111I11111 IIIII 11111 11111I IIIIII 11II1I 11111 IIII IIII IIIII IIII IIIIII 111111MIIIiiiiii 111111MIII IliiilIIiSECTION 1
PAGE 1 of 2U.S. NUCLEAR REGULATORY COMMISSION
GL-714332-19
01/05/2015
NRC FORM 664
02 - 2004
10 CFR 31.5GENERAL LICENSEE REGISTRATION
APPROVED BY OMB: NO. 3150-0198 EXPIRES: 03131/2010Estimated burden per response to comply with this mandatory coilection request: 20 minutes. NRC will use ths information to track general licensees and their deuces to ensure a higherleve ot device accountability. Send conmmnts regarding burden estimate to the Records and FOlAPrivacy Ser'lces Branch (T-5 F52), U.S. Nuclear Regulatory Cornrnssion, Washington,DC 20555-0001, or by internet e-mai to [email protected] to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0000). Office of Management endBudget Washington, DC 20503. If a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, end aerson is not reouired to resoond to. the information collection.
Complete all six sections of this registration form. If any of the preprinted information is incorrect, provide thechanges in the applicable boxes. USE CAPITAL LETTERS.
General License
Registration Number
GL-714332-19
SECTION 1 - GENERAL LICENSEE INFORMATION
Enter the company name and the street address/physical location of use for your device(s). Forportable devices, specify the primary storage location. Do not use a P.O. Box address.
Company Name: PACIFICORP
I I I I I I I I I I I I I III I I I I I I I IDepartment: WYODAK POWER PLANT
I I II I I I I I I I I I I I I I I I I I I IAddress Line 1: 48 WYODAK ROAD
I I 1 -1l l 1 1IAddress Line 2: GARNER LAKE RTI I 1 -1 1I 1 1City: GILLETTE
I I I I I I I I p
I I I I I I I I I I
State: WY Zip Code: 82718 - E IiI I B Z
A A
ID lIIIlIII I III l~ ll IIII IIIIIIIIIII 1111111 IIIIII IIII IIII IIIIGL-714332-19
01/05/2015
I IllMil MIIII IIII IU III1 I III ISECTION 1
PAGE 2 of 2SECTION 1 - GENERAL LICENSEE INFORMATION (Continued)
Enter the name, telelphone number and title of the person who is the responsible individual for the device(s).
Last Name: BASTIAN
First Name: KEITH Middle Initial: L
Telephone: (307) 687-4230 Extension:
I III I I I T ] IITitle: PLANT MANAGING DIRECTOR
I I I I I I I I I I I III I I I I I I I I I I
Enter the mailing address where correspondence regarding your device(s) should be sent.This address should be specific to the use or storage location of your device(s).
Department: WYODAK POWER PLANT
Address Line 1: 48 WYODAK ROAD
Address Line 2: GARNER LAKE RT
I l l I 1 I I11 1 1 1 1 1 1 1City: GILLETTE
State: WY L] Zip Code: 82718- iiE• L• I - L __L
II
II
A A
11111 111111II II IIIIII IIIIIIIII IIII I1II 11111 11111 IIII 11 I111 iiiI IIII 1111 IIIIII 111111GL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SEC
Our records indicate that you have these devices. Please update the information as necessary. PAGE
NRC Device Key 735715 (Internal Control Number)
Distributor/Distributed By: Stock Equipment Company
Distributor License Number: 1370-1
Manufacturer Name: STOCK EQUIPMENT COMPANY
Device Model (Not Source Model): D14400
Device Serial Number: SE3865
Transfer Date (Receipt Date): 11/09/1989Not in possession of device (Also
E] complete Section 4.)
