MATERIAL TESTING SERVICES, INC.

September 27, 2013

Ms. Carol Hill US Nuclear Regulatory Commission 1600 E. Lamar Blvd. Arlington, TX 76011 -4511

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j U SEP 2 7 2013 ~ DNMS

Ref: AMENDMENT TO NRC LICENSE 33-27066-01

Ms. Hill:

This letter is in regards to amending our NRC license (33-27066-01). We are changing addresses for our Minot location and removing the Grand Forks locat ion. Attached is NRC form 3 13.

We realize NRC does not have jurisdiction in North Dakota but we wish to use material at temporary jobsitcs that have NRC jurisdiction as stated in our current license.

The fil es for inspection will be changed from #8 20th Avenue SE in Minot, ND to 3001 North Broadway, Minot, ND 58703.

All the other license items will remain the same.

Thank you,

Sincerely, MATERIAL TESTING SERVICES, INC.

// (j C)dV . ./0 Steven A. Wald, PE President

PO Box 634 Minot, NO 58702

701 -852-5553

NON-PUBUc: o A-3 11I11III •• a.curtly IWIIId o A.7 .... 1t1ve 1nI8mIII o Other: ____ _

RllRllvIVM_IM ... w:r:~ i;::.I1J~- 0-. __

PO Box 14516 Grand Forks, NO 58208

701-746-6398

PO Box 1093 Williston, NO 58802

701-572-4226

I ... J 8 2 2 1 1

U.S. NUCLEAR REGULATORY NO. 3150.0120 EXPIRES: 0513112015

I\~:~:';'.~i", 32, 33, per response 10 COfTllIy with this mandalory coUec\kJn request 4.3 hoofS. Submlnal 01 the 35,36.39 •• r\CI40 to tleterlrine lIlatlhe applICant Is qualll'lIld and that adequate procedures e~lsllo

."'" and safety. Send comments regartlJng burden esUmale to tile InfOnnal.kln ServICes

#aJ" ~<t...... 1:~:~1~U~.S~'r,N~""'~M~""'?;latory Commission, Waslllnglon, DC 20555-0001, Of by lfItemellHllai to f~~ APPLICATION FOR MATERIALS "" .... Desk W.", 0"", 0/ .Iom"'" "" .og"'"" An", to : r Managemerl\ end Budget, WashlnglDII, DC 20503. If a means used I \" '/ Lie ENSE 1'101 dISplay a currently valid OMB control number. the NRC may

. ..... required to respond to,lhII InklnnaUon collectIOn.

SEE THE FOR COMPLETING APPLICATION. OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW, ·AMENDMENTS/RENEWALS

THE SCOPE OF THE EXISTING LICENSE TO A NEW OR HIGHER FEE CATEGORY WILL REQUIRE A FEE,

APPUCATtON FOR DISTRlBUnON OF EXEMPT PRODUCTS FIL.E APPLICAnONS WITH:

OFFICE OF FEDERAl & STAlE MATERIALS ANO ENVIRONMENTAL MANAGEMENT PROGRAMS DMStON OF MATERIALS SAFElY AND STATE AGREEMENTS u.s. NUClEAR REGUlATORY COMMISSION WASHINGTON. DC 20555-0001

ALL OTHER PERSONS ALE APPUCAT!ONS AS FOLLOWS:

IF YOU AR! LOCATED IN:

I ~~~~~::~~~~~'~~'~~: MICHIGAN, MINNESOTA, MISSOURI, OHIO, OR WISCONSIN,

MATERIALS LICENSING BRANCH U.S. NUCLEAR REGUlATORY COMMISSION. REGION III 2443 WARREtMLLE ROAD, SUITE 210 LISLE. IL 80532 ... 352

ALABAMA, CONNECnCUT, D!LAWAR!, DISTRICT OF COLUMBIA, FLORIDA, G!ORGIA, 1~~~~~ii~*?C~~1~~.~~~i~~~~~?'~i~:':;K~A:'WAIi. IDAHO, KANSAS, KENTUCKY, MAINE, MAR't'lAND, MASSACHUSETTS, NfW HAMPSHIRE, NEW JERSEY, NEW MEXICO, NORTH NEW YORK, NORTH CAROUNA, PENNSYLVANIA, PUERTO RICO, RHODE ISLAND, SOUTH SOUTH DAKOTA, TEXAS, CAROL.INA, TENNESSEE, VERMONT, VIRGINIA, VIRGIN ISLANDS, OR WEST VIRGINIA,

SEND APPUCAlIOH5 TO:

lICENSING ASSISTANCE TEAM DMSION OFNUClEAA MATERIALS SAfETY U.S. NUCLEAR REGUlATORY COMMISSION. REGION I 2100 RENAISSANCE BOULEVARD, SUITE 100 KING OF PRUSSIA., PA 19406-2713

