1111 IIII I111II111I IIIII HIIII lUll lIII lll ... · !411 1111 iiii i111ii111i iiiii hiiii lull...

!411 1111 IIII I111II111I IIIII HIIII lUll lIII lll 11111111111111111III1IHM III iii I III II UIIIIII11111 IIIGL-725760-19

04/07/2015

NRC FORM 664

02 - 2004

10 CFR 31.5

SECTION 1PAGE 1 of 2

U.S. NUCLEAR REGULATORY COMMISSION

GENERAL LICENSEE REGISTRATIONAPPROVED BY OMB: NO. 3150-0198 EXPIRES: 03/31/2010Estimated burden per response to comply with this mandatory collection request: 20 minutes. NRC wil use ths information to track general licensees and their devices to ensure a higherlevel of device accountability. Send comments regarding burden estimate to the Records and FOIAJPrivecy Services Branch (T-5 F52), U.S. Nuclear Regutatory Coirmission, Washington,DC 20555-0001, or by internet e-mall to [email protected] to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0000). Office of Management andBudget Washington, DC 20503. If a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and aoerson is not reaured to resoond to. the information collection.

Complete all six sections of this registration form. If any of the preprinted information is incorrect, provide thechanges in the applicable boxes. USE CAPITAL LETTERS.

General License

Registration NumberGL-725760-19

SECTION 1 - GENERAL LICENSEE INFORMATION

Enter the company name and the street address/physical location of use for your device(s). Forportable devices, specify the primary storage location. Do not use a P.O. Box address.

Company Name: LLOG EXPLORATION COMPANY LLC

I I I I I I I I I I I I I I I i I I I I I I I I-1Department: FACILITIES

I I I I I I I I I I I I I I I I I I I I I I I I

Address Line 1: 1001 OCHSNER BLVD

I I I I I I I I I I I I I I I I I I I I IIAddress Line 2:

I I I I I I I I I I ICity: COVINGTON

I I I I I I I I I I I IState: LA [ Zip Code: 70433 - I II1= -I IDIjin

A A

GL-725760-19 SECTION 104/07/2015

PAGE 2 of 2SECTION 1 - GENERAL LICENSEE INFORMATION (Continued)

Enter the name, telelphone number and title of the person who is the responsible individual for the device(s).

Last Name: COOLEY

First Name: BRUCE Middle Initial:

I I II I I I I I I I ITelephone: (985) 801-4300 Extension:

II II I EI ITitle: VICE PRESIDENT

Enter the mailing address where correspondence regarding your device(s) should be sent.This address should be specific to the use or storage location of your device(s).

Department: FACILITIES

I I I I I I III II I II IIIIII I I I I I I IAddress Line 1: 1001 OCHSNER BLVD

Address Line 2:

City: COVINGTON

State: i [ Zip Code: 70433 1 ZII I

A A

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04/07/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2

Our records indicate that you have these devices. Please update the information as necessary. PAGE 1 of 8

NRC Device Key 818778 (Internal Control Number)

Distributor/Distributed By: ROXAR, INC.

Distributor License Number: 42-27765-01

Manufacturer Name: ROXAR, INC.

Device Model (Not Source Model): RFM SH-7950

I I I I I 17 - 1 1 1Device Serial Number: 1162-05

Transfer Date (Receipt Date): 06/15/2005Not in possession of device (Also

LI complete Section 4.)

MM DD YYYY

Isotope (e.g. AM241)

1 CS137

DIE]2

3

4

5

6 DIIIEI]

Activity (e.g. 100)

30.000000000

IIIIIIIIIIII

Unit (e.g. mCi)

mCiDIDI

DIII

DIIIDIIIDID1

A A

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04/07/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECOur records indicate that you have these devices. Please update the information as necessary. PAG


Distributor/Distributed By: ROXAR, INC.

I II I II I I11 11 11 11 -T I I I IlDistributor License Number: 42-27765-01

IL49 56 I I 1 1 IManufacturer Name: ROXAR, INC.I I I I I I I III IIII I I I I I I I I =Device Model (Not Source Model): RFM SH-7950

I I I I I I I I III I I I I I I I I I I I I IDevice Serial Number: 1105-04

1 1 AI I I I I I I I 1 1 1 1 HITTransfer Date (Receipt Date): 06/15/2005

Not in possession of device (Also

II complete Section 4.)