MM DD YYYY
11111iiiIITION 2
- 1 of 14
Isotope (e.g. AM241)
1 CS137
2
3 DIDID4
5
6
Activity (e.g. 100)
25.000000000
Unit (e.g. mCi)
mCi
Dlii
Dlii
A A
GL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SEC
Our records indicate that you have these devices. Please update the information as necessary. PAGE
NRC Device Key 735716 (Internal Control Number)
Distributor/Distributed By: Stock Equipment Company
Distributor License Number: 1370-1
Manufacturer Name: STOCK EQUIPMENT COMPANY
Device Model (Not Source Model): D14400
Device Serial Number: SE3866I I I I I I I I I III I I I Il I I -Transfer Date (Receipt Date): 11/09/1989
Not in possession of device (AlsoEl complete Section 4.)
MM DD YYYY
,TION 2- 2 of 14
Isotope (e.g. AM241)
1 CS137
2
3
4
5
6 KIILLZI
Activity (e.g. 100)
25.000000000
Unit (e.g. mCi)
mCi
DID_
A A
IIII IIII IIIIII1111 Iii I 1 I 1II1111111111111 IIII 111111 111111 IIIII IIIIIIII IIII 11111 IIII 11II IIIIGL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2
Our records indicate that you have these devices. Please update the information as necessary. PAGE 3 of 14
NRC Device Key 735717 (Internal Control Number)
Distributor/Distributed By: Stock Equipment Company
Distributor License Number: 1370-1
Manufacturer Name: STOCK EQUIPMENT COMPANY
Device Model (Not Source Model): D14400
Device Serial Number: SE3867
Transfer Date (Receipt Date): 11/09/1989Not in possession of device (Also
_[ complete Section 4.)
MM DD YYYY
Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi)
1 CS137 25.000000000
2
3 DILIIILZI4
5
6
FTT1
mCi
ElillillDIDDIEZZIDIDLwLIDI
A
1111111 IIIII 11111 11111 II 111111 0111111111111111 I IIIII 1111111 111111 IIII 11111 IIII iiiI IIIIGL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2
Our records indicate that you have these devices. Please update the information as necessary. PAGE 4 of 14
NRC Device Key 735718 (Internal Control Number)
Distributor/Distributed By: Stock Equipment Company
Distributor License Number: 1370-1
Manufacturer Name: STOCK EQUIPMENT COMPANY
Device Model (Not Source Model): D14400
Device Serial Number: SE3868
Transfer Date (Receipt Date): 11/09/1989Not in possession of device (Alsocomplete Section 4.)
MM DD YYYY
Isotope (e.g. AM241)
1 CS137
W I[]2
3
4
5
6
Activity (e.g. 100)
25.000000000
Unit (e.g. mCi)
mCi
WIJIZ
A A
I 1111II 11IIII 11111 1111 II 11111 11111 11111 IIII 11HIll l iIII liii 1111 iii 11111GL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SE(
Our records indicate that you have these devices. Please update the information as necessary. PAGE
NRC Device Key 735719 (Internal Control Number)
Distributor/Distributed By: Stock Equipment Company
Distributor License Number: 1370-1
I I I I I II I I ITManufacturer Name: STOCK EQUIPMENT COMPANY
Device Model (Not Source Model): D14400
Device Serial Number: SE3869
Transfer Date (Receipt Date): 11/09/1989Not in possession of device (Also
E complete Section 4.)
MM DD YYYY
IIIII IIIII'TION 2E 5 of 14
I
Isotope (e.g. AM241)
1 CS137
2
3 IWIW4
5
6 EWIW
Activity (e.g. 100)
25.000000000
Unit (e.g. mCi)
mCi
LiiiLIJIJ
A A
11111111 11111 11111 11111 IIII 11111 111111111 IIIIIII IIII IIII iiiI liiiH liii lIII liii iii IIIIiGL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2Our records indicate that you have these devices. Please update the information as necessary. PAGE 6 of 14
NRC Device Key 735720 (Internal Control Number)
Distributor/Distributed By: Stock Equipment Company
Distributor License Number: 1370-1
Manufacturer Name: STOCK EQUIPMENT COMPANY
I I I I I I I -TiI I IDevice Model (Not Source Model): D14400
Device Serial Number: SE3870
Transfer Date (Receipt Date): 11/09/1989Not in possession of device (Also
E] complete Section 4.)
