Taghleef Industries INC.

October 15, 2013

Director of Nuclear Material Safety and Safeguards

U.S. Nuclear Regulatory Commission

ATTN: GLTS

Washington, DC 20555-001

RE: Elimination of General License Registration Number GL-704487-17

Dear Sir:

With the disposal of the source referenced in the attached sheets, I am requesting that you terminate our general

license. All of the sources remaining on our site are covered under our specific license number 13-13300-01

amendment number 33. We no longer have a need for the general license.

If you have any questions or comments, please call, E-Mail, or mail.

Thank You

Mi~alMichlRSO

3600 E. Head AvenueRosedale, IN 47874-9124Tel.: 812 462-5275Fax.: 812 462-5103E-Mail: mike.michl@ti-films.com

3600 E. Head Avenue, Rosedale, IN 47874-9124TEL: 812-466-4277 * FAX: 812-462-5100

www.ti-filme.com

9214382

Taghleef Industries INC.October 10, 2013

Director of Nuclear Material Safety and SafeguardsU.S. Nuclear Regulatory CommissionATTN: GLTSWashington, DC 20555-001

RE: Update General License Registration Number _GL-704487-17

Dear Sir:

Our facility possessed the device identified below as a Generally Licensed device. This device hasbeen properly transferred to Thermo Fisher Scientific for disposal. The transfer document isattached.

i) The nuclear gauge general licensed information:

Reg # Manf Model SN Nuclide Activity Ref DatemCi

NDC 103 11954 Am-241 150 7/12/1999

ii) The transfer of this source was completed by James Hatten, Stan Huber Consultant Inc. onSeptember 4, 2013. The source was shipped as a UN2911 RQ package via FedEx directlyto Thermo Fisher Scientific.

iii) A receipt from the transferee for disposal is attached.

As required by 10 CFR 31.5, we will maintain a record of the transfer for disposal of the device. Thisdocument is our official notice to your organization of this action.

If you have any questions on our notification, please contact me at 812-462-5275.

Sincerely,

ichael Michl, RSO

awrenc erPlant Manager

Enclosures: Transfer for disposal documents

3600 E. Head Avenue, Rosedele, IN 47874-9124TEL: B12-468-4277 • FAX: 812-462-5100

www.ti-films.com

9214382

ThenrmoRshSCIENTIFIC

The world leaderIn serving science

ACKNOWLEDGMENT OF RECEIPT OF RADIOACTIVE MATERIAL

October 8, 2013

Michael MichlTaghleef Industries, Inc.3600 East Head RoadRosedale, [N 47847

RMA Number 32376

Attention Michael Michl:This is to certify that Thermo Fisher Scientific has received and accepted ownershipof the radioactive material described below pursuant to applicable regulations and asauthorized by our Texas Radioactive Material License L03524.

Usnufamtru

NOC, INC

Summary (11 source)

4418 sthal wIeo- Source Ad"~* Unbf An103 11954 Am-241 11954 150 mCi

150 mNO

7112/2005

This receipt should be retained in your files as a permanent record showing the disposition of thisradioactive material. If you are not the Radiation Safety Officer or responsible for maintainingregulatory records for radioactive material, please forward this letter to the appropriate person.

If you have any questions or require additional assistance, please contact us at (800) 437-7979or (713) 272-2204

Sincerely,Thermo Fisher Scientific

Danny VicenteNuclear Services Specialist

s"IMI43 1~

T """a ýOTa

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Attachment 2Stan A. Huber Consultants, Inc.

Health Physics and Radiation Safety Service-s

Fixed Gauge Installation, Relocation, and Removal Survey Form

El Installation X Storage for disposal El Relocation (complete one form for each Install & Removal)

DATE: PERFORMED BY:September 4, 2013 James Hatten

LICENSEE FACILITY AND ADDRESS: CONTACT PERSON AND PHONE NUMBERTaghleef Industries, Inc. Michael Michl3600 East Head Rd. 812-462-5275Rosedale, IN 47847

FIXED GAUGE MANF & MODEL NUMBER FIXED GAUGE SERIAL NUMBER:NDC Infrared, Model 103 11954

RADIONUCLIDE: ACTIVITY:Am-241 150mCi

MONITORING INSTRUMENT MAKE AND MONITORING INSTRUMENT: SERIALMODEL: NUMBER:Ludlum 3 93601

MONITORING INSTRUMENT CALIBRATION DATE: 6/14/2013

LOCATION OF DEVICE AND DESCRIPTION OF PHYSICAL CONDITION

Device was already unmounted with shutter closed. Additional tape was placed on shutter to ensure thatit remained closed. Leak test was current. Gage is clean and in good condition. Measurements recordedwith shutter in closed position.

