Fort Wayne, IN 46809 · 3005 Commercial Road Fort Wayne, IN 46809 November 16, 2015 Director,...

3005 Commercial RoadFort Wayne, IN 46809

November 16, 2015

Director, Office of Nuclear Material Safety and SafeguardsAttn: GLTSU.S. Nuclear Regulatory CommissionWashington, DC 20555-0001

Dear Director NRC:

This letter serves to inform the NRC of the transfer of devices registered under the general licenseGL-706574 Foamex, INC from our company to other responsible parties.

The first devices are 10 components RLL-1 with serial numbers 7806574-001 through 780654-010.These components were part of a measuring device that our company trialed in the spring of 2001 formeasuring defects in polyurethane foam as it was being produced. The device was not able to detect

defects and was returned to the manufacturer RONAN Engineering Systems of 8050 ProductionDrive, Florence KY 41042 in October 2001.1I have included an attachment with this letter thatsupports this equipment being returned to the manufacturer via Conway Central Express on10/8/2001. RONAN's specific license number is 201-260-95.

There is a discrepancy between the serial numbers of the 10 RLL-1 components that are registeredwith the NRC and the Serial numbers returned to RONAN Engineering Systems. I have included asecond attachment that was provided to me by RONAN Engineering Systems that is a copy of theiroriginal letter of submission to the NRC by RONAN wherein they identify the RLL-1 components ashaving serial number 735-68 RO. It is not known by FXI, Inc. (formerly FOAMEX, INC) where theserial numbers 7806574-001 through 780654-010 on file with the NRC originated from.

The second of the registered devices are 20 exit signs that contain tritium with the followingassociated information; Manufacturer: Safety Light Corporation, Model: 2040-XX, Serial No: 703628-011 to 703628-030. Isotope: H-3, 11.5 Ci per exit sign.

In 2013 FXI, Inc removed twelve hardwired exit signs disposed of them through K-COMMEnvironmental Resources. 1 have included information from K-Comm regarding this disposal. At thattime we disposed of Brand Hurst Model N-10 B-100 Serial numbers 1845 & 1846 along with.Safety Light Model 2040 Serial Numbers A05352/53531535515356/53571535815359153601536 1/5396.

We do still have Safety Light!/Isolite AO5363/A05390 plus several exit signs where the serial numberis no longer legible. We plan to arrange for disposal of the remaining exit lights in the near future.

If you have questions concerning the information provided in this letter please feel free to contact ourRegional Environmental Health and Safety Manager, Audrey Tremblay at [email protected] ormyself directly at jdarcv~fxi.com. Either or both of us can be reached by telephone at 260 747

7485.

Jal ,•s L. Darcy

Plant Manager

FXI, Inc. Fort Wayne Indiana

For the transfer of Self Luminous EXIT signs

Self Luminous EXIT signs are illuminated with internal light sources powered by tritium g'as.Tritium gas is a radioactive isotope of hydrogen. For this reason, Federal Regulations require thatany person shipping this product must have training sufflcient to comply with US Department ofTransportation regulations in the Code of Federal Regulations #49 Part 172.

STo receive this training the shipper must read, understand and perform the following steps. Also

comply with all instructions contained in ulsolite Packaging Inst-uctions". Place a check mark ineach box after completing then sign and date this form.

>Keep this completed form in your files for at least three years in case of regulatory inspection.

i•A The EXiT signs are to be shipped as "excepted packages for radioact~ive instruments and articles/(49 CFR 173.42-4.."SA sturdy cardboard box will be sufficient to ship the signs because they meet the general package

design requirements of 49 CFR 173.41o.VYou must insure that the active materials (the glowing inner tubes) are completely enclosed by

non-active components (the sign housing). Each sign must be visually inspected to ensure that it•/is not crushed or punctured in any way that might cause the inner tubesto be broken.1/Each sign must contain less then 22 ci or .9 tbq of tritium (see sign labels). The total amount of

tritium to be placed in each box must be less than 100 c__i or 3.7 tbq (add up ci ortbq content ofAach sign).

rVer "Isolite Packaging Instructions" do not place more then 8 signs per box.o6 If a transportation incident occurs, you must report the incident to the US DOT per 49 CFR lji1-5

and 49 CFR 171.16.