SEND APPLICATIONS TO:

NtJCl.EAR MATERIALS LICENSING BRANCH U.S. NUCLEAR REGUlATORY COMMISSION, REGION IV 1800 E. LAMAR BOULEVARD ARLINGTON, TX 76011~511

PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U,S. NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL IN STATES SUBJECT TO U,S.NUCLEAR REGULATORY COMMISSION JURISDICTIONS,

1. THIS IS AN APPLICATION FOR (ChICk approptfflfe Ilem)

o A. NEW UCENSE

[(] B. AMENDMENT TO LICENSE NUMBER

o C. RENEWAL OF UCENSE NUMBER

33-27066-01

3, ADDRESS WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED

1. 3001 N Broadway, Minot, ND 58701 2, 621A East Broadway, Williston, ND 58801 Material to be used at temporary jobsites within NRC

a. Elamlnl and m .. s number; b. dlomlclllandfOfphyaJeaI form: and c. mllJdml.Wl1 amount Which will ba pol,.lItd Itlny one ttme.

12. LICENSE FEES (Feell'lqulred only for new applleeUons. wtth lew eXClptlons") (See !OCFR !70end S«JIM 17D.31)

SEP 2 7 2013

BUSINESS CELLUlAR TELEPHONE NUMBER

(701) 720-5554

, .

• INDMOUAl(S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR TRAINING EXPERIENCE.

FEE CATEGORY AMOUNT I ENCLOSED S 0.00

by Ipplfclnt1 THE APPt/CANT UNDERSTANDS THAT ALL STATEMENTS ANDREPRESENTATfONS MADE IN THIS APPLICATION ARE BINDING

THE APPLICANT AND ANY OFFICIAl EXECUTING THIS CERTIFICATION ON BEHALF OF THE APPlICAHT, NAMED IN ITEM 2, CERTIFY THAT THIS APPLICATION 15 PREPARED IN CONFORMITY WITH TITLE 10. CODE OF FEDERAL REGULATIONS, PARTS 30. 32. 33. 34, 35.36.39. AND 40. AND THAT AlL INFORMATION CONTANED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE ANDBEUEF. WARNING: 18 U.S.C. SECTION 1001 AClOF JUNE 25. '94862 STAT. 749MAJ(ES IT AC RfMINALOFFENSE TO MAKE A WlLLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OFlHE UNITED STATES AS TO ANY MAnER WITHIN ITS JURISDICTION.

TYPEDJPRINTED NAME AND TITLE

NRC FORM 313 (03-2013)

0 8 2 2 11

I

r ,

Murnahan. Colleen

From: Hill, Carol Sent: To:

Friday, September 27,20139:47 AM Murnahan, Colleen

Subject: FW: NRC License 33-27066-01 Attachments : 2013 license amendment letter. pdf; 2013 NRC form 313 license amendment.pdf

For set up

CaTOe L. Hiff} Licel1-Sing Assista.nt

Direct: 817-200-1140 To[{ Free: 1-800-952-9677

Fax: 817-200-1083 fr ,naif: Ca.roLHi/I@nrc.gav

us Nuclear RrguIatory Commission

1600 E. Lanuu Bfvd. Arlington, TX 76011-4511

From: Steve Wald [mailto:swald@srt.com] Sent: Friday, September 27, 2013 9:34 AM To: Simmons, Michelle Cc: Hill, Carol; Roldan, Lizette Subject: Re : NRC License 33-27066-01

Attached is our amendment letter on our letterhead as requested.

Thank you for your assistance.

Steve Wald, PE Material Testing Services, Inc. PO Box 634 Minot, ND 58702 701-852-5553 fax 701-839-4045

From: Simmons, Michelle Sent: Friday, September 27, 2013 8:06 AM To: swald@srt.com Cc: Hill. Carol Subject: RE: NRC License 33-27066-01

Mr. Wald,

You can submit this information to us on letterhead. Please be sure it is signed and dated. You may submit this information by email using the pdf format. We will update our records once we receive your notification. Thank you

Michelle Simmons I Senior Health Physicist I U.S. Nuclear Regulatory Commission

1

MATERIAL TESTING SERVICES, INC.

September 27, 20 13

Ms. Carol Hill US Nuclear Regulatory Commission 1600 E. Lamar Blvd. Arlington, TX 76011-45 11

Ref: AMENDMENT TO NRC LICENSE 33-27066-01

Ms. Hi ll:

This letter is in regards to amending our NRC license (33-27066-0 I). We are changing addresses for our Minot location and removing the Grand Forks location. Attached is NRC form 3 13 .

We realize NRC does not have jurisdiction in North Dakota but we wish to usc material at temporary j obsites that have NRC jurisdiction as stated in our current license.