MM DD YYYY
Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi)
1 CS137 25.000000000
'DID2
3
4
5
Dliii'6 ililll'
Flý
I I FTTI
Din
Din
111111II II~IIII II 1111II IIII IIII 11111 11111 11111 III 111111I IIIII 1111111 iii lii liii 1111GL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECOur records indicate that you have these devices. Please update the information as necessary. PAGE
NRC Device Key 735721 (Internal Control Number)
Distributor/Distributed By: Stock Equipment Company
Distributor License Number: 1370-1
Manufacturer Name: STOCK EQUIPMENT COMPANYI I I I I I I I I I I I I I I IDevice Model (Not Source Model): D14400
Device Serial Number: SE3871
1 1 1 1 1 1 1 I I I 11Transfer Date (Receipt Date): 11/09/1989
Not in possession of device (Also[] complete Section 4.)
MM DD YYYY
II IIIIIIII,TION 2
S7 of 14
Isotope (e.g. AM241)
1 CS137
2
3
4
5
6 DIDIZ.I
Activity (e.g. 100)
25.000000000
Unit (e.g. mCi)
mCiDIEZII_1_IDWECWE[_DIDIDE
A A
I 111011I 111I1I 11111 11III 1 1III 111II 1111I111I1I11111I1111 iii IIII iiiII I 1111H1I lii IIII iiiI 1111111GL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2
Our records indicate that you have these devices. Please update the information as necessary. PAGE 8 of 14
NRC Device Key 735722 (Internal Control Number)
Distributor/Distributed By: Stock Equipment Company
Distributor License Number: 1370-1
Manufacturer Name: STOCK EQUIPMENT COMPANY
Device Model (Not Source Model): D14400
I I I I I I I III I I I I IIDevice Serial Number: SE3872
Transfer Date (Receipt Date): 11/09/1989Not in possession of device (Also
_ complete Section 4.)
MM DD YYYY
Isotope (e.g. AM241)
1 CS137
2
3
4
5
6
EDJFTI
Activity (e.g. 100)
25.000000000
Unit (e.g. mCi)
mCi
DI_!II
A A
GL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2
Our records indicate that you have these devices. Please update the information as necessary. PAGE 9 of 14
NRC Device Key 735724 (Internal Control Number)
Distributor/Distributed By: Stock Equipment Company
Distributor License Number: 1370-1
Manufacturer Name: STOCK EQUIPMENT COMPANYI I I I I I I I III I I I IDevice Model (Not Source Model): D14400
Device Serial Number: SE3873
Transfer Date (Receipt Date): 11/09/1989Not in possession of device (Also
El complete Section 4.)
MM DD YYYY
Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi)
1 CS137 25.000000000 mCi
2
3
4
5
6
A
EDZDiiDID
DliiiDuD
A
11111111I IIII II nIIIII IIIII l 11111 1111111 11111 11II 11 iiiII IIII 11111111 IIII OrlII~ I I~ ~IIGL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2Our records indicate that you have these devices. Please update the information as necessary. PAGE 10 of 14
NRC Device Key 735725 (Internal Control Number)
Distributor/Distributed By: Stock Equipment Company
Distributor License Number: 1370-1
Manufacturer Name: STOCK EQUIPMENT COMPANY
Device Model (Not Source Model): D14400
Device Serial Number: SE3874
Transfer Date (Receipt Date): 11/09/1989Not in possession of device (Alsocomplete Section 4.)
