information submitted by the licensee for inspection 2017 ... · attached please find the nuclear...

Piskura, Deborah

From: Sent: To: Cc: Subject: Attachments:

Ms. Piskura,

Dibakar Sundi <[email protected]> Thursday, August 10, 2017 4:38PM Piskura, Deborah Joe Gundersen [Externai_Sender] NRC Inspection, 161 Garstang Street, Beech Grove, IN Nuke Training & Hazmat Certs_BG Office. pdf; Emails to Landauer re Mon Reports_BG Off.pdf; Radiation Safety Reviews_2014-2017.pdf; Niuclear Gauge Storage _BG Off.pdf

Attached please find the Nuclear Gauge Training & HAZMAT certificates for Dipak Tiwari, Muzzafar Hasan and Srinivas Gone, as requested. Mr. Gone is in the process of getting his HAZMAT certification and we will forward that on to you as soon as it is received. As we discussed, he is an Engineer working in the office preparing reports, etc., and does not use the nuclear gauge. Attached are copies of the door to the storage area at the Beech Grove office and the nuclear gauge, which are secured properly. We are in the process of getting the other photos you requested and will send them as soon as possible.

We contacted Landauer regarding getting copies of the Badge Monitoring reports. Attached are copies of emails requesting them. As soon as we are in receipt of same, we will forward those on to you, as well.

Also attached are copies of our Semi-Annual Safety Reviews from 2011 to the present, as requested. Should you have any questions regarding the items we are sending, or need any additional information, please do not hesitate to contact us. Thank you.

Dibakar Sundi, P.E.

K & S Engineers, Inc. 9715 Kennedy Avenue Highland, IN 46322 (219)-924-5231 ext. 105 www.kandsengineers.com

1

,-

Portabl Gauge afety ' r ~ ~

tntn

Srinivas Gone

Has successfully completed training In accordance with rutes and regulations governing portable nuclear moistureldensft gauges and transportation requirements: NUREG-1556, Volume 1 and 49 CFR subpart Hand lATA 1.5.2. Topics covered include: Radio!Qgical safetylprinciptes, practices of radiation protection, leak testing procedures, measurement of radioactivity, biological effects of radiation, incident, labeling, marking, storage, ALARA, shipping, packaging, shipping documents, emergency procedures and security awareness. A closed book examination was administered and a passin.g score was achieved.

This certificate is only valid If signed by a Radiation Safety Officer vertfying that hands on training in operation of the gauge ha8 been conducted under direct supervisiQn of an authorized user prior to operating the gauge alone.

Record keeping Is in accon:iance with 49 CFR 172.704-(d). North East Technical Services, lne., 75 Aileron Court, Suite 4, Westminster, MD 21157

~· ---·---------~-=-':...........---------=--

Rr\~~-~t..l"!('lfx.f ~,.\:.c·r~: C"~::.!~':R

1{ucfear CJauge Safety Certification This certifies that

MUZAFFAR HASAN

has successfully completed training on radiation safety and regulato1y requirements for the use of portable nuclear gauges on this date.

September 29, 2015

This certificate is not valid until signed by the licensee RSO. l attest that the person named above, and no other, has completed the online course and tests. I certify that the individual has completed practical skills training for setting up and making measurements, routine maintenance, packaging and transport, storage, and emerge~.:.JJ rocedt~ fgr portable nuclear gauges.

LicenseeRSO .D I &AkAK SUND I ~ 9-3o ·-l~ (pl'intn.uue) Signanu·e Date

Troxler Online Training meets the requirements in Chapter 64E, Part XIII, Florida Administrative Code.

~· Troxler Electronic Laboratories, Inc. P.O. Box 12057- 3008 E. Cornwallis Road- Research Triangle Park, NC 27709

TheleaderinCon!.tr;_;-ct~-fustin'gEq~;e~ Phone:{919) 549-8661- Fax: (919) 549-0761- www.troxlerlabs.com

Nuclear Gauge Safety ~ OL Tracking Code: 75A596E6889EK9A_82580

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as required by U.S. DOT and lATA This certifies that

MUZAFFAR HASAN .

has been trained and tested in accordance with the U.S. Department of Transportation and International Air Transport Association (lATA) hazardous material requirements for general awareness/familiarization, function-specific, safety, and security awareness training as related to the transportation of nuclear gauges. A description of the training course materials is available from Troxler Electronic Laboratories, Inc. This certificate expires three years from the training date shown below.

September 29, 2015

EMPLOYER CERTIFCATION I certify that the hazmat employee identified on this certifcate has been trained and tested as required by U.S. DOT Hazardous Material Regulations (49 CFR 172 Subpart H).

n ~- -i + Signature ~ Title f f) 0 l 1.---0 (_("

~

The leader in Construction Testing Equipment

Course: Hazmat

Troxler Electronic Laboratories, Inc. PO Box 12057-3008 Cornwallis Road- Research Triangle Park, NC 27709

Phone: (919) 549-8661 -Fax (919) 549-0761 - www.troxlerlabs.com

Tracking Code:75A596E6889EK9A_82579

JVucCear qauge Safety Certification This certifies that

Dipak Tiwari

has successfully completed training on radiation safety and regulatory requirements for the use of portable nuclear gauges on this date.

March 04,2016

This certificate is not valid until signed by the licensee RSO. I atte>st that the person named above, and no other. has completed the online course and tests . (certify that the individual has completed practical skills training for setting up and making measurements. routine maintenance, packaging and transport, storage, and emergew1cy · rocedures for portable nuclear gr:mges. 7 ~~ Licensee RSO .D,c,~~<.ll.e-.. S'c.NvJO 1 3 -<f - tC,

(pti.ntno.uue) Signatun• Date

Troxler Online Training meets the requirements in Chapter 64E, Part XIII, Florid<l. Administrative Code .

