER PERSONS FilE APPLICATIONS AS FOLLOWS

IF YOU ARE LOCATEO IN

CONNECTICUT DELWARE DISTRICT OF COLUMBIA MA1NE MARYLAND MASSAHUSETTS tgt1N HAMPSHIRE NEW JERSEY NEV YORK PENNSYLVANIA

RHODE ISLAND OR -IERMONT SENO APPLICATiONS TO

UCENSING ASSIST ANT SECTION NuCLEAR MA T(RIALS SAfETY BRANCH U~ NUClEAH H(GULATQRY COMMISSION REGiON I 4n ALLENOALE ROAD KINGOFPRUS$IilPA 19400-1415

ALA8AMA FLORIDA GEOROIA KENTUCKY MISSISSIPPI NORTH CAROUNA PlJER10 RICO SOUTH CAROUNA TENNESSEE VIRGINIA VIRGIN ISLANQS OR WEST VIRGINIA SEND APPLICATIONS TO

S~M NUNN ATLJTA FEDERAL CENTER U S NUCLEAR REGULATORY COMMISSION REGION 11

61FORsYTHSTREE1SW SUITE23T85 ATLANTA GEORGIA 30303 6931

IF YOU ARE LOCATED I~

llLlNOISINOIANAIOWA MICHIGAN MINNESOTA MISSOURI OHIO OR WISCONSIN SEND APPLICATIONS TO

MATERjALSlICENSING SECTION pr3 us NUCLEAR REGULATORY COMMISSION REGlON III 801 WARRENVILLE RD USLEll 00512middot4351

ALASKA ARIZONA ARKANSAS CALIFORNIA COlORAOO HAWAII IDAHO KANSAS LOUISIANA MONTANA tEBRASKA NCVADA NEW MEXICO NORTH OAKOT A OKLAHOMA OREGON PACIFIC TRUST TERRITORIES SOUTH DAKOTA TEXAS UTM~ WASHINGTON OR WYOMINQ SENO APPLICATIONS TO

NUCLEAR MATERIALS LICENSING SECTION US NUCLEAR REGULATORY COMMISSION REGION IV 611 RYAN PLAZA DRIVE SUITE 400

ARliNGTON T)( IdO H064

l l 1_ gt

-1tgt 3 ~~O ~ () 111-1

I V

A_ ~U3r 1gt 7 r V -A 1 V

PERSONS lOCATEC IN AGREEMENT STATeS SENO APPLICATIONS TO THE u S NUCLEAR REGULATOR~OMM1SSION ONLYF THEY WISH TO possESS AND USE LICENSED

MATERIAL IN STATES SUBJECT TO uSNlJCLEAR REOULATORY COMMISSION JURISDICTIONS

~ AN APPUCA TlON FOR ~HIS I (CIIeCK 4PPOPfllllf If)

A NEW LICENSe

fJ AMrtlOM~NT TO LICENSE NUM8ER _____________

C RENEWAL Of LICENSE NuMBER ______________

3 AOORtSS(ES) WrlcRE LcENSED MATc~IAl Wil L BE USFO OR POSStissEo 4 NAME OF PERSON TO BE CONTACTED ASOUT THIS

APPLICATION

M~IJ LUlHte -K~r~ ~Dpound1AC bm yenhB8i2T YgtttHDNNkiCNAL MA LL-1

WJ~I~1GN tgtC SUBMIT ITEMS 5 THliOUGH 1 ON ij1I2 X 11 PAPER THE TYPF ANO SCOPE OF INIORMAnoN TO BE PROVIDED IS DeSCRIBED IN THE UCNSE APPLICA-liON GUOE

5 ADIOACTlvE MATER~AL

a EI~m~lt and mass umber b chemlc1 ilndJor phYS1e-1 101m and e rnal1(lmUm angtovnt B PURPOSE(Sl FOR WHICH LICENSED ~ATER1AL WILL BE USED wnlaquoh11 ~ posuued ~t any on tim

7 lNOIVIDUAL(S) RESPONSIBLE FOR RAOIATION SAFETY PROGRAM ANO THEIR 6 TRAINING FOR INDIVIOUALS WORKING IN OR fREOUENTING RtSTRLCTED ARtij~S

TRAINING EXPRIENCE

9 IAC1UTlti5 AN) EQUIPMENT 10 RADIATION SAFETY PROGRAM

r-------------------------------------+--~~~~~~~~~~~~----------__12 UCENSEEFEES (S 0CFR 170sndSeciion 17031) 4aY

11 WASTE MANAGEMENT ~-t-gtA IAMOUNT C12 FEE CATEGORY Jt( ENCLOSED S - shy

13 _ _I~~ b comp by pphesnl) THE APPLICANT UNOERSTANDS THAT All STATEMENTS ANO REPRESoNTATIONS MAOE IN THIS APPUCAnON ARE SINOtNC

THE APPLleA T ANO ANY OFFICIAL EXECUTING THIS CERTIHCATION ON BEHALF OF THE APPUCANT NAMED IN rrEM 2 CtRT1FY THAT THtS APPLICATION IS PREPARED tN CONrOF-tMTY WIn TITLE 10 CODE Of FEDERAl REGULATiONS PARTS 30 32 33 3 35 36 39 ANO ~O AND THAT ALL INFORMATION CONTAINED HEREIN 1$ TRUE AND CQRRECT TO hE SEST OF rnpoundIR KNOWLEDGE AND BELIEF I~

WARNING 113 U SC SECTION Xl ACT OFJUNE 25 1pound14852 STAT 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALj TEMENT OR REPRESENTATION TO ANY OEPART1yenENT OR AGENCY OF THE JNrnO STATES AS TO ANY MATTER WITHIN ITS JURISDJGTIONI I

FOR NRC USE 0 liLY ____ IFEE CATEGORy IOUNT REC~IVEO ICHECK NUMBER COENTS ------

IDATE

A-J NUREG 1556 VoL I Rev I

l~ffflJF

APPENDIX A

NRC FORM 313 (8-ampIll)

U S NUCLEAR REGULATORY COMMISSION APPROVED BY OM6 NO 0020 EXPIRES0Sl31f(OO2

10 CFI1 30 32 33-34 3536 39 and 40

APPLICATION FOR MATERIAL LICENSE

Estlmatad burden per rltllsponu to comply with this mandatory information eotlfCtfon request 14 hout$ Submittal 0 the application 1$ neenuty to c$~terrmne th~t the applicanl ~s qUaII(Hd aM thaI adequate pro~dlJ(u eJUSf 0 piotbct Ite p1Jblic heanh and ut Send eomlTI~n~ regarding burden utimate to the Records Managemsnt Branch (fe EeL US Nycleat ReQulatory CommisSlon WuhJn01on OC 2055$CXJ01 Of by intrnt e_mail to b51nrc OY and to the Dult Offlce( Office ofnlormation and Regulatory Mfain NE08-10202 l15()Ol~Dl Office at Managmtnt and Budget Washington DC 20503 11 a mUMS used to impose an ifltormatlon colle(tion dOles not display 11 cutTently valid OMB contlot numbet NRC may not conduct Of sponsor and a pef50n iamp not required to respond to the infofmati(m collelttion

INSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW

APPLICATION FOR OlSTRI8UTtON OF EXEMPT PROOUCTS FllE APPLICATIONS WITH

DIVISION OF INOUSTRIAL AND MEDICAL NUCLEAR SAFETY OFrJCE OF NUCUAR MATERIALS SAFETY ANO SAFpoundGUAR()S US NUCLEAR REGULATORY COMMISSION WASHINGTON DC 2055gt--OOO1

ALL OTHER PERSONS FilE APPLICATIONS AS FOLLOWS

IF YOU ARE LOCATEO IN

CONNECTICUT DELWARE DISTRICT OF COLUMBIA MA1NE MARYLAND MASSAHUSETTS tgt1N HAMPSHIRE NEW JERSEY NEV YORK PENNSYLVANIA

RHODE ISLAND OR -IERMONT SENO APPLICATiONS TO

UCENSING ASSIST ANT SECTION NUCLEAR MA T(RIALS SAfETY BRANCH U~ NUClEAH H(GULATQRY COMMISSION REGiON I 4n ALLENOALE ROAD KINGOFPRUSSIilPA 19400-1415

ALA8AMA FLORIDA GEORGIA KENTUCKY MISSISSIPPI NORTH CAROUNA PlJER10 RICO SOUTH CAROUNA TENNESSEE VIRGINIA VIRGIN ISLANQS OR WEST VIRGINIA SEND APPLICATIONS TO

S~M NUNN ATLATA FEDERAL CENTER U S NUCLEAR REGULATORY COMMISSION REGION 11

IF YOU ARE LOCATED I~

ilLlNOISINOIANAIOWA MICHIGAN MINNESOTA MISSOURI OHIO OR WISCONSIN SEND APPLICATIONS TO

MATERIALS LICENSING SECTION pr 3 us NUCLEAR REGULATORY COMMISSION REGlON III 801 WARRENVILLE RD USLEll 00512middot4351

ALASKA ARlZONA ARKANSAS CALIFORNIA COlORAOO HAWAII IDAHO KANSAS LOUISIANA MONTANA tEBRASKA NCVADA NEW MEXICO NORTH OAKOT A OKLAHOMA OREGON PACIFIC TRUST TERRITORIES SOUTH DAKOTA TEXAS UTM~ WASHINGTON OR WYOMINQ SENO APPLICATIONS TO

NUCLEAR MATERIALS LICENSING SECTION US NUCLEAR REGULATORY COMMISSION REGION IV 611 RYAN PLAZA DRIVE SUITE 400

ARliNGTON T)( IdO H064 l l 1_ gt

-1tgt 3 ~~O () 111-1

61FORsYTHSTREE1SW SUITE23T85 A_ ~U3 A 1 ATLANTA GEORGIA 30303 6931 r 1gt 7 r V - V

PERSONS lOCATEC IN AGREEMENT STATeS SENO APPLICATIONS TO THE u S NUCLEAR REGULATOR~OMM1SSION DNLYF THEY WISH TO possESS AND USE LICENSED

MATERIAL IN STATES SUBJECT TO uSNlJCLEAR REGULATORY COMMISSION JURISDICTIONS

~ ~HIS I AN APPUC TlON FOR (CIIeCK 4PPOPfllllf If)

A NEW LICENSe

fJ AMrtlOM~NT TO LICENSE NUM8ER ____________ _

C RENEWAL Of LICENSE NuMBER _____________ _

3 AOORtSS(ES) WrlcRE LcENSED M Tc~Il Wil L BE USFO OR POSStissEo

M~IJ LUlHte -K~r~ ~Dpound1AC bm NkiCNAL MA LL-

1

4 NAME OF PERSON TO BE CONTACTED ABOUT THIS

APPLICATION

yenhB8i2T YgtttHDN W J~I ~1GN tgtC

SUBMIT ITEMS 5 THliOUGH 1 ON ij1I2 X 11 PAPER THE TYPF ANO SCOPE OF INIORMATlON TO BE PROVIDED IS DeSCRIBED IN THE UCNSE APPLICA-liON GUOE

5 ADIOACTlvE MATER~AL a El~m~lt and mass umber b chemlc1 ilndJor phYS1e-1 101m and e rnal1(lmUm angtovnt

wnlaquoh11 ~ posuued ~t any on tim B PURPOSE(Sl FOR WHICH LICENSED ~ATER1AL WILL BE USED

7 lNOIVIDUAL(S) RESPONSIBLE FOR RAOIATION SAFETY PROGRAM AND THEIR

TRAINING EXPRIENCE 6 TRAINING FOR INDIVIOUALS WORKING IN OR fREOUENTING RtSTRLCTED ARtij~S

9 IAC1UTlti5 AN) EQUIPMENT 10 RADIATION SAFETY PROGRAM

r--------------------------------------+--~~~~~~~~~_=~~----------__1 2 UCENSEEFEES (S 0CFR 170sndSeciion 17031) 4m~

11 WASTE MANAGEMENT ~-t-gtA I AMOUNT C12 FEE CATEGORY )tf ENCLOSED S --

13 _ _I~~ b comp by pphesnl) THE APPLICANT UNOERSTANDS THAT All STATEMENTS ANO REPRESNTATIONS MAOE IN THIS APPLiCAnON ARE SINOtNC

