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FEDERAL NOTIFICATION LETTER

Thursday, March 26, 2020

Director of .FSME
Attn: GLTS
U.S. Nuclear Regulatory Commission
Washington, DC 20555-0001
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This letter is a notificati on per 10 CFR 31.5(c}(8) or correspon9111g State regulatio
n indicatiog 'that a
device containing rac;Hoactive material was transferred. from a general licensee
to a specific licensee.
The following informat ion is provided:

From Gerie~aflicensee: ·
FCI Sandstone
2300 county Rd. 29
PO Box.999
Sandstone, MN 55767

To Specific Licensee:
SRB Technologies, Inc .
. 2580 tandmar k Drive
Winston-Salem, NC 27103
. {316)~659-:2610
Radioactive Materials License #034-0534-2

I
· Date of Transfer: I··
(Enter Date Dlsposal Box was
shipped ~. Specific Ucensee) 4
D.escription of Device(s) Transferred:
Exit signs containing tritium as per attached Inventor y Form{s) ....

If there are questions or concerns, please contact me,

Sincerely,

Printed Name:
CTIA.:~ Sf-etit;n s .

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s~~Ure;I C-~ -
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. Phone Nurnbel".:
3)._¢- f>
d-- l-\ ~·- 6 GE

FEDERAL LETTER- MAiL TO USNRC WITHIN 30 DAYS OF SHIPMENT

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VEOLIA, USE ONLY . . I ------ ---- ·----------------·--·
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Sales Orde r#: 2183896 RGA#: 998289

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RGA # Expiration Date: 6/25/2020
Cas.e #: 00029 222 I
UCN: 1U51387V-5W56052X
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Box 1 ,of4 I
I FedexT racking #: 69119170029558.5
,-·----·- ... -------------- .----- '----------------- ·---- ,: I

·----- ·----------- ----- .. '----- ___: -- .-- . ----------- --- ,...f

.TRITIUM E){ITSIGN' INVENTORY FORM
Record an Inventory of the exit signs using the manufacturer labe.1 lnformiltlon on the baekcifthe ~lgn. Make sure that
all Information Is leglble.
00 NOT-REMOVE THE (ABEL FROM THE SIGN, ALL FIELDS BELOW.MUST BE*ILl:EDOUTFOR·EACH:
SIGN. DO NOT PUT ARROWS OR DITTO,MARKS
FOR REPETITIVE INFORMAITON. Note: Double faced srgns made by connecting two signs.bilck~to 0 bat:k
sholi.ld be counted 'as two·s,lgns even If there
Is one serial number on the housing, lfyou·have one of.more back-to,back slgns,.please list each o"e 'twice. · · ·

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9.
De.c:.. -98 ll1S
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Nov- tt& 'll,S
Describe any damaged unJts: . ·
Please ema(/ pictures of damaged signs to
pak,ts@veollti.com ·

I hereby cert(jy that. alf!nformotlon submitted on this form contains true and.accurote·d,escrlptfons ofthe exit signs.

'Generator Signature:

l!rlnfName:

Date. Received:

Customer Service lTcill Fnie:,1-888•669•972S Monday•Frlda y-Bilm to 5pm CST

Tritium Exit Sign Disposal Dax I·REV D6/2016 · r:'\
..~VEO LIA.
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VEOLIA USE ONLY
. ~- .-----------------------. --.
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Sal es Ord er·# : 21-83896 i I

I RGA #: 9982 89 .
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RGA # Expiratfon Date: 6/25/2020
Case #: 00029222 - .,I
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I UCN: 8Y51386Z~1A56069B.
.·so x 2 of 4 ,:.,J

Fede x Tracking#: 691191700295554

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·-··-· ·······- ---··-- ··. ·····-· -······ -- ···-·--- ------·
-···- ·1 ,__ ---. -------------------1 ------------------- --.-·
TRITIUM EXITSIGN. 1-NVENTORY,FOR·M
Record.an lnventoiyof the exit signs using the •manufacture·rlabel lnforma
tlcm on
the back of the sign. Make sure that all hiformatlon ls legible.
. DO NOTREMOVE :fHEtABEL: FROM THE SIGN; :ALL FIELDS;BElOW
MUST BE FILLED.OUT FOR'EACH'SIGN. DO :NOT PUT ARROWS OR
FOR-REPETITIVE iNFORMAITON, Note:·Double faced signs made· D11TO;MARKS
bycon11ec:tlhg two slgns,pack•to-back·should be counted·as twcrslgns even
·fs one.serial number on·the houshig. If ycu have one or more back.to-back slgns,_please fist each one twice. _/ If there

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:oescrlbo any damaged.units:
Pfease .emallplctiJres afdamaged·:signs .to
pak.ts@veolla.com

I h~reby certify that al/lnfprmatlon submitted on this/arm contains

true and occui-ate descrlp'tfons of the exltslgns.