YES NO N/A

INVENTORY/INSPECTION LIST1. Legible manufacturer's label(s) and requiredradioactive material labels are affixed to the Xgauge.

2. A legible sign bearing the statement "CautionRadioactive Material" is posted in the proximity Xof the gauge.

3. Shutter functions properlyX

4. Fixed gauge is not in use and is in securedstorage X

If any responses to Items 1-3 above are "NO". the following action(s) have been implemented prior to usingthe fixed gauge:

Attachment 2TYPE OF MONITORING PIPE/VESSEL ON WHICH FIXED GAUGE IS

(Check all that apply) MOUNTED IS: (Check one)

Initial Radiation Monitoring FullAfter Relocation Partially Full

From Storage XXXXX Empty

MEASUREMENTS (mR/hr)

SHUTTER

SHUTTER OPEN CLOSED CLOSED

SURFACE I FOOT 13 FEET SURFACE I FOOT 3 FEET SURFACE(30 cm) (I meter) (30 cm) (I meter) mR/hr

1. top 0.03 1.52. bottom 0.03 1.53. front 0.03 1.54.back 0.03 1.55. Left side 0.03 1.5

[6.Right side _ 0.03 1.5

11II .5. ___________ ~

Additonal Cotmnents: Gage packaged as a UN291 tLimited Quantity RQThermo Fisher Scientific for transfer classification for disposal.

package for FedEx shipment to

Performed By: James Hatten Date: 4 Semember 2013

MURýI

k"P IX PackageExpr;es US Airbill ,oW 8019 4735 6436

Sw~ends Fed&xj-~

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IjNo E] m. Xg-r AE" WJ irtO`P~fOAM_ F Cargo Aitcraft Only,

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Toted Packiages Tutlftight TOWa Declared Valie

F 61710 Ship it. Track it. Pay for it. All online.Go to fedex.com.

SHIPPER'S DECLARATION FOR DANGEROUS GOODS (Provide at least three copies to the airline.)SHIPPERS DECLARA11ON FOR DANGEROUS GOODS (Provide at least three copies to the airline.) m

ShipperSAHCI200 N Cedar RoadNew Lenox, IL 60451Jim Hatten, 815-370-6538

Air Waybill No. 801947356436

Page 1 of 1 Pages

Shipper's Reference Number(optbnail) 32376

IConsignee

Thermo Fisher Scientific1410 Gillingham LaneAttn: 32376Sugar Land, TX 77478George Greenwood, 800-437-7979

Two completed and signed copies of this Declaration mustbe handed to the operator

TRANSPORT DETAILS

This shipper's declaration was prepared using a FedEx Express template.It must be used ONLY for:* Class 7 radioactive shipments" Shipments using an 023 air waybill (IP1, IXF orATA service)* Shipments originating from a non-US location

This shipment is within the Airport of Departurelimitations prescribed for: Terra Haute(dekt non appicable)

PAirpor CARGOA AIRCRAF

Airport ofDestination: Sugar Land, TX

WARNING

Failure to comply with all respects with the applicableDangerous Goods Regulations may be in breach ofthe applicable law, subject to legal penalties.

Shipment tye. (Ie non-appkcable)N N:' IVF I RAI~OACTIVF I

hI. N0.----.EIRAIOCIV

NATURE AND QUANTITY OF DANGEROUS GOODS

Dangerous Goods IdentificationUN Clss Quantity and Packing Authorizationor Proper S i m type of packaging Inst.ID (subsicery

No. Risk) Group

UN291 Radioactive Material, Limited 7 Am-241, Solid Metal, 1 LQ IUN2911

Quantity, Special Form, RQ Exempt Type A X 5 55GBq

Additional Handling InformationEmergency Response: 815-370-6538 or 800-383-0468

I hereby declare that the contents of this consignment are fully and Name/Title of Signatoryaccurately descdbed above by the proper shipping name, and are James Hatten, Senior HP Consultantclassified, packaged, marked and labelied/placarded, and are In all Place and Daterespects in proper condition for transport according to applicable Rosedale, IN, 4 Sep 2013Intemational and National Governmental Regulations. I declare thatall of the applicable air transport requirements have been met. Signature