THE APPLlC T ANO ANY OFFICIAL EXECUTING THIS CERTIHCATION ON BEHALF OF THE APPUCANT NAMED IN rrEM 2 CtRT1FY THAT THtS APPLICATION IS PREPARED tN CONOfMITY WIn TITLE 10 cooe Of FEDERAl REGULATiONS PARTS 30 32 33 3 35 36 39 ANO ~O AND THAT ALL INFORMATION CONTAINED HEREIN 1$ TRUE AND CQRRECT TO hE SEST OF rnpoundIR KNOWLEDGE AND BELIEF 1~ WARNING 113 U SC SECTION Xl ACT OFJUNE 25 1pound14852 STAT 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALS TEMENT OR REPRESENTATION TO ANY OEPART1yenENT OR AGENCY OF THE JNrnO STATES AS TO ANY MATTER WITHIN ITS JURISDJGTIONI

FOR NRC USE 0 gtJL Y ____ I FEE CATEGORy I OUNT REC~IVEO I CHECK NUMBER CO ENTS ----J

I DATE

A-J NUREG 1556 VoL I Rev I

l~ffflJF

i

indigo engineering

groupllc Application for Material License

Items 5 through 11

Cs-137 Sealed source Electronic labs

Troxler Drawing

Number A 102112

Am-241 Be Sealed source Troxler Electronic Labs Drawing Number A 1024S1

i Cs-137 Sealed source Amersham Corporation Model CDCW SS6 Capsule Type X 1218 Model CDCW SS6 Capsule type XN30 Isoto~e ~roducts Labs Model HEG-137-8M

Am-241 Be Sealed source Amersham Corporation Model AMNV 997 Capsule type X1lsotope Products Lab Model Nos 3021 or 3027

-I Cs-137 Sealed source CPN 131

Am-241 Be Sealed source CPN 131

Cs-137 bull Sealed source Amersham Corporation Model CDCW SS6 Capsule type X 1218 Model CDCW S56 Capsule type XN 30 Isotope Products Labs Model HEG 00S8 Capsule type 3024

Maximum amount of Purpose for Which radioactivity which will Licensed Material Will be be possessed at anyone Used time

No source to exceed 9 Used in Troxler model 3401 mCi and 3411 to measure

physical properties of materials

No source to exceed 44 Used in Troxler model 3401 mCi and 3411 to measure

physical propertiES of materials

No source to exceed 9 Used in Troxler model 3401 mC and 3411 to measure

physical properties of materials

No source to exceed 44 Used in Troxler model 3401 mCi and 3411 to measure

physical propertiEs of materials

No source to exceed 10 Used in Troxler model 3401 mCi and 3411 to measure

physical propertiES of materials

No source to exceed SO Used in Troxler model 3401 mC and 3411 to measure

physical propertiES of materials

No source to exceed 9 Used in Troxler 4640 and mCi 4640B to measure physical

properties of materials

INDIGO ENGINEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20036 SUSTAINABLE DESIGN P 2023559030 F 2023559031

Cs-137

i

indigo engineering

groupllc

Sealed source Electronic labs

Troxler Drawing

Number A 102112

Am-241 Be Sealed source Troxler Electronic Labs Drawing Number A 1024S1

i Cs-137 Sealed source Amersham Corporation Model CDCW SS6 Capsule Type X 1218 Model CDCW SS6 Capsule type XN30 Isoto~e ~roducts Labs Model HEG-137-8M

Am-241 Be Sealed source Amersham Corporation Model AMNV 997 Capsule type X1lsotope Products Lab Model Nos 3021 or 3027

-I Cs-137 Sealed source CPN 131

Am-241 Be Sealed source CPN 131

Cs-137 bull Sealed source Amersham Corporation Model CDCW SS6 Capsule type X 1218 Model CDCW S56 Capsule type XN 30 Isotope Products Labs Model HEG 00S8 Capsule type 3024

INDIGO ENGINEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

Application for Material License Items 5 through 11

Maximum amount of Purpose for Which radioactivity which will Licensed Material Will be be possessed at anyone Used time

No source to exceed 9 Used in Troxler model 3401 mCi and 3411 to measure

physical properties of materials

No source to exceed 44 Used in Troxler model 3401 mCi and 3411 to measure

physical propertiES of materials

No source to exceed 9 Used in Troxler model 3401 mC and 3411 to measure

physical properties of materials

No source to exceed 44 Used in Troxler model 3401 mCi and 3411 to measure

physical propertiEs of materials

No source to exceed 10 Used in Troxler model 3401 mCi and 3411 to measure

physical propertiES of materials

No source to exceed SO Used in Troxler model 3401 mC and 3411 to measure

physical propertiES of materials

No source to exceed 9 Used in Troxler 4640 and mCi 4640B to measure physical

properties of materials

1730 M St NW SUITE 1030 WASHINGTON DC 20036

P 2023559030 F 2023559031

~---indIgo

engIneeringgroupllc

Application for Material License Items 5 through 11

Item 7 Indivic1ual Responsible for Radiation Safety Program and Their Training Experience Robert Johnson will be solely responsible for the Radiation Safety Program

ROBERT JOHNSON Bachelor ofScience Biology 1980

REGISTRATIONS amp (ERTIFICATIONS bull First AidCPR Exp 42311 bull Certificate of Completion for Annual Audit RSO bull HAlMAT Refresher for Nuclear Gauges Exp211 bull 8 Hour Nuclear Gauge Safety Certification Exp 211 bull Tunnel Safety Trained bull OSHA 40 HR Exp 12712 bull Confined Space bull Respiratory Protection bull AHERA Asbestos Inspector bull Asbestos Project Designer bull Practices and Procedures for Asbestos Control

bull Bio Hazard Control bull Hazard Communication bull lead Awareness Training bull Asbestos Project Designer bull Asbestos Project Monitor bull ACOE Quality Control Cert Exp 2011 bull Fire Stop System trained(hilti)

bull Va Project Monitor

LICENSES Virginia AHERA Inspector Virginia Project Monitor

EXPERIENCE 210 - Present Indigo Engineering Group LLC RSOQuality Assurance Radiation Safety Officer conduct annual audits maintain and update nuclear gauge inventory every six months supervise training of all gauge operators Update and maintain nuclear safety program supervise proper disposal of nuclear gauges

1200-2010 EMSI Engineering Inc Company Safety Officer Conducted company safety audits maintained OSHA safety records and decided whether a case should be recorded or not stay current on OSHA 1903 1904 and 1926 maintained employee safety training and PPE conducted vehicle safety inspections conducted accident investigations monitored lab safety and nuclear safety as the company Nuclear Regulator Office conducted safety talk for EMSI and PSI employees conducted

I respirator fit test and confine space air monitoring performed Annual Audit of Nuclear Gauges supervised the I disposal of nuclear gauges conducted training for all nuclear gauge operators

INDIGO ENGINEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20036 SUSTAINABLE DESIGN P 2023559030 F 2023559031

~---indIgo

engIneering groupllc

Application for Material License Items 5 through 11

Item 7 Indivic1ual Responsible for Radiation Safety Program and Their Training Experience Robert Johnson will be solely responsible for the Radiation Safety Program

ROBERT JOHNSON Bachelor of Science Biology 1980

REGISTRATIONS amp (ERTIFICATIONS bull First AidCPR Exp 42311 bull Certificate of Completion for Annual Audit RSO bull HAlMAT Refresher for Nuclear Gauges Exp211 bull 8 Hour Nuclear Gauge Safety Certification Exp 211 bull Tunnel Safety Trained bull OSHA 40 HR Exp 12712 bull Confined Space bull Respiratory Protection bull AHERA Asbestos Inspector bull Asbestos Project Designer bull Practices and Procedures for Asbestos Control

bull Bio Hazard Control bull Hazard Communication bull lead Awareness Training bull Asbestos Project Designer bull Asbestos Project Monitor bull ACOE Quality Control Cert Exp 2011 bull Fire Stop System trained(hilti)

bull Va Project Monitor

LICENSES Virginia AHERA Inspector Virginia Project Monitor

EXPERIENCE 210 - Present Indigo Engineering Group LLC RSOQuality Assurance Radiation Safety Officer conduct annual audits maintain and update nuclear gauge inventory every six months supervise training of all gauge operators Update and maintain nuclear safety program supervise proper disposal of nuclear gauges

1200-2010 EMSI Engineering Inc Company Safety Officer Conducted company safety audits maintained OSHA safety records and decided whether a case should be recorded or not stay current on OSHA 1903 1904 and 1926 maintained employee safety training and PPE conducted vehicle safety inspections conducted accident investigations monitored lab safety and nuclear safety as the company Nuclear Regulator Office conducted safety talk for EMS I and PSI employees conducted

I respirator fit test and confine space air monitoring performed Annual Audit of Nuclear Gauges supervised the I disposal of nuclear gauges conducted training for all nuclear gauge operators

INDIGO ENGINEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20036

P 2023559030 F 2023559031

i

indigo engineering

groupnc Application for Material License

Items 5 through 11

598- 600 eTl Engineering Company Safety Officer Maintained all company safety training record updated and maintained employee safety training maintained and issued PPE to employee and instructed employee in the proper use of PPE conducted accident investigations conducted vehicle safety inspections maintained OSHA records maintained Material Safety Data Sheets conducted safety inspections monitored lab safety and nuclear safety as company Nuclear Regulator Officer conducted confine space air monitoring

997- 498 American Environmental Safety Officer Industrial Hygienist Performed on-site safety and environmental inspections conducted fit test wrote and maintained respiratory protection program reviewed MSDS performed air quality tests monitored employee safety training and PPE maintained OSHA rE~cords

495- 997 elaVSlovich Environmental Environmental Specialists Conducted on-site Environmental and safety inspection on projects maintain daily logs coordinated with clients on safety and environmental issues

893- 1295 Alcon Demo Project Manager Performed on-site project management services for contract customers conducted building inspection for safety and environmental hazards performed air monitoring during abatement analyzed airborne asbestos fiber phase contras microscopy following NIOSH 582-7400 method performed air monitoring of heavy metals both EPA and OSHA responsible for the site safety of the demolition of the World Bank building located in downtown Washington DC

392-893 Web Environmental Group Project Manager Managed field operation implemented lab safety program maintained MSDS responsible for project quality control performed client interface with general and sub contractors maintained companys PPE

891-392 I-Tem Environmental Inspector Performed as on-site project monitor performed client interface maintained daily logs wrote final reports conducted progress meetings

1190-1191 Analvtical Laboratory Environmental Inspector Performed on-site project monitoring and oversight for environmental and safety issues

1086-990 BeM Engineering Environmental Inspector Inspected buildings through-out the United States for environmental and safety issues Over 100000000 square feet inspected Performed construction surveillance in schools hospitals high-rise office building etc On-site project oversight coordinated activities of field crews maintained daily log and wrote final reports

1285-986 Tractor Jitco Environmental Inspector Crew leader on major asbestos building inspection project for the State of Maryland performed environmental survey on all state owned building Testified for the State of Maryland as to my findings

885-1285 National Food Processors Association Laboratory Technician Tested food samples nutritional value member of lab safety committee wrote SOP for chemical storage and handling

INDIGO ENGiNEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20036 SUSTAINABLE DESIGN P 2023559030 F 2023559031

i

indigo engineering

groupnc Application for Material License

Items 5 through 11

598- 600 eTl Engineering Company Safety Officer Maintained all company safety training record updated and maintained employee safety training maintained and issued PPE to employee and instructed employee in the proper use of PPE conducted accident investigations conducted vehicle safety inspections maintained OSHA records maintained Material Safety Data Sheets conducted safety inspections monitored lab safety and nuclear safety as company Nuclear Regulator Officer conducted confine space air monitoring

997- 498 American Environmental Safety Officer Industrial Hygienist Performed on-site safety and environmental inspections conducted fit test wrote and maintained respiratory protection program reviewed MSDS performed air quality tests monitored employee safety training and PPE maintained OSHA rE~cords

495- 997 elaVSlovich Environmental Environmental Specialists Conducted on-site Environmental and safety inspection on projects maintain daily logs coordinated with clients on safety and environmental issues

893- 1295 Alcon Demo Project Manager Performed on-site project management services for contract customers conducted building inspection for safety and environmental hazards performed air monitoring during abatement analyzed airborne asbestos fiber phase contras microscopy following NIOSH 582-7400 method performed air monitoring of heavy metals both EPA and OSHA responsible for the site safety of the demolition of the World Bank building located in downtown Washington DC

392-893 Web Environmental Group Project Manager Managed field operation implemented lab safety program maintained MSDS responsible for project quality control performed client interface with general and sub contractors maintained companys PPE

891-392 I-Tem Environmental Inspector Performed as on-site project monitor performed client interface maintained daily logs wrote final reports conducted progress meetings

1190-1191 Analvtical Laboratory Environmental Inspector Performed on-site project monitoring and oversight for environmental and safety issues

1086-990 BeM Engineering Environmental Inspector Inspected buildings through-out the United States for environmental and safety issues Over 100000000 square feet inspected Performed construction surveillance in schools hospitals high-rise office building etc On-site project oversight coordinated activities of field crews maintained daily log and wrote final reports

