~IISI'O, IN(~. 3000 WRIGHT ROAD !lUlTE B, IDAHD FALL!i, IDAHD B34D'

Native American Owned Business, DBE

Date: April 30. 2013

NUCLEAR MATERlALS LICENSING SECTION U.S. Nuclear Regulatory Commission, Region IV 611 Ryan Plaza Drive. Suite 400 Ar1il1i,~on. TX 76011-8064

AT rN: Licensing Assistant

PUBLIC o-)r6medlate Release il' Nonnal Release ~ .--. 0 ~ " c.j

jA..t: ::. 0

NON-PUBUC . I ted a A.3 sensltlve-5ecunly Re a a A.7 Sensitive Internal

a Other: ~"2 .A( Date: I ./

Reviewer: ... I"Ut,:.::::...---

Information Needed for Change of RSO

Docket# License #

030-38005 11-29341-01

We are requesting an expedited amendment to our materials license stated above. due to a change in RSO assi gnment.

I) Any change in personnel having control over licensed acti vities (e.g., officers of a corporation) and any change in personnel named in the license such as RSO, authorized users, or any other person identified in previous license applications as responsible for radiation safety or use of licensed material. The licensee should include information concerni ng the qualifications, training. and responsibilities of new individuals.

Rick R. Gokey will become RSO ~rMJSKO. il1c., and is responsible charge 0/011 radialion sa/ely and the use of licensed materials. All individuals re!,ponsihle/or the radiation safety and the use ofllle licensed material will be trained as staled in fhe originallicelIse.

The change in RSO is e{reclive April 26.2013.

Attached is a copy of Rick Gokey's resume (Exhibit A) and his Radiation Safety O fficer Certification (Exhibit B). These documents shall be pan of this document and identified as Exhibit A and Exhibit B. If you have any additional questions or need further clarification, please cal l Rick Gokey at 208-589-4925. Thank you in advance for your efforts to expedite thi s Materials License Amendment.

Information Needed for Change of RSO Page 1

~IISI'O, INf. 3000 WRIGHT ROAD SUITE B, IDAHO FALl.!i, IDAHO B34D'

Native American Owned Business, DBE

Rick Gokey

Attachment: Exhibit A (Rick Gokey Resume) Exhihit B (Rick Gokey RSO Cel1i fication)

CC: Rick Gokey Karen Gokey

Info rm ation Needed for Change of RSO Page 2

NRC FORM 313 U .S . NUCLEAR REGULATORY COMMISSION APPROVED BY OMB; NO. 3150-0120 EXPIRES: 313112012

(3·2009) Estimated burden per response to comply wah th is mandatory collection request: <1 .3 10 CFR 30.32,33, hours, Submitta l of the application is necessary to determine that the applicant is 34.35.36.39 , ;:md 40 ~uallfied and that adequate proceoures exist to protect the pubtlc heal.!h and safety.

end comments r1jarding burden estimate to the Records and FOIAlPnvacy Services Branch (T·S FS3), .5. Nuclear Regulatory Commission, washi~on. DC 20555-0001.

APPLICATION FOR MATERIALS LICENSE or by internet e-mail to infocollects,resoun::~flfC,goV , and to the ask OffICer, Office of Information and Regulatory A ffa irs, NEOB·1 202, (3150-01 20), Office of Management and Budget. washington, DC 20503. If a means used to impose an information collection does not d isplay a currently valid OMS control number. the NRC may not conduct or sponsor, and a person IS not reqUired to respond to, the Information collection.

INSTRUCTIONS: SEE THE APPRO PRIATE LICEN SE APPLICATION GUIDE FOR DETAILED INSTRlCTION S FOR COM PLETIN G APPLICATION. SEND TWO COPIE S OF THE E N T IRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIE[ BELOW.

APPLICATION FOR OISTRIBUTION OF EXEMPT PROOUCTS fiLE APPLICATIONS WITH : IF YOU ARE LOCATED IN :

OFFICE OF FEDERAL &. STATE MATERIALS !\NO ILLINOIS, INDlANA. IOWA, MICHIGAN, MINNESOTA, MISSOURI. OHIO. OR WISCONSIN, SEll)

ENVIRONMENTAL MANAGEMENl PROGRAMS APPLICATIONS TO;

DIVISION OF MATERiAlS SAFETY AND STATE AGREEMENTS US. NUCLEAR REGUlATORY r..ov.MISSION WASHINGTON. DC 20555-0001

MATERIALS LICENSING BRANCH US. NUCLEAR REGULATORY COMMISSION REGION 111

ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS; 2443 WARRENVILLE ROAD, SUITE 21O LISLE, Il 60532-4352

IF YOU ARE LOCATED IN ;

ALABAMA, CONNECTICUT. DELAWARE, DISTRICT OF COLUMBIA, FLORIDA, GEORGIA, ALASKA, ARIZONA. ARKANSAS, CALifORNIA, COLORADO, HAWAII, IDAHO, KANSAS, KENTUCKY, MAINE , MARYLAND, MASSACHUSETTS, NEW HAMPSHIRE, NEW JERSEY, lOUISIANA, MISSISSIPPI, MONTANA, NEBRASKA, NEVADA, NEW MEXICO. NORTH NEW YORK, NORTH CAROLINA. PENNSYLVANIA, PUERTO RICO, RHODE ISLAND. SOUTH DAKOTA. OKLAHOMA, OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, TEXAS. CAROLINA, TENNESSEE , VERMONT, VIRGINIA, VIRGIN ISLANDS, OR WEST VIRGINIA. UTAH. WASHINGTON. OR WYOMING, SENO APPLICATIONS TO; SEND APPLiCATIONS TO:

LICENSING ASS ISTANCE TEAM I NUCLEAR MATERIAlS LICENSING BRANCH DtVlSIONOF NUCLEAR MAT ERlAl.$ SAFETY U.S. NUCLEAR REGUlATORY COMMISSION. REGtON IV US NUCLEAR REGULATORY COMMISSION. REGION J

I e12 E. lAMAR BOUlEVARD, SUITE 400

4 / !> ALLENDALE ROAD ARLINGTON, TX 76011..4125 K1NG OF PRUSSIA. PA 19406·141!>

PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUC LEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL IN STATES SUBJECT TO U.S.NUCLEAR REGULATORY COMMISSION JUR1SDICTIONS,

1. THIS IS AN APPLICATION FOR (CIHx:Jf appropriiJlO item) 2. NAME ANO MAILING ADDRESS OF APPliCANT (fncJudo ZIP caal1)

0 " NEW LICENSE MISKO, Inc.

[Z] B. AMENDMENT TO LICENS!: NUMBER 11-29341-01 3000 Wright Rd. St. B

0 Idaho Falls, ID 83401

C. RENEWAL OF LICENSE NUMBER

3. ADDRESS WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED 4. NAME OF PERSON TO BE CONTACTED ABOUT THIS APPLICATION

3000 Wright Rd. St. B Rick Gokey, President

Id"ho rail" ID 83401 TELEPHONE NUMBER

(208) 522-3188

SUBMIT ITEMS 5 THROUGH I I ON8·1/2 X 11" PAPER THE TYPf Aro.tl SCOP€: OF INFORMATION TO BE. PROVIDED IS DESCRIBED IN THE LICENSE APPUCATION GUIDE. , RADIOACTIVE MATERIAl. I . Bemenl ancl mass number; b. chemil;al andIOf ~hr.>lI;al form anC c. ma,~imum amounl , PURPQSE(S) FOR WHICH LICENSED MATERIAL WILL BE USeD

.... fllCh WIll 00 possessed at any one ~me .

7. INOIVIDUAl(S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR , TRAINING FOR INDIVIDUAlS WORKING IN OR FREOUENTING RESTRICTED AREAS, TRAINING EXPERIENCE

,. FACILITIES AND EQUiPMENT 10. RADIATION SAFETY PROGRAM.

-". LICENSE FEES 1500 FOCFR F701Jf'lOS6Q1Oft 170 31J 11 . WASTE MANAGEMEN1.

FEE CATEGORY I ~,U.w s -

_ __ . SED

13. CERlIFICATION. rMust 1Je oompieled by appJiCiJnt) THE APPLICANT UNDERSTANDS THAT AlL STATEMENTS AND REPRESENTATIONS MADE IN THISAPPUCATION ARE BINDING UPON THE APPlICANT.

THE APPliCANT AND At.ff OFfICIAL EXECUTING THIS CERTIFICATION ON BEHALF OF THE APPliCANT, NAMED IN ITEM 2, CERTIFY THAT THIS APPLICATION IS PREPARED IN CONFORMITY WITH TITlE 10. COof OF FEDERAl RrGULATIONS. PARTS 30. 32, 33, 34, 35 , 36, 39. AND 40. AND THAT Al.LINFORMATION CONTANED HEREIN IS TRUE AND CORRECT TO THE !3E.ST OF HEIR KNQ'M.EOGE AND BELIEF.

WARNING: 18 U.S.C. SECTION /001 ACT OF JUNE 2S. 194862 STAT 149 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLV FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISOICTION.

CERTIFYING OFFICER - TYPED/PRiNTED NAME ANO TITLE

~~ I~/"J .. Rick Goke)" Pr<.'s idcnt

FOR NRC ;tlSE b1 I I TY!'f OF fEE I FEE LOG I FEE CATEGORY I ;1AOUNT RECENED 1 CHECK NUMBER COMMENTS

I __ APPROVED8Y I DATE

i NRC FORM 313 (3·2009) PRINTED ON RECYCLED PAPER

G~RTIFICAr~ OF

COMPLETION PRESENTED BY

QAL-TE:.c ASSOCIATES~ L_L_C_

TO

RICK GOKEY FOR Hi\. VING SUCCESSFULT,Y COMPI.ETED THE RADIATION SAFETY AND NUCLEAR GAUGE USER SAFETY TRAINING IN ACCORDANCE WITH THE REQUIREMENTS or NUREG 1556 VOL I,

10 eFR PARTS 19 & 20, AND DOT HAZMAI' REQUIREMENTS IN 49 eFR PART 172.

PRESENTED THIS DAY

APRIL 25, 2013

Signature of Trainer L...df.,,~ I STEVE WILSON Location: IDAHO FALLS, ID

G~RTIFICAr~ OF

COMPLETION PRESENTED BY

QAL-TEK. ASSOCIATES, L.L.C.

TO

RICK GOKEY FOR HAVING SUCCESSFULLY COMPLETED THE RADIA nON SAFETY OFFICER TRAINI NG fN

ACCORDANCE WITH THE REQUIREMENTS OF NUREG 1556 VOL 1 APPENDIX D, to CFR PARTS 19,20 & 30, AND DOT HAZMAT IN 49 CFR PART 172

PRESENTED THIS

A PUll . 26. 2013

S;g",,"re ofT";",, L -2L~ ISTEVE WILSON Location: IDAHO FALLS, ID