The files for inspection will be changed from #8 20th Avenue SE in Minot, ND to 3001 North Broadway, Minot, ND 58703.

All the other license items will remain the same.

Thank you,

Sincerely, MATERIAL TESTING SERVICES, INC.

Steven A. Wald, PE President

PO Box 634 Minot, NO 58702

701-852-5553

PO Box 14516 Grand Forks, NO 58208

701-746-6398

PO Box 1093 Williston, NO 58802

701-572-4226

8 2 ?

U.S. NUCLEAR REGULATORY OMB: NO. 315D-0120 EXPIRES:

to dalenrht lhallhe appiIcanlls qualified and 1hal per response 10 cofTll/y will this mandaloly colleclbl reque~~§ffi§~~~ I ;-~ health and safety. Send corrvnenlS regatdJng burden astImals 10

~ ....... 1:::~~~::~::~U'~S'I;N~UC,,':~";;RegUlatory Commission, Washington, DC 20555-0001, {~ i APPLICATION FOR MATERIALS , "" " .. Dos' Off''', Dme. Of "10",,,.,, "" '. LICENSE _ .. ,m' "" ...... , W"",,,,IOO, DC ,.,.,. If' •. "", .. .... ~ '/ .. , dis"" • "''"'''''' wild 0"" ""''''' """"', .. NRC ... ,

•••• ' reqund 10 respond 1O,Iha Inkllmalkln c:oIeetbn.

THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS I OF THE ENT'RE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW. 'AMENDMENTS/RENEWALS

THE SCOPE OF THE EXISTING LICENSE TO A NEW OR HIGHER FEE CATEGORY WILL REQUIRE A FEE.

APPUCAlION FOR DISTRIBUTION OF EXEMPT PRODUCTS FIL.E APPUCATIONS WITH:

OfFICE OF FEDERAL & STATE MATERIALS AND ENVIRONMENTAL. MANAGEMENT PROGRAMS DMSfON OF MATERIALS SAFETV ANOSTATE AGREEMENTS U.S. NUCLEAR REGULATORV COMMISSION WASHINGTON, DC 20555.0001

AU OTHER PERSONS RLE APPUCATIONS AS FOUOWS:

IF YOU ARfLOCATeO IN:

I ~~~~~::~~~.~~:~~~~; MICHIGAN, MINNESOTA, MISSOURI, OHIO, OR WISCONSIN,

MATERIALS LICENSING BRANCH U.S. NUCLEAR REGULATORY COMMISSION, REGION III 2443 WARRENVIllE ROAD, SUITE 210 LISLE, IL &0532--4352

ALABAMA. CONN~CTlCUT, D~LAWARf, DISTRICT OF COLUMBIA, FLORIDA, G~ORGIA, 1~!~~;:~~~~~~~1~~~~~:i:f~~~~~~!~:~~f~?:~i~~~~~ KENllICKY, MAINE, MARYlAND, MASSACHUSETTS, Ne:W HAMPSHIRE, NEW JERSEY, NEW YORK, NORTH CAROUNA, PENNSYLVANIA. PUERTO RICO, RHODE ISLAND, SOUTH , TI!XAS, CAROL»llA,. TENNESSEE, VERMONT, VIRGINIA, VIRGIN ISLANDS, OR WEST VIRGINIA,

SEND APPUCATlDNS TO:

UCENSINO ASSISTANCE TEAM DMSION OF NUCLEAR MATERIALS SAFETY U.s. NUCLEAR REGut.ATORY COMMISSION, REGION I 2100 RENAISSANCE BOULEVARD, SUITE 100 KING OF PRUSSIA.. PA 19406-2713

SEND APPLICATIONS TO:

NUCLEAR MATERIALS LICENSING BRANCH U.S. NUCLEAR REGUlATORV COMMISSION, REGION IV 1600 E. lAMAR BOUlEVARD ARLINGTON, TX 76011-4511

PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR REGULATORY WISH TO POSSESS AND USE LICENSED MATERIAL IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY

1. THIS IS AN APPLICATION FOR (Ch~l:k ",.>propria'e lIem)

o ANEW UCENSE

[l] B. AMENDMENT TO LICENSE NUMBER

o C. RENEWAL OF UCENS!:: r~UMUEH

33-27066-01

3. ADDRESS WHERE LICENSED MATEIML WILL liE USED OR POSSESSED

1. 3001 N Broadway, Minot, Nil 58701 2. 621AEast Broadway, Wii;i"on, ND 58801 Material to be used at temporury jobsites within NRC jurisdiction.