1285-986 Tractor Jitco Environmental Inspector Crew leader on major asbestos building inspection project for the State of Maryland performed environmental survey on all state owned building Testified for the State of Maryland as to my findings

885-1285 National Food Processors Association Laboratory Technician Tested food samples nutritional value member of lab safety committee wrote SOP for chemical storage and handling

INDIGO ENGiNEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20036

P 2023559030 F 2023559031

i

indigo engineering

groupnc Application for Material License

Items 5 through 11 980-1285 Labeff Associates Municipal Wastewater Treatment Engineer Performed testing of heavy metal in wastewater operated an industrial wastewater treatment plant performed testing of waters at AWT plant Supervised the construction of an Industrial wastewater treatment plant testing lab

Item8 shyTraining for Individuals Working in or Frequenting Restricted Areas Training for individuals frequenting restricted areas will have successful completion of an authorized radiation safety training class in accordance with appendix D of NUREG 1556 Vol 1 Rev 1 dated November 2001

Item 9-Facilitits and Equipment Information is not rE~quired to be submitted at this time in response to this item Key issues are addressed under Radiation Safety Program-Public Dose and Radiation Safety Program-Operating and Emergency Procedures

Item 10 - Radiation Safety Program PERSONNEL MONITORING

bull Ensure all radioactive materials are used only by individuals who are authorized and that personal monitoring devices are worn at all times Badges will be exchanged at intervals not to exceed 3 months and be provided by an accredited NVLAP processor

bull Dose reports shall be reviewed by the RSO to determine compliance with regulatory exposure limits and to confirm that personnel exposures are ALARA

bull The monitoring report shall be posted and the RSO will maintain a copy on file

SEALED SOURCE LEAK TESTING

bull Leak tests will be performed at intervals not to exceed 6 months Leak test samples will be analyzed by an organization authorized by the NRC or agreement state to perform analysis

RADIATION DETECTION INSTRUMENTS We will possess a survey meter in the event of an incident involving the gauge It will be calibrated annually

MATERIAL RECEIPT AND ACCOUNTABILITY

bull Ensure that all terms and conditions of the license and applicable regulations are complied with bull Ensure radioactive materials are properly secured against unauthorized removal bull Ensure audits are of the program are performed annually and corrective action is taken bull Ensure licensed is maintained current and amendment and renewal requests are submitted in a timely

manner

bull Physical inventories of sealed sources will be conducted at intervals not to exceed 6 months

bull Records of receipt transfer and disposal of gauges will be maintained for at least 3 years

bull Annual audits will be performed and corrective action taken

PUBLIC DOSE

bull Ensure that gauges are used transported and stored in a manner that no member of the public receives more than 100 mrem in one year

bull Ensure that the dose in any unrestricted area does not exceed 2 mrem in anyone hour

OPERATING AND EMERGENCY PROCEDURES

bull Locate sources bull Seal off or cordon off a 15 foot radius around the gauge to prevent unauthorized entry bull If a vehicle is involved it must not be moved until the extent of contamination (if any) is determined

INDIGO ENGINEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20036 SUSTAINABLE DESIGN P 2023559030 F 2023559031

i

indigo engineering

groupnc Application for Material License

Items 5 through 11 980-1285 Labeff Associates Municipal Wastewater Treatment Engineer Performed testing of heavy metal in wastewater operated an industrial wastewater treatment plant performed testing of waters at AWT plant Supervised the construction of an Industrial wastewater treatment plant testing lab

Item8 - Training for Individuals Working in or Frequenting Restricted Areas Training for individuals frequenting restricted areas will have successful completion of an authorized radiation safety training class in accordance with appendix D of NUREG 1556 Vol 1 Rev 1 dated November 2001

Item 9-Facilitits and Equipment Information is not rE~quired to be submitted at this time in response to this item Key issues are addressed under Radiation Safety Program-Public Dose and Radiation Safety Program-Operating and Emergency Procedures

Item 10 - Radiation Safety Program PERSONNEL MONITORING

bull Ensure all radioactive materials are used only by individuals who are authorized and that personal monitoring devices are worn at all times Badges will be exchanged at intervals not to exceed 3 months and be provided by an accredited NVLAP processor

bull Dose reports shall be reviewed by the RSO to determine compliance with regulatory exposure limits and to confirm that personnel exposures are ALARA

bull The monitoring report shall be posted and the RSO will maintain a copy on file

SEALED SOURCE LEAK TESTING

bull Leak tests will be performed at intervals not to exceed 6 months Leak test samples will be analyzed by an organization authorized by the NRC or agreement state to perform analysis

RADIATION DETECTION INSTRUMENTS We will possess a survey meter in the event of an incident involving the gauge It will be calibrated annually

MATERIAL RECEIPT AND ACCOUNTABILITY

bull Ensure that all terms and conditions of the license and applicable regulations are complied with bull Ensure radioactive materials are properly secured against unauthorized removal bull Ensure audits are of the program are performed annually and corrective action is taken bull Ensure licensed is maintained current and amendment and renewal requests are submitted in a timely

manner

bull Physical inventories of sealed sources will be conducted at intervals not to exceed 6 months

bull Records of receipt transfer and disposal of gauges will be maintained for at least 3 years

bull Annual audits will be performed and corrective action taken

PUBLIC DOSE

bull Ensure that gauges are used transported and stored in a manner that no member of the public receives more than 100 mrem in one year

bull Ensure that the dose in any unrestricted area does not exceed 2 mrem in anyone hour

OPERATING AND EMERGENCY PROCEDURES

bull Locate sources bull Seal off or cordon off a 15 foot radius around the gauge to prevent unauthorized entry bull If a vehicle is involved it must not be moved until the extent of contamination (if any) is determined

INDIGO ENGINEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20036

P 2023559030 F 2023559031

iyshy

indIgo engineering

groupllc Application for Material License

Items 5 through 11 bull Visually inspect the gauge to determine whether the any damage to the source shielding or housing has

been sustained bull As soon as possible notify the RSO Describe the present conditions and follow the instructions of the

RSO

The RSO will take the following action upon notification of an incident An incident is defined as 1 Lost stolen or missing sources 2 Events that cause or threaten exposures to individuals in excess of regulatory limits 3 Leaking or contaminated sealed sources

Arrange for a radiation survey to be conducted as soon as possible by a knowledgeable person using the appropriate radiation detection equipment to assess the integrity of the source encapsulation and shielding and determine the extent of contamination if any of personnel equipment and facilities or areas Notify regulatory authorities as required If initial notification was made by phone a written report must be submitted within 30 days

MAINTENANCE Maintenance shall be conducted by the manufacturer or other persons specifically licensed by the US Nuclear Regulatory Commission or an Agreement State to perform such services

TRANSPORTATION Transportation of radioactive material will be in accordance with all applicable Department of Transportation i requirements HAZMAT training will be accomplished at intervals not to exceed 3 years for ground transportation

and 2 year intervals if shipping by air

Item ll-Waste Management No radioactive waste per se is generated by the operations conducted under this license

INDIGO ENGINEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20()36 SUSTAINABLE DESIGN P 2023559030 F 2023559031

iy-

indIgo engineering

groupllc Application for Material License

Items 5 through 11 bull Visually inspect the gauge to determine whether the any damage to the source shielding or housing has

been sustained bull As soon as possible notify the RSO Describe the present conditions and follow the instructions of the

RSO

The RSO will take the following action upon notification of an incident An incident is defined as 1 Lost stolen or missing sources 2 Events that cause or threaten exposures to individuals in excess of regulatory limits 3 Leaking or contaminated sealed sources

Arrange for a radiation survey to be conducted as soon as possible by a knowledgeable person using the appropriate radiation detection equipment to assess the integrity of the source encapsulation and shielding and determine the extent of contamination if any of personnel equipment and facilities or areas Notify regulatory authorities as required If initial notification was made by phone a written report must be submitted within 30 days

MAINTENANCE Maintenance shall be conducted by the manufacturer or other persons specifically licensed by the US Nuclear Regulatory Commission or an Agreement State to perform such services

TRANSPORTATION Transportation of radioactive material will be in accordance with all applicable Department of Transportation i requirements HAZMAT training will be accomplished at intervals not to exceed 3 years for ground transportation

and 2 year intervals if shipping by air

Item ll-Waste Management No radioactive waste per se is generated by the operations conducted under this license

INDIGO ENGINEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20()36

P 2023559030 F 2023559031

January 28 2010

Robert Johnson

Has successfully completed training in accordance with policies set forth by the following rules and regulations goveming portable nuclear moisturedensity gauges and transportation requirements NUREG 1556 and 49CFR subpart H and lATA 152

A closed book examination was administered and a passing score was achieved The person listed above has demonstrated a thorough understanding of all aspects needed for transportation with specific emphasis placed on portable nuclear density gauges This certificate is only valid if signed by a Radiation Safety Officer verifying that further hands on training will be conducted under direct supervision of an authorized user prior operating the gauge alone Subjects included in this course include Radiological safetyprinciples practices of radiation protection leak-testing procedures measurement of radioactivity biological effect of radiation incident labeling markin9 storage ALARA shipping packaging shipping documents emergency procedures and security awareness Record keeping in accordance with 49 CFR 172704(d) North East Technical~ 4 AQcdmmiddotlntQr MrI 211 r7 ( ~ ~ GW

January 28 2010

Robert Johnson

Has successfully completed training in accordance with policies set forth by the following rules and regulations goveming portable nuclear moisturedensity gauges and transportation requirements NUREG 1556 and 49CFR subpart H and lATA 152

A closed book examination was administered and a passing score was achieved The person listed above has demonstrated a thorough understanding of all aspects needed for transportation with specific emphasis placed on portable nuclear density gauges This certificate is only valid if signed by a Radiation Safety Officer verifying that further hands on training will be conducted under direct supervision of an authorized user prior operating the gauge alone Subjects included in this course include Radiological safetyprinciples practices of radiation protection leak-testing procedures measurement of radioactivity biological effect of radiation incident labeling rna I storage ALARA shipping packaging shipping documents emergency procedures and security awareness Record keeping in accordance with 49 CFR 172704(d) North East Technical~

4 Westminster MD 21157 ~~-t-lt-~

APNGA Certificate of Completion

This confirms that

_ ____ R (2bert J0 blQQ1_QtI9)11112D ny n[1 nlQJ_______

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

~

APNGA Certificate of Completion

This confirms that

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Rohlrl Johnson-_ ---~-~--bull shy

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Lo JtJO~ijJIilQQyj~ tJJeJ1-f-lr ~J10~~ ompany me Company RSO I Official (print)

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

Company RSO I Official (print)

~---indIgo

engIneeringgroupllc

Application for Material License Items 5 through 11

Item 7 Indivic1ual Responsible for Radiation Safety Program and Their Training Experience Robert Johnson will be solely responsible for the Radiation Safety Program

ROBERT JOHNSON Bachelor ofScience Biology 1980

REGISTRATIONS amp (ERTIFICATIONS bull First AidCPR Exp 42311 bull Certificate of Completion for Annual Audit RSO bull HAlMAT Refresher for Nuclear Gauges Exp211 bull 8 Hour Nuclear Gauge Safety Certification Exp 211 bull Tunnel Safety Trained bull OSHA 40 HR Exp 12712 bull Confined Space bull Respiratory Protection bull AHERA Asbestos Inspector bull Asbestos Project Designer bull Practices and Procedures for Asbestos Control

bull Bio Hazard Control bull Hazard Communication bull lead Awareness Training bull Asbestos Project Designer bull Asbestos Project Monitor bull ACOE Quality Control Cert Exp 2011 bull Fire Stop System trained(hilti)

bull Va Project Monitor

LICENSES Virginia AHERA Inspector Virginia Project Monitor

EXPERIENCE 210 - Present Indigo Engineering Group LLC RSOQuality Assurance Radiation Safety Officer conduct annual audits maintain and update nuclear gauge inventory every six months supervise training of all gauge operators Update and maintain nuclear safety program supervise proper disposal of nuclear gauges

1200-2010 EMSI Engineering Inc Company Safety Officer Conducted company safety audits maintained OSHA safety records and decided whether a case should be recorded or not stay current on OSHA 1903 1904 and 1926 maintained employee safety training and PPE conducted vehicle safety inspections conducted accident investigations monitored lab safety and nuclear safety as the company Nuclear Regulator Office conducted safety talk for EMSI and PSI employees conducted

I respirator fit test and confine space air monitoring performed Annual Audit of Nuclear Gauges supervised the I disposal of nuclear gauges conducted training for all nuclear gauge operators

INDIGO ENGINEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20036 SUSTAINABLE DESIGN P 2023559030 F 2023559031