*Please Note: Any signs broken and/or contaminated due to failure to comply with DOT

regulation or Isolite Packaging Instructions will be sent, per law• for burial. The shipment

generator agrees to be financially responsible for any and all addition costs.

Name

Company

Phone Number

Email Address

•ignature y; Date.

Isolite Corporation 31 Waterloo Avenue -Berwyn, PA 19312 800-888-5483 Fax 610-296-8952D-7-2.3-0-56 RevI 2Nov12

__._--___________- ___ Order # 75737P•Expiration -Date: 6/20/201t3Trm

131lt To: Ship To:

KCogm Transport K•Com Transport

F•t •/ye •0 Fort Wayne, IN 48803

USA USA

260°969=41 23 260-9S9=41 23

Patrick l•mp

PROtJUCT NO DESCRIPTiON QTY' PRICE RESTocKEXFJTrENDED PRI|'

RETURN Return of Expired Thtium Exits 12 $0.00 0.00%

IRestock'ing Fee:

Total Credit~:

$0.0'

RMIA# must appear on shipp~ng label or retur may be refused! •'

I' f apaplicable a CREDIT will be issued upon receipt and inspectin! -

Return To:

ISOLITE PETURNS

925=211.C Airport Road

CANADA

• 1••''•• El=•.•'=d••.•U '• I•.A ttn: .. , -RMA # 9. 842PA-R ll IA jI #'= 'i, '••

SThAIGHT .•LL O2F LALi~N•ORIGINAL- NOT NEGOTIABL-E Shipper No.

Carrier No.

~'Z 0DM TRAt~PORT SERVl0E~. INC.P~~e ~ of -1--Date--S_-2A

INenme at rcmrzea) tSCAC)

TO; Shipper FXI-FOAMvEX INNOVATIONS. INC.

Sl~eet 3005.COMMERO•IAL RD,Stret 1021 E. WAIUACE CiyF.WAN tteI T c~8I

cityyT. FTNE Stal INEipsCie 4SIS •, SroyitT;r'.

• CofnrTzi . UN or NANumber. Proper Shipping tierns, Hazard Cliiss~ Pazkirig Group" tw5-Phi. 'IfumaGl trntet.) ("Sit o~)•bii ta Is •AT . Po G t.st ly

" I I I

1 3- ~ ETE~~i, OR A~IA~T.IN5RUMI4T _________ ________ _________

-_________. ___. __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

__________________________________ I___ ___ __,__ _ i-.: _____,____ _________ ___....

_____ .6 - -~, IA ___ ____ __ ___

--.witl ir euiw ee.Gl+ i~teuvig~iswd.n orn mrillFor 6i~hmi~elIirenparraliun 8m~teplJnc )rtO~irnO spill. iook, lire. oxpomire or ssitnti e n h, mIotl }

: _ _ _ I . .. . _ _ _

PLACARDS TEtiDERSO.- YES ~ NO ~ - - _________j C.O.O?10

liStS - It ~.tas St ISa ara~na at 511 nttta starts as tasatad an itsis ~ AOOI~EE5is ,-sstt sit .-asd nt dsszsd nt.s~ at iSa tis~s1y as stiana. tltit ~a*aM as Is is atir .-atat~

-~ s 5'~trdvsit5 Si tiW 5V~5I1I Ii rt5ts~ SlS5ititiSY/ -~ Sf 555' 4,-ists 553555! asbllrt es at---~sae 0.0.0. FEEsYPJLiirnzza- e~s ssatsi-r- ty;siaz ~aatstar~stassaa. ss~ .~.ini: S PREPAID 0

tat sa---'- laiOy as ise. Ssssatsst'S 1tttt~ 5Sai55~53I 5 I 555551 *tass~.st -= as~ is -- asss~ tiS~55 to ituiastsi t~s 55 ti55~5tfa5astti a s~ Ssiiisait is Sn I TOTALI SatittittaS 155551t5i555t 555 si53 15' 1 CI-IAISGES a