5. RADKlACTIVE MATfRIAL II. Elemenlllnd m.u number; b. chomlc;.1 and/or phyllcal form; and c. m.IJdmum amount

whlchwlil be po .... ueel.! an~ oflollr,

12. UCENSE FEES (Feu rall,ulf&d only fot nrm appllcaUons, with few excapUons') (So 10CFR ITO.1Id Sed/on ITO.31)

13. CERTIFICATION. (MUst be compM"d by applicanQ UPON THE APPUCANT.

NAME AND MAILING ADDRESS OF APPLICANT (InclUde ZIP{XJdeJ

IMlat,,,hai Testing Services, Inc. Box634

ND 58702

PERSON TO BE CONTACTEOABOllT THIS APPLICATION

TELEPHONE NUMBER BUSINESS CELLUlAR TfLEPHONE NUMBER

(701) 852-5553 (701) 720-5554

INDIVIDUAL(S) RESPONSIBLE FOR RADIATION SAFETV PROGRAM AND THEIR TRAINING EXPERIENCE.

STATEMENTS ANDREPRESENTATIQNS MADE IN THIS APPUCA710N ARE BINDING

THE APPLICANT AND ANY OFFICiAl EXECUTING THIS CERTIFICATlON ON BEHAlF OF THE APPLICANT. NAMED IN ITEM 2. CERTIFY THAT THIS APPUCATION IS PREPARED IN I REGULATIONS, PARTS 30, 32. 33, 34, 35,36, 39. AND 40, AND THAT ALL INFORMATION CONTANEO HEREIN IS TRUE AND CORRECT TO , ,

WARNING: 18 U.S.C. SECTION 1001 r" .1 OF JUNE 25,194802 STAT. 749 MAKES IT AC R1MINALorr-ENSE TO MAKE A WILLFULLY FAlSE STATEMENT OR REPRESENTATION TO /IN'( OfPARTMENTOR AGENCV OF I " . UI-oi : ;) STAT!:.S AS TO ANY MATTER WITHIN ITS JURISDICTION.

OFFICER _ TYPEDIPAIN, d ll'os ..... f. NIIO Tn I.E

NRC FORM 313 (03-2013)

2 2 1 1

r , ,

BElWEEN:

Accounts Receivable/Payable and

Regional licensing Branches

[ FOR ARPB USE I INFORMATION FROM WBL

Program Code: 03121 Status Code: Pending Amendment Fee Category: 3P Exp. Date: 10/31/2011 Fee Comments: Decem Fin Assur Reqd: N

License Fee Worksheet - License Fee Transmittal

A. REGION

1. APPLICATION ATTACHED ApplicanULicensee: MATERIAL TESTING SERVICES, INC.

Received Date: 09/2712013 Docket Number: 3032117

Mail Control Number: 582211 License Number: 33·27066-01

Action Type: Amendment

2. FEE ATTACHED

Amount:

Check No.:

3. COMMENTS

Signed:

Dale:

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

1. Fee Category and Amount

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

Amendment:

Renewal:

License:

3. OTHER ____ ____ _____ _

Signed:

Date:

NRC FORM 532 U. S. NUCLEAR REGULATORY COMMISSION (1-2012)

DATE

10/03/2013

NAME AND ADDRESS OF APPLICANT ANDIOR LICENSEE LICENSE NUMBER

Material Testing Services, Inc. ATTN: Steven A. Wald, PE, President P.O. Box 634 Minot, ND 58702-0634

This is to acknowledge the receipt of your:

o LEDER and/or 0 APPLICATION

33-27066-01

MAIL CONTROL NUMBER

582211

LICENSING ANDIOR TECHNICAL REVIEWER

cmurnahan ~

DATED: 09127/20 13

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

o AMENDMENT 0 TERMINATION 0 NEW LICENSE 0 RENEWAL

[{] There were no administrative omissions identified during our initial review.

o This is to acknowledge receipt of your application for renewal of the material(s) license identified above. Your application is deemed timely filed , and accordingly , the license will not expire until final action has been taken by this office.

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

http://WWVY.nrc.gov/reading-rm/doc-coliections/forms/n rc531 .p,<!f

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

A copy of your action has been emailedtoourLicenseFeeandAccountsReceivableBranch . in our Headquarters office in Rockville, MD. You will be contacted separately if there is a fee issue involved.

Your application has been assigned the above listed MAIL CONTROL NUMBER. When calling to inquire about this action , please refer to this control number. Your application has been forwarded to a technical reviewer. Please note that the technical review, which is normally completed within 180 days for a renewal application (90 days for all other requests), may identify additional omissions or require additional information. If you have any questions concerning the processing of your application, our contact information is listed below:

NRC FORM 532 (1-2012)

Region IV U. S. Nuclear Regulatory Commission DNMS/NMSB - B 1600 E. Lamar Blvd . Arlington , TX 76011-4511 (817) 200-1103 or (817) 200-1140