~ '' Troxler Elect ronic Laboratories, Inc. __ · ·~_,.R.QXlER. P.O. Box 12057 • 3008 E. Cornwallis Road- Research Triangle Park, NC 27709 Th·"' L~"dcr .,... c~r,s-:ru-.:r·o!" Tes~ '~'~'3 Eo~ ... ~cr.: Phone: (919) 549-8661 - Fax.: (919) 549-0761 - vvww.troxlerlabs.com

Nuclear Gauge Safety- OL Tracking Code: FE7HK8AKHD979M5_89539

l/'' ".:'' 'iiaWi QiiAW ':. '~' 'XflBfW.W: • §3!·.~··---·..!'.··· •32!-"-IIIJ. ~·~:-.!~-.··-···iii· ·5··· ~QJJ&f' t'iC' ;a::;;

I CAT as required by U.S. DOT and lATA

This certifies that

Dipak Tiwari

has been trained and tested in accordance with the U.S. Department of Transportation and International Air Transport Association (lATA) hazardous material requirements for general awareness/familiarization, function-specific, safety, and security awareness training as related to the transportation of nuclear gauges. A description of the tra ining course materials is available from Troxler Electronic Laboratories, Inc. This certificate expires three years from the training date shown below.

March 04, 2016

EMPLOYER CERTIFCATION I certify that the hazmat employee identified on this certifcate has been trained and tested as required by U.S. DOT Hazardous Material Regulations (49 CFR 172 Subpart H) . .

Signature ~~ Title ~6ftOt::.AJT (!!.so

J, 'r~t)Y:!,~ '"

The Leader in Construction Testing Equipment

Course: Hazmat

....

Troxler Electronic Laboratories, Inc. PO Box 12057-3008 Cornwallis Road- Research Triangle Park, NC 27709 Phone: (919) 549-8661 - Fax (919) 549-Q76l- www.troxlerlabs.com

Tracking Code:FE7HK8AKHD979M5_89538

"'

Radiation Safety Program

Annual Review

Date of Audit: March 31, 2017

Licensee Name K&S Engineers, Inc. License No. IL-020055-0 1

Auditor(s) ~ .~b Signature(s)

1. Audit History A. Last audit ofthis location was conducted on October 03,2016 B. Were previous audits conducted yearly?YES C. Were records of previous audits maintained? YES ll. Were any deficiencies identified during the last two audits or two years, whichever is

longer?

2. Organization and Scope of Program A. If the physical or mailing address has changed, was the license amended? N/ A B. If the RSO changed, was the license amended? N/ A C. Does the license authorize the possession and use of all radioactive material contained in

the gauges possessed by the company?YES C. Is the license possession limit exceeded? NO D. Are the actual uses of the gauges consistent with the authorized uses listed on the license?

YES E. Is there a copy of the Illinois Emergency Management Agency (lEMA) radioactive

material license in-house? YES

3. Training and Instruction to Workers A. Did each gauge operator attend a manufacturer's training course, or a training course

recognized and approved by lEMA, prior to using the gauge? YES B. Are nuclear gauge training certificates available for each gauge operator? YES C. Does each user have hazmat employee training as required by 49 CFR 172? YES D. Are hazmat transportation training records available for each gauge operator?_ YES __ _ E. Do hazmat employee training records contain all required information?YES F. Has each DOT training record been signed by an employer certifying official?

YES __ _ G. Have all individuals who frequent areas where radioactive material is used or stored

received the radiation safety instructions required by 32 lAC 400.120(a)? _YES __ H. Do records for 32 lAC 400.120(a) training include the workers signing a statement that

they have received the information and understand it?_ YES ___ _

lEMA PORT GAUGE AUDIT FORM Rc1·l

Radiation Safety Program Annual Review Page 2 of 4

4. Gauge Inventory and Accountability A. Does the licensee have records showing the receipt, transfer, use, storage, and disposal

for EACH gauge possessed under the license? YES B. Are all gauges physically inventoried at least every six months? YES C. Are inventory records maintained? YES D. Are use logs maintained? _YES ___ _ E. Do use logs include times of gauge removal and gauge return to storage? _. _YES __ _

5. Personnel Radiation Protection A. Is there a dosimetry badge for each gauge user? _YES ___ _ B. Are badges exchanged at the appropriate frequency? YES C. Are the reports reviewed by the RSO when they are received? YES D. Is the licensee maintaining records of personnel dosimetry? YES E. Did RSO ensure annual exposure totals for each gauge operator? F. Are dosimetry badges stored in the designated area? YES G. Were abnormal exposures investigated by RSO? NLA

6. Dose to members of the General Public A. Have there been any changes in the storage location, security of the gauges, or use of

surrounding area? NO B. Are the gauges stored in a manner which would prevent unauthorized use or removal of

the gauges? YES

7. Operating and Emergency Procedures A. Does each travel binder have a current copy of the operating and emergency procedures?

YES B. Were there any abnormal occurrences? NO If yes, summarize each incident on a

separate page and determine whether the operator handled the situation appropriately, and that appropriate corrective actions have been taken.

C. Was every incident reported to lEMA in a timely fashion? N/ A

8. Leak Test A. Was each sealed source leak tested at required one-year or six-month intervals?

YES __ _

B. Was the leak test sampling procedure followed?YES C. Are leak test records maintained on file?YES D. Were any sources found to be leaking? _NO __

N/A

9. Paperwork Required at Temporary Jobsites

If yes, was lEMA notified?

