ATTN: GLTS U.S. Nuclear Regulatory Commission Washington ... · Note that under 10 CFR 31 .5(c)(1...

• Keane Group Holdings, LLC 2121 Sage Rd, Suite 370 Houston, TX 77056 713.960.0381

December 15, 2015

Office of Nuclear Materials Safety and Safe GuardATTN: GLTSU.S. Nuclear Regulatory CommissionWashington DC 20555-0001Attention: Hector Rodriguez-Luccioni

RE: Annual Registration of GL Devices

Dear Mr. Rodriguez-Luccioni,

The permanent storage location for the devices listed in the attached Annual Registration (GL-727349-20) is as

follows:

Keane Frac, LP14235 U.S. Route 6Mansfield, PA 16933

These devices are portable devices used in hydraulic fracturing at remote well sites throughout the State of WestVirginia. The operations are performed for numerous clients and will exceed 180 days during the calendar year, thusthe need to register these devices with the NRC.

If there are any questions regarding this letter, I can be contacted at 713-898-1811. Please accept my apology forbeing late on submitting this as it is my fault.

Thank you for your cooperation.

Sincerely,

Clay ReavisVP QHSE

UNITED STATESNUCLEAR REGULATORY COMMISSION

WASHINGTON, D.C. 20555-0001

%•' •;;.•;' J"November 20, 2015

TO: Users of Devices Subject to General License Registration

SUBJECT: ANNUAL REGISTRATION OF GENERALLY LICENSED DEVICES

The U.S. Nuclear Regulatory Commission (NRC) requires annual registration of certain devices that arepossessed under the general license issued in Section 31.5 of Title 10 U.S. Code of Federal Regulations (10CFR 31.5). Devices subject to registration include those containing the radioactive material and activity listedin Table I of the attached NRC Form 864. You are receiving this notice because NRC records indicate thatyou have one or more such devices. Information about the general license registration program is availableNRC website at http://www.nrc..qov/materialslmiau/miau-reci-initiativesl/qen-Iicense.html

Note that under 10 CFR 31 .5(c)(1 1), the attached General Licensee Registration Package must be completed,signed, and returned to the NRC within 30 days from the date of this letter. Read all of the instructions prior tocompleting the package. Mail the completed package in the enclosed envelope to:

Director, Office of Nuclear Material Safetyand Safeguards

ATTN: OLTSU.S. Nuclear Regulatory CommissionWashington DC 20555-0001

Registration Fee: Commission regulations (10 CFR 170.31, Category 3Q) require that you submit aregistration fee with each registration on an annual basis. The registration fee is subject to change yearly, andyou are required to submit the fee that is in effect as of the date of this letter. An invoice for the current amountdue will be sent to you under separate cover. If you have any questions about the fee or the invoice, pleasecontact the License Fee Billing Help Desk at 301-415-7554 or e-mail at [email protected].

NRC amended 10 CFR Parts 170.11 and 170.31 to provide that 10 CFR Part 170 fees be assessed to Federalagencies, where applicable, in accordance with the Energy Policy Act of 2005. Therefore, those Federalfacilities required to register certain generally licensed devices in their possession will be required to pay theannual registration fee.

Attachment: NRC Form 864 -- General Licensee Registration and Instructions

Sincerely_ •::......••..

Hector Rodriguez-Luccioni, PhDU.S. Nuclear Regulatory CommissionOffice of Nuclear Material Safety andSafeguardsDivision of Material Safety, State, Tribal andRulemaking ProgramsMaterial Safety Licensing Branch

INSTRUCTIONS FOR COMPLETING NRC FORM 664"GENE RAL LICENSEE REGISTRATION"

Review all six sections of this registration form. If any information is incorrect or missing, makecorrections in the applicable boxes. If you have more devices than space provided in the form,copy the form before starting, as needed. Use black ink and print in CAPITAL LETTERS.Start information in the first box provided. If the information contains a number with a dash (-) ora decimal point (.), include the dash or decima[ point as an individual character. Use the "0"character to represent the number 0 (zero).

