July 25, 2016

Director of FSME Attn: GLTS USN RC Washington, DC 20555-0001

NOURISHING THE: BE:ST START IN LIFE:

2400 W. Lloyd Expressway Evansville, Indiana 47721

(812) 429-5000

In fulfillment of the requirements of 10 CFR 31.5 (c) 8, we hereby notify you that we transferred 32 self-luminous exit signs as described below:

From General Licensee: Mead Johnson Nutrition 2400 West Lloyd Expressway Evansville, Indiana 47721 - 0001 GL-704570-20 .

To Specific Licensee: SRB Technologies, Inc. 2850 Landmark Drive Winston-Salem, NC 27103 NC DHHS Radioactive Materials License #034-0534-2

Date of Transfer: 3/24/2016

Description of Devices Transferred: Exit signs containing tritium as per the attached Inventory Form

If you have any. questions related to the above noted items, please contact me at 812-429-7150.

teve Schapker Radiation Safety Officer

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TRITIUM EXIT SIGN INVENTORY FORM i::~[ Record an inventory of the exit signs using the manufact~1 re r label information on the back of the sign. DO NOT REMOVE THE LABEL FROM THE : :·: r SIGN. Note: Double faced signs made by con.nect lng two "gns ba ck-to-back should be cou nted as two signs even if th ere is one se ri al number on :} : the housing. If you have one or more back-to-back signs, b1ease list each one twice. ~:~ . ~ t :::::

INSTALLATION SITE NAME: ---~M~ea=d~J~o~h~n=so=n~N~u~t~ri=t i=o"'-n------------------------

BOX # 1 OF _ _ 4~--Decay corrected 8

I I I DATE OF I CURIES PER

DESCRIPTION/MFR. MODEL NUMBER SERIAL NUMBER MANUFACTURE UNIT or LIFE RATING

Omniglo 7DDC/20 6147 2/93 5.4

Omniglo 700C/20 1565 1/95 6.1

Omniglo 7DDC/20 6146 2/93 5.4

Omniglo 7DDC/20 8105 6/91 4 .9

Omnlglo 7DOC/20 8110 6/91 4.9

Dmniglo 7DDC/2 0 1792 1/95 6.1

Omniglo 70DC/2D 7823 6/91 4.9

Omniglo 7DDC/20 2145 2/95 6.1

Omniglo 7DDC/20 J710 3/90 4.6

Omniglo 700C/20 7805 6/92 5.2

Describe any damaged units : Please email pictures of damaged signs to Veolia.

I hereby certify that all information submitted on this form contains true and accurate descriptions of the exit signs.

Generator Signature:

Print Name: Date: 2o!b :-=~~-

Tritium Exit Sign Ins t ructions (Field Services) , Revision 0, Oct 2015

9

,---------------------------------------------! l .-VEOLIA USE a;gLY, FIELD SERVICES : : -~ ! ~ i I I I I I I I I I I

I l L--------- -------------- - ---------- .r~~------ -!

G)veOLIA ,---------------------------------------------. I VEOLJA,!!SE ONLY : I " IFS. 1 I RGA #· I·--· I : . ~ : ! DATE ISSUED: i I I : EXPIRATION DATE: :

L---- ---------- - - - ---------- - ---------~------ ! TRITIUM EXIT SIGN INVENTORY FORM

Reco rd an inventor!Jf the exit signs using the manufacturer label information on the back of t he sign . DO NOT REMOVE,k HE LABEL FROM THE SIGN. Note: Double ~·ced s igns made by connecting two signs back-t.o-back should be counted as two sigrys even if there is ~ne serial number on t he housing. If you h~ve one or more back-to-back signs, please list each one twice. I~

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BOX # _ _,2,,__ _ _ OF __ -'4 __ _

Decay corrected

Onmiglo 700C/20 7845 6/92 5.2

Onmiglo 700C/20 7840 6/9Z 5.2

Onmiglo 700C/20 1731 1/95 6.1

Onmiglo 700C/20 7811 6/92 5.2

Onmiglo 700C/20 7850 6/92 5.2

Onmiglo 700C/20 1546 1/95 6.1

Onmiglo 700C/20 2843 10/92 5.3

Onmiglo 700C/20 1555 1/95 6.1

Onmiglo 700C/20 Label damaged 2 N/A N/A

Onmiglo 700C/20 Labe l damaged 3 N/A N/A

Describe any damaged uriits : Please email pictures of damaged signs to Veolia.

I hereby certify that all information submitted on th is form contains true and accurate descriptions of the exit signs.

Generator Signature :

Print Na me: Dat e:

Tritium Exit Sign Instructions (Fie ld Se rvices), Revisio n 0, Oct 2015

9

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:---------------------------------------------, : 1- ~- \- VEQ PA us~ ON LY~- i l !., RGA 1#: ~ . ~ !., ' l I I

l DATE ISSUED: ; I I

i EXPIRATION DATE: l J : ~-------------------------------------- - ----- · ~-

TRITIUM EXIT SIGN INVENTORY FORM Record an inventory of the exit signs using the ri;nufact~·er label information on the back of the sign. DO NOT REMOVE THE LABEL FR~M THE SIGN. Note·: Doub.le faced signs made by co:nnecti(lg two si ns back-to-back should be counted as two signs even if there is one serial number on the housing. If you have one or more back-to-back signs, p ease list each one twice.

r r t INSTALLATION SITE NAME: ----~M~e=ad~Jo=h~n~s=o~n~N~u~t~r~it~io~n~----------------....,,----------

BOX #_--'4 ___ OF __ 4~--

Perm-Ex by NRD Inc.

Perm-Ex by NRD Inc.

Describe any damaged units: Please email pictures of damaged signs to Veolia .

T-4001 109346 5/96

T-4001 109347 5/96

I hereby certify that QI/ information submitted on this form contains true and accurate descriptions of the exit signs.

Ge ne rator Signature:

Print Name: Date:

Tritiu m Exit Sign Instructions (Fi eld Se rvices), Revision O, Oct 2015

Decay corrected

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