MM DD YYYY
Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi)
1 CS137 25.000000000 mCi
2
3
4
5
6
LIIJIII
I I IIIIII
LiiizDIJIEDIIWEDIDDID
A
1111 IIIII 111111 11111 1111 IIIIIIIIIIIIII 111 IIII liiiI 11111111 IIIliiiI 11111 IIIII IIII IIIIIII 1II111IIGL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2Our records indicate that you have these devices. Please update the information as necessary. PAGE 11 of 14
NRC Device Key 735727 (Internal Control Number)
Distributor/Distributed By: TN TECHNOLOGIES, INC.
Distributor License Number: L01105
Manufacturer Name: TN TECHNOLOGIES, INC.
Device Model (Not Source Model): 5201
Device Serial Number: B309
Transfer Date (Receipt Date): 05/15/1985Not in possession of device (Also
- complete Section 4.)
MM DD YYYY
Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi)
1 CS137 100.000000000 mci
2
3
4
5
6
A
IIIII IIIII II GIII IIIIIIIII IIII1111 I1 111111 IIII IIIIIII I III11 I IIII IIIIIIII IIII liiiI IIII IIII IIIIGL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2
Our records indicate that you have these devices. Please update the information as necessary. PAGE 12 of 14
NRC Device Key 735728 (Internal Control Number)
Distributor/Distributed By: TN TECHNOLOGIES, INC.
Distributor License Number: L01105
Manufacturer Name: TN TECHNOLOGIES, INC.I I I I I I I I I III I I I I I I I IIIDevice Model (Not Source Model): 5201
Device Serial Number: B310
Transfer Date (Receipt Date): 05/15/1985Not in possession of device (Also
-I complete Section 4.)
MM DD YYYY
Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi)
1 CS137 100.000000000
DII2
3 DI4
DI1ILIJ5
6
iAl
I111]1111111
mCi
DIDDIDEDIZIDliiDiiDii
A
1111 IIIII 111111111 111111111 WII III WII IIII 1111111 iiiI liii i IIII IIII IIII IIII iiiI IIIIGL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2Our records indicate that you have these devices. Please update the information as necessary. PAGE 13 of 14
NRC Device Key 735730 (Internal Control Number)
Distributor/Distributed By: TN TECHNOLOGIES, INC.
Distributor License Number: L01105
Manufacturer Name: TN TECHNOLOGIES, INC.
Device Model (Not Source Model): 5202
Device Serial Number: B259
I I I I I I I III I I I I I T -ITransfer Date (Receipt Date): 05/15/1985
Not in possession of device (AlsoD complete Section 4.)
MM DD YYYY
Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi)
1 CS137 200.000000000 mCi
ZEL I2
3 wDl4
5
6
A
71
DID•
A
I II1111I 111I 11111 IIIIIII IIII IIII1111 I11 I W IIIII I III 111 11 iII iiiI 11111 M IIII I 11111 liii iiiiiGL-714332-19
01/05/2015 SECTION 2 - DEVICES SUBJECT TO REGISTRATION SECTION 2Our records indicate that you have these devices. Please update the information as necessary. PAGE 14 of 14
NRC Device Key 735731 (Internal Control Number)
Distributor/Distributed By: TN TECHNOLOGIES, INC.
Distributor License Number: L01105
Manufacturer Name: TN TECHNOLOGIES, INC.
Device Model (Not Source Model): 5202
Device Serial Number: B260
Transfer Date (Receipt Date): 05/15/1985Not in possession of device (Also
TE complete Section 4.)
MM DD YYYY
Isotope (e.g. AM241) Activity (e.g. 100) Unit (e.g. mCi)
1 CS137 200.000000000
2
3
4
5
6
A
~I I 17TTr l l
mCi
DIIIKillDliiiDIDDliiDlii
A
1111111 IIIII IIII 111111 II IIIII 11111 11111 lIII 11111 11111 IIII ~IIIIIIII 11111 l 11111 lIIII IIIGL-714332-19
01/05/2015 SECTION 3SECTION 3 -ADDITIONAL DEVICES SUBJECT TO REGISTRATION PAGE 1 of 1
Provide information about other devices you have that are subject to registration. Do not report specifically licensed devices.