Verify information about the devices by reviewing the label on the outside of the device. Forsafety reasons, DO NOT TRY TO TAKE APART any device to verify this information. Ifyou are uncertain how to identify the device's label, contact the device's manufacturer or anauthorized service agent for this information. Also, contact the manufacturer for any additionalinformation about NRC requirements. You may also review 10 CFR 31.5 and other applicableregulations on the NRC web site at httpxllwww.nrc..qovlreadinaq-rmldoc-collections/cfr/, or reviewspecific information about the general licensee project athttp:l/www.nrc.g ov/mate ri als/miau/mia u-reg-initiatives/gen-l icense .html

Note to specific licensees: If you believe the device(s) listed on the registration form arepossessed under your specific license, then verify the device label does not state the device issubject to a general license. if the labels indicate the device is subject to a general license, thencomplete the registration form as instructed below. If not, complete the registration asinstructed below, however, in Section 2, follow the instructions for "not in possession of device"and complete one Section 4 page per device transferred to your specific license.

Section 1 - General Licensee Information. Provide the requested information about you, thegeneral licensee.

On Page 1, provide the street address/location where your device(s) are used. For portabledevices, provide the storage location. P.O. Box addresses are not allowed.

Do not write in thebox marked For NRC Use Only.

On Page 2, provide the name, telephone number, and title of the individual responsible for yourdevice(s), and a mailing address where correspondence about your device(s) ca n be sent. Themailing address should be specific to the physical location where the devices are used and/orstored (P.O. boxes may be used if this is the only available mailing address). The individualindicated in this section as responsible for your device(s) must also verify and sign the form inSection 5.

Section 2 - Devices Subject to Registration. This section lists each device subject toregistration and in your possession, according to NRC records. Devices subject to registrationinclude those containing at least one of the radionuclides listed in Table I, with the activityindicated, at the time of manufacture.

Table 1. Criteria for Registration

,Strontiurn-90, Radium-226 ,3.7m mcabec uerel {0.,1 millicurie•ICobalt-60, Curium-244, Americium-241, and Californium-252 I37 me~abecciuerel (1 miflicurie)Cesium-137 ,370 me abec uerel (10 millicurie)

Use the codes from Table 2 when correcting isotope information for devices in this section. Ifyou do not possess a device on this list, blacken the "not in possession of device" circle, andprovide the relevant information in Section 4. Note that each device is assigned a unique six-digit number called the NRC Device Key.

_______________Table 2. Isotope Codes for Sections 2 and 3 ________

Radlonuclide Code for form Radilonuclide Code for formAmericium-241 AM241 Curium-244 CM2l44Californium-252 C F252 Strontium-90 SR90Cesium-137 CS137 Radium-226 RA226Cobalt-Co0 CO60________ __ ______

Section 3 - Additional Devices, If you have other generally licensed devices (not listed inSection 2) that meet the conditions for registration listed in Table 1, provide information abouteach additional device. Before starting, copy this section as needed for your additionaldevices. Also indicate how you acquired each device by blackening the proper cirdle.

When entering isotope and unit information for your device(s), use the codes listed in Table 2 ofSection 2 for isotope information, and use the codes from Table 3 for unit information:

________________ Table 3. Unit Codes for Section 3 ________

U nit Code for form Unit Code for formpicocurie PCI becquerel BQn anocurie N CI kilo becquerel KBQmicrocurie U CI meg abecqu erel MBQmillicurie .McI gigabecQuerel GBQcurie Cl terabecquerel .... TBQ

pound LB microgram UG ...___________ mill igram MG

kilogram KG gram G

Section 4 -Not in Possession of Device. Use this section to report any devices that are listedin Sections 2 or 6, but that you no longer possess. Before starting, copy this section asneeded for additional devices that are not in your possession. Enter the NRC Device Key,as listed in Section 2 or 6. Blacken the cirdle (choose only one) that best describes thedisposition of the device and complete the rest of the section as appropriate.

Section 5 - Certification and Signature. The responsible individual must certify, sign, anddate Section 5.

Section 6 - Devices NotSubject to Registration. This fist contains information about devicesthat NRC records indicate are in your possession, but are not subject to registration. If youno longer have one or more of the listed devices, you are required to make a transfer report toNRC in accordance with 10 CFR 31.5(c)(8) or(9), as applicable. You may use Section 4 forthispurpose. T[his section does not list any static eliminators containing polonium-210 (Po-210), orluminous exit signs containing tritium (H-3). These devices are not subject to registration, andare not indluded in this section in an effort to reduce the length of this form.

RETURN THE COMPLETED FORM IN THE ENCLOSED ENVELOPE WITH PROPERPOSTAGE.