A. Is current license, including all active amendments, included in travel binder/packet or shipping case? YES

M:\WORDUEMA I'OIU GAUG E AUDIT FORM DOC


B. Is manufacturer's instruction manual for the sealed sources and devices included in travel binder/packet or shipping case? _YES __ _

C... Are licensee's emergency procedures included in travel binder/packet or shipping case? YES ___ _

D. Are the results of the most recent leak tests included in travel binder/packet or shipping case? YES

10. Transportation A. Are Type A Package certifications maintained on file? YES B. Are Special Form certificates maintained on file? YES C. Does each package have two (2) labels on opposing sides (e.g. Radioactive Yellow-H)

with transport index (TI), radionuclide, and activity? YES D. Is each shipping case properly marked (e.g. , RQ, proper shipping name, UN ID, and USA

DOT 7A TYPE A)? YES E. Arc shipping papers and emergency response infonnation maintained within easy reach

of driver (i.e., on front seat beside driver) and readily visible? YES F. Do shipping papers contain the proper information? YES G. Was the shipping case properly blocked and braced during transport to prevent

movement? YES H. Were locks fastened on the source rod handle, shipping case, and truckbed box?YES I. Were any transportation incidents reported to lEMA or DOT? N/A J. Does EACH transport vehicle meet the two-lock rule? _ YES __

11 . Posting and Labeling A. Is the latest revision of the lEMA form "Notice to Employees" posted? YES B. Are regulations located where indicated on the "Notice to Employees" form? YES

C. Is a warning label with the international radiation symbol and "Caution, Radioactive Materials" posted on each storage cabinet? YES

12. Deficiencies Identified In Audit; Corrective Actions A. Summarize any problems/deficiencies identified during this audit.N/ A B. If problems were identified during this audit, describe corrective actions planned or

taken.N/A C. Provide any recommendations for improvement.N/A

13. Evaluation of Other Factors A. Senior licensee management is appropriately involved with the radiation protection

program and/or the Radiation Safety Officer (RSO) oversight of the program? YES B. RSO has sufficient time and resources to perform his/her radiation safety duties? YES C. Licensee has sufficient staff to support the radiation protection program? YES D. Is the RSO fulfilling his/her duties? YES

M' \WORD\IEMA PORT GAUGE AUDIT FORM.IJOC

Radiation Safety Program Annual Review

Page4of4 ~

...... RSO Signature Dibakar Sundi

Managemen~ijit~

M·IWORD'JEMA f~)ltr GAUGE AUDJT FORM.DOC

Date 03/31 /2017

Date 03/31/2017


Annual Review

Date of Audit: October 03 , 2016

Licensee Name K&S Engineers, Inc. License No. IL-020055-0 1

Signature(s)

1. Audit History A. Last audit of this location was conducted on May 03 , 20 16 B. Were previous audits conducted yearly?YES C. Were records of previous audits maintained? YES .lb Were any deficiencies identified during the last two audits or two years, whichever is

longer?



YES E. Is there a copy of the Illinois Emergency Management Agency (lEMA) radioactive



recognized and approved by lEMA, prior to using the gauge? YES B. Are nuclear gauge training certificates available for each gauge operator? YES C. Does each user have hazmat employee training as required by 49 CFR 172? YES D. Are hazmat transportation training records available for each gauge operator?_ YES __ _ E. Do hazmat employee training records contain all required information?YES F. Has each DOT training record been signed by an employer certifying official?



they have received the information and understand it? _YES ___ _

lEM A PORT GAIJt.E AUDIT FORM Rev2



for EACH gauge possessed under the license? YES B. Are all gauges ,physically inventoried at least every six months? YES C. Are inventory records maintained? YES D. Are use logs maintained? _YES ___ _ E. Do use logs include times of gauge removal and gauge return to storage? _YES __ _

5. Personnel Radiation Protection A. Is there a dosimetry badge for each gauge user? _YES ___ _ B. Are badges exchanged at the appropriate frequency? YES C. Are the reports reviewed by the RSO when they are received? YES D. Is the licensee maintaining records of personnel dosimetry? YES E. Did RSO ensure annual exposure totals for each gauge operator? F. Are dosimetry badges stored in the designated area? YES G. Were abnormal exposures investigated by RSO? N/ A .



the gauges? YES




C. Was every incident reported to lEMA in a timely fashion? N/A


YES __ _ B. Was the leak test sampling procedure followed?YES C. Are leak test records maintained on file?YES D. Were any sources found to be leaking? _NO __

N/A




~ :IWORD\IEMA I'Oitf GAUG~ AUDIT FORM,[)()('


B. Is manufacturer's instruction manual for the sealed sources and devices included in travel binder/packet or shipping case? _YES __ _

C.. Are licensee's emergency procedures included in travel binder/packet or shipping case? YES ___ _


10. Transportation A. Are Type A Package certifications maintained on file? YES B. Are Special Form certificates maintained on file? YES C. Does each package have two (2) labels on opposing sides (e.g. Radioactive Yellow-II)


DOT 7 A TYPE A)? YES E. Are shipping papers and emergency response information maintained within easy reach


movement? YES H. Were locks fastened on the source rod handle, shipping case, and truckbed box?YES I. Were any transportation incidents reported to lEMA or DOT? Nl A J. Does EACH transport vehicle meet the two-lock rule? _YES _ _

11. Posting and Labeling A. ls the latest revision of the lEMA form "Notice to Employees" posted? YES B. Are regulations located where indicated on the "Notice to Employees" form? YES



taken.N/A C. Provide any recommendations for improvement.N/ A


program and/or the Radiation Safety Officer (RSO) oversight of the program? YES B. RSO has sufficient time and resources to perform his/her radiation safety duties? YES C. Licensee has sufficient staffto support the radiation protection program? YES D. Is the RSO fulfilling his/her duties? YES

M:IWOI\DVEMA PORT GAUGE AUDfT FORM. DOC


... RSO Signature Dibakar Sundi Date 10/03/2016

¥~ Management Signature Dijita Sundi Date 10/03/2016

M:\WORD~ EMA I'ORT GAUGE AUDIT FORM DOC


Annual Review

Date of Audit: May 03, 2016

Licensee Name K&S Engineers, Inc. License No. TL-020055-0 1

Auditor(s) Dijita Sundi

[J~9c;io Signature(s)

1. Audit History A. Last audit of this location was conducted on November 12, 2015 B. Were previous audits conducted yearly?YES C. Were records of previous audits maintained? YES J2. Were any deficiencies identified during the last two audits or two years, whichever is

longer?