~as~sls; a~rtlS53~. 5551 CliSitliE. tstssiitlstsl .. sJatas3as~st~ssssa~ ~tSP 5.-sistiSl 5.tt.Z55I .stt. .t5ti1O. itt 555555 Si 05.55 ta~?55ssi.- ~ttt 5555555551 St Stat dSt~5t~t Si 555 st55*555~ ~ 5Sf5~5t SI FREIGHT CHAHEES

sas, 55 ass 5 '55 it5S5~5~~ i555l~555sa5.Sn~s5zirs-t2le 51 ~ Sssast. GE057Fti55ztZs t5555,a~ssssoS~ Sf~-5i ls~ Stst5ttt Stir SisttiStiS at CSSISS' its ss.-~t it~i ti F

its c~-t- rsi--srat Cssf,~t05 isis rntis~sitds 05titre ~ - - -~ satpsAi.-.ts~s________________________________________________________ I #~~5'

1150-555 itsdtSabl sfstla~ as4"- ris.-it si a51it~5P 51sbSss a.rsaz. Lsis~.-staY 5itiriis~A abS'' a aSfIsIn' ~sad Sab, sastO 55 5555 trot-ratS Sn a.s~, a. sat-

aatt SI eitS55nt littiiittit). a-stts~ nti~ais. sat dsstnsd r ..,5sa.nt sssso s~Ot ttitd sat-5510 SaSS 51.tt~t S ~ .55551.5,5 St.t~551S 5 tta5s" s ~tsast,.rrarit.55 re 5SSf.SS-l-~'- 5155555555551 5bS' at S.- 1.55 ~.-ss53s, at is ads aitlf-5- ta 5453515 555155 S.-tSSt -t 5555555155515 Ssitasss*sV .a tsss-,-5~( Sft~-S Stit S5ISd all5 ~5 S 555 P5-Si? 5551 ~E s- 55~- sass at stat rtt'.

fststsi itni as is ste P55(55 ass foss 55sf 5,55 at say s~i SSfstSs 0515505 isttstIsrssfs-stS assa'-stS'lbs ~ SasS '~ it'-' 51 asano sss sat ssb5s rats'S-ti as'-tSlatS15tSliiSsulsts otstfpastii.

~ ilsisty C taut lititS 5,5 is is Eas-iftit 55 las s5~ tittus 555 iss55itsssastiissj t 5sttist.ttsS5tn:sitIllsts~sd as- itsss.ss Itoassit 'S~ta disisyt5s laS'Sit 551 thiS 55115551 55 5555

iCARRIER K-(CDM TRANSPORT SERVICES. INC.

PE N..-.O ;--i-' tflermari•nt post'ofice addzess of shlpPen erisertent pOSt-otlise eddisssolsliippiti. srfLECF3tie-4 C,2O~2 IDEl~1A5TER0 (acts) eat -51105 ssssz.labslmaster.sitss

COMMERCIAL INVOICE 0-7.2.3.0-64 Re,,. 2 l4Nul-

DATE OF EXPOhiT TERMS flFSALE cUIiJENCY COUINTRY OF ULThMATE DESTINA'nON BiLL OF LADING 'A RW,,AySILL. NO.

RETURN US DOLLAR CANADA

FROMEN (3O~slaNEE IMPORTERiIF OTRF.7NLE•s1GNFE1:

•O). ':. L.JALLACt~ 9-1 A.TTN:LISAMCMURRAY

_~ti L. IL 4O&CAVAN MONAGHAN, ON K9J 0E7- CANADA

___________________.___750-74a-6146 ______________________

RMA# 1PURCHASE ORDERN NOTES:

C.ARTOHAl W.eIG-HT FULDESON•PT1ON OF GOODS (HARMONRZEDTA.RTFF CODE IF KNOWN.) CfO 0 1118 (ITY IHTCI UNIT TOT',AL VALUE(lAS.) NO EXPORT DOCUMENTS AVAI LABLE (IITq vALuE

