HomeMy WebLinkAboutWA Department of HealthtffR 220l,8 D
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
OFFICE OF RADIANON PROTECTION
I I I Israel Road SE . PO Box 47827. Olympia, Washington 98504-7827
TDD Relay Service: l-800-833-6388
February 26, 2018
The Honorable Sissi Bruch
Mayor of City of Port Angeles
Port Angeles City Hall
321 East Fifth Street
Port Angeles, Washington 98362
Dear Mayor Bruch:
The Department of Health, Office of Radiation Protection is required by law (RCW 70.98.080
(2)) to notify the appropriate local government officials when a radioactive materials license
application is received. The Office must notiff either: the Chief Executive Office, if the
applicant is located in a city; or the county legislative authority, iflocated in the county.
This is your official notification ofthe specific use and possession ofradioactive material as
described in paragraph four below. As a courtesy, we are forwarding a copy to your local
jurisdictional health department. We urge that you forward a copy to the appropriate fire
departrnent for their review.
The Offrce ofRadiation Protection will delay the issuance of a license at least twenty (20) days
from the date ofthis notice. During this time period, if you deem appropriate, you may file
written objections against the applicant or the activity for which the license is sought. The law
states that you may file a written objection against the applicant or against the applicant's
activity for which the license is sought, and shall include all facts upon which the objection is
based. In the case ofwritten objections, under chapter 34.05 RCW you may request a formal
hearing and the agency may in its discretion hold a formal hearing regarding the application.
On February 20th,2018, Elite Quality Management LLC (License Number 10629) submitted an
application requesting to be licensed to receive and use radioactive material at 271 Bames Point
Road, Port Angeles, WA 98363. The applicant stated that the only use for radioactive materials
will be in equipment that tests surface moisture measurement, density measurement, and depth
moisture measurernent in soil and construction materials.
EGE
J
OF PORT AN
If you have corffnents, they should be submitted to this office by March 18, 2018. Please submit
comments to:
Mayor Sissi Bruch
February 26, 2018
Page 2
DOH OFFICE OF RADIATION PROTECTION
RADIOACTTVE MATERIALS SECTION
POBOX47827
oLYMPIA WA 98504-7827
If you have any questions, please feel free to contact me al (360) 236-3220, or by email at
Tanner.Depert@doh.wa. gov.
Sincerely,
Depert
Administrative Assistant
Radioactive Materials Section
cc: Clallam County Health and Human Services Department
-
fri*rn
RHF - 1PG
Application for
Radioactive Material License
- Portable Gauge
RECETVED
FrB 2 0 20lB
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lnstructions - Completa all items in this application for a n€w license or the ren€wal of an Existing license. Use supplemental sheets where necossary.
Item 21 must be complated on all applicatjons. Send to Washington Slate Departmont of Health in accordance with the directions contained in the
application covor letter. Upon approval of this application, the applicant will receive a State of Washington Radioactive Material License issued in
ac@rdanc€ wilh th€ general .equirements contained in Washing(on State OopartmEnt o, Health. Orfice of Radiation Protection, Radiation Control
Regulations, and the Washington Nuclsar En€rgy and Radiation Control Act, Chapter 70.98 RCW.
1a. NAME AND MAILING ADDRESS OF APPLICANT
flilz Au4l;r/ /YlA nvlen tnf LLC
.ltL € Lov,;lse,' BlvJ gn;t fr4
?octhn5ele5'wA 18362
1b. STREET ADDRESS(ES) AT WHICH RADIOACTIVE MATERIAL
WILL
BE STORED OR USEO (if different than 1a) INCLUDE ZIP CODE
2? I B^cnd5 Polnt R.l '
?on An5et.5, WA 98363
'tc. Will radioactive matorial be used at temoorary6 job localions?
Yes ENo
2. PERSON TO CONTACT REGARDING THIS APPLICATION
Jotdon Ulrich
TELEPHONE NUMBER
5o3 321 6372
3. THIS lS AN APPLICATION FOR (check appopdato item)
A. I New License B tr Renewal of License No. WN-
4a. INDIVIDUAL USERS (Ne€d not be spsciflcally named but must
be trained as indicated in 4b.)
Jo r,'lcr.r U,r icl"
4b. TRAINING AND EXPERIENCE (Check at least ono)
tr Approved Certificate(s) of Trdining for Each User
0 lndividu8ls trainod in ln.Holse Training Program
(Detailed information attached)
0 Hazmat refreshor training wjthin three ysars
5a. RADIATION SAFETY OFFICER (RSO)
(Person designated as RSO - lncluds Training Cortificates)
NAME Jo".)or,''' Uir;ct'.
RSO FAX 5o3 255 3146
RSo EMAIL El; ie A,*l:+ln neal @
5b. DUTIES OF RADIATIoN SAFETY oFFlcER (check ono)
(sign ano oate Attachment 'A' and retum. oR
I Equivalent Duties Attached
6. RADIOACTIVE MATERIAL
(elements and Mass numberol each.)
7. SEALED SOURCE MANUFACTURER
AND MODEL NUMBER
8. MAXIMUM ACTIVITY OF EACH SOURCE
B
C,
B
c
9. DEVICE AND USE OESCRIPIION (Make lette.ing correspond to letteing in ltems 6. 7. and 8 above.)
MANUFACTURER OF DEVICE MODEL NUI/BER,OF DEVICE USE Checkall boxes that a
V surface Inoistur€
measuremgnt
fdensity measurement
[Tdepth moisture measurement
f onstruction materials
(sott
frox\er 34 oo
! surface moisture
measuremant
0 density measu.em60t
ln
B 0 soil
I consbudioo materhls
I
B,
in
I
I
I
322-028 JAR 4117112 Pags 'l of 8
E EI
APR 2 2018
r ANGELES
IFK
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
OFFICE OF RADIATION PROTECTION
1 I I lsrael Road SE . PO Box 47827'Olympia, llashington 98504-7827
TDD Relay Semice: 1-800-833-6388
March 26, 2018
The Honorable Sissi Bruch
Mayor of City of Port Angeles
Port Angeles City Hall
321 East Fifth Street
Port Angeles, Washington 98362
Dear Mayor Bruch:
The Department of Health, Office of Radiation Protection, is required by law (RCW 70.98.080
(2)) to notiff the appropriate local govemment officials when a radioactive materials license is
issued in their jurisdiction. The Office must notift either: the Chief Executive Office, if the
applicant is located in a city; or the county legislative authority, if located in the county.
This is your official notification ofa specific license for use and possession ofradioactive
material as described in the paragraph below.
On February 20th, 2018, Elite quality Management, LLC, was granted a license to receive and
use radioactive mateial at27l Bames Point Road, Port Angeles, WA 98363. The applicant
stated that the only use for radioactive materials will be in equipment that tests surface moisture
measurement, density measurement, and depth moisture measurernent in soil and construction
materials.
If you have any questions, please feel free to contact me at 360.236.3220, or by ernail at
Tanner.Depert@doh.wa. gov.
Sincerely,
Tanner Depert
Administrative Assistant
Radioactive Materials Section
ITY C
D