YES E. Is there a copy of the T11inois Emergency Management Agency (lEMA) radioactive



recognized and approved by lEMA, prior to using the gauge? YES B. Are nuclear gauge training certificates available for each gauge operator? YES C. Does each user have hazmat employee training as required by 49 CPR 172? YES D. Are hazmat transportation training records available for each gauge operator?_ YES __ _ E. Do hazmat employee training records contain all required information?YES F. Has each DOT training record been signed by an employer certifying official?



they have received the information and understand it?_ YES ___ _

lEMA PORT GAUGE AUDIT FORM Rcvl

Radiation Safety Program Annual Rev iew Page 2 of 4


for EACH gauge possessed under the license? YES B. Are all gauges physically inventoried at least every six months? YES C. Are inventory records maintained? YES D. Are use logs maintained? _YES ----E. Do use logs include times of gauge removal and gauge return to storage? _YES __ _

5. Personnel Radiation Protection A. Is there a dosimetry badge for each gauge user? _YES ___ _ B. Are badges exchanged at the appropriate frequency? YES C. Are the reports reviewed by the RSO when they are received? YES D. Is the licensee maintaining records of personnel dosimetry? YES E. Did RSO ensure annual exposure totals for each gauge operator? F. Are dosimetry badges stored in the designated area? YES G. Were abnormal exposures investigated by RSO? NLA



the gauges? YES




C. Was every incident reported to lEMA in a timely fashion? N/A


YES ---B. Was the leak test sampling procedure followed?YES C. Are leak test records maintained on file?YES D . . Were any sources found to be leaking? _NO __

NIA;___




M:\WORD\IEMA I'OHT GAUGE AUDIT FORM.DOC


B. Is manufacturer's instruction manual for the sealed sources and devices included in travel binder/packet or shipping case? _YES--,-__

C. Are licensee 's emergency procedures included in travel binder/packet or shipping case? YES _ __ _


10. Transportation A. Are Type A Package certifications maintained on file? YES B. Are Special Form certificates maintained on file? YES C. Does each package have two (2) labels on opposing sides (e.g. Radioactive Yellow-II)


DOT 7 A TYPE A)? YES E. Are shipping papers and emergency response information maintained within easy reach


movement? YES H. Were locks fastened on the source rod handle, shipping case, and truckbed box?YES I. Were any transportation incidents reported to lEMA or DOT? N/ A 1. Does EACH transport vehicle meet the two-lock rule? _YES _ _

11. Posting and Labeling A. Is the latest revision of the lEMA form "Notice to Employees" posted? YES B. Are regulations located where indicated on the "Notice to Employees" form? YES



taken.N/A C. Provide any recommendations for improvement.N/A


program and/or the Radiation Safety Officer (RSO) oversight of the program? YES B. RSO has sufficient time and resources to perform his/her radiation safety duties? YES C. Licensee has sufficient staff to support the radiation protection program? YES D. Is the RSO fulfilling his/her duties? YES

M·\WORDU EMA PORT GAUGE AUD IT fORM,DOC


RSOSignatur~ ~

Management Signature

Date 05/03/2016

Date 05/03/201 6

M:\W('JRDI/EMA PORT (iAUGL AUDIT FORM DOC


Annual Review

Date of Audit: __ N_o_v_e_m_b_e_r _12_,_2_0_1_5 __

K & S Engineers, Inc. Licensee Name License No. IL-02055-01 ------------------------------

Dibakar Sundi ,{/ ~ Auditor (s) -----------------Signature -----'~--------------------

I. Audit History A. Last Audit of this location conducted on ___ J_u_ne_6._2_0_1_5 __________ _

B. Were previous audits conducted yearly? -----..,..,Y~e_s ____________ ____ _ C. Were records of previous audits'maintained? _Y_e_s ____ _______ _

D. Were any deficiencies identified during the last two audits or two years, whichever is longer? No

2. Organization and Scope of Program A. If the physical or mailing address has changed, was the license amended? _ N_IA __ _ B. If the RSO changed, was the license amended? N/A Does the new RSO meet

training requirements? N/A

C. Does the license authorize the possession and use of all radioactive material contained in the. gauges possessed by the company? VAs

D. Is the License possession limit exceeded? "ffNm-------E. Are the actual uses of the gauges consist~nt with the authorized uses listed on the

license? Yes ----F. Is there a copy of the license in-house? Yes

3. Training and Instruction to Workers A. Did each gauge operator attend the manufacturers training course, or a training course

recognized and approved by the Illinois Department of Emergency Management (lEMA), prior to using the gauge? __ Y_e_s _________ _

B. Are nuclear gauge training records available for each gauge operator? Yes C. Does each user have HAZMA T training as required under 49 CFR 172? __,_Y.wAOLs ---:-:-

D. Is HAZMAT transportation training records available for each gauge operator? Yes E. Do HAZMAT training records contain all required information? _ Y_e_s __ _ F. Has each hazmat training record been signed by an employer certifying official?~


4. Gauge Inventory and Accountability

Licensee

A. Does the licensee have a record of receipt, transfer, use, storage and disposal for EACH gauge possessed under the license? _ Y_e_s __ _

B. Are all gauges inventoried at least every six months? Yes C. Are inventory records maintained? _ _ Y_e_s __ _ D. Are use logs maintained? Yes

5. Personnel Radiation Protection A. Is there a dosimetry badge for each gauge user? Yes B. Are badges exchanged at the appropriate frequency? Yes C. Are the reports reviewed by the RSO when they are received? Yes D. Is the licensee maintaining records of personnel dosimetry? Yes E. Did RSO ensure annual exposure totals for each gauge operator? _Y_e_s _ _ _ F. Are dosimetry badges stored in the designated area? Yes

YeS G. Were abnormal exposures investigated by RSO? ____ _

6. Dose to members of the General Public A. Have there been any changes in the storage location, security of the gauges or use of

surrounding area? __ N_o _ _ _

B. Are the gauges stored in a manner which would prevent unauthorized use or removal of the gauges? Yes


Yes

B. Were there any abnormal occurrences? No Is so, summarize each incident on a separate page and determine whether the operator handled the situation appropriately, and that appropriate corrective actions have been taken.