MM DD YYYY

IIIIIIIIII.TION 2E 2 of 8


1 CS137DIIIZEID2

3

4

5

6 DIJIJID

Activity (e.g. 100)

30.000000000

Unit (e.g. mCi)

mCiDID

A A

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04/07/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION

Our records indicate that you have these devices. Please update the information as necessary.


Distributor/Distributed By: ROXAR, INC.I I I I I I I I I I I III I If l I I I I I I=Distributor License Number: 42-27765-01

1 /- l t-l I-0e 15 ý5 1Manufacturer Name: ROXAR, INC.

I I I I I I I I I I I I III I I IIT -I I IDevice Model (Not Source Model): RFM SH-7950

I I I lI I I I I I I II III II I I I I I IDevice Serial Number: 1104-04

I II I I I I I I I III I I IIII I ITransfer Date (Receipt Date): 06/15/2005

Not in possession of de'LI complete Section 4.)

MM DD YYYY

I IIIIIIIIIIl l11SECTION 2PAGE 3 of 8

I

]

]]IEI

vice (Also


1 CS137

2

3 KKIIZIfl4 LulJill5

6 KIZIZEKI

Activity (e.g. 100)

30.000000000

Unit (e.g. mCi)

mCi

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04/07/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2Our records indicate that you have these devices. Please update the information as necessary. PAGE 4 of 8


Distributor/Distributed By: MULTI PHASE METERS, INC.

Distributor License Number: L06458

Manufacturer Name: MULTIPHASE METERS ASI I I I A I I II I I I I lI I I IDevice Model (Not Source Model): SS-MPM SERIES

Device Serial Number: 7961-12-18

Transfer Date (Receipt Date): 12/18/2013Not in possession of device (Alsocomplete Section 4.)

MM DD YYYY


1 CS137"InI2

3

4

5

I6

II lED

Activity (e.g. 100)

200.000000000

Unit (e.g. mCi)

mCiDIIIDIDI

EDIII"III

A A

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GL-725760-19



Distributor/Distributed By: MULTI PHASE METERS, INC.I I I I I I I III I I I I I I I I I I I IMDistributor License Number: L06458

Manufacturer Name: MULTIPHASE METERS AS

Device Model (Not Source Model): SS-MPM SERIES

I I I I I I I I I III I I I I I I I I IIDevice Serial Number: 7961-13-02

Transfer Date (Receipt Date): 12/18/2013Not in possession of device (Alsocomplete Section 4.)

MM DD YYYY

Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi)

1 CS137 200.000000000 mci

2

3

4

5

6

LIILI

DILiiiDID'IiiDliDID

A

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1I1 1 1 1 1 1 1 1 1 1 I I1 IT 1 11 I ITransfer Date (Receipt Date): 12/15/2013

Not in possession of device (Also

E] complete Section 4.)

MM DD YYYY


1 CS137 200.000000000 mci

2

3

4

5

6

A

DIDLIELZDIDDliiLIDE

A

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04/07/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SE(

Our records indicate that you have these devices. Please update the information as necessary. PAC






I I I I I I I I I I I I I III I I I I I =Device Serial Number: 7961-12-16


Li complete Section 4.)

MM DD YYYY

IIIIIIIIIII'TION 2

E 7 of 8


1 CS137

2

3

4

5

6

Activity (e.g. 100)

200.000000000

Unit (e.g. mCi)

mCi

IAI

A

GL-725760-19




I I I I I I I I I III I I I I I T FDistributor License Number: L06458





El complete Section 4.)

MM DD YYYY


1 CS137 200.000000000

KIliw2

3 IIiIIIE4

5

E II E6

A

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mCi

DinKill'LIEDDliiKill'Dlii]

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0,/07/2015 SECTION 3SECTION 3 - ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1

Provide information about other devices you have that are subject to registration. Do not report specifically licensed devices.

Manufacturer Name

C0, 1OlUU ll IMPlC r S ls I-IsiInitial Transferor Name

10IO1uWiiT- lPlI'PiSI6i mkI r1i61 P%1SI Iý1= IJici ~I I7]Initial Transferor License Number (if known)

Device Model Number (Not Source Model)

ssI- IAP I -I 3Device Serial Number[l 916 It1 1-1113 1- 10131 !1 1 1 1 1 I1I 1I I 1 1T

H Manufacturer/Initial Transferor listed aboveHow acquired and date (e.g.,,

from a distributor/manufacturer, 0 Other General Licensee Date Transferred: 4 f 0 0[ .

other licensee, other source)? 0 Other Source (Received) MM DD YYYYO OtherSource(RUnitvd(eMg. m YY)

I.