815-370-6538 or 800-383-0468 Emergency Telephone Number

FOR RADIOACTIVE MATERIAL SHIPMENT ACCEPTABLE FOR PASSENGER AIRCRAFT, THE SHIPMENT CONTAINS RADIOACTIVE MATERIAL INTENDED FOR USE IN ORINCIDENT TO RESEARCH, MEDICAL DIAGNOSIS, OR TREATMENT. ADR EUROPEAN TRANSPORT STATEMENT CARRIAGE IN ACCORD[ANCE WITH 1 1 421

iEALTH• Radiation presents minimal risk to transport workers, emergency response personnel and

the public during transportation acciaents. Packaging durability increases as potentialhazard of radioactive content increases

" Undamaged packages are safe Contents of damaged packages may cause higher externalradiation exposure, or both external and internal radiation exposure if contents are released.

" Low radiation hazard when material is inside container. If material is released from package orbulk container, hazard will vary front low to moderate. Level of hazard will depend on the type andamount of radioactivity, the kind of material it is in, and/or the surfaces it is on

" Some material may be released from packages during accidents of mod erate severity butrisks to people are not great.

, Released radioactive materials or contaminated objects usually will be visible it packaging fails" Some exclusive use shipments of bulk and packaged materials will not have 'RADIOACTIVE'

labels Placards, markings and shipping papers provide identification." Some packages may have a *RADIOACTIVE" label and a second hazard label. The

second hazard is usually greater than the radiation hazard; so follow this GUIDE as wellas the response GUIDE for the second hazard class label.

* Some radioactive materials cannot be detected by commonly available instruments" Runoff from control of cargo fire may cause low-level pollution

PIKIM" Presence of radioactive material will not influence the fire control processes and should not

influence selection of techniques." Move containers from fire area if you can do it without risk" Do not move damaged packages:, move undamaged packages out of fire zone.Small Fire- Dry chemical, CO, water spray or regular foam.Large Fire. Water spray, fog (flooding amounts),. Dike fire-control water for later disposal.

SPILL OR LEAK" Do not touch damaged packages or spilled material" Cover liquid spill with sand, earth or other non-combustible absorbent material" Dike to collect large liquid spills" Cover powder spill with plastic sheet or tarp to minimize spreading.

FIRST AID" Call 911 or emergency medical service" Medical problems take priority over radiological concerns" Use first aid treatment according to the nature of the injury." Do not delay care and transport of a seriously injured person." Give artificial respiration if victim is not breathing." Administer oxygen if breathing is difficult" In case of contact with substance, wipe from skin immediately; flush skin or eyes with

running water for at least 20 minutes.• Injured persons contaminated by contact with released material are not a serious hazed to

health care personnel, equipment or facilities." Ensure that medical personnel are aware of the material(s) involved, take precautions to

protect themselves and prevent spread of contamination

"IRE OR EXPLOSION* Some of these materials may burn, but most do not ignite readily.* Uranium and Thorium metal cuttings may ignite spontaneously if exposed to air (see

GUIDE 1361* Nitrates are oxidizers and mau innit, nther rnmhtjstihlbe Isee GUIDE 1411

- ^EIL . #uIIIuuI I I ni a Ul•quen l lptuii a ,mluwiu vl III a 1IIilp r aJplm II4 L. II

Shipping Paper not available or no answer, refer to appropriate telephonenumber listed on the inside back cover.

* Priorities for rescue, life-saving, first aid, fire control and other hazards arehigher than the priority for measuring radiation levels.

* Radiation Authority must be notified of accident conditions Radiation Authority is usuallyresponsible for decisions about radiological consequences and closure of emergencies.

* As an immediate precautionary measure, isolate spill or leak area for at least 25 meters(75 feet) in all directions - Stay upwind - Keep unauthorized personnel away

* Detain or isolate uninjured persons or equipment suspected to be contaminated; delaydecontamination and cleanup until instructions are received from Radiation Authority

Notify the Radiation

I Safety Officer (JimHatten) at the followingPROTECTIVE CLOTHINGPositive pressure self-contained breathing apparatus (SCBA) and structural firefighters'protective clothing will provide adequate protection

EVACUATIONLarge Spill• Consider initial downwind evacuation for at least 100 meters (330 feet).Fire- When a largequantity of this material is involved in a major fire, consider an initial

evacuation distance of 300 meters (1000 feet) in all directions.

numbers:

Work: 800-383-0468 or

815-485-6161Home: 815-476-@ 7007/

Cell: 815-370-6538

If the Radiation Safety Officer is

not available, notify Glenn Huber

at the following numbers:

Work: 800-383-0468 or

815-485-6161

Home: 815-462-9727

Cell: 815-530-1874

aU.S. Departmentof TransportationPipeline andHazardous MaterialsSafety Administration

East Building, PHH-231200 New Jersey Avenue Southeast

IAZA CERTIFICATE OF COMPETENT AUTHORITY Washington, D.C. 20590

SPECIAL FORK RADIOACTIVE MATERIALSCERTIFICATE USA/0716/S-96, REVISION 1

This certifies that the source described has been demonstrated to meet theregulatory requirements for special form radioactive material as prescribedin the regulations of the International Atomic Energy Agency' and the UnitedStates of America 2 for the transport of radioactive material.

1. Source Identification - QSA Global, Inc. Model X1277 (Manufactured onor after February 16, 1994).

2. Source Description - Cylindrical single encapsulation made ofstainless steel and tungsten inert gas or laser seal welded.Approximate outer dimensions are 4.7 mm (0.19 in.) in diameter and10.4 mm (0.41 in.) in length. Minimum wall thickness is 0.2 mm (0.008in.). Construction shall be in accordance with attached AFATechnology QSA, Inc. Drawing No. RBA62783, Rev. A.

3. Radioactive Contents - No more than 7.4 GBq (200.0 mCi) ofAmericium-241. The Am-241 is in the form of an oxide incorporatedinto a ceramic enamel.

4. Quality Assurance - Records of Quality Assurance activities requiredby Paragraph 310 of the IAEA regulations' shall be maintained and madeavailable to the authorized officials for at least three years afterthe last shipment authorized by this certificate. Consignors in theUnited States exporting shipments under this certificate shall satisfythe applicable requirements of Subpart H of 10 CFR 71.

5. Expiration Date - This certificate expires on June 30, 2015.

"Regulations for the Safe Transport of Radioactive Material, 1996Edition (Revised), No. TS-R-l (ST-l, Revised)," published by theInternational Atomic Energy Agency(IAEA), Vienna, Austria.

2 Title 49, Code of Federal Regulations, Parts 100-199, United States ofAmerica.

(- 2 -)

CURTIFICATE USA/0716/S-96, REVISION 1

This certificate is issued in accordance with paragraph 804 of the IAEARegulations and Section 173.476 of Title 49 of the Code of FederalRegulations, in response to the June 09, 2010 petition by QSA Global, Inc.,Burlington, MA, and in consideration of other information on file in thisOffice.

Certified By:

ADr. Magdy El-SibaieAssociate Administrator for Hazardous Materials Safety

Jun 17 2010(DATE)

Revision 1 - Issued to extend the expiration date and to update corporatename.

F~EM DESCRIPTION aT,.1 ,BODY STAIN. STL. 1

2 LID STAIN. STL. 1

3 CERAMIC FIBRE A/R

4 ACTIVE MATERIAL A/R

APPROVALSDESCRIPTIVE

DRAWING

x *"aMILK WO. wTE4vmLxm *m

iauw~a Ar -w

T•rml X1277 CAPSULE ASSEZMBLY

I ERF # 1 1107-SIZE I 0 . NO. RBA62783EARl aA V. 107k'li I v r

4REVA

•-- A ^P a

200 NORTH CEDAR ROAD -- NEW LENOX IL 60451-1751 - PHONE 815-485-6161

SEALED GAMMA/BETA SOURCES - LEAK TEST CERTIFICATE

REPORT DATE:

FACILITY:

08/29/2013

TAGHLEEF INDUSTRIES INC.ROSEDALE, IN

NRC LICENSE NO: 13-13300-01

ORIGINAL ORIGINAL OTHER LLD MAX NET A-ctiv-yIsotope ACTIVITY CAL. DATE Manufacturer Model No. Serial No. DESCRIPTION 9KG EFFICIENCY lu CPM CPM DPM (U i)