19405.60000 illuminated signs, illuminiated name-plates and the like O ANADA EAcH $6.00 $"•2

9405.6000 0 Illuminated signs, illuminated name-plates and the like CND AH [ $6.00 $ 3 _0

2 . CANADA EACH-

39405.6000 0 Illuminated signs, illuminated name-plates and the like CA DA AC$.0

" 9405.6000 0 Illuminated signis, illuminated name-plates and the like CND EAH$6.00 $4 ~~CANADA EACH$60 $

9405.6000 0 Illuminated signs, illuminated name-plates and the like 6.0 •6CANADA EACH$60 $

9405.6000 0 Illuminated signs, illuminated name-plates and the like CANADA EACH $6.00 $;6

79405,6000 0 Illuminated signs, illuminated name-plates and the like CN A EAH$6.00) $

8 CANADA EACH

9405.6000 0 Illuminated signs, illuminated i-ame-plates and the like $.0'•9 CANADA EACH$60 $

109405.6000 0 Illuminated signs, illuminated name-plates and the like CANADA EACH $6.00 $9.05.600 .luiae .inil .iae aepae n helk AAA EC 60

9405.6000 0 Illuminated signs; illunminated namieplates and the like CANADA. EACH $60 $

:12 ~~~9405.6000 0 Illuminated signs, illuminated nlame-plates and the like CND. AH$0.ANAA.EA. $600.

149405.6000 0 Illuminated signs,, illuminated name-plates and the like CANADA EACH $6.00 $

9405.60000O Illuminated signs, illuminated name-plates and the like CND EAH$6•00 $

16445600Ilmntdsgs llmntdnm-ltsadtelk CANADA EACH$60 $

9405.60000 illuminated signs, illuminated name-plates and tie like CAAA EC$60 $175 .... . DA ECH$.0

16 ~~~~9405.6000 0 Illuminated signs, illuminated name-plates and the like CAAA E H$60

1, ANDA EAH.6.0,

9405.6000 0 Illuminated signs, illuminated name-plates and the like I"$6.00 $

19 CANADA EACH$

18 ~~~~9405.6000 0 Illuminated signs, illuminated name-plates and the like CA DA EC$.0 $

20 CANADA . EACH $60

•m•m,,d°&-, • s rftw `•4 # IC5unk•stP 'tfr•'yt~USLA TOTAL INVOICE VALUE $ 7 a-.'•' pwh5Aed.

SIGNATUJRE PRINT NAMENHERE IT TOTAL WEIGHT (LBS)

8ewlltl N 8mepre sl ee

Company Name - ... Cot.tNme.TgAddes meoo /•=e¢=- " -Contact~hone •rz •Te&

Address 2 Contact Fax ___________

.Zip Code z• BO 9 Today's Date __________

*Please completely fill out the above fields

Line~ Manufacturer Manufacturer Model Serial Activity

Name { Date Number Number (C! or Tbq)

517 .~ " °~ .....c ~

8 f•,-r~I -Ocx o ~- -- c§

S2c2 ,~ Ži2 . .. .

13 . .. ... ...___ ___ __ __ _ __ __ _

14- ... .. ___ _

*Th : bvein_ rmtiosoulbeontesinsabs.___nynrtoo__hsin___mssnglese__l19 the__________h__issin _ _________", _t.__es pin dary

20 l 1 oprto 3 aeloAeu eryP 9• 8o88-43o6o2685

2 _____D-7.2._.0-59__Re_____No____

InvoiceShipment ID: 1Z440X426896508031III111 l~lll II II 11111 I! lii11111111 IIII I IIIII i 1

05/22/201.305122/201.3Shipper Information:Tax ID/VAT No.: ________

Contact Name:Company Name: K-COM TRANSPORT SVC

Company Address: 1021 E WALLACE ST

Bill of LadinizlAir Waybill No.: 1Z440X426896508031

Invoice Number:

Purchase O)rder No.