C. Was incident reported to agency in a timely fashion? N/A

8. Leak Test A. Was each sealed source leak tested at six-month intervals? __ Y_e_s __

B. Was the leak test sampling procedure followed? Yes Yes

C. Does each travel binder have a copy of the most recent leak test? - --- -0. Are leak test records maintained on file? Yes E. Were any sources found to be leaking? If yes, was the agency notified? _N_o ___ _

9. Paperwork Required at Temporary Jobsites A. Current license, including all active amendments, included in travel binder? Yes B. Manufacturers instruction manual for the sealed sources and devices included in travel

binder? Yes C. Emergency procedures included in travel binder? Yes

D. Results of current test for leakage and/or contamination performed on the sealed source devices included in travel binder? Yes - ----

C :IDocumen" and Scllings\Linda\L<x:al Senings\Tcmporvy lntcmcl f-11u\ConlcnlJEl\84DSLMVI\IEMA_Pon_Gauge_Audit_footnl 1l dot


10. Transportation A. Are Type A Package certifications maintained on file? Yes B. Are Special form certificates maintained on file? __ Y_e_s _ _ _

Licensee

C. Does each package have two (2) labels on opposing sides (e.g. Radioactive Yellow-H) with Transport Index (TD, Nuclide and Activity? __ Ye_s _ _ _

D. Is each shipping case pr~rly marked (e.g. RQ, proper shipping name, UN ID, and USA DOT 7 A TYPE A)? _ _ e_s ___ _

E. Are shipping papers and emergency response information maintained within easy reach of driver (i.e. on front seat beside driver)? _ _ Y_es _ _ ___,

F. Do shipping papers contain the proper information? Yes G. Was the transport case properly blocked and braced during transport to prevent

movement? Yes

H. Were locks fastened on the source rod handle, shipping case and truckbed box? Yes I. Were any transportation incidents reported to the agency or DOT? Yes

11. Posting and· Labeling Yes A. Is the .latest revision of the agency fonn "Notice to Employees, posted? ____ _ B. Are regulations located were indicated on the "Notice to Employees" form? _Y_e_s __ C. Is the warning label with the international symbol; "Caution, Radioactive Materials"

posted on each storage cabinet? Yes

12. Deficiencies Identified In Audit; Corrective Actions N/A

A. Summarize any problems/deficiencies identified during this audit. B. If problems were identified during this audit, describe corrective actions planned or

taken. C. Provide any recommendations for improvement.


prow-am and/or the Radiation Safety Officer (RSO) oversight of the program? Yes B. RSO has sufficient time and resources to perform his/her radiation safety duties? Yes C. Licensee has sufficient staff to support the radiation protection program? Yes D. Is the RSO fulfilling his/her duties? _Y_es __ _

11/12/15

RSO Signature Dibakar Sund1 Date

Management Signature Date

C: \Documcnt• ond Sctt ings\Lind&\Loul Seuings\Temporary lnl<m<l Files\ContcnliES\Il4DSLMVNEMA_Port_Gau~c_lludit_Fomt[ I] doc

Radiation Safety Program .

Annual Review

Date of Audit: 616 11 5 ----------------K & S Engineers, Inc. L' . N IL-02055-01 Licensee Name ______________ ....:·--- u~..~"'o~ _

Auditor(s) 4eljko Novakovich Signature £~-~-/

1. Audit History 11/14/14 A. Last Audit of this location conducted on B. ytere previous audits ~nducted yearly? -~Y;:e:::s:--_------.,.._ ___ _

C. Were records of previous audits~JD&intaill¢?-~Y.JiiieUiiils'-----:-::--------D. Were any deficiencies identified during the last two audits or two years, whichever is

longer? ~0

2. Organization and Scope of Program A. If the physioaJ or mailing address has changed, was the license amended? N/A B. If the RSO c.henged, was the license amended? N/A Does the new RSO meet

training requilements? N I A C. Does the license authorize the possession and • of all radioactive material contained in

the gauges possessed by the company? Yes · D. Is the License possession limit exceeded? _·_N_o __ _ E. Are the · actual uses of the gauges consistent with the autho~ us.es listed on the

license? Yes · F. Is there a copy of the license in-house? Yes

3. Training and InstructioJ:l to Workers A~ Did each gauge oneratw attend the mQ~ training course, or a training course

recognized and approved by the Dlinois Department of Emergency Management (lEMA), prior to using the gauge? __ :r_e~$-·----:----.,..-

B: Are nuclear gauge training records avai18ble for each gauge opennor?. Yes C. Does each user have HAZMAT training as requimd under 49.CFll172? _Y_-e...,.s--.,--=-D. Is HAZMA T transportation training records a~le for each gauge cperatotl ~ E. Do HAZMA T training records contain. all requimd infonna1ion? --.:Y;..;;e;;.;;s:;..._ __ F. Has each ha?JDat training record been siped by an employer certifying offic~? ~



Licensee

A. Does the licensee have a record of receipt, transfer, use, storage and disposaJ for EACH gauge possessed under the license? Yes

B. Are aU gauges inventoried at ]east evezy six ·months? Yes C. Are inventory records maintained? _Y_e_s __ _

D. Are use logs maintained? Yes

5. Personnel Radiation Protection A. Is there a dosimetry badge for each gauge user? Yes

B. Are badges excbansed at the appropriate frequency? Yes

C. Are the reports reviewed by the RSO when they are received? Yes

D. Is the licensee maintaining records of personnel dosimetry? Yes E. Did RSO ensure annual exposure totals for each gauge operator? _Y_e_s _ _ _

F. Are dosimetry badges stored in the designated area? ves G. Were abnormal exposures investigated by RSO? Yes

6. Dose to members of the General Public A. Have there been any changes in the storage· location, security of the gauges or use of

surroimding area? No · .