~---indIgo

engIneering groupllc

Application for Material License Items 5 through 11

Item 7 Indivic1ual Responsible for Radiation Safety Program and Their Training Experience Robert Johnson will be solely responsible for the Radiation Safety Program

ROBERT JOHNSON Bachelor of Science Biology 1980

REGISTRATIONS amp (ERTIFICATIONS bull First AidCPR Exp 42311 bull Certificate of Completion for Annual Audit RSO bull HAlMAT Refresher for Nuclear Gauges Exp211 bull 8 Hour Nuclear Gauge Safety Certification Exp 211 bull Tunnel Safety Trained bull OSHA 40 HR Exp 12712 bull Confined Space bull Respiratory Protection bull AHERA Asbestos Inspector bull Asbestos Project Designer bull Practices and Procedures for Asbestos Control

bull Bio Hazard Control bull Hazard Communication bull lead Awareness Training bull Asbestos Project Designer bull Asbestos Project Monitor bull ACOE Quality Control Cert Exp 2011 bull Fire Stop System trained(hilti)

bull Va Project Monitor

LICENSES Virginia AHERA Inspector Virginia Project Monitor

EXPERIENCE 210 - Present Indigo Engineering Group LLC RSOQuality Assurance Radiation Safety Officer conduct annual audits maintain and update nuclear gauge inventory every six months supervise training of all gauge operators Update and maintain nuclear safety program supervise proper disposal of nuclear gauges

1200-2010 EMSI Engineering Inc Company Safety Officer Conducted company safety audits maintained OSHA safety records and decided whether a case should be recorded or not stay current on OSHA 1903 1904 and 1926 maintained employee safety training and PPE conducted vehicle safety inspections conducted accident investigations monitored lab safety and nuclear safety as the company Nuclear Regulator Office conducted safety talk for EMS I and PSI employees conducted

I respirator fit test and confine space air monitoring performed Annual Audit of Nuclear Gauges supervised the I disposal of nuclear gauges conducted training for all nuclear gauge operators

INDIGO ENGINEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20036

P 2023559030 F 2023559031

i

indigo engineering

groupnc Application for Material License

Items 5 through 11

598- 600 eTl Engineering Company Safety Officer Maintained all company safety training record updated and maintained employee safety training maintained and issued PPE to employee and instructed employee in the proper use of PPE conducted accident investigations conducted vehicle safety inspections maintained OSHA records maintained Material Safety Data Sheets conducted safety inspections monitored lab safety and nuclear safety as company Nuclear Regulator Officer conducted confine space air monitoring

997- 498 American Environmental Safety Officer Industrial Hygienist Performed on-site safety and environmental inspections conducted fit test wrote and maintained respiratory protection program reviewed MSDS performed air quality tests monitored employee safety training and PPE maintained OSHA rE~cords

495- 997 elaVSlovich Environmental Environmental Specialists Conducted on-site Environmental and safety inspection on projects maintain daily logs coordinated with clients on safety and environmental issues

893- 1295 Alcon Demo Project Manager Performed on-site project management services for contract customers conducted building inspection for safety and environmental hazards performed air monitoring during abatement analyzed airborne asbestos fiber phase contras microscopy following NIOSH 582-7400 method performed air monitoring of heavy metals both EPA and OSHA responsible for the site safety of the demolition of the World Bank building located in downtown Washington DC

392-893 Web Environmental Group Project Manager Managed field operation implemented lab safety program maintained MSDS responsible for project quality control performed client interface with general and sub contractors maintained companys PPE

891-392 I-Tem Environmental Inspector Performed as on-site project monitor performed client interface maintained daily logs wrote final reports conducted progress meetings

1190-1191 Analvtical Laboratory Environmental Inspector Performed on-site project monitoring and oversight for environmental and safety issues

1086-990 BeM Engineering Environmental Inspector Inspected buildings through-out the United States for environmental and safety issues Over 100000000 square feet inspected Performed construction surveillance in schools hospitals high-rise office building etc On-site project oversight coordinated activities of field crews maintained daily log and wrote final reports

1285-986 Tractor Jitco Environmental Inspector Crew leader on major asbestos building inspection project for the State of Maryland performed environmental survey on all state owned building Testified for the State of Maryland as to my findings

885-1285 National Food Processors Association Laboratory Technician Tested food samples nutritional value member of lab safety committee wrote SOP for chemical storage and handling

INDIGO ENGiNEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20036 SUSTAINABLE DESIGN P 2023559030 F 2023559031

i

indigo engineering

groupnc Application for Material License

Items 5 through 11

598- 600 eTl Engineering Company Safety Officer Maintained all company safety training record updated and maintained employee safety training maintained and issued PPE to employee and instructed employee in the proper use of PPE conducted accident investigations conducted vehicle safety inspections maintained OSHA records maintained Material Safety Data Sheets conducted safety inspections monitored lab safety and nuclear safety as company Nuclear Regulator Officer conducted confine space air monitoring

997- 498 American Environmental Safety Officer Industrial Hygienist Performed on-site safety and environmental inspections conducted fit test wrote and maintained respiratory protection program reviewed MSDS performed air quality tests monitored employee safety training and PPE maintained OSHA rE~cords

495- 997 elaVSlovich Environmental Environmental Specialists Conducted on-site Environmental and safety inspection on projects maintain daily logs coordinated with clients on safety and environmental issues

893- 1295 Alcon Demo Project Manager Performed on-site project management services for contract customers conducted building inspection for safety and environmental hazards performed air monitoring during abatement analyzed airborne asbestos fiber phase contras microscopy following NIOSH 582-7400 method performed air monitoring of heavy metals both EPA and OSHA responsible for the site safety of the demolition of the World Bank building located in downtown Washington DC

392-893 Web Environmental Group Project Manager Managed field operation implemented lab safety program maintained MSDS responsible for project quality control performed client interface with general and sub contractors maintained companys PPE

891-392 I-Tem Environmental Inspector Performed as on-site project monitor performed client interface maintained daily logs wrote final reports conducted progress meetings

1190-1191 Analvtical Laboratory Environmental Inspector Performed on-site project monitoring and oversight for environmental and safety issues

1086-990 BeM Engineering Environmental Inspector Inspected buildings through-out the United States for environmental and safety issues Over 100000000 square feet inspected Performed construction surveillance in schools hospitals high-rise office building etc On-site project oversight coordinated activities of field crews maintained daily log and wrote final reports

1285-986 Tractor Jitco Environmental Inspector Crew leader on major asbestos building inspection project for the State of Maryland performed environmental survey on all state owned building Testified for the State of Maryland as to my findings

885-1285 National Food Processors Association Laboratory Technician Tested food samples nutritional value member of lab safety committee wrote SOP for chemical storage and handling

INDIGO ENGiNEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20036

P 2023559030 F 2023559031

i

indigo engineering

groupnc Application for Material License

Items 5 through 11 980-1285 Labeff Associates Municipal Wastewater Treatment Engineer Performed testing of heavy metal in wastewater operated an industrial wastewater treatment plant performed testing of waters at AWT plant Supervised the construction of an Industrial wastewater treatment plant testing lab

Item8 shyTraining for Individuals Working in or Frequenting Restricted Areas Training for individuals frequenting restricted areas will have successful completion of an authorized radiation safety training class in accordance with appendix D of NUREG 1556 Vol 1 Rev 1 dated November 2001

Item 9-Facilitits and Equipment Information is not rE~quired to be submitted at this time in response to this item Key issues are addressed under Radiation Safety Program-Public Dose and Radiation Safety Program-Operating and Emergency Procedures

Item 10 - Radiation Safety Program PERSONNEL MONITORING

bull Ensure all radioactive materials are used only by individuals who are authorized and that personal monitoring devices are worn at all times Badges will be exchanged at intervals not to exceed 3 months and be provided by an accredited NVLAP processor

bull Dose reports shall be reviewed by the RSO to determine compliance with regulatory exposure limits and to confirm that personnel exposures are ALARA

bull The monitoring report shall be posted and the RSO will maintain a copy on file

SEALED SOURCE LEAK TESTING

bull Leak tests will be performed at intervals not to exceed 6 months Leak test samples will be analyzed by an organization authorized by the NRC or agreement state to perform analysis

RADIATION DETECTION INSTRUMENTS We will possess a survey meter in the event of an incident involving the gauge It will be calibrated annually

MATERIAL RECEIPT AND ACCOUNTABILITY

bull Ensure that all terms and conditions of the license and applicable regulations are complied with bull Ensure radioactive materials are properly secured against unauthorized removal bull Ensure audits are of the program are performed annually and corrective action is taken bull Ensure licensed is maintained current and amendment and renewal requests are submitted in a timely

manner

bull Physical inventories of sealed sources will be conducted at intervals not to exceed 6 months

bull Records of receipt transfer and disposal of gauges will be maintained for at least 3 years

bull Annual audits will be performed and corrective action taken

PUBLIC DOSE

bull Ensure that gauges are used transported and stored in a manner that no member of the public receives more than 100 mrem in one year

bull Ensure that the dose in any unrestricted area does not exceed 2 mrem in anyone hour

OPERATING AND EMERGENCY PROCEDURES

bull Locate sources bull Seal off or cordon off a 15 foot radius around the gauge to prevent unauthorized entry bull If a vehicle is involved it must not be moved until the extent of contamination (if any) is determined

INDIGO ENGINEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20036 SUSTAINABLE DESIGN P 2023559030 F 2023559031

i

indigo engineering

groupnc Application for Material License

Items 5 through 11 980-1285 Labeff Associates Municipal Wastewater Treatment Engineer Performed testing of heavy metal in wastewater operated an industrial wastewater treatment plant performed testing of waters at AWT plant Supervised the construction of an Industrial wastewater treatment plant testing lab

Item8 - Training for Individuals Working in or Frequenting Restricted Areas Training for individuals frequenting restricted areas will have successful completion of an authorized radiation safety training class in accordance with appendix D of NUREG 1556 Vol 1 Rev 1 dated November 2001

Item 9-Facilitits and Equipment Information is not rE~quired to be submitted at this time in response to this item Key issues are addressed under Radiation Safety Program-Public Dose and Radiation Safety Program-Operating and Emergency Procedures

Item 10 - Radiation Safety Program PERSONNEL MONITORING

bull Ensure all radioactive materials are used only by individuals who are authorized and that personal monitoring devices are worn at all times Badges will be exchanged at intervals not to exceed 3 months and be provided by an accredited NVLAP processor

bull Dose reports shall be reviewed by the RSO to determine compliance with regulatory exposure limits and to confirm that personnel exposures are ALARA

bull The monitoring report shall be posted and the RSO will maintain a copy on file

SEALED SOURCE LEAK TESTING

bull Leak tests will be performed at intervals not to exceed 6 months Leak test samples will be analyzed by an organization authorized by the NRC or agreement state to perform analysis

RADIATION DETECTION INSTRUMENTS We will possess a survey meter in the event of an incident involving the gauge It will be calibrated annually

MATERIAL RECEIPT AND ACCOUNTABILITY

bull Ensure that all terms and conditions of the license and applicable regulations are complied with bull Ensure radioactive materials are properly secured against unauthorized removal bull Ensure audits are of the program are performed annually and corrective action is taken bull Ensure licensed is maintained current and amendment and renewal requests are submitted in a timely

manner

bull Physical inventories of sealed sources will be conducted at intervals not to exceed 6 months

bull Records of receipt transfer and disposal of gauges will be maintained for at least 3 years

bull Annual audits will be performed and corrective action taken

PUBLIC DOSE

bull Ensure that gauges are used transported and stored in a manner that no member of the public receives more than 100 mrem in one year

bull Ensure that the dose in any unrestricted area does not exceed 2 mrem in anyone hour

OPERATING AND EMERGENCY PROCEDURES

bull Locate sources bull Seal off or cordon off a 15 foot radius around the gauge to prevent unauthorized entry bull If a vehicle is involved it must not be moved until the extent of contamination (if any) is determined

INDIGO ENGINEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20036

P 2023559030 F 2023559031

iyshy

indIgo engineering

groupllc Application for Material License

Items 5 through 11 bull Visually inspect the gauge to determine whether the any damage to the source shielding or housing has

been sustained bull As soon as possible notify the RSO Describe the present conditions and follow the instructions of the

RSO

The RSO will take the following action upon notification of an incident An incident is defined as 1 Lost stolen or missing sources 2 Events that cause or threaten exposures to individuals in excess of regulatory limits 3 Leaking or contaminated sealed sources

Arrange for a radiation survey to be conducted as soon as possible by a knowledgeable person using the appropriate radiation detection equipment to assess the integrity of the source encapsulation and shielding and determine the extent of contamination if any of personnel equipment and facilities or areas Notify regulatory authorities as required If initial notification was made by phone a written report must be submitted within 30 days