Terms elf Sale ( Incoterm ):_____

Reason for Export: Repair 1 Return

City:State/Province:

Postal Code:Country:Telephone No.:

E-Mail ID:

FORT WAYNE

IN46803-2553

Us

[email protected]

EEl Status: NO EEl 30.364-

Tax ID/VAT No.:________Contact Name: RMA #9642PA-RMACompany Name: ISOLITE RETURNS

Company .Address: 925-211 C AIRPORT RD,

Sold To:Ta'x ID/VAT No.:Contact Name:Company Name:Company Address:

:City:State/Province:Postal Code:Country:Telephone No.:

E-Mail ID:

ISOLITE RETURNS925-21 iC AIRPORT RD

RMA #9642PA-RMA

City:State/Prov'ince:Postal Code:

Country:Telephone No.:E-Mail ID:

CAVAN MONAGHANON

CAVAN MONAGI-lANON

K9JOE7 K9JOE7

CA7364 CA

[email protected]

[email protected]

rNo. IUnit of Description of Goods Country of I UnitUnits Measure (include Harmonized Tariff Number If known) Origin Value Total Value

1 PKG exit signs (excepted for radioactive instruments and articles) US 36.00 36.00

1 PKG extt signs (excepted for radioactive instruments and articles) US 36.00 36.00

Additional Comments:. InVoice Line Total: 72.00

Discount/Rebate: 0.00

Invoice Sub-Total: 72.00

Freight Charges: Q0.oDeclaration Statement: InsUrance: 0.00

Other (Specify T'ype) : 0.00Invoice Total Amount: 72.00

_________________________________________________ Currency Code: USD

Shj!Jpptq-•ghatu re / Title Date: Total Number of Packages: 2

('- &"A k-- •'-. - • " Total Weight (indicate LBS or KGS): 42.78 LBS

6-

V'orsionlfOL) 1. 6 12061 0J Prinied S12212013 5:471l I PMl LrlC

These commodities, technology, or software Were exported from the United States in accordancewith the Export Administration Regulations. Diversion contrary to U.S. law prohibited.

Page 1 of

, '

it 5r~

JuLY -zq, ZOO

REGI9N WUSNR~QFFr~EQYINPECTIQN AND FNFORCEMENTsbi WA ENV LLE~R0AbLi VS E;IL 60.5324357

RE: QUARTERtY REPORT - apsctri.c LkSNSEj~ # 2O1~2~&-~TRANSFER OF' BY~RQDUtT MAT~RIAL TO GENERAL [ICF~$E~S

GEl '14L.FIV1ENI:

I~ACCO~DAN~E WITH. 19 QFR 6?1 ~ FINb ~NctdsEtTwQ~2) GOrnES OF THE QUARTERLY TRANSFER R~ORT FQRROrSFANENGINEERING COMPANYr RON~NCE~ KENTUOKY, rQR THE QUARTERENDING JUNE $, 20.0%

sfl4C ER ELY.

RbNAN ENGINEERING GOM~ANYMEASUREMENTS DIVISION

JO: 'ENOLOSUREa

I - - I

MEASUREMENTS DIVISION8050 Producti~fl Drive * Fkrenoe, Kentucky 4104? * (806) 342-8600 ~ FAX (808) 342-8426

CUJSTOI4ER; FOAD•............ ER 1•ODE•ti 141.

SOURE W)DEL : PHI1-0Q90QTY. OFSORE 1

......... SIZP DATE): 0.09

$HIPPER: CONWAY CP•TRA •XPRESS

AGREEMENT STATE, (YI5): N/Ro

CUSTOMER AFlR• F OAM AMX IN/C/0! AP CTO OUDNT•R

Fort Wayne, IN 46809 · 3005 Commercial Road Fort Wayne, IN 46809 November 16, 2015 Director,...

Documents

Transcript of Fort Wayne, IN 46809 · 3005 Commercial Road Fort Wayne, IN 46809 November 16, 2015 Director,...