B. Are. the gauges stored in a manner which wou1d prevent unauthorized use or remova1 of the gauges? Yes


Yes

B. Were there any abnonna1 occurrences? No Is so, summarize each incident on a separate page and detenniile whether the operator handled the situation appropriately, and that appropriate corrective actions pave been taken.

C. Was incident reported to agency in a timely fashion? N /A

8. Leak Test A. Was each sealed source leak tested at six-month interva1s? Yes - ----B. Was the leak test sampling procedure followed? _Y_e_s ___ _

Yes C. Does each travel binder have a copy of the most recent leak test? ---- -D. Are leak test reoord$ maintained on file? Yes E. Were any sources found to be leaking? If yes, was the agency notified? _N_o _ _ _ _

9. Paperwork Required at Temporuy Jobsites A. Current license. including all active amendments, included in travel binder? Yes

B. Manufacturers instruction manual for the sealed sources and devices included in travel

bind~? ___ Y_e_s ________ ~----------~~---------------------------C. Emergency procedures included in travel binder? Yes

D. Results of current test for leakage and/or contamination performed on tbe sealed source devices included in ~vel bind~? Yes ··

'"'•,. •uift Kevtew Page 3 of 3

10. Transportation A. Are Type A Package certifications maintained on file? Yes B. Are Special form certificates maintained on file? Yes

Licensee

c. D?es each package have two(~) Jabels 0~ ~pposinR sides (e.g. Radioactive YelJow-11) with Transport Index ('11), Nuchde and Act1v1ty? Y s ·

D. Is each shipping case properly marked (e.g. RQ, proper shipping name, UN ID, and USA DOT 7 A TYPE A)? ves

E. Are shipping papers and emergency response information maintained within easy reach of driver (i.e. on front seat beside driver)? _Y_e_s ___ _

F. Do shipping papers contain the proper information? Yes

G. Was the transport case properly blocked and braced during transport to prevent movement? Yes

H. Were locks fastened on the source rod handle, shipping case and truckbed box? Yes I. Were any transportation incidents reported to the agency or DOT? _N_o __ _

11. Posting and· Labeling A. Is the latest revision of the agency form ''Notice to Employees" posted? Yes B. Are regulationS located were indicated on the "Notice to Employees" form? Yes C. Is the warning label with the international symbol; "Caution, Radioactive Materials"


12. Deficiencies Identified In Audit; Corrective Actions N I A A. Summarize any problems/deficiencies identified during this audit. B. If problems were identified during this audit, describe corrective actions planned or



program and/or the Radiation Safety Officer (RSO) oversight of the program? Yes B. RSO .has sufficient time and resources to perform hislhe-.r radiation safely duties? .Yea C. Licensee has sufficient staff to support the radiation protection program? ___,Y:..::e:.::s __

D. Is the RSO fulfilling~ duties'! . Yes

RSO Signature ~ .. .

Zeljko Novakovich Date

Management Signature oibakar sundi ..,_ Date

C:\Docwneats and Seuq;ill .. inda\Loc:ol Seuinss\Tomporary lnten>Ol F"du1Contcn1.Je\1140SOOJ\IEMA_Port_<iti!p_Aullit_Fonnilldoc

Radiation Safety Program .

Annual Review

Date of Audit: __ · ..1..1 ..1..1 ;../...~..1 ._4~.-1..:...1 ..:..4 ----.---

K & s Engineers, Inc. L' IL-02055-01

Licensee Name ----------S-1.-rn.-atn-~e -~.- . ( lcense No. .

Auditor (s) -~tidol:f pas ~~· ~

I. Audit Histozy s 1 1.41 1 4 · A. Last Audit of this location conducted on--=--------------B. Yfere previous audits ~nducted yearly? __ Y_e_s_..,..._ -----------C. Were records of previous audits'nurin~?-__.Y....,e....,s.__--:-:--------D. Were any deficiencies identified during the last two audits or two years, whichever is

longer? No

2. Organization and Scope of Program A. Ifthc physical or mailing address has changed. was the license amended? N{A B. If the RSO changed, was the license amended? N {A Does the new RSO meet

training rcquimnents? N I A C. Docs the license authorize the possession and ~e of all radioactive material contained in

the gauges possessed by the company? Yes D. Is the License possession limit exceeded? _N_o __ _

E. Are the actual uses of the gauges consistent with the authorized uses listed on the license? Yes

F. Is there a copy of the license in-house? Yes

3. Training and Instruction to Workers A: Did C8Ch gauge operator attend the manufac~rs training course, or a training course

recognized and approved by the Dlinois Department of Emergency Management (lEMA), prior to using the gauge? _':;{_e_s:--· -------

B: Are nuclear gauge training records a~le for each gauge opemtor?. Yes C. Does each user have HAZMAT training as required under 49_CFR 172? ...,Y_·e...,.s----r~I":'::'-D. Is HAZMA T transportation training records available for each gauge operator? Yes E. Do HAZMA T training records contain all .required information? Yes · F. Has each hazmat training record been signed by ari employer certifYing offic~? ~

""u•at•on barely Program Annual Review Page 2 of 3


Licensee

A. Does the licensee have a record of receipt, transfer, use, storage and disposal for EACH gauge possessed under the license? Yes

B. Are all gauges inventoried at least every six .months? Yes C. Are inventory records maintained? _Y_e_s __ _ D. Are use logs maintained? Yes

5. Personnel Radiation Protection A. Is there a dosimetry badge for each gauge user? Yes B. Are badges exchanged at the appropriate frequency? Yes C. Are the reports reviewed by the RSO when they are received? Yes

D. Is the licensee maintaining records of personnel dosimetry? Yes E. Did RSO enswe annual exposure totals for each gauge operator? _Y_e_s __ _ F. Are dosimetry badges stored in tlie designated area? ves

G. Were abnonnal exposures investigated by RSO? Yes

6. Dose to members of the General Public A. Have there been any changes in the storage location, security of the gauges or use of

surroimding area? _N;..;.o..;;..._ _ _ _

B. Are. the gauges stored in a manner which would prevent unauthorized use or removal of the gauges? Yes


Yes

B. Were there any abnonnal occurrences? No Is so, summarize each incident on a separate page and detennine whether the operator handled the situation appropriately, and that appropriate corrective actions have been taken.