MAINTENANCE Maintenance shall be conducted by the manufacturer or other persons specifically licensed by the US Nuclear Regulatory Commission or an Agreement State to perform such services

TRANSPORTATION Transportation of radioactive material will be in accordance with all applicable Department of Transportation i requirements HAZMAT training will be accomplished at intervals not to exceed 3 years for ground transportation

and 2 year intervals if shipping by air

Item ll-Waste Management No radioactive waste per se is generated by the operations conducted under this license

INDIGO ENGINEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20()36 SUSTAINABLE DESIGN P 2023559030 F 2023559031

iy-

indIgo engineering

groupllc Application for Material License

Items 5 through 11 bull Visually inspect the gauge to determine whether the any damage to the source shielding or housing has

been sustained bull As soon as possible notify the RSO Describe the present conditions and follow the instructions of the

RSO

The RSO will take the following action upon notification of an incident An incident is defined as 1 Lost stolen or missing sources 2 Events that cause or threaten exposures to individuals in excess of regulatory limits 3 Leaking or contaminated sealed sources

Arrange for a radiation survey to be conducted as soon as possible by a knowledgeable person using the appropriate radiation detection equipment to assess the integrity of the source encapsulation and shielding and determine the extent of contamination if any of personnel equipment and facilities or areas Notify regulatory authorities as required If initial notification was made by phone a written report must be submitted within 30 days

MAINTENANCE Maintenance shall be conducted by the manufacturer or other persons specifically licensed by the US Nuclear Regulatory Commission or an Agreement State to perform such services

TRANSPORTATION Transportation of radioactive material will be in accordance with all applicable Department of Transportation i requirements HAZMAT training will be accomplished at intervals not to exceed 3 years for ground transportation

and 2 year intervals if shipping by air

Item ll-Waste Management No radioactive waste per se is generated by the operations conducted under this license

INDIGO ENGINEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20()36

P 2023559030 F 2023559031

January 28 2010

Robert Johnson

Has successfully completed training in accordance with policies set forth by the following rules and regulations goveming portable nuclear moisturedensity gauges and transportation requirements NUREG 1556 and 49CFR subpart H and lATA 152

A closed book examination was administered and a passing score was achieved The person listed above has demonstrated a thorough understanding of all aspects needed for transportation with specific emphasis placed on portable nuclear density gauges This certificate is only valid if signed by a Radiation Safety Officer verifying that further hands on training will be conducted under direct supervision of an authorized user prior operating the gauge alone Subjects included in this course include Radiological safetyprinciples practices of radiation protection leak-testing procedures measurement of radioactivity biological effect of radiation incident labeling markin9 storage ALARA shipping packaging shipping documents emergency procedures and security awareness Record keeping in accordance with 49 CFR 172704(d) North East Technical~ 4 AQcdmmiddotlntQr MrI 211 r7 ( ~ ~ GW

January 28 2010

Robert Johnson

Has successfully completed training in accordance with policies set forth by the following rules and regulations goveming portable nuclear moisturedensity gauges and transportation requirements NUREG 1556 and 49CFR subpart H and lATA 152

A closed book examination was administered and a passing score was achieved The person listed above has demonstrated a thorough understanding of all aspects needed for transportation with specific emphasis placed on portable nuclear density gauges This certificate is only valid if signed by a Radiation Safety Officer verifying that further hands on training will be conducted under direct supervision of an authorized user prior operating the gauge alone Subjects included in this course include Radiological safetyprinciples practices of radiation protection leak-testing procedures measurement of radioactivity biological effect of radiation incident labeling rna I storage ALARA shipping packaging shipping documents emergency procedures and security awareness Record keeping in accordance with 49 CFR 172704(d) North East Technical~

4 Westminster MD 21157 ~~-t-lt-~

APNGA Certificate of Completion

This confirms that

_ ____ R (2bert J0 blQQ1_QtI9)11112D ny n[1 nlQJ_______

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

~

APNGA Certificate of Completion

This confirms that

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Rohlrl Johnson-_ ---~-~--bull shy

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Lo JtJO~ijJIilQQyj~ tJJeJ1-f-lr ~J10~~ ompany me Company RSO I Official (print)

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

Company RSO I Official (print)

i

indigo engineering

groupnc Application for Material License

Items 5 through 11

598- 600 eTl Engineering Company Safety Officer Maintained all company safety training record updated and maintained employee safety training maintained and issued PPE to employee and instructed employee in the proper use of PPE conducted accident investigations conducted vehicle safety inspections maintained OSHA records maintained Material Safety Data Sheets conducted safety inspections monitored lab safety and nuclear safety as company Nuclear Regulator Officer conducted confine space air monitoring

997- 498 American Environmental Safety Officer Industrial Hygienist Performed on-site safety and environmental inspections conducted fit test wrote and maintained respiratory protection program reviewed MSDS performed air quality tests monitored employee safety training and PPE maintained OSHA rE~cords

495- 997 elaVSlovich Environmental Environmental Specialists Conducted on-site Environmental and safety inspection on projects maintain daily logs coordinated with clients on safety and environmental issues

893- 1295 Alcon Demo Project Manager Performed on-site project management services for contract customers conducted building inspection for safety and environmental hazards performed air monitoring during abatement analyzed airborne asbestos fiber phase contras microscopy following NIOSH 582-7400 method performed air monitoring of heavy metals both EPA and OSHA responsible for the site safety of the demolition of the World Bank building located in downtown Washington DC

392-893 Web Environmental Group Project Manager Managed field operation implemented lab safety program maintained MSDS responsible for project quality control performed client interface with general and sub contractors maintained companys PPE

891-392 I-Tem Environmental Inspector Performed as on-site project monitor performed client interface maintained daily logs wrote final reports conducted progress meetings

1190-1191 Analvtical Laboratory Environmental Inspector Performed on-site project monitoring and oversight for environmental and safety issues

1086-990 BeM Engineering Environmental Inspector Inspected buildings through-out the United States for environmental and safety issues Over 100000000 square feet inspected Performed construction surveillance in schools hospitals high-rise office building etc On-site project oversight coordinated activities of field crews maintained daily log and wrote final reports

1285-986 Tractor Jitco Environmental Inspector Crew leader on major asbestos building inspection project for the State of Maryland performed environmental survey on all state owned building Testified for the State of Maryland as to my findings

885-1285 National Food Processors Association Laboratory Technician Tested food samples nutritional value member of lab safety committee wrote SOP for chemical storage and handling

INDIGO ENGiNEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20036 SUSTAINABLE DESIGN P 2023559030 F 2023559031

i

indigo engineering

groupnc Application for Material License

Items 5 through 11

598- 600 eTl Engineering Company Safety Officer Maintained all company safety training record updated and maintained employee safety training maintained and issued PPE to employee and instructed employee in the proper use of PPE conducted accident investigations conducted vehicle safety inspections maintained OSHA records maintained Material Safety Data Sheets conducted safety inspections monitored lab safety and nuclear safety as company Nuclear Regulator Officer conducted confine space air monitoring

997- 498 American Environmental Safety Officer Industrial Hygienist Performed on-site safety and environmental inspections conducted fit test wrote and maintained respiratory protection program reviewed MSDS performed air quality tests monitored employee safety training and PPE maintained OSHA rE~cords

495- 997 elaVSlovich Environmental Environmental Specialists Conducted on-site Environmental and safety inspection on projects maintain daily logs coordinated with clients on safety and environmental issues

893- 1295 Alcon Demo Project Manager Performed on-site project management services for contract customers conducted building inspection for safety and environmental hazards performed air monitoring during abatement analyzed airborne asbestos fiber phase contras microscopy following NIOSH 582-7400 method performed air monitoring of heavy metals both EPA and OSHA responsible for the site safety of the demolition of the World Bank building located in downtown Washington DC

392-893 Web Environmental Group Project Manager Managed field operation implemented lab safety program maintained MSDS responsible for project quality control performed client interface with general and sub contractors maintained companys PPE

891-392 I-Tem Environmental Inspector Performed as on-site project monitor performed client interface maintained daily logs wrote final reports conducted progress meetings

1190-1191 Analvtical Laboratory Environmental Inspector Performed on-site project monitoring and oversight for environmental and safety issues

1086-990 BeM Engineering Environmental Inspector Inspected buildings through-out the United States for environmental and safety issues Over 100000000 square feet inspected Performed construction surveillance in schools hospitals high-rise office building etc On-site project oversight coordinated activities of field crews maintained daily log and wrote final reports

1285-986 Tractor Jitco Environmental Inspector Crew leader on major asbestos building inspection project for the State of Maryland performed environmental survey on all state owned building Testified for the State of Maryland as to my findings

885-1285 National Food Processors Association Laboratory Technician Tested food samples nutritional value member of lab safety committee wrote SOP for chemical storage and handling

INDIGO ENGiNEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20036

P 2023559030 F 2023559031

i

indigo engineering

groupnc Application for Material License

Items 5 through 11 980-1285 Labeff Associates Municipal Wastewater Treatment Engineer Performed testing of heavy metal in wastewater operated an industrial wastewater treatment plant performed testing of waters at AWT plant Supervised the construction of an Industrial wastewater treatment plant testing lab

Item8 shyTraining for Individuals Working in or Frequenting Restricted Areas Training for individuals frequenting restricted areas will have successful completion of an authorized radiation safety training class in accordance with appendix D of NUREG 1556 Vol 1 Rev 1 dated November 2001

Item 9-Facilitits and Equipment Information is not rE~quired to be submitted at this time in response to this item Key issues are addressed under Radiation Safety Program-Public Dose and Radiation Safety Program-Operating and Emergency Procedures

Item 10 - Radiation Safety Program PERSONNEL MONITORING

bull Ensure all radioactive materials are used only by individuals who are authorized and that personal monitoring devices are worn at all times Badges will be exchanged at intervals not to exceed 3 months and be provided by an accredited NVLAP processor

bull Dose reports shall be reviewed by the RSO to determine compliance with regulatory exposure limits and to confirm that personnel exposures are ALARA

bull The monitoring report shall be posted and the RSO will maintain a copy on file

SEALED SOURCE LEAK TESTING

bull Leak tests will be performed at intervals not to exceed 6 months Leak test samples will be analyzed by an organization authorized by the NRC or agreement state to perform analysis

RADIATION DETECTION INSTRUMENTS We will possess a survey meter in the event of an incident involving the gauge It will be calibrated annually

MATERIAL RECEIPT AND ACCOUNTABILITY

bull Ensure that all terms and conditions of the license and applicable regulations are complied with bull Ensure radioactive materials are properly secured against unauthorized removal bull Ensure audits are of the program are performed annually and corrective action is taken bull Ensure licensed is maintained current and amendment and renewal requests are submitted in a timely

manner

bull Physical inventories of sealed sources will be conducted at intervals not to exceed 6 months

bull Records of receipt transfer and disposal of gauges will be maintained for at least 3 years

bull Annual audits will be performed and corrective action taken

PUBLIC DOSE

bull Ensure that gauges are used transported and stored in a manner that no member of the public receives more than 100 mrem in one year

bull Ensure that the dose in any unrestricted area does not exceed 2 mrem in anyone hour

OPERATING AND EMERGENCY PROCEDURES

bull Locate sources bull Seal off or cordon off a 15 foot radius around the gauge to prevent unauthorized entry bull If a vehicle is involved it must not be moved until the extent of contamination (if any) is determined

INDIGO ENGINEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20036 SUSTAINABLE DESIGN P 2023559030 F 2023559031

i

indigo engineering

groupnc Application for Material License

Items 5 through 11 980-1285 Labeff Associates Municipal Wastewater Treatment Engineer Performed testing of heavy metal in wastewater operated an industrial wastewater treatment plant performed testing of waters at AWT plant Supervised the construction of an Industrial wastewater treatment plant testing lab

Item8 - Training for Individuals Working in or Frequenting Restricted Areas Training for individuals frequenting restricted areas will have successful completion of an authorized radiation safety training class in accordance with appendix D of NUREG 1556 Vol 1 Rev 1 dated November 2001

Item 9-Facilitits and Equipment Information is not rE~quired to be submitted at this time in response to this item Key issues are addressed under Radiation Safety Program-Public Dose and Radiation Safety Program-Operating and Emergency Procedures

Item 10 - Radiation Safety Program PERSONNEL MONITORING

bull Ensure all radioactive materials are used only by individuals who are authorized and that personal monitoring devices are worn at all times Badges will be exchanged at intervals not to exceed 3 months and be provided by an accredited NVLAP processor

bull Dose reports shall be reviewed by the RSO to determine compliance with regulatory exposure limits and to confirm that personnel exposures are ALARA

bull The monitoring report shall be posted and the RSO will maintain a copy on file