1111 11111111111111111 !! 1[ !11 11 11111 11111 Mii 11111 !11111 II11 111III 111i!11111 Ilil MI111 III iii 1111111 ili IIGL-727349-2011/04/2015

NRC FORM 664

07 -201510 CFR 31.5

SECTION 1PAGE 1 of 2

U.S. NUCLEAR REGULATORY COMMISSION

GENERAL LICENSEE REGISTRATION

APPROVED BY 0MB: NO. 31 50-0198 EXPIRES: 0413012016

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 LicenseRegistration NumberGL-727349-20

SECTION 1 - GENERAL LICENSEE INFORMATION

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

Company Name: KEANE FRAC, LP

F-I 1 II1Department:

Address Line j: 2121 SAGE ROAD14235 U OT

Address Line 2: SUITE 370

/1..11I I I ., I.,I t I..ICity: HOUSTON

1 AINI\I IIs FI'IEfL...Di I I1 I I III iState" TX IP A Zip Code: 77056 - IIhLJI IZZID1'

Fo.o.or NR Us nycategor.: EI I(Donotwrie hre)Packet Receipt Date (MMDDYYYY):

I 11 ~ II IAccession Number:

I I I I I I

A A

I 1111111 111111 11111111111111 IIIIIII I!i 11111 11111 li!i111]11]111111 liIIII!i 1111 I ii 11111 liii 1111111 III li]! l111GL-727349-20 SECTION 11110412016 PAGE 2of 2

SECTION 1 - GENERAL LICENSEE INFORMATION (Continued)

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

Last Name: REAVIS

First Name: HENRY Middle [nitial:

I I I~ l 1 [ -DTelephone: (713) 898-1811 Extension:

D iIDl LIED LItIDI WILD fTitle: VP- QHSE

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:

Address Line 1: 2121 SAGE ROAD

Address Line 2: SUITE 370

City: HOUSTON

Stte T 11 I1 Ziod:775 I L11t1111Z IZIZIl

A A

iIl ll IIII1!11111 11III1IIII 111II1I1 11111 11111 11111 11111! I1 IIII11i111111 IiiIII 111111 l 11 111 Oi liiiIII!GL-727349-20

1110412015 SECTION 2 -DEVICES SUBJECT TO REGISTRATION SECTION 2Our records indicate that you have these devices. Please update the information as necessary. PAGE 1 of 13

NRC Device Key 837048 (Internal Control Number)

Distributor/Distributed By: BERTHOLD TECHNOLOGIES U.S.A., LLC

Distributor License Number: R-01082-B2a

Manufacturer Name: BERTHOLD TECHNOLOGIES U.S.A., LLC

Device Model (Not Source Model): LB 8010

Device Serial Number: 10094

[--II complete Section 4.)

MM DD YYYY

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

1 CS137 20.000000000 mCi

It lE DID ,If2

4

IEJIDIt! ,I WI6

DIDID W1, .. I

AA

11111I111 II11I1 11111 11111 11111 11111 M 11 1111 IilI111111111111 ~iii IIII 11111111 IH i 11111111III!i 111liGL-727349-201110412015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2

Our records indicate that you have these devices. Please update the information as necessary. PAGE 2 of 13



Distributor License Number: R-01 082-B23



DevIce Serial Number: 10095

Transfer Date (Receipt Date): jo/i15/2010Not in possession of device (Also

]l I [-- complete SectIon 4.)

MM DD YYYY

Isotope (e.g. AM241)1 CS137

2

3

4

5

6

Activity (e.g. 100)20.000000000

Unit (e.g. mCi)

mCi

WI1LWLWI

A A

I 1111111 111111 II 1111[1 11111 1ll 1111 11111 11111 11 III IIIII 111111 11 111111 I 111111 IIGL-727349-201110412016 SECTION 2 - DEVICES SUBJECT TO REGISTRATION

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



Distributor License Number: R-01082-B23



I1111111111Ilii IIII IISECTION 2

PAGE 3 of 13


Transfer Date (Receipt Date): 0511512012Not in possession of device (Also

{ I jl l [--Icomplete Section 4.)

MM DD YyYY

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

1 CS137

2

3

4

ID IIL5

6

IEZ iL

20.000000000

IlI I I 1 ,. I

I I ..I I .I I

mCi

IED

DIDDIII I , I 1

I I I I I I t I I

I 1 1 1 1 I I I I

A A

11111111 111111 11111 IIIIII 1111 11111 11111 11111 lllIili ff111ll lii lii1111111 IIIl~ iii11111 II II I lilIIII I1I1GL-727349-2011/0412015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2








Transfer Date (Receipt Date): 07/15/2011•1 FT T Not in possession of device (AlsoLI~iIJ L J [j ~ j L complete Section 4.)