C. Was incident reported to agency in a timely fashion? N I A

8. Leak Test A. Was each sealed source leak tested at six-month intervals? _Y_e_s_· __ B. Was the leak test sampling procedure followed? Yes ------Yes C. Does each travel binder have a copy of the most recent leak test?-----D. Are leak test records maintained on file? Yes E. Were any sources found to be leaking? If yes, was the agency notified? _N_o ___ _

. 9. Paperwork Required at Temporary Jobsites

A. Current license, including all active amendments, included in travel binder? Yes B. Manufacturers instruction manual for the sealed sources and devices included in travel

binde~ ___ Y~e~s-----------------------------------------C. Emergency procedures included in travel binder? Yes D. Results of current test for leakage and/or contamination performed on ~he sealed source

devices included in travel binder? Yes ·

C :\DocumoniJ Uld SctiU.,s\Linda\Local Scltiftii$\Temporwy lntcmol filoslContOAt.IES\84DSLMVI\IEMA_Port_ Gauj~<_A~dil_f~rm[ I]Aiot

Annual Review Page 3 of 3

1 0. Transportation A. Are Type A Package certifications maintained on file? Yes B. Are SpeciaJ form certificates maintained on file? Yes

Licensee

C. D?es each package have two(~) .labels o~ ~pposin~Jides (e.g. Radioactive YelJow~Il) w1th Transport Index (11), Nuchde and Activity? _Y ___ _

D. Is each shipping case properly marked (e.g. RQ, proper shipping name, UN ID, and USA DOT 7 A TYPE A)? ves

E. Are shipping papers.and emergency response infonnation maintained within easy reach of driver (i.e. on front seat beside driver)? _Y_e_s __ _

F. Do shipping papers contain the proper information? Yes G. Was the transport case properly blocked and braced during transport to prevent

movement? Yes H. Were locks fastened on the source rod handle, shipping case and truckbed box? Yes I. Were any transportation incidents reported. to the agency or DOT? _N_o __ _

1 1. Posting and· Labeling A. Is the latest revision of the agency fonn ''Notice to Employees" posted? Yes B. Are regulationS located were indicated on the "Notice to Employees" form? xes C. Is the warning label with the international symbol; "Caution, Radioactive Materials"


12. Deficiencies Identified In Audit; Corrective Actions N I A A. Summarize any problems/deficiencies identified during this audit. B. If problems were identified during this audit, describe corrective actions planned or



program and/or the Radiation Safety Officer (RSO) oversightofthe program? Yes B. RSO has sufficient time and resources tQ perfonn his/her mdiation safety duties? ..Yes. C. Licensee has sufficient staff to support the radiation protection program? ---=Y=e=s __ D. Is the RSO fulfiiiing his/her duties? . Xes

RSO Signature Date

Management Signature Dibakar sundi Date

C:\Documento ond Setti~~j;s\Llnda\Local Settings\Tomporary Internet Filu\Conltnt.IESIB4DSLMVJ\IEMA_Port_Gauae_Audit_Fonn(l).doc

--------------


Annual Review

Date of Audit: __ 5 _I 1_4_1_1_4 ____ _

IL-02055-01 Licensee Name K & S Engineers' Inc· -~~License No.

Auditor(sfudolf Das Signature ~-----------

1. Audit History A. Last Audit of this location conducted on ___ 1_1_/_1_1_/_1_3 ________ _ B. Y'fere previous audits conducted yearly? __ _,Y...,eus..__· __________ _

C. Were records of previous audits-maintained? -¥¥-ee~s~-----------D. Were any deficiencies identified during the last two audits or two years, whichever is

longer? __ ~~-----------------------------

2. Organization and Scope of Program A. If the physical or mailing address has changed. was the license amended? _N...;.../_A. ___ _

B. If the RSO changed, was the license amended? No* Does the new RSO meet training requirements? Yes

C. Does the license authorize the possession and use of all radioactive material contained in the gauges possessed by the company? Yes

D. Is the License possession limit exceeded? ....~Nwoo.t.._ __ _ E. Are the actual uses of 1he gauges consistent with the authorized uses listed on the

license? Yes F. Is there a copy of the license in-house? Yes

3. Training and Instruction to Workers A. Did each gaug~ operator attend the manufacturers training course, or a training course

recognized and approved by the Illinois Department of Emergency Management (lEMA), prior to using the gauge? -Y.&.JPo:=.oS:lo.----------

B. Are nuclear gauge training records available for each gauge operator? Yes C. Does each user have HAZMAT training as required under 49 CFR 172?Y_e_s ___ _ D. Is HAZMA T transportation training records available for each gauge operator? ve s

E. Do HAZMA T training records contain all required information? _Y.=,.e;:::;s=----F. Has each hazmat training record been signed by an employer certifying official? Yes

* New RSO information was included in IEM~ License Renewal ~pplication submitted 1/14/14.

-- --- - ---------------------'



Licensee

A. Does the licensee have a record of receipt, transfer, use, storage and disposal for EACH gauge possessed under the license? Yes

B. Are all gauges inventoried at least every six months? Yes

C. Are inventory records maintained? Yes D. Are use logs maintained? Yes

5. Personnel Radiation Protection A. Is there a dosimetry badge for each gauge user? Yes

B. Are badges exchanged at the appropriate frequency? _Y=-e=s __ C. Are the reports reviewed by the RSO when they are received? Yes

D. Is the licensee maintaining records of personnel dosimetry? Yes E. Did RSO ensure annual exposure totals for each gauge operator? _Y_e_s ___ _

F. Are dosimetry badges stored in the designated area? Yes G. Were abnormal exposures investigated by RSO? Yes

6. Dose to members of the General Public A. Have there been any changes in the storage· location, security of the gauges or use of

surrounding area? ___.;N;.;;_o.:;._ __ _

B. Are the gauges stored in a manner which would prevent unauthorized use or removal of the gauges? _Y ..... eM,.Ws __ _

7. Operating and Emergency Procedures A. Does each travel binder have a current copy of the operating and. emergency procedures?

