RAM Services Inc - PDF document

1 RAM Services, Inc. Jerry Wiza 920-686-38
RAM Services, Inc. Jerry Wiza 920-686-3889 jwiza@ramservicesinc.com www.ramservicesinc.com 510 County Highway V Two Rivers, WI 54241 [same] Figure: 31 TAC §675.23(f)(1)ANNEX ATEXAS LOWLEVEL RADIOACTIVE WASTE DISPOSALCOMPACT COMMISSIONPPLICATION FOR MPORTATION OF Generator Type:Industrial Academic/Research Medical Utility GovernmentIs Applicant the entity responsible for the waste shipment? yesIf no, please include the name and contact information for the entity responsible for the waste shipment.Is Waste from a "Small Generator"? yes Term/Duration from Date of Approval:_____________________________Waste proposed for importation. Waste Volume (Cubic Feet)_____________________________Waste Radioactivity in Curies_____________________________Place of origination (State) of waste:Waste description:Waste classification (Class A, Class B, or Class C):___________________Waste form: stable unstableDoes waste contain any of the following radionuclides, check box(es) and complete blank(s): C-___________________________ millicuries (mCi)___________________________microcuries (uCi) I-129________

2 ___________________nanocuries (nCi) Dep
___________________nanocuries (nCi) Depleted Uranium ______________________microcuries (uCi) Concentration __________________________(provide units) Source of generation ____________________________________________________________________________________________________________ 4. Is the proposed waste a sealed source?No. Please explain: _____________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________Does Broker and/or Generator(s) have any unresolved violation(s), complaint(s), unpaid fee(s), or past due report(s) with the Texas LowLevel Radioactive Waste Disposal Compact Commission? Yes. Please explain: ______________________________________________________________________________________________________________________________________________________________________ _____________________________________________________________________Does Broker and/or Generator(s) have any u

3 nresolved violation(s), complaint(s), un
nresolved violation(s), complaint(s), unpaid fee(s), or past due report(s) pending with any other regulatory agency with jurisdiction to regulate radioactive material including, without limitation, the Texas Commission on Environmental Quality (TCEQ)? Yes. Please explain:____________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________Certifications.Applicant hereby certifies the following.The information provided herein is complete, accurate and correct.The lowlevel radioactive waste for which this Application is submitted will be packaged and shipped in accordance with applicable state and federal regulations and is acceptable for disposal at the Compact Facility. The person submitting this Application is authorized by Applicant to commit Applicant to each and every obligation and condition set forth herein and in the Agreement for Importation of Nonparty Compact Waste. A copy of a written document containi

4 ng such authorization must be attached t
ng such authorization must be attached to this Application.Applicant has delivered to the Compact Facility operator and TCEQ a copy of this Application and the Agreement for Importation of Nonparty Compact Waste (along with any supplements or amendment thereto).Authorized Signatory: _______________________________________Print or type name_______________________________________Signature______________________________________________________________________________ DateATTACHMENTS: (Attachments should include all applicable licenses, authorizations, and other materials needed or useful to fully explain the application.) NONE PRESENT NONE PRESENT NONE PRESENT N / A 7.5 NONE PRESENT 10.5 Class C Domestic sealed sources 01February 2014 to 31 December 2014 Industrial gauging devices from manufacturing facilities Industrial gauging devices, foils Reference and calibration sources. Academic, government & medical institutions President & Radiation Safety Officer 26 November 2013 Jerry Wiza Digitally signed by Jerry Wiza DN: cn=Jerry Wiza, o=RAM Services, Inc., ou, email=JWiza@ramservicesinc.com, c=US Date: 2013.11.26 14:49:54 -06'00