DRC-2024-007097

CLIVE SITE
LETTER OF TRANSMITTAL

DATE: 10/4/2024
ATTN: LLRW
CC; Treesa Parker
Karen Kirkwood
RE: Transmittal 2024-072

Description of Documents Transmitted Qty

See attached for update to Qualification Cards.
Q2244 Rev 0 CLSM – Macro Testing 1

------------------------------------------------------------------------------------------------------------

Please replace your current procedure revisions with the documents within 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

CL-TN-PR-100-F7
Revision 1
QUALIFICATION CARD
Page 1 of 2
EMPLOYEE NAME ___________________________________________
QUALIFICATION #: QUALIFICATION TITLE:
QUALIFICATION APPROVAL:

SCOPE:
QUALIFICATION FOR QUALITY CONTROL TESTING OF CLSM AND MACRO
PREREQUISITE TRAINING/QUALIFICATIONS: DATE COMPLETED INITIALS
Defensive Driving
(ADD ADDITIONAL LINES AS NECESSARY)
PREREQUISITE READING MATERIALS: DATE COMPLETED INITIALS
LLRW & 11e.(2) Construction Quality Assuance/Quality Control (CQA/QC)
Manual
Attachment ll-1-5 Macro Permit
ASTM D4832 Standard Test Method for Preparation and Testing of CLSM Test
Cylinders
ASTM D6023 Standard Test Method for Density (Unit Weight), Yield, Cement
Content, and Air Content (Gravimetric) of CLSM
ASTM D6103 Standard Test Method for Flow Consistency of CLSM
CL-QC-WI-003, Macro Vault QC Inspections
CL-QC-PR-001, Quality Control Inspections and Testing
JHA-CL-QC-14831, CLSM/Macro Sampling and Testing
(ADD ADDITIONAL LINES AS NECESSARY)
QUALIFICATION CRITERIA: Page No (if applicable) SME SIGNATURE DATE COMPLETED INITIALS
Observed CLSM testing
Performed CLSM Testing
Observed Macro Testing
Performed Macro Testing
Written Exam Passed at 80% or Higher
(ADD ADDITIONAL LINES AS NECESSARY)
Q2244 TESTING CLSM AND MACRO
Qual Manager ___________________________ ___________________________ Date_________
PRINTED NAME SIGNATURE
Radiation ___________________________ ___________________________ Date_________
Safety Officer PRINTED NAME SIGNATURE
No
Practical Evaluation (included) Yes/No
This SECTION is filled out by DOCUMENT CONTROL.
Effective Date:Revision No.: __0_
Garrett Q. Dutson
Thomas A. Brown
10/4/2024
CL-TN-PR-100-F7
Revision 1 QUALIFICATION CARD

Page 2 of 2
PRACTICAL CRITERIA:

Task
(Description) Satisfactory
(Check Mark) SME Date
(Completed) Initials
Interview (1) new employee (Perform a mock
exercise as necessary).
(Perform mock exercises as necessary).
Perform the following items
In OnBase:
• Locate Files
• Locate Records for

ALL REQUIRED ITEMS HAVE BEEN COMPLETED AND THIS QUALIFICATION IS VALID:

EMPLOYEE _______________________ ______________________ DATE_________
PRINTED NAME SIGNATURE
EMPLOYEE MANAGER _______________________ ______________________ DATE_________ PRINTED NAME SIGNATURE
RSO _______________________ ______________________ 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***