SEALED SOURCE LEAK TESTING

bull Leak tests will be performed at intervals not to exceed 6 months Leak test samples will be analyzed by an organization authorized by the NRC or agreement state to perform analysis

RADIATION DETECTION INSTRUMENTS We will possess a survey meter in the event of an incident involving the gauge It will be calibrated annually

MATERIAL RECEIPT AND ACCOUNTABILITY

bull Ensure that all terms and conditions of the license and applicable regulations are complied with bull Ensure radioactive materials are properly secured against unauthorized removal bull Ensure audits are of the program are performed annually and corrective action is taken bull Ensure licensed is maintained current and amendment and renewal requests are submitted in a timely

manner

bull Physical inventories of sealed sources will be conducted at intervals not to exceed 6 months

bull Records of receipt transfer and disposal of gauges will be maintained for at least 3 years

bull Annual audits will be performed and corrective action taken

PUBLIC DOSE

bull Ensure that gauges are used transported and stored in a manner that no member of the public receives more than 100 mrem in one year

bull Ensure that the dose in any unrestricted area does not exceed 2 mrem in anyone hour

OPERATING AND EMERGENCY PROCEDURES

bull Locate sources bull Seal off or cordon off a 15 foot radius around the gauge to prevent unauthorized entry bull If a vehicle is involved it must not be moved until the extent of contamination (if any) is determined

INDIGO ENGINEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20036

P 2023559030 F 2023559031

iyshy

indIgo engineering

groupllc Application for Material License

Items 5 through 11 bull Visually inspect the gauge to determine whether the any damage to the source shielding or housing has

been sustained bull As soon as possible notify the RSO Describe the present conditions and follow the instructions of the

RSO

The RSO will take the following action upon notification of an incident An incident is defined as 1 Lost stolen or missing sources 2 Events that cause or threaten exposures to individuals in excess of regulatory limits 3 Leaking or contaminated sealed sources

Arrange for a radiation survey to be conducted as soon as possible by a knowledgeable person using the appropriate radiation detection equipment to assess the integrity of the source encapsulation and shielding and determine the extent of contamination if any of personnel equipment and facilities or areas Notify regulatory authorities as required If initial notification was made by phone a written report must be submitted within 30 days

MAINTENANCE Maintenance shall be conducted by the manufacturer or other persons specifically licensed by the US Nuclear Regulatory Commission or an Agreement State to perform such services

TRANSPORTATION Transportation of radioactive material will be in accordance with all applicable Department of Transportation i requirements HAZMAT training will be accomplished at intervals not to exceed 3 years for ground transportation

and 2 year intervals if shipping by air

Item ll-Waste Management No radioactive waste per se is generated by the operations conducted under this license

INDIGO ENGINEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20()36 SUSTAINABLE DESIGN P 2023559030 F 2023559031

iy-

indIgo engineering

groupllc Application for Material License

Items 5 through 11 bull Visually inspect the gauge to determine whether the any damage to the source shielding or housing has

been sustained bull As soon as possible notify the RSO Describe the present conditions and follow the instructions of the

RSO

The RSO will take the following action upon notification of an incident An incident is defined as 1 Lost stolen or missing sources 2 Events that cause or threaten exposures to individuals in excess of regulatory limits 3 Leaking or contaminated sealed sources

Arrange for a radiation survey to be conducted as soon as possible by a knowledgeable person using the appropriate radiation detection equipment to assess the integrity of the source encapsulation and shielding and determine the extent of contamination if any of personnel equipment and facilities or areas Notify regulatory authorities as required If initial notification was made by phone a written report must be submitted within 30 days

MAINTENANCE Maintenance shall be conducted by the manufacturer or other persons specifically licensed by the US Nuclear Regulatory Commission or an Agreement State to perform such services

TRANSPORTATION Transportation of radioactive material will be in accordance with all applicable Department of Transportation i requirements HAZMAT training will be accomplished at intervals not to exceed 3 years for ground transportation

and 2 year intervals if shipping by air

Item ll-Waste Management No radioactive waste per se is generated by the operations conducted under this license

INDIGO ENGINEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20()36

P 2023559030 F 2023559031

January 28 2010

Robert Johnson

Has successfully completed training in accordance with policies set forth by the following rules and regulations goveming portable nuclear moisturedensity gauges and transportation requirements NUREG 1556 and 49CFR subpart H and lATA 152

A closed book examination was administered and a passing score was achieved The person listed above has demonstrated a thorough understanding of all aspects needed for transportation with specific emphasis placed on portable nuclear density gauges This certificate is only valid if signed by a Radiation Safety Officer verifying that further hands on training will be conducted under direct supervision of an authorized user prior operating the gauge alone Subjects included in this course include Radiological safetyprinciples practices of radiation protection leak-testing procedures measurement of radioactivity biological effect of radiation incident labeling markin9 storage ALARA shipping packaging shipping documents emergency procedures and security awareness Record keeping in accordance with 49 CFR 172704(d) North East Technical~ 4 AQcdmmiddotlntQr MrI 211 r7 ( ~ ~ GW

January 28 2010

Robert Johnson

Has successfully completed training in accordance with policies set forth by the following rules and regulations goveming portable nuclear moisturedensity gauges and transportation requirements NUREG 1556 and 49CFR subpart H and lATA 152

A closed book examination was administered and a passing score was achieved The person listed above has demonstrated a thorough understanding of all aspects needed for transportation with specific emphasis placed on portable nuclear density gauges This certificate is only valid if signed by a Radiation Safety Officer verifying that further hands on training will be conducted under direct supervision of an authorized user prior operating the gauge alone Subjects included in this course include Radiological safetyprinciples practices of radiation protection leak-testing procedures measurement of radioactivity biological effect of radiation incident labeling rna I storage ALARA shipping packaging shipping documents emergency procedures and security awareness Record keeping in accordance with 49 CFR 172704(d) North East Technical~

4 Westminster MD 21157 ~~-t-lt-~

APNGA Certificate of Completion

This confirms that

_ ____ R (2bert J0 blQQ1_QtI9)11112D ny n[1 nlQJ_______

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

~

APNGA Certificate of Completion

This confirms that

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Rohlrl Johnson-_ ---~-~--bull shy

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Lo JtJO~ijJIilQQyj~ tJJeJ1-f-lr ~J10~~ ompany me Company RSO I Official (print)

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

Company RSO I Official (print)

i

indigo engineering

groupnc Application for Material License

Items 5 through 11 980-1285 Labeff Associates Municipal Wastewater Treatment Engineer Performed testing of heavy metal in wastewater operated an industrial wastewater treatment plant performed testing of waters at AWT plant Supervised the construction of an Industrial wastewater treatment plant testing lab

Item8 shyTraining for Individuals Working in or Frequenting Restricted Areas Training for individuals frequenting restricted areas will have successful completion of an authorized radiation safety training class in accordance with appendix D of NUREG 1556 Vol 1 Rev 1 dated November 2001

Item 9-Facilitits and Equipment Information is not rE~quired to be submitted at this time in response to this item Key issues are addressed under Radiation Safety Program-Public Dose and Radiation Safety Program-Operating and Emergency Procedures

Item 10 - Radiation Safety Program PERSONNEL MONITORING

bull Ensure all radioactive materials are used only by individuals who are authorized and that personal monitoring devices are worn at all times Badges will be exchanged at intervals not to exceed 3 months and be provided by an accredited NVLAP processor

bull Dose reports shall be reviewed by the RSO to determine compliance with regulatory exposure limits and to confirm that personnel exposures are ALARA

bull The monitoring report shall be posted and the RSO will maintain a copy on file

SEALED SOURCE LEAK TESTING

bull Leak tests will be performed at intervals not to exceed 6 months Leak test samples will be analyzed by an organization authorized by the NRC or agreement state to perform analysis

RADIATION DETECTION INSTRUMENTS We will possess a survey meter in the event of an incident involving the gauge It will be calibrated annually

MATERIAL RECEIPT AND ACCOUNTABILITY

bull Ensure that all terms and conditions of the license and applicable regulations are complied with bull Ensure radioactive materials are properly secured against unauthorized removal bull Ensure audits are of the program are performed annually and corrective action is taken bull Ensure licensed is maintained current and amendment and renewal requests are submitted in a timely

manner

bull Physical inventories of sealed sources will be conducted at intervals not to exceed 6 months

bull Records of receipt transfer and disposal of gauges will be maintained for at least 3 years

bull Annual audits will be performed and corrective action taken

PUBLIC DOSE

bull Ensure that gauges are used transported and stored in a manner that no member of the public receives more than 100 mrem in one year

bull Ensure that the dose in any unrestricted area does not exceed 2 mrem in anyone hour

OPERATING AND EMERGENCY PROCEDURES

bull Locate sources bull Seal off or cordon off a 15 foot radius around the gauge to prevent unauthorized entry bull If a vehicle is involved it must not be moved until the extent of contamination (if any) is determined

INDIGO ENGINEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20036 SUSTAINABLE DESIGN P 2023559030 F 2023559031

i

indigo engineering

groupnc Application for Material License

Items 5 through 11 980-1285 Labeff Associates Municipal Wastewater Treatment Engineer Performed testing of heavy metal in wastewater operated an industrial wastewater treatment plant performed testing of waters at AWT plant Supervised the construction of an Industrial wastewater treatment plant testing lab

Item8 - Training for Individuals Working in or Frequenting Restricted Areas Training for individuals frequenting restricted areas will have successful completion of an authorized radiation safety training class in accordance with appendix D of NUREG 1556 Vol 1 Rev 1 dated November 2001

Item 9-Facilitits and Equipment Information is not rE~quired to be submitted at this time in response to this item Key issues are addressed under Radiation Safety Program-Public Dose and Radiation Safety Program-Operating and Emergency Procedures

Item 10 - Radiation Safety Program PERSONNEL MONITORING

bull Ensure all radioactive materials are used only by individuals who are authorized and that personal monitoring devices are worn at all times Badges will be exchanged at intervals not to exceed 3 months and be provided by an accredited NVLAP processor

bull Dose reports shall be reviewed by the RSO to determine compliance with regulatory exposure limits and to confirm that personnel exposures are ALARA

bull The monitoring report shall be posted and the RSO will maintain a copy on file

SEALED SOURCE LEAK TESTING

bull Leak tests will be performed at intervals not to exceed 6 months Leak test samples will be analyzed by an organization authorized by the NRC or agreement state to perform analysis

RADIATION DETECTION INSTRUMENTS We will possess a survey meter in the event of an incident involving the gauge It will be calibrated annually

MATERIAL RECEIPT AND ACCOUNTABILITY

bull Ensure that all terms and conditions of the license and applicable regulations are complied with bull Ensure radioactive materials are properly secured against unauthorized removal bull Ensure audits are of the program are performed annually and corrective action is taken bull Ensure licensed is maintained current and amendment and renewal requests are submitted in a timely

manner

bull Physical inventories of sealed sources will be conducted at intervals not to exceed 6 months

bull Records of receipt transfer and disposal of gauges will be maintained for at least 3 years

bull Annual audits will be performed and corrective action taken

PUBLIC DOSE

bull Ensure that gauges are used transported and stored in a manner that no member of the public receives more than 100 mrem in one year

bull Ensure that the dose in any unrestricted area does not exceed 2 mrem in anyone hour

OPERATING AND EMERGENCY PROCEDURES

bull Locate sources bull Seal off or cordon off a 15 foot radius around the gauge to prevent unauthorized entry bull If a vehicle is involved it must not be moved until the extent of contamination (if any) is determined

INDIGO ENGINEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20036

P 2023559030 F 2023559031

iyshy

indIgo engineering

groupllc Application for Material License

Items 5 through 11 bull Visually inspect the gauge to determine whether the any damage to the source shielding or housing has

been sustained bull As soon as possible notify the RSO Describe the present conditions and follow the instructions of the

RSO

The RSO will take the following action upon notification of an incident An incident is defined as 1 Lost stolen or missing sources 2 Events that cause or threaten exposures to individuals in excess of regulatory limits 3 Leaking or contaminated sealed sources

Arrange for a radiation survey to be conducted as soon as possible by a knowledgeable person using the appropriate radiation detection equipment to assess the integrity of the source encapsulation and shielding and determine the extent of contamination if any of personnel equipment and facilities or areas Notify regulatory authorities as required If initial notification was made by phone a written report must be submitted within 30 days

MAINTENANCE Maintenance shall be conducted by the manufacturer or other persons specifically licensed by the US Nuclear Regulatory Commission or an Agreement State to perform such services

