DRC-2018-004908 - 0901a0688082213f

Div of '4%7.1 - • —Pnt
e.,nd i•kaVion Control
CLIVE SITE
MAY 1 8 2018
LETTER OF TRANSMITTAL DRC-2o16-öo4los
DATE: 05/15/2018
ATTN: Don Verbica — DWMRC
CC; Treesa Parker
Karen Kirkwood
RE: Transmittal 18020
Description of Documents Transmitted
See attached for an update to Qualification Forms;
Q1163 Rotary Operator 1, Rev 0 1
Please replace your current procedure revisions with the documents with in this
Transmittal.
You are not required to sign any documents to verify receipt of this distribution.
However, you should make every effort to ensure that your copy of the License is
current.
FROM: EnergySolutions
Document Control
Clive Facility
cosi3n Roger Ekins
Roger Ekins
May 14 2018 12:24 PM Date
SIGNATURE PRINTED NAME
Yes / No
(included) Yes/No Practical Evaluation
[
Qual Manager
Radiation
Safety Officer
cm8n Thomas A. Brown
PRINTED NAME SIGNATJE Thomas Brown ergAdiA.m May 14 2018_1:29 PM Date
Tsis:swiatoispi .iatii4QCUAAENiT 011111P0
Effective Date: 05/15/2018 Revision No.: 0
QUALIFICATION CRITERIA: Page No (if applicable) SME SIGNATURE DATE COMPLETED INITIALS
Written Exam Completed with a Score of 80%
of Better
On the Job Training
ENERGYSOLUTIONS CL-TN-PR-100-F7
Revision 1
QUALIFICATION CARD
EMPLOYEE NAME

QUALIFICATION #: [ Q1163 ] QUALIFICATION TITLE:

ROTARY OPERATOR 1

QUALIFICATION APPROVAL:

SCOPE:
THIS QUALIFICATION APPLIES TO THOSE WHO ARE OR MAY BE REQUIRED TO PERFORM BASIC OPERATIONS OF
RAILCAR PROCESSING AND DECONTAMINATION AT THE ROTARY FACILITY.
PREREQUISITE TRAINING/QUALIFICATIONS: DATE COMPLETED INITIALS
JTA Operator 1 Rotary Facility N/A
(ADD ADDITIONAL LINES AS NECESSARY)
PREREQUISITE READING MATERIALS: DATE COMPLETED INITIALS
JHA-CL-GF-4535 Decon
CL-CH-PR-250
Railroad Safety Training (CL-T1146)
CL-CH-PR-109 Rotary Dump Facility Operations
JHA-CL-LLRW-RR-12368 Rotary Facility Operations
(ADD ADDITIONAL LINES AS NECESSARY)
Page 1 of 3
_",,;..,,,,..,..........
ENERGYSOLUTIONS CL-TN-PR-1 00-F7
Revision 1
QUALIFICATION CARD
r ALL REQUIRED ITEMS HAVE BEEN COMPLETED AND THIS QUALIFICATION IS VALID: Li\
EMPLOYEE
EMPLOYEE MANAGER
RSO
DATE
PRINTED NAME SIGNATURE
DATE
PRINTED NAME SIGNATURE
DATE
PRINTED NAME SIGNATURE
Verification of Completed Documentation
QUAL MANAGER DATE
PRINTED NAME SIGNATURE
***ONCE COMPLETE, SCAN AND PLACE IN FOLDER FOR DATA ENTRY AND DOC CONTROL***
Page 2 of 3
...r..

A.
ENERGYSOLUTIONS CL-TN-PR-100-F7
Revision 1
QUALIFICATION CARD
DOCUMENT SUMMARY FORM
Please provide the following information for new/revised documents.
Forward the completed form, approved document, and electronic file, to Document Control.
Document No.: Q1163 Revision No.: 0
Title: Rotary Operator 1
Special Status (i.e. Restricted; SSI; etc.):
If special status is applicable, please note any special distribution/handling requirements:
Summary of changes (if this is a revision):.
This is the creation on a Rotary operator 1 qualification card for the beginning laborer to
work at the Rotary facility.
0 Yes D This document requires evaluation per the requirements of a license. If yes,
No attach evaluation results.
0 Yes D This document requires regulatory agency approval before implementation. If
No yes, contact Document Control.
Distribution (or changes to distribution) for controlled copies of this document.
Source: ES-AD-PR-001, Rev.7, Document Preparation [Attachment 5.4]