Title: . -Co~IA.h.1CA+,~o Tech11,c1c.

Date:. 3 .._ '\-aCi~O

Date Recerved:

Customcr·Senilce poll Free: 1-888-669·9725 1V1oniliiy-Frll:lay-·sam

to 5pm CST
Tritium Exit Sign Disposal Box I REV 06/2016
· ' ·
G)veOLIA
 -t------
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- ·-----------. ------------------. ------------,
; VEOLIA USE ONLY . ! .---,

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.- - - _ - < ·-----· -------

VEOLIA USE ONLY.

--------- '---- :-----------:

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Sales Ord er# : 2183896 I

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RGA #: 99e289
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Case #: 00029222 . RGA # Expiration Date: 6/25/ 2020

UCN:, 6C51 385D -8E5 6075 F
Box 3 of 4 Fede x Trac king# : 691191700295561.
·-----------------------------.-.-· -- ·-----------·
...

TRITIUM EXIT SJGNJNVENTORY FORM

Record an lriventoryof the exit signs using.the manufact.urerlabel
lriformatlon Or'! the back of the-slgri.:Make sure that all lnformatlon
DO NOT REMOVE THE LABEL-FROM THE SIGN; ALL FIELOS.BELOWM is legible,
UST<'BE'FILLED OUTFOR'EACH SIGN.,DO·NOT-POTARROWS:OR
. FOR REPETITIVE INFORMAITON. Note: Double faced signs DITTO MARKS
made by connettlng-tyJe> sfgns',back-tq;baek·shoOld be counted as·two signs ev!!n If there
Is one setlal.nu!11ber on the housing. If you have one or:more bacl<ato•back'slg
ns, please 11st each one-twice.

t>escrlbe any.damaged units: . .

Please 'email pictures of damaged signs to
pok.ts@veolla.com
---,-- ·--i

. I hereby certify that all lnformatlansubnilttedon th/sfarm.contains

true a_nd occu111te descriptions ofthe.exltslgns.

'Genera_tor'SJgnature:
Title: (At1":tW:Q;~b60Teck11,'g'4-0
Print Name:
Date: S --:- \ _:_ c}O ~0 -

Date Received:

Customer Service I Toll Free: l-888-669·97ZS·Monday•Fiiday-8iim.to·s11m

CST
Tritium E,clt Sign Disposal Box f REV 06/20.16

G)V EOU A
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VEOLIA USE ONLY !·
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·------------------------- ----, ------- -----------------·
VEOUA USE ONLY I
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Sales .Orde r#: 2183 896 I

. .,I
RGA #: 998289
Case #: 0002 9222 :
I
·RGA # Expiration Date: 6/25/2020
I'' UCN: 3G513 84H-2I 56088 J
Box4 of 4 ':
I
I Fedex Tracking #: 691191700295578
'
TRITI UM EXIT SIGN INVENTORY FORM
Record an inventory or. the exit signs ·u~ing the m~nufactur.er. label Information on the back ~f th~
sign. Make sure that.all Information
Is legible.
DO. NOT REMOVE THE LABEL-FROM-THE SIGN. ALL FIELDS BELOW MUST·BE FILLED OUT
FOR EACH SIGN. DO NOT PUT ARROWS OR DITTO MARKS
FOR REPETITIVE INFORMAITON; Note: Double faced signs made by connecting two signs
back•to,backshould be counted as two.signs even if there
is one serial nu,:nber on the housing. tfyou have one or more back•to-back signs, please 11st each cine
twice.

,sst
.s
10
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Describe any damaged units: ·
Pleaseemailplctureso/damagedsfgnsto
pak,u@11ealla.com ·
· (_1) ~~io..\ (\ ~12..\ ' lM'\ ~k...l ,·.-u1 ..,· 1 : ~· 'l.

thereby certify that all information submitted on thfs form contains true and accurate dest:rlptlon
s of the·exit-sfgns.

"~cner~for Signature: ..
Title: .lo~w r~+.eJ 'TI:..c.h .,,,,. "<1/1
t
_Print Name:
Date: "3 -: I -- )..C, J.. 0

Date Received:

Customer Service f Toll Free: 1~888-669•97ZS Monday-Friday- 8am. to Spm CST

Tritium Exit Sign Dlspos11l'D0K f REV DG/2016
G)veOUA_