TRANSPORTATION Transportation of radioactive material will be in accordance with all applicable Department of Transportation i requirements HAZMAT training will be accomplished at intervals not to exceed 3 years for ground transportation

and 2 year intervals if shipping by air

Item ll-Waste Management No radioactive waste per se is generated by the operations conducted under this license

INDIGO ENGINEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20()36 SUSTAINABLE DESIGN P 2023559030 F 2023559031

iy-

indIgo engineering

groupllc Application for Material License

Items 5 through 11 bull Visually inspect the gauge to determine whether the any damage to the source shielding or housing has

been sustained bull As soon as possible notify the RSO Describe the present conditions and follow the instructions of the

RSO

The RSO will take the following action upon notification of an incident An incident is defined as 1 Lost stolen or missing sources 2 Events that cause or threaten exposures to individuals in excess of regulatory limits 3 Leaking or contaminated sealed sources

Arrange for a radiation survey to be conducted as soon as possible by a knowledgeable person using the appropriate radiation detection equipment to assess the integrity of the source encapsulation and shielding and determine the extent of contamination if any of personnel equipment and facilities or areas Notify regulatory authorities as required If initial notification was made by phone a written report must be submitted within 30 days

MAINTENANCE Maintenance shall be conducted by the manufacturer or other persons specifically licensed by the US Nuclear Regulatory Commission or an Agreement State to perform such services

TRANSPORTATION Transportation of radioactive material will be in accordance with all applicable Department of Transportation i requirements HAZMAT training will be accomplished at intervals not to exceed 3 years for ground transportation

and 2 year intervals if shipping by air

Item ll-Waste Management No radioactive waste per se is generated by the operations conducted under this license

INDIGO ENGINEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20()36

P 2023559030 F 2023559031

January 28 2010

Robert Johnson

Has successfully completed training in accordance with policies set forth by the following rules and regulations goveming portable nuclear moisturedensity gauges and transportation requirements NUREG 1556 and 49CFR subpart H and lATA 152

A closed book examination was administered and a passing score was achieved The person listed above has demonstrated a thorough understanding of all aspects needed for transportation with specific emphasis placed on portable nuclear density gauges This certificate is only valid if signed by a Radiation Safety Officer verifying that further hands on training will be conducted under direct supervision of an authorized user prior operating the gauge alone Subjects included in this course include Radiological safetyprinciples practices of radiation protection leak-testing procedures measurement of radioactivity biological effect of radiation incident labeling markin9 storage ALARA shipping packaging shipping documents emergency procedures and security awareness Record keeping in accordance with 49 CFR 172704(d) North East Technical~ 4 AQcdmmiddotlntQr MrI 211 r7 ( ~ ~ GW

January 28 2010

Robert Johnson

Has successfully completed training in accordance with policies set forth by the following rules and regulations goveming portable nuclear moisturedensity gauges and transportation requirements NUREG 1556 and 49CFR subpart H and lATA 152

A closed book examination was administered and a passing score was achieved The person listed above has demonstrated a thorough understanding of all aspects needed for transportation with specific emphasis placed on portable nuclear density gauges This certificate is only valid if signed by a Radiation Safety Officer verifying that further hands on training will be conducted under direct supervision of an authorized user prior operating the gauge alone Subjects included in this course include Radiological safetyprinciples practices of radiation protection leak-testing procedures measurement of radioactivity biological effect of radiation incident labeling rna I storage ALARA shipping packaging shipping documents emergency procedures and security awareness Record keeping in accordance with 49 CFR 172704(d) North East Technical~

4 Westminster MD 21157 ~~-t-lt-~

APNGA Certificate of Completion

This confirms that

_ ____ R (2bert J0 blQQ1_QtI9)11112D ny n[1 nlQJ_______

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

~

APNGA Certificate of Completion

This confirms that

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Rohlrl Johnson-_ ---~-~--bull shy

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Lo JtJO~ijJIilQQyj~ tJJeJ1-f-lr ~J10~~ ompany me Company RSO I Official (print)

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

Company RSO I Official (print)

iyshy

indIgo engineering

groupllc Application for Material License

Items 5 through 11 bull Visually inspect the gauge to determine whether the any damage to the source shielding or housing has

been sustained bull As soon as possible notify the RSO Describe the present conditions and follow the instructions of the

RSO

The RSO will take the following action upon notification of an incident An incident is defined as 1 Lost stolen or missing sources 2 Events that cause or threaten exposures to individuals in excess of regulatory limits 3 Leaking or contaminated sealed sources

Arrange for a radiation survey to be conducted as soon as possible by a knowledgeable person using the appropriate radiation detection equipment to assess the integrity of the source encapsulation and shielding and determine the extent of contamination if any of personnel equipment and facilities or areas Notify regulatory authorities as required If initial notification was made by phone a written report must be submitted within 30 days

MAINTENANCE Maintenance shall be conducted by the manufacturer or other persons specifically licensed by the US Nuclear Regulatory Commission or an Agreement State to perform such services

TRANSPORTATION Transportation of radioactive material will be in accordance with all applicable Department of Transportation i requirements HAZMAT training will be accomplished at intervals not to exceed 3 years for ground transportation

and 2 year intervals if shipping by air

Item ll-Waste Management No radioactive waste per se is generated by the operations conducted under this license

INDIGO ENGINEERING GROUP LLC 1730 M St NW SUITE 1030 DEDICATED TO GREEN amp WASHINGTON DC 20()36 SUSTAINABLE DESIGN P 2023559030 F 2023559031

iy-

indIgo engineering

groupllc Application for Material License

Items 5 through 11 bull Visually inspect the gauge to determine whether the any damage to the source shielding or housing has

been sustained bull As soon as possible notify the RSO Describe the present conditions and follow the instructions of the

RSO

The RSO will take the following action upon notification of an incident An incident is defined as 1 Lost stolen or missing sources 2 Events that cause or threaten exposures to individuals in excess of regulatory limits 3 Leaking or contaminated sealed sources

Arrange for a radiation survey to be conducted as soon as possible by a knowledgeable person using the appropriate radiation detection equipment to assess the integrity of the source encapsulation and shielding and determine the extent of contamination if any of personnel equipment and facilities or areas Notify regulatory authorities as required If initial notification was made by phone a written report must be submitted within 30 days

MAINTENANCE Maintenance shall be conducted by the manufacturer or other persons specifically licensed by the US Nuclear Regulatory Commission or an Agreement State to perform such services

TRANSPORTATION Transportation of radioactive material will be in accordance with all applicable Department of Transportation i requirements HAZMAT training will be accomplished at intervals not to exceed 3 years for ground transportation

and 2 year intervals if shipping by air

Item ll-Waste Management No radioactive waste per se is generated by the operations conducted under this license

INDIGO ENGINEERING GROUP LLC DEDICATED TO GREEN amp SUSTAINABLE DESIGN

1730 M St NW SUITE 1030 WASHINGTON DC 20()36

P 2023559030 F 2023559031

January 28 2010

Robert Johnson

Has successfully completed training in accordance with policies set forth by the following rules and regulations goveming portable nuclear moisturedensity gauges and transportation requirements NUREG 1556 and 49CFR subpart H and lATA 152

A closed book examination was administered and a passing score was achieved The person listed above has demonstrated a thorough understanding of all aspects needed for transportation with specific emphasis placed on portable nuclear density gauges This certificate is only valid if signed by a Radiation Safety Officer verifying that further hands on training will be conducted under direct supervision of an authorized user prior operating the gauge alone Subjects included in this course include Radiological safetyprinciples practices of radiation protection leak-testing procedures measurement of radioactivity biological effect of radiation incident labeling markin9 storage ALARA shipping packaging shipping documents emergency procedures and security awareness Record keeping in accordance with 49 CFR 172704(d) North East Technical~ 4 AQcdmmiddotlntQr MrI 211 r7 ( ~ ~ GW

January 28 2010

Robert Johnson

Has successfully completed training in accordance with policies set forth by the following rules and regulations goveming portable nuclear moisturedensity gauges and transportation requirements NUREG 1556 and 49CFR subpart H and lATA 152

A closed book examination was administered and a passing score was achieved The person listed above has demonstrated a thorough understanding of all aspects needed for transportation with specific emphasis placed on portable nuclear density gauges This certificate is only valid if signed by a Radiation Safety Officer verifying that further hands on training will be conducted under direct supervision of an authorized user prior operating the gauge alone Subjects included in this course include Radiological safetyprinciples practices of radiation protection leak-testing procedures measurement of radioactivity biological effect of radiation incident labeling rna I storage ALARA shipping packaging shipping documents emergency procedures and security awareness Record keeping in accordance with 49 CFR 172704(d) North East Technical~

4 Westminster MD 21157 ~~-t-lt-~

APNGA Certificate of Completion

This confirms that

_ ____ R (2bert J0 blQQ1_QtI9)11112D ny n[1 nlQJ_______

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

~

APNGA Certificate of Completion

This confirms that

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Rohlrl Johnson-_ ---~-~--bull shy

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Lo JtJO~ijJIilQQyj~ tJJeJ1-f-lr ~J10~~ ompany me Company RSO I Official (print)

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

Company RSO I Official (print)

January 28 2010

Robert Johnson

Has successfully completed training in accordance with policies set forth by the following rules and regulations goveming portable nuclear moisturedensity gauges and transportation requirements NUREG 1556 and 49CFR subpart H and lATA 152

A closed book examination was administered and a passing score was achieved The person listed above has demonstrated a thorough understanding of all aspects needed for transportation with specific emphasis placed on portable nuclear density gauges This certificate is only valid if signed by a Radiation Safety Officer verifying that further hands on training will be conducted under direct supervision of an authorized user prior operating the gauge alone Subjects included in this course include Radiological safetyprinciples practices of radiation protection leak-testing procedures measurement of radioactivity biological effect of radiation incident labeling markin9 storage ALARA shipping packaging shipping documents emergency procedures and security awareness Record keeping in accordance with 49 CFR 172704(d) North East Technical~ 4 AQcdmmiddotlntQr MrI 211 r7 ( ~ ~ GW

January 28 2010

Robert Johnson

Has successfully completed training in accordance with policies set forth by the following rules and regulations goveming portable nuclear moisturedensity gauges and transportation requirements NUREG 1556 and 49CFR subpart H and lATA 152

A closed book examination was administered and a passing score was achieved The person listed above has demonstrated a thorough understanding of all aspects needed for transportation with specific emphasis placed on portable nuclear density gauges This certificate is only valid if signed by a Radiation Safety Officer verifying that further hands on training will be conducted under direct supervision of an authorized user prior operating the gauge alone Subjects included in this course include Radiological safetyprinciples practices of radiation protection leak-testing procedures measurement of radioactivity biological effect of radiation incident labeling rna I storage ALARA shipping packaging shipping documents emergency procedures and security awareness Record keeping in accordance with 49 CFR 172704(d) North East Technical~

4 Westminster MD 21157 ~~-t-lt-~

APNGA Certificate of Completion

This confirms that

_ ____ R (2bert J0 blQQ1_QtI9)11112D ny n[1 nlQJ_______

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

~

APNGA Certificate of Completion

This confirms that

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Rohlrl Johnson-_ ---~-~--bull shy

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Lo JtJO~ijJIilQQyj~ tJJeJ1-f-lr ~J10~~ ompany me Company RSO I Official (print)

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

Company RSO I Official (print)

APNGA Certificate of Completion

This confirms that

_ ____ R (2bert J0 blQQ1_QtI9)11112D ny n[1 nlQJ_______

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

~

APNGA Certificate of Completion

This confirms that

has successfully completed the license required company

Ann I Audit

on this day

Saturday Febmary 20 2010

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Rohlrl Johnson-_ ---~-~--bull shy

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Lo JtJO~ijJIilQQyj~ tJJeJ1-f-lr ~J10~~ ompany me Company RSO I Official (print)

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

Company RSO I Official (print)

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Rohlrl Johnson-_ ---~-~--bull shy

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Lo JtJO~ijJIilQQyj~ tJJeJ1-f-lr ~J10~~ ompany me Company RSO I Official (print)

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

middotAPNGA HAZMAT Refresher Training for Portable Nuclear Gauges

Certificate of Completion to

Training must be renewed within three years from todays date

Saturday February 202010 This course satisfies the training requirments of 49 CFR 172 Subpart H Including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training - lATA Requirements

The organization RSOOfficial must certify that the employee has been properly trained and tested per the requirements of 49 CFR 172 Subpart H The acknowledgment and signature

of the RSOOfficial makes the training and certificate relevant and valid

Amena Portab~ Nuclear G~uge 4ssociation (APNG~ wWIraquoapngacom

Company RSO I Official (print)

Annual Refresher Training for Portable Nuclear Gauges Certificate of Completion to

Robert Johnson

Friday February 26 2010

This course covers aspects of NUREG 1556 The Agreement States and 49 CFR 172 Subpart H including