2.

3,

4.

5.

6.

7.

8.

9.

10.

Isotope (e~g. AM241)

EIIIJILD11111W

DILIIII

Activity (e.g. 100)

E~L IlLDILLhIlL

DILLDILLIELLELEL

LLLLIEZZEJILLKILELEIIJILJIEDILIDILJIJILJZLELLEEDILIILELEKIFIT

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04/07/2015 SECTION 3SECTION 3 - ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1


Manufacturer Name

l6l f lRS PsIInitial Transferor Name

Ifnli l0•1lI l IPl~IO lS161 IMPI-rli lsI )I I~ iiJl1 dI IIInitial Transferor License Number (if known)


IsIsI- * IF A -13I I I I I I I I I I I I I I I IDevice Serial Number1-7 1 le l I I1 -1 JA J -I -1 19 1 Jil 1 1 1 1 1 11 lll

0 Manufacturer/Initial Transferor listed aboveHow acquired and date (e.g.,

frorn a distributor/manufacturer, 0 Other General Licensee Date Transferred: • /[_7 • 0 • _[Lother licensee, other source)? 1

U Other Source (Received) MM DD YYYY

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.


CS 131Iu IsIIIELTI"

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I• l I T

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I I I I

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04/07/2015

IIIh,,iC IlONl l3ii IIU liiiSECTION 3

SECTION 3 - ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1Provide information about other devices you have that are subject to registration. Do not report specifically licensed devices.

Manufacturer Name

P•1Olu0-Ifl 1p 6l1TrO Rlsl IRsl I I I I I I I I I I I-IInitial Transferor Name

If O[llCW lf[ IP I ISl61 PSI i-I 6 lS1I IAlsl C-I I I I1Initial Transferor License Number (if known)


Device Serial Number

1J1 19 l(0 l11 - I11 l Ok l- I A 10 I I I I I I I I I I I I I I I I0 Manufacturer/Initial Transferor listed above

How acquired and date (e.g.,from a distributor/manufacturer, 0 Other General Licenseeother licensee, other source)? 0 Other Source

Date Transferred: I O 1 0 1

(Received) MM DD YYYY


1. L I13

2. EILEDI3. E1IDED4. LLIII5. WEED6.WI D7- LIVEDI8. i 1 11 D9. LIPIDF-10. L 1 iLIID

Activity (e.g. 100)

lo l I I I I I I I

FTI I I- I I I I I I 1-

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Il i IILEDLEDILEDIIEDI

LDDILEDILIDEI~iD

ALAA A

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04/07/2015 SECTION 3SECTION 3- ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1


Manufacturer Name

i(l 0 blo-rif I fi rlo RisI Ia-s I I - I I I I I I I I SInitial Transferor Name1f10Llul• 7rl IP10lR15161 IM1Eýl-r10 &lSl =l•q .Initial Transferor License Number (if known)14' VI '/ l I~ ll I 1 1 1 1 1 1 FDevice Model Number (Not Source Model)'Sls -~ ~ n -I• I S I I I M I P IDevice Serial Number

l-7q( I I I I I I I 2H( ManufacturerlInitial Transferor listed aboveHow acquired and date (e.g.,

from a distributor/manufacturer, 0 Other General Licensee Date Transferred: I I 3 &lalol I Iother licensee, other source)? . .


1.

2.

3.

4.

5,

6.

7.

8.

9.

10.

Isotope (e g. AM241)[cs I a131

DIIIIDI

LIIIDIIIEIEIDIIEIlEDl

IEIIiIII

Activity (e.g. 100)

I•1 I F~I o

EiIIIILIIIIZII llE ILI JI I IBIlIEEil"IDIDI1

I

!