Sr-90 0.05 CI 09/17/84 MEASUREX _SIRFD2 W = TENTER # 65 E CASTING 16 0.945 0.00001 19 3 <LLD <LLDSr-90 0.05 Ci 01/14/86 MEASUREX SIF.D2 0089BG TENTER B CASTING 16 0.945 0.00001 21 5 <LLD <LLDSr-90 0.05 Cl 09/17/84 MEASUREX SIF.D2 0035BG TEN TER C CASTING 16 0.945 0.00001 21 5 <LLD <LLDSr-90 0.05 Ci 06/01181 MEASUREX 3FIV 1306 TENTER A CASTING 16 0.945 0.00001 20 4 <LLD <LLDSr-90 0.05 Ci 03/01/77 MEASUREX 3FIV 1138 TENTER# 71 CASTING 16 0.945 0.00001 15 0 <LLD <LLDSr-90 0,05 Ci 09/1989 MEASUREX SIF.D2 0288BG TENTER #54 CASTING 16 0.945 0.00001 25 9 <LLD <LLDPm-147 2.Z =i 07101/2001 MEASUREX HC.C2 15 TENTER A REEL 17! 0.945 000001 8 <LLD <LLDPm-147 0.5 Ci 0412008 MEASUREX PHBDI RB280 TENTER #15 WINDER 11 0,945 0.00001 8 0 <LLD <LLDPm-147 2.0Ci 02/2007 MEASUREX PHC.C2 ND212 TENTER III#071 WINDER 11 0.945 0.00001 17 6 <LD <cLLCs-137 2'rCI October-04 OHMARTNEGA SHGL CZ790 56 TUBE EXT. HOPPER 1166 0.220 0.00013 145 0 <LLD <LLDCs-137 2 mCi October-04 OHMART SHGL CZ789 56 TUBE EXT. HOPPER 166 0.220 0.00013 130 0 <LLD <LLDCs-137 2.4 Ci August-88 OHMART SR-2 M-2287 TOWER I MR SCANNER 166 0.220 0.00013 154 0 <LLD <LDCs-137 2 mCI October-04 OHMARTNEGA SHGL CZ791 55 TOWER II TUBE EXT 166 0.220 0.00013 148 0 <LLD <LLDCs-137 2 mCi 10/2004 OHMARTNEGA SHGL CZ792 55 TOWER II TUBE EXT 166 0.220 0.00013 151 0 <LLD <LLDCS-13 7 80 mCi 08/01/90 OHMART SHD-45 M-4837 TENTER II D TOP REC. A 166 0.220 0.00013 153 0 <LLD <LLDCs-13 7 80 mCi 08/01/90 OHMART SHD-45 M-4838 TENTER U D TOP REC. B 166 0.220 0.00013 154 0 <LID <LLDCs-13 7 10 mCi 08)01/90 OHMART SHRM-B-14 3603 TENTER II D BOT REC. A 166 0.220 0.00013 155 0 <LLD <LLDCs-137 10 mCi 08/01)90 OHMART SHRM-B-14 3604 TENTER I D BOT REC. 8 166 0.220 0.00013 124 0 <LDD <LLDCs-137 35 rmCi 11/12/97 OHMART SHRM-B 2742 TENTER III 0 RECLAIM BIN 166 0.220 0.00013 146 0 <LLD <LLD

__-241_ 5.55_GB_ 07112/2005 NDC 103 1¶9 _WER IUa BACKSCATIER 68 0.8__35 0.0M2 64 0 <LLD <LLD

ANALYSIS PERFORMED USING:Packard Auto-Gamma Scintillator Spectrometer Model #015003 Serial #406282 and / orPackard 1900CA Td-Carb Liquid Scintillation Analyzer Model #A1900 Serial #101464

ANALYSIS OF RESULTS:Sources are not leaking at this timeRemovable contamination is less than 5E-3 uCi. (0.005)

NEXT LEAK TEST DUE:

LEAK TEST PERFORMED BY: M. J. Michl

ANALYSIS PERFORMED BY: Joel Ahrweiler (SAHCI)

RADIATION SAFETY OFFICER SIGNATURE: -

February 22, 2014

DATE: August 22 & 26, 2013

DATE: August 29, 2013

Page 1 of 1

From: (812)462-5275Michael MichlTaghleef Industries, Inc.3600 E. Head Avenue

Rosedale, IN 47874

Onigin ID HUFA Fedig.Exgrms

.13213]f2

Ship Date: 15OCT13ActWgt 0.5 LBCAD: 105718131ANET3430

SHIP TO: (812) 555-1212 BILL SENDER

U.S. Nuclear Regulatory CommissionDirector of Nuclear Material SafetyATTN: GLTS

WASHINGTON, DC 20555

Delivery Address Bar Code

I111111111Ref # 650000 120714Invoice #P0#Dept #

¢7

TRK#02061I

7969 1566 4684

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https://www.fedex.com/shipping/html/en//PrintlFrame.html 10/15/2013