MM DD YYYY


I 0S137 20.000000000 mCi

WIilD E I I[il]

4

5

LIIilIII LlaulIl] I6

WI lD mRLWi"ii

AA

11111111 1111 1111111 11111 11111 11111 Ilii! 11 l 11111 II1I1 lll 11111111 riil 11111 IIGL-72734g-2011/0412015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SEC

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







D LII WIDII .... IL

MM DD YYYY

11111111113TION 2-5of 13


2

3

WIDE~l4

5 - 11

6 • 1 t

FLILIILI

Activity (e.g. 100)

20.000000000Unit (e.g. mCi)

mCi

WIl

DID1DIIIIlIDt

A A

111111111111 111111111 111n11111101111111 lii 11111 1111 lii 111111 11iii 110 I I 1 II1111111I0111 Ol111111!111GL-727349-201110412015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2

Our records Indicate that you have these devices. Please update the Information as necessary. PAGE 6 of 13


Distributor/Distributed By: BERTHOLD TECHNOLOGI ES U.S.A., LLC

Distributor License Number: R-01 082-823




I 1 Not In possession of device (AlsoD] complete Section 4.)

MM DD YYYY


t CS137 20.000000000 mCi

WEE D •IIID2 DIDtID D ... l IID3 EWID DID t4 DIEWI D 1 ,iID5 DIDID' 1 . DID6

I !E E WilIt

A A

I11 III III IIIII ii11 11111 1 II II 1111 111111 11111 11i 11111111 I11 11I1111 IIII I 11~11111 l iii111111111 III! l!!iGL-727349-2011104/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2








Not In possession of device (Also• l" I I " D complete Section 4.)

MM DD YYYY

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

1 0S137 20.000000000 mCi

WIlD WI I t2

W11lD WIt3

EDI E WII4

DIWI 1 I WI,5 WIl D W 1 " .I6 EW II W II

A A

111111l1111111111111l1111111111111l1llii 11 11111111 iii 111111111 lIIIM111IIIIIIGL-727,349-20li/0412o15 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SEC

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







[]complete Sect ion 4.)

MM DD YYYY

!11I11111I3TION 2--8of 13


ED1 ]2

IDIJII3 DIDID4

DII5 'D 116

D IiIfl

Activity (e.g. 100)20.000000000

Unit (e.g. mCi)

mCi

DIDiDID,1

DlID

A A

1111 111111I IIDi~ii II I 11111 1II II II 1111 IHi I~III IIII ll IIIII 1111111 liiHii ii11 11111 llIfIII~ III lII!1ilGL-727349-20

11104/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2Our records indicate that you have these devices. Please update the information as necessary. PAGE 9 of 13




Manufacturer Name: BERTHOLD TECHNOLOGiES U.S.A., LLC



• '-• ] I ' 1 L I complete Section 4.)

MM DD YYYY

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

1 CS137

2

3

4

5

EDI6 WEED

A

20.0O000000O ~mED

DIDWI

A

I 111111I1111 1111111 1111 11111 11111 111 lll III II lii 111111 1111111 Iliii 111111111 H ll 11111 llil IIIGL-727349-201l10412015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2

Our records Indicate that you have these devices. Please update the Information as necessary. PAGE 10 of 13







Transfer Date (Receipt Date): 05/1612012Not in possession of device (Also

I•"• I 1 I I complete Sectlon 4.)

MM DD YYYY

Isotope (e.g. AM241)I CS137

D III"2

LW",3 DIII',4

5

6

D1IL

Activity (e.g. 100)20.000000000

li I III liltt

I I I lt l FIIll II

Unit (e.g. mCi)mCi

ILIIIDID1IDtIWI1

I 1 1I I I t l II I L I I I

A

II111111 111111 11111111 11111 li!11111II11111 11111lii111111 11111 li ii111111111 IIIIII 11IIIi111 11111111 liGL-727349-2011/0412015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2

Our records indicate that you have these devices. Please update the Information as necessary. PAGE 11 of 13


DistributortDistributed By: BERTHOLD TECHNOLOGIES U.S.A., LLC




Device Serial Number: i0363

LI complete Section 4.)