IIIIIii:II-r-r

! I

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IILIIIDIDZD1DII]l

1-F--F--

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ILEDiF-lIDDIIIEIDIDI]IIEDl

FI~lDIEDI

EDElI ! I

A

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04/07/2015 SECTION 3SECTION 3 - ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1


Manufacturer Name

[(nlU lL, l l lRSlIInitial Transferor Name

~1rP3Lu1~1- I i I 01PrI I~ S1 1 A IfkL---1 1 1 K IS I I A/'c1 ~I 1 ]:1Initial Transferor License Number (if known)

14a'~ ~ ll (V 1 14 IS 1 1 1IDevice Model Number (Not Source Model)

1sls1-1m1P~mT-F1I I I I I I I I I I I I I I I EDDevice Serial Number1-'71011471 [ I- 1/ 13 1- 11 17 1 1 1 1 1 1 1- 1 1 1 1 1 1 1 1

H Manufacturer/Initial Transferor listed aboveHow acquired and date (e.g.,

from a distributor/manufacturer, 0 Other General Licensee Date Transferred: .l? • sother licensee, other source)? I-/



2.WIE

3.BEE

4. I I E5. BIZIII6. BID

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I~lo IoTEIZIII

DIIIILIlLIIIN

I I I I I I I

. . . . . I I

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0410712015 SECTION 3SECTION 3 - ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1


Manufacturer Name

1ULM1" l l I lRIS R I I I I I I I IF ]Initial Transferor Name

IPj LVl -rr :Ilr I Pl IIRs 161 1 M I-rI 1&1S )I Iz 1 ,1lic1 I I IInitial Transferor License Number (if known)

Device Model Number (Not Source Model)Sss- fr•P f•3

Device Serial Number

0 Manufacturer/Initial Transferor listed aboveHow acquired and date (e.g.,

from a distributor/manufacturer, 0 Other General Licensee Date Transferred: F[_ i 0 'other licensee, other source)?

0 Other Source (Received) MM DD YYYY

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.


lis I I T3- lTIS 131-

LIILIIIDLELIE_IDIDEkkDllinJ

I.9~4O Jo IBIlLIEEIJIE[BilliEDulLLIII"BIlLIEBELIEElf IIIFF17

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I I I I I

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LIDE

I I I I I I

.... I

A, A

I iillllll II11 III 111111 11111 11111 11111 11111 11111 11111111 IIIII inI IIII I 11II1II IIII IIIII noI IIII iiiIGL-725760-19 SECTION 4 - NOT IN POSSESSION OF DEVICE SECTION 404/07/2015

Provide information about devices listed in Section 2 or 6, but no longer in your possession. PAGE 1 of 1

Part I Transfer Date:

NRC Device Key:

(from Section 2 or 6)

Location of the Device:

O Whereabouts Unknown (complete Part 1 only) 0 Transferred to a er general licensee (complete Parts 2 and 3)

O Never Possessed the Device (complete Part 1 only) 0 Transferred t Specific Licensee (Not the manufacturer)

O Returned to Manufacturer (complete Part 1 only) (complete rt 2)

Part 2 License Number of Recipient (if transferred to a specific licen e):

Company Name:

Department:

Address Line 1:

Address Line 2:

City:

State: Z Zip ode: I II III

Part 3 Enter e name of the individual responsible for this device:

Last Name:

First Name: Middle Initial:

Telephoý umber: Extension: LflTitle:

A A

GL-725760-19 SECTION 5 - CERTIFICATION SECTION 504/07/2015 PAGE 1 of 1

I hereby certify that:

A. All information contained in this registration is true and complete to the best of my knowledge and belief.

B. A physical inventory of the devices subject to registration has been completed, and the device information on

this form has been checked against the device labeling.

C. I am aware of the requirements of the general license, provided in 10 CFR 31.5.

(Copies of applicable regulations may be viewed at the NRC website at:

http://www. nrc.gov/reading-rm/doc-collections/cfr)

SIGNATURE - RESPONSIBLE INDIVIDUAL (Listed in Section 1) DATE

WARNING: FALSE STATEMENTS MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC

REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL

MATERIAL ASPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY

WRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED

STATES AS TO ANY MATTER IN ITS JURISDICTION.

A A

.1111111111111 II 11111 1111 11111 11111 111 11111111111111 IIIII IIII IIl IIII I II11M III 1 1111111GL-725760-1904/07/2015 SECTION 6 - DEVICES NOT SUBJECT TO REGISTRATION SECTION 6

PAGE 1 of 1

NRC Device Key: Manufacturer License No:

Manufacturer Name:

Model Number: Serial #: Transfer Date:

1111 IIII I111II111I IIIII HIIII lUll lIII lll ... · !411 1111 iiii i111ii111i iiiii hiiii lull...

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Transcript of 1111 IIII I111II111I IIIII HIIII lUll lIII lll ... · !411 1111 iiii i111ii111i iiiii hiiii lull...