Manufacturer Name
Initial Transferor Name
Initial Transferor License Number (if known)
Device Model Number (Not Source Model)
Device Serial NumberI
0 Manufacturer/Initial Transferor listed aboveHow acquired and date (e.g.,from a distributor/manufacturer, 0 Other General Licensee Date Transferred: fj [jj [ J•jother licensee, other source)? II
U Other Source (Received) MM DD YYYY
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Isotope (e.g. AM241)
K 11 =fZ~Tfli1
Activity (e.g. 100)
IIIII1III1
Unit (e.g. mCi)
"_'llEZIZEZ
K i il
A A
I IEIII
11111111II1111111 liiiI111IIII11111I111I1111IiiiHI111111111III11111I IIII"GL-714332-19 SECTION 4 - NOT IN POSSESSION OF DEVICE01/05/2015
Provide information about devices listed in Section 2 or 6, but no longer in your possession.
HIIII liiiI lIII lIII IIIiiSECTION 4
PAGE 1 of 1
Part I Transfer Date:
NRC Device Key: F TF L](from Section 2 or 6)MM DD YYYY
Location of the Device:
O Whereabouts Unknown (complete Part 1 only) 0 Transferred to another general licensee (complete Parts 2 and 3)
O Never Possessed the Device (complete Part 1 only) 0 Transferred to a Specific Licensee (Not the manufacturer)
O Returned to Manufacturer (complete Part 1 only) (complete Part 2)
Part 2 License Number of Recipient (if transferred to a specific licensee):
Company Name:
Department:
sI I I I I:I I I I I I I I I I I I I
Address Line 1:
Address Line 2:
City:
State: Zip Code: I I I - I I I
Part 3 Enter the name of the individual responsible for this device:
Last Name:
First Name: Middle Initial:
Telephone Number: Z:IL I 1 Extension:Title:
A A
IIII IIII III I 11IIII IIIII1111111111111 IIIII 11II11 111 IIII iiiIII 11111 IIIIII IIII IIII iii III IIGL-714332-19
01/05/2015SECTION 5 - CERTIFICATION SECTION 5
PAGE 1 of 1
I hereby certify that:
A. All information contained in this registration is true and complete to the best of my knowledge and belief.
B. A physical inventory of the devices subject to registration has been completed, and the device information on
this form has been checked against the device labeling.
C. I am aware of the requirements of the general license, provided in 10 CFR 31.5.
(Copies of applicable regulations may be viewed at the NRC website at:
httpj:w .g ovlreadinm/doc-collections/cfr)
21411<SIGNATURE - RESPONSIBLE INDIVIDUAL (Listed in Section 1) DATE
WARNING: FALSE STATEMENTS MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL PENALTIES. NRC
REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL
MATERIAL ASPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY
WRONG STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED
STATES AS TO ANY MATTER IN ITS JURISDICTION.
A i
I IIIII IH 111111111111111111 II II IIIIIII HII lIi IIII111111111 IIIIII III111 lIII lIIIGL-714332-1901/05/2015 SECTION 6 - DEVICES NOT SUBJECT TO REGISTRATION SECTION 6
PAGE 1 of 1
NRC Device Key: Manufacturer License No:
Manufacturer Name:
Model Number: Serial #: Transfer Date:
IqPACuIFCORP ENERGYWyodak Plant48 Wyodak RoadGillette, WY 82718
January 29, 2015
Director, Office of Nuclear Material Safety and SafeguardsAttn: GLTSUS Nuclear Regulatory CommissionWashington DC 20555-0001
Re: Wyodak PlantRegistration Number GL-714332-19
Dear Sir:
Enclosed are General Licensee Registration Forms for the PacifiCorp-Wyodak PowerPlant.
Should you have any questions or require any additional information, please callBernadette Hinshaw at (307) 687-4283.
Sincerely,
Keith L. BastianPlant Managing Director
Aitachments
bxc: Bernadette Hinshaw