MM DD YYYY


2

EI11I113

EDWEl4 WEED15

EEIIliE6 EEEEID

A

Activity (e.g. 100)20.000000000

Unit (e.g. mCi)

rnCiWEWE1

WEWEIWEt

A

I ~IIIII1IIIi 1111 111111 11111 11111 11111 11111 11111 IIII 1111 11 li IIi !111 111111111 iiiI 1111111 iii liiiIIGL-727349-2•01110412015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2








[• ][ I L I complete Section 4.)

MM DD YYYY


I CS137

2

3

4

5

EIIZIiE.I6 WItt]

A

20.00000000020.000000000

I 1 I1 II II III I

mCi

LI IIi

DI

DIDI

A

11111[111 H1 i1111111111 IIIII H il~ll 111 111IIII 111111 11111 1111 11II1I11 l iii1111 i ii E lIIi IIII IIIIGL.-727349-201i10412015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2



Distributor/Distributed By: BERTHOLD TECHNOLOGIES U.S.A,, LLC





I I INot ,n posssson ,ofodevice (AsoLI complete Sect~on 4.)

MM DD YYYY


1 CS137 20.000000000 mCiWiIlD W l I t il2

4

6 W il L W.1I I l l l l1 I

AA

111111I III111111 11111 1111111111llli lllll[illll111111111111 111111l1 II!1111111lii111111111it ll[1111GL-727349-20

111042o15SECTION 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

Initial Transferor Name

Initial Transferor License Number (if known)

Device Model Number (Not Source Modei)

Device Seriar Number

0 Manufacturer/Initial Transferor listed aboveHow acquired and date (e.g., ..----1 --- !-from a distributor/manufacturer, 0 Other General Licensee Date Transferred: [jJ LI I IL Jother licensee, other source)?

(..9 Other Source (Received) MM DD

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

isotope (e.g. AM241)

IIDIIII1WIllh

WIlll

IlllWlIll

Activity (e.g. 100)WIIIWEIIDIEIWElEWEE1DLIWE11W11EWEtE..

I I I I I

I I ! I i

i f I I I

II

EilI.IIIItELELITI

11IDII

ID[IIDIDI

YYYYUnit (e.g. mCi)

WIWI

WI

WI

I ] ' E [ I

I I I I I

T I I I I

I I I I I I I t I I • I I

A A

IIII illl 1111 1111101I11111111I1III IIIIII IIII 111111 11111 IIII IIIIH 111 ii 11111 00111 IIIIIG1107491205 SECTION 4 - NOT IN POSSESSION OF DEVICE SECTION 4

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

Part 1 Transfer Date:

NRC DeviceoKey: _ _ _I-- 1(from Section 2 or 6) ~L L L~MM DD YYYY

Location of the Device:o Whereabouts Unknown (complete Part 1 only) 0 Transferred to another general licensee (complete Parts 2 and 3)o Never Possessed the Device (complete Part 1 only) Q Transferred to a Specific Licensee (Not the manufacturer)

o Returned to Manufacturer (complete Part I only) (complete Part 2)

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

Company Name:

Department:

I i 1il i ....IAddress Line 1:

Address Line 2:

City:

state:I LUipcode: • .. -jIJ L 1J IIPart 3 Enter the name of the individual responsible for this device:

Last Name:

First Name: Middle Initial:

Title:

' I I lif I I I1 I

A A

111111111111111111111111111111111111111 liii111111I IIII II III1111I1II11 Iii I11111 1111 III I fl!1ii 1i ~III

GL-727349-20 SECTION 5 - CERTIFICATION SECTION 511/0412015 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:

p:11w.nrc. /eading-rmldoc-collections/cfr)

SIGNATURE - I'ESPONSIBLE INDIVIDUAL (Listed in Section 1) DATE

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

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

MATERIALASPECTS. 18 U.S.C. SECTION 1001 MAKES IT ACRIMINAL OFFENSE TO MAKE AWILLFULLY

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

STATES AS TO ANY MATTER IN ITS JURISDICTION.

A A

ATTN: GLTS U.S. Nuclear Regulatory Commission Washington ... · Note that under 10 CFR 31 .5(c)(1...

Documents

Transcript of ATTN: GLTS U.S. Nuclear Regulatory Commission Washington ... · Note that under 10 CFR 31 .5(c)(1...