Yes

B. Were there any abnormal occurrences? No Is so, summarize each incident on a separate page and determine whether the operator handled the situation appropriately, and that appropriate corrective actions have been taken.

C. Was incident reported to agency in a timely fashion? N I 'A

8. Leak Test A. Was each sealed source leak tested at six-month intervals? _....y._,e .... s.._ __ B. Was the leak test sampling procedure followed? -.::::.Y..;;;.e..;:.s __ _

C. Does each travel binder have a copy of the most recent leak test? ves

D. Are leak test records maintained on file? yes E. Were any sources found to be leaking? If yes, was the agency notified? _N_o ___ _

9. Paperwork Required at Temporary Jobsites A. Current license, including all active amendments, included in travel binder? Yes B. Manufacturers instruction manual for the sealed sources and devices included in travel

binder?_~~--------------------------------------------------C. Emergency procedures included in travel binder? Yes

D. Results of current test for leakage and/or contamination performed on t.he sealed source devices included in travel binder? Yes ------

C:\Documenl• and Senings\Undo\l..oul Senings\Tempol'll}' fnlemel File•\Content.IESIB40Sl.MVJIIEMA_Port_Gouge_Audit_F~nn[ 1 ].doc

--------------------------------

Radia tion Safety Program Annual Review

Licensee

Page 3 of 3

1 0. Transportation A. Are Type A Package certifications maintained on file? Yes B. Are Special form certificates maintained on file? Yes C. Does each package have two (2) labels on opposing sides (e.g. Radioactive Yellow-H)

with Transport Index (TD, Nuclide and Activity? Yes D. Is each shipping case properly marked (e.g. RQ, proper shipping name, UN ID, and USA

DOT 7 A TYPE A)? _Y_e_s ___ _ E. Are shipping papers and emergency response information maintained within easy reach

of driver (i.e. on front seat beside driver)? -=Y...;::e...;::s __ _ F. Do shipping papers contain the proper information? y 950

G. Was the transport case properly blocked and braced during transport to prevent movement? Yes

H. Were locks fastened on the source rod handle, shipping case and truckbed box? --Y.e.s I. Were any transportation incidents reported to the agency or DOT? --'N:...:.o.;:;._ __

11. Posting and· Labeling A. Is the latest revision of the agency form. "Notice to Employees» posted? Yes B. Are regulations located were indicated on the "Notice to Employees" form? Yes C. Is the warning label with the international symbol; "Caution, Radioactive Materials"

posted on each storage cabinet? Yes , •

12. Deficiencies Identified In Audit; Corrective Actions A. Summarize any problems/deficiencies identified during this audit. N I A

B. If problems were identified during this audit, describe corrective actions planned or taken.

C. Provide any recommendations for improvement.


program and/or the Radiation Safety Officer (RSO) oversight ofthc program? Yes B. RSO has sufficient time and resources to perform his/her radiation safety duties? Yes C. Licensee has sufficient staff to support the radiation protection program? Yes D. Is the RSO fulfilling his/her duties? .-,y~e:w;s~--

'itf oas Date

5/14/14

RSO Signature

5/14/14

Management Signature Dibakar sundi, Pres. Date

C\Documents and Scnings\Linda\Local Sellings\Temporary Intern<! Files\ContcnUE51Jl4D5LMVJ\IEMA_Port_Gauge_Audit_Form[l ],doc

KE: Account No. 7UY/J2

Reply Reply Al l Forward

RE: Account No. 705732

Dibakar Sundi

To: [email protected]

Can you please send the reports from 2013 to date?

Dibakar Sundi, P.E.


From: [email protected] [[email protected]] Sent: Wednesday, August 09, 2017 8:36AM To: Dibakar Sundi Subject: RE: Account No. 705732

Good morning Dibakar,

Page 1 of l

Wednesday, August 09, 2017 11:06 AM

I have updated the contact to your information as requested. Can you provide which reports you are requesting to be mailed to you? Thank you, Nicole

From: [email protected] Sent: 2017-08-09TI3:31 :04.000Z To: [email protected] Subject: Account No. 705732 Please be advised that Mr. Firooz Zandi left K & S Engineers, Inc. in June 2015. Therefore, I am asking that you please change your contact information to my name, email and phone number in your records for th is account. Also, can you please release the reports in connection with this account and send them to me at the address below as soon as may be possible. Should you have any questions or need any additional information in order to process this request, please do not hesitate to contact me. Thank you.

Dibakar Sundi, P.E. President


https://remote.kandsengineers.com/OW A/?ae=Item&a=Open&t=IPM.Note&id=RgAAAAA. .. 8/9/2017

Account No. 705732 Page 1 of 1

Reply Reply All Forward

Account No. 705732

Dibakar Sundi

To: [email protected]

Tuesday, August 08, 2017 4:13PM

This message was sent with High importance.

Please be advised that Mr. Firooz Zandi left K & S Engineers, Inc. in June 2015. Therefore, I am asking that you please change your contact information to my name, email and phone number in your records for this account. Also, can you please release the reports in connection with this account and send them to me at the address below as soon as may be possible. Should you have any questions or need any additional information in order to process this request, please do not hesitate to contact me. Thank you.

Dibakar Sundi, P.E. President

K & S Engineers, Inc. 9715 Kennedy Avenue Highland, IN 46322 (219)-924-5231 ext. 105 www .kandsengineers.com

https:/ /remote.kandsengineers.com/0 W A/?ae=Item&a=Open&t=IPM.N ote&id=RgAAAAA... 8/8/2017