- General AwarenessFamiliarization bull Security Awareness

- Function Specific Training bull Driver Training

- Safety Training

The organization RSOOfficial should also re-familiarize the employee with the state specific regulations and the

company radiation safety program specifically gauge safety operating and emergency response procedures

The acknowledgment and signature of the RSOOfficial makes the training and certificate relevant and valid

710J~ E~l000(J lobJ-i Jdh~ mpany Na Company RSO I OffIcIal (Print)

Pmerioan Portabie Nuoiear Gauge Assoolation (AP NGA www apnga oom

----- - --- -- _-

Annual Refresher Training for Portable Nuclear Gauges Certificate of Completion to

Robert Johnson

Friday February 26 2010

This course covers aspects of NUREG 1556 The Agreement States and 49 CFR 172 Subpart H including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training

- Safety Training

The organization RSOOfficial should also re-familiarize the employee with the state specific regulations and the

company radiation safety program specifically gauge safety operating and emergency response procedures

The acknowledgment and signature of the RSOOfficial makes the training and certificate relevant and valid

710J~ E ~l000(J lobJ-i Jdh~ mpany Na Company RSO I OffIcIal (Print)

Pmerioan Portabie Nuoiear Gauge Assoolation (AP N GA www apnga oom

Annual Refresher Training for Portable NuclearG~auges

Certificate of Completion to

Robert Johnson Friday February 26 2010

This course covers aspects ofNUREG 1556 The Agreement States and 49 CFR 172 Subpart H including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training

The organization RSOOfficial should also re-familiarize the employee with the state specific regulations and the company radiation safety program specifically gauge safety operating and emergency response procedures The acknowledgment and signature of the RSOjOfficial makes the training and certificate relevant and valid

T~1312EiVJ iIUIltQYIj RobQ~middott 4 j6~~h-Company Name Company RSO I Official (print)

Anerican Portable Nuclear Gauge Association CAP NGA) WIIJ Wapnga com

Annual Refresher Training for Portable NuclearG~auges Certificate of Completion to

Robert Johnson Friday February 26 2010

This course covers aspects ofNUREG 1556 The Agreement States and 49 CFR 172 Subpart H including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training

- Safety Training

The organization RSOOfficial should also re-familiarize the employee with the state specific regulations and the company radiation safety program specifically gauge safety operating and emergency response procedures The acknowledgment and signature of the RSOjOfficial makes the training and certificate re and valid

Anerican Portable Nuclear Gauge Association CAP N GA) WIIJ W apnga com

RobQ~middott 4 j6~~h-Company RSO I Official (print)

APNGA Certificate of Achievement

This confirms that

Robert Johnson

has successfully completed the APNGA Portable Nuclear Gauge

Radiation Safety Officer Class

on this day

Friday February 262010

merican Portabl Nucle- Gauge 4ssociation (APHOA) wwwapngacom

APNGA Certificate of Achievement

This confirms that

Robert Johnson

has successfully completed the APNGA Portable Nuclear Gauge

Radiation Safety Officer Class

on this day

Friday February 262010

merican Portabl Nucle- Gauge 4ssociation (APHOA) wwwapngacom

Annual Refresher Training for Portable NuclearG~auges

Certificate of Completion to

Robert Johnson Friday February 26 2010

This course covers aspects ofNUREG 1556 The Agreement States and 49 CFR 172 Subpart H including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training - Safety Training

The organization RSOOfficial should also re-familiarize the employee with the state specific regulations and the company radiation safety program specifically gauge safety operating and emergency response procedures The acknowledgment and signature of the RSOjOfficial makes the training and certificate relevant and valid

T~1312EiVJ iIUIltQYIj RobQ~middott 4 j6~~h-Company Name Company RSO I Official (print)

Anerican Portable Nuclear Gauge Association CAP NGA) WIIJ Wapnga com

Annual Refresher Training for Portable NuclearG~auges Certificate of Completion to

Robert Johnson Friday February 26 2010

This course covers aspects ofNUREG 1556 The Agreement States and 49 CFR 172 Subpart H including

- General AwarenessFamiliarization - Security Awareness - Function Specific Training - Driver Training

- Safety Training

The organization RSOOfficial should also re-familiarize the employee with the state specific regulations and the company radiation safety program specifically gauge safety operating and emergency response procedures The acknowledgment and signature of the RSOjOfficial makes the training and certificate re and valid

Anerican Portable Nuclear Gauge Association CAP N GA) WIIJ W apnga com

RobQ~middott 4 j6~~h-Company RSO I Official (print)

APNGA Certificate of Achievement

This confirms that

Robert Johnson

has successfully completed the APNGA Portable Nuclear Gauge

Radiation Safety Officer Class

on this day

Friday February 262010

merican Portabl Nucle- Gauge 4ssociation (APHOA) wwwapngacom

APNGA Certificate of Achievement

This confirms that

Robert Johnson

has successfully completed the APNGA Portable Nuclear Gauge

Radiation Safety Officer Class

on this day

Friday February 262010

merican Portabl Nucle- Gauge 4ssociation (APHOA) wwwapngacom

APNGA Certificate of Achievement

This confirms that

Robert Johnson

has successfully completed the APNGA Portable Nuclear Gauge

Radiation Safety Officer Class

on this day

Friday February 262010

merican Portabl Nucle- Gauge 4ssociation (APHOA) wwwapngacom

APNGA Certificate of Achievement

This confirms that

Robert Johnson

has successfully completed the APNGA Portable Nuclear Gauge

Radiation Safety Officer Class

on this day

Friday February 262010

merican Portabl Nucle- Gauge 4ssociation (APHOA) wwwapngacom

APNGA 8 Hour Nuclear Gauge Safety Certification

Certificate of Completion to Robert Johnson (Certificate Number 784)

Hazmat refresher training is required within 3 years from todays date Sunday February 28 2010

Covers criteria of the NRC Agreement States and 49 CFR 172 Subpart H (Includes lATA Requirements) The Company RSO completes the training requirements by familiarizing the employee with

- State specific regulations including introduction to the state regulatory website - The company radiation safety program specifically gauge safety operating and emergency procedures - A tour of storage area with emphasis on security documents and po stings - Loading security and transporting gauges in company vehicles - The safety and operating features of the gauge(s) in use by the company - Introduction to gauge safety content on gauge manufacturer website - The RSO must also monitor the employee completing and passing a closed book test of this class material

The RSO signature confirms that the trainee has received the above requirements

IJUJI(JObJUJI0eQ)jj 4ftflf~((~~ I~ C Ipany Na me bull Signature of RSO

tmencan Portable Nuclear Gauge Associrtion (APHGA) George E Marshall U~J IJJ apnga com AP HGA Diretor

APNGA 8 Hour Nuclear Gauge Safety Certification

Certificate of Completion to Robert Johnson (Certificate Number 784)

Hazmat refresher training is required within 3 years from todays date Sunday February 28 2010

Covers criteria of the NRC Agreement States and 49 CFR 172 Subpart H (Includes lATA Requirements) The Company RSO completes the training requirements by familiarizing the employee with

- State specific regulations including introduction to the state regulatory website - The company radiation safety program specifically gauge safety operating and emergency procedures - A tour of storage area with emphasis on security documents and po stings - Loading security and transporting gauges in company vehicles - The safety and operating features of the gauge(s) in use by the company - Introduction to gauge safety content on gauge manufacturer website - The RSO must also monitor the employee completing and passing a closed book test of this class material

The RSO signature confirms that the trainee has received the above requirements

tmencan Portable Nuclear Gauge Associrtion (APHGA) U~J IJJ apnga com

George E Marshall AP H GA Diretor

Robert Johnson

CPR Course Chesapeake Region Safety Council

iliiApril232009

April 23 2011

Robert Johnson

Standard

Chesapeake Region Safety Council

i April 23 2009

April 23 20 II

Robert Johnson

CPR Course Chesapeake Region Safety Council

iliiApril232009

April 23 2011

Robert Johnson

Standard

Chesapeake Region Safety Council

i April 23 2009

April 23 20 II

This is to acknowledge the receipt of your letterapplication dated

__1_~_~_-z_1tgt=---- ____ and to inform you that the initial processing which includes an administrative review has been performed

IJ tk LC6MJJ lampRt~P ( Otgt ~z-5o )~] There were no admimstrative omissions Your application was assigned to a

technical reviewer Please note that the technical review may identify additional omissions or require additional information

o Please provide to this office within 30 days of your receipt of this card

A copy of your action has been forwarded to our License Fee amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved

Your action has been assigned Mail Control Number I ~) When calling to inquire about this action please refer to this control number You may call us on (610) 337-5398 or 337-5260

NRC FORM 532 (RI) Sincerely (eurol96) Licensing Assistance Team Leader

This is to acknowledge the receipt of your letterapplication dated

__ 1_~_~_-z_1tgt=---- ____ and to inform you that the initial processing which includes an administrative review has been performed

IJ tk L C6M JJ lampRt~P ( Otgt ~ z-5o ) ~] There were no admimstrative omissions Your application was assigned to a

technical reviewer Please note that the technical review may identify additional omissions or require additional information

o Please provide to this office within 30 days of your receipt of this card

A copy of your action has been forwarded to our License Fee amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved

Your action has been assigned Mail Control Number I ~) When calling to inquire about this action please refer to this control number You may call us on (610) 337-5398 or 337-5260

NRC FORM 532 (RI)

(eurol96)

Sincerely Licensing Assistance Team Leader

Robert Johnson

CPR Course Chesapeake Region Safety Council

iliiApril232009

April 23 2011

Robert Johnson

Standard

Chesapeake Region Safety Council

i April 23 2009

April 23 20 II

Robert Johnson

CPR Course Chesapeake Region Safety Council

iliiApril232009

April 23 2011

Robert Johnson

Standard

Chesapeake Region Safety Council

i April 23 2009

April 23 20 II

This is to acknowledge the receipt of your letterapplication dated

__1_~_~_-z_1tgt=---- ____ and to inform you that the initial processing which includes an administrative review has been performed

IJ tk LC6MJJ lampRt~P ( Otgt ~z-5o )~] There were no admimstrative omissions Your application was assigned to a

technical reviewer Please note that the technical review may identify additional omissions or require additional information

o Please provide to this office within 30 days of your receipt of this card

A copy of your action has been forwarded to our License Fee amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved

Your action has been assigned Mail Control Number I ~) When calling to inquire about this action please refer to this control number You may call us on (610) 337-5398 or 337-5260

NRC FORM 532 (RI) Sincerely (eurol96) Licensing Assistance Team Leader

This is to acknowledge the receipt of your letterapplication dated

__ 1_~_~_-z_1tgt=---- ____ and to inform you that the initial processing which includes an administrative review has been performed

IJ tk L C6M JJ lampRt~P ( Otgt ~ z-5o ) ~] There were no admimstrative omissions Your application was assigned to a

technical reviewer Please note that the technical review may identify additional omissions or require additional information

o Please provide to this office within 30 days of your receipt of this card

A copy of your action has been forwarded to our License Fee amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved

Your action has been assigned Mail Control Number I ~) When calling to inquire about this action please refer to this control number You may call us on (610) 337-5398 or 337-5260

NRC FORM 532 (RI)

(eurol96)

Sincerely Licensing Assistance Team Leader

This is to acknowledge the receipt of your letterapplication dated

__1_~_~_-z_1tgt=---- ____ and to inform you that the initial processing which includes an administrative review has been performed

IJ tk LC6MJJ lampRt~P ( Otgt ~z-5o )~] There were no admimstrative omissions Your application was assigned to a

technical reviewer Please note that the technical review may identify additional omissions or require additional information

o Please provide to this office within 30 days of your receipt of this card

A copy of your action has been forwarded to our License Fee amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved

Your action has been assigned Mail Control Number I ~) When calling to inquire about this action please refer to this control number You may call us on (610) 337-5398 or 337-5260

NRC FORM 532 (RI) Sincerely (eurol96) Licensing Assistance Team Leader

This is to acknowledge the receipt of your letterapplication dated

__ 1_~_~_-z_1tgt=---- ____ and to inform you that the initial processing which includes an administrative review has been performed

IJ tk L C6M JJ lampRt~P ( Otgt ~ z-5o ) ~] There were no admimstrative omissions Your application was assigned to a

technical reviewer Please note that the technical review may identify additional omissions or require additional information

o Please provide to this office within 30 days of your receipt of this card

A copy of your action has been forwarded to our License Fee amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved

Your action has been assigned Mail Control Number I ~) When calling to inquire about this action please refer to this control number You may call us on (610) 337-5398 or 337-5260

NRC FORM 532 (RI)

(eurol96)

Sincerely Licensing Assistance Team Leader