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Home My WebLink AboutDRC-2025-000262 CLIVE SITE LETTER OF TRANSMITTAL DATE: 1/23/2025 ATTN: LLRW CC; Treesa Parker Karen Kirkwood RE: Transmittal 2025-004 Description of Documents Transmitted Qty See attached for update to Qualification Cards. Q1100 Rev 3, Rock Placement 1 Q1101 Rev 4, Sealed Single-Ring Infiltrometer Field Permeability 1 Q1102 Rev 4, Clay Placement for Embankment Construction 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 0 QUALIFICATION CARD Page 1 of 3 EMPLOYEE NAME ___________________________________________ QUALIFICATION #: QUALIFICATION TITLE: QUALIFICATION APPROVAL: SCOPE: QUALITY CONTROL INSPECTION AND APPROVAL OF EMBANKMENT ROCK EROSION LAYERS (NO EXPIRATION) PREREQUISITE TRAINING/QUALIFICATIONS: DATE COMPLETED INITIALS Defensive Driver (ADD ADDITIONAL LINES AS NECESSARY) PREREQUISITE READING MATERIALS: DATE COMPLETED INITIALS LLRW & 11e.(2) Construction Quality Assurance/Quality Control (CQA/QC) Manual State-issued Part B Permit, Attachment II-9, Construction Quality Assurance/Quality Control (CQA/QC) Manual ASTM D5519, Particle Size Analysis of Natural and Man-Made Riprap Materials. (ADD ADDITIONAL LINES AS NECESSARY) QUALIFICATION CRITERIA: Page No (if applicable) SME SIGNATURE DATE COMPLETED INITIALS Observed placement of rock erosion barrier Written exam passed at 80% or higher (ADD ADDITIONAL LINES AS NECESSARY) Q1100 ROCK PLACEMENT 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.: __3 _ Garrett Q, Dutson Thomas A. Brown 01/21/2025 Garrett Q. Dutson, P.E. Digitally signed by Garrett Q. Dutson, P.E. Date: 2025.01.21 14:56:41 -07'00' Digitally signed by Thomas BrownDN: OU=Health Physics, O="EnergySolutions, LLC", CN=Thomas Brown, E=tabrown@energysolutions.comReason: I am approving this documentLocation: Clive Date: 2025-01-21 15:17:45Foxit PhantomPDF Version: 9.7.5 Thomas Brown CL-TN-PR-100-F7 Revision 0 QUALIFICATION CARD Page 2 of 3 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*** CL-TN-PR-100-F7 Revision 0 QUALIFICATION CARD Page 3 of 3 CL-TN-PR-100-F7Revision 0 QUALIFICATION CARD Page 1 of 3 EMPLOYEE NAME ___________________________________________ QUALIFICATION #: QUALIFICATION TITLE: QUALIFICATION APPROVAL: SCOPE: QUALITY CONTROL TESTING OF CLAY LINER AND RADON BARRIER PERMEABILITY (NO EXPIRATION) PREREQUISITE TRAINING/QUALIFICATIONS: DATE COMPLETED INITIALS Defensive Driver (ADD ADDITIONAL LINES AS NECESSARY) PREREQUISITE READING MATERIALS: DATE COMPLETED INITIALSLLRW & 11e.(2) Construction Quality Assurance/Quality Control (CQA/QC) Manual, Appendix B, Procedure for Sealed Single-Ring Infiltrometer Field Permeability Test State-issued Part B Permit, Attachment II-9, Construction Quality Assurance/Quality Control (CQA/QC) Manual, Appendix 1, Procedure for Sealed Single-Ring Infiltrometer Field Permeability Test CL-QC_WI-001, Sealed Single Ring Infiltrometer(ADD ADDITIONAL LINES AS NECESSARY) QUALIFICATION CRITERIA: Page No (if applicable) SME SIGNATURE DATE COMPLETED INITIALS Observed permeability test using single-ring apparatus. Perform permeability test using single-ring apparatus. Written exam passed at 80% or higher (ADD ADDITIONAL LINES AS NECESSARY) Q1101 SEALED SINGLE-RING INFILTROMETER (FIELD PERMEABILITY TEST) 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.: __4 Garrett Q. Dutson Thomas A. Brown 01/21/2025 Garrett Q. Dutson, P.E. Digitally signed by Garrett Q. Dutson, P.E. Date: 2025.01.21 14:57:59 -07'00' Digitally signed by Thomas BrownDN: OU=Health Physics, O="EnergySolutions, LLC", CN=Thomas Brown, E=tabrown@energysolutions.comReason: I am approving this documentLocation: Clive Date: 2025-01-21 15:17:22Foxit PhantomPDF Version: 9.7.5 Thomas Brown CL-TN-PR-100-F7 Revision 0 QUALIFICATION CARD Page 2 of 3 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*** CL-TN-PR-100-F7 Revision 0 QUALIFICATION CARD Page 3 of 3 CL-TN-PR-100-F7 Revision 0 QUALIFICATION CARD Page 1 of 3 EMPLOYEE NAME ___________________________________________ QUALIFICATION #: QUALIFICATION TITLE: QUALIFICATION APPROVAL: SCOPE: QUALITY CONTROL INSPECTION AND TESTING OF CLAY LINER AND RADON BARRIER (NO EXPIRATION) PREREQUISITE TRAINING/QUALIFICATIONS: DATE COMPLETED INITIALS Defensive Driver (ADD ADDITIONAL LINES AS NECESSARY) PREREQUISITE READING MATERIALS: DATE COMPLETED INITIALS LLRW & 11e.(2) Construction Quality Assurance/Quality Control (CQA/QC) Manual State-issued Part B Permit, Attachment II-9, Construction Quality Assurance/Quality Control (CQA/QC) Manual CL-QC-PR-039, Clay Liner & Radon Barrier Construction (ADD ADDITIONAL LINES AS NECESSARY) QUALIFICATION CRITERIA: Page No (if applicable) SME SIGNATURE DATE COMPLETED INITIALS Observed field inspection, testing and documentation. Perform field inspection, testing and documentation. Written exam passed at 80% or higher (ADD ADDITIONAL LINES AS NECESSARY) Q1102 CLAY PLACEMENT FOR EMBANKMENT CONSTRUCTION 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.: _3__ Garrett Q. Dutson Thomas A. Brown 01/21/2025 Garrett Q. Dutson, P.E. Digitally signed by Garrett Q. Dutson, P.E. Date: 2025.01.21 14:58:37 -07'00' Digitally signed by Thomas BrownDN: OU=Health Physics, O="EnergySolutions, LLC", CN=Thomas Brown, E=tabrown@energysolutions.comReason: I am approving this documentLocation: CliveDate: 2025-01-21 15:16:57Foxit PhantomPDF Version: 9.7.5 Thomas Brown CL-TN-PR-100-F7 Revision 0 QUALIFICATION CARD Page 2 of 3 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*** CL-TN-PR-100-F7 Revision 0 QUALIFICATION CARD Page 3 of 3