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Home My WebLink AboutDRC-2025-001057 CLIVE SITE LETTER OF TRANSMITTAL DATE: 3/24/2025 ATTN: LLRW CC; Treesa Parker Karen Kirkwood RE: Transmittal 2025-019 Description of Documents Transmitted Qty See attached updates to Qualification Cards, corrected Effective Date. Q1055 Rev 2 Mixed Waste Disposal Operator 1 Q1142 Rev 2 Loader Operator 1 Q1143 Rev 2 Articulated Haul Truck Operator 1 Q1149 Rev 2 Dozer Operator 1 Q1159 Rev 2 Large Intermodal Roll-Over Operator 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 3 EMPLOYEE NAME ___________________________________________ QUALIFICATION #: QUALIFICATION TITLE: QUALIFICATION APPROVAL: SCOPE: IDENTIFY THE NECESSARY PREREQUISITES FOR CONSIDERATION AS QUALIFIED TO PERFORM MIXED WASTE DISPOSAL OPERATIONS AND TO VERIFY THE ABILITY OF THE ABOVE NAMED APPLICANT IN ALL ASPECTS OF THE IDENTIFIED PREREQUISITES, GENERAL KNOWLEDGE REQUIREMENTS, PERFORMANCE REQUIREMENTS, AND WRITTEN TESTS. PREREQUISITE TRAINING/QUALIFICATIONS: DATE COMPLETED INITIALS DEFENSIVE DRIVER TRAINING Q1143 ARTICULATED HAUL TRUCK OPERATOR Q1149 DOZER OPERATOR Q1152 TRACK HOE (EXCAVATOR) OPERATOR Q1140 LIFT TRUCK OPERATOR Q1054 MIXED WASTE CONTAINER MANAGEMENT (ADD ADDITIONAL LINES AS NECESSARY) PREREQUISITE READING MATERIALS: DATE COMPLETED INITIALS CL-LD-PR-020 MANAGEMENT AND DISPOSAL OF MS & LLRW WASTE CL-GF-4536 EQUIPMENT OPERATIONS CL-SH-PR-500 CONTIGENCY PLAN (ADD ADDITIONAL LINES AS NECESSARY) QUALIFICATION CRITERIA: Page No (if applicable) SME SIGNATURE DATE COMPLETED INITIALS CLASSROOM TRAINING WITH WRITTEN EXAM PASSED AT 80% OR HIGHER PRACTICAL DEMONSTRATION (ADD ADDITIONAL LINES AS NECESSARY) Q1055 MIXED WASTE DISPOSAL OPERATIONS 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.: __2_ 3/24/2025 Roger Ekins Digitally signed by Roger Ekins Date: 2025.03.21 12:01:25 -06'00' Digitally signed by Thomas Brown DN: OU=Health Physics, O="EnergySolutions, LLC", CN=Thomas Brown, E=tabrown@energysolutions.comReason: I am approving this document Location: CliveDate: 2025-03-21 13:12:00 Foxit PhantomPDF Version: 9.7.5 Thomas Brown CL-TN-PR-100-F7 Revision 1 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 1 QUALIFICATION CARD Page 3 of 3 CL-TN-PR-100-F7 Revision 1 QUALIFICATION CARD Page 1 of 3 EMPLOYEE NAME ___________________________________________ QUALIFICATION #: QUALIFICATION TITLE: QUALIFICATION APPROVAL: SCOPE: THIS DOCUMENT APPLIES TO PERSONNEL WHO ARE OR MAY BE REQUIRED TO OPERATE AN ARTICULATED TRUCK THAT IS OWNED OR OPERATED BY ENERGYSOLUTIONS. PREREQUISITE TRAINING/QUALIFICATIONS: DATE COMPLETED INITIALS DEFENSIVE DRIVER TRAINING Walk Around Training and Power Point Training PREREQUISITE READING MATERIALS: DATE COMPLETED INITIALS CL-GF-4536 EQUIPMENT OPERATIONS APPLICABLE EQUIPMENT OPERATORS MANUAL QUALIFICATION CRITERIA: Page No (if applicable) SME SIGNATURE DATE COMPLETED INITIALS CLASSROOM TRAINING WITH WRITTEN EXAM PASSED AT 80% OR HIGHER COMPLETION OF PRACTICAL EVALUATION & PRE-USE INSPECTION FORM PRACTICAL CRITERIA: Q1143 ARTICULATED HAUL TRUCK OPERATOR Task (Description) Satisfactory (Check Mark)SME Date (Completed)Initials Performs the Pre-Use Inspection correctly. Demonstrates ability to steer and turn smoothly. Demonstrates ability move and place a materials. Demonstrates ability to brake and stop appropriately. Sounds horn at all appropriate locations. Qual Manager ___________________________ ___________________________ Date_________ PRINTED NAME SIGNATURE Radiation ___________________________ ___________________________ Date_________ Safety Officer PRINTED NAME SIGNATURE Yes Practical Evaluation (included) Yes/No This SECTION is filled out by DOCUMENT CONTROL. Effective Date: ______________ ________________ Revision No.: __2_ 3/24/2025 Roger Ekins Digitally signed by Roger Ekins Date: 2025.03.21 12:03:50 -06'00' Digitally signed by Thomas Brown DN: OU=Health Physics, O="EnergySolutions, LLC", CN=Thomas Brown, E=tabrown@energysolutions.com Reason: I am approving this documentLocation: Clive Date: 2025-03-21 13:10:56 Foxit PhantomPDF Version: 9.7.5Thomas Brown CL-TN-PR-100-F7 Revision 1 QUALIFICATION CARD Page 2 of 3 Keeps moving components in the appropriate position while traveling. Demonstrates ability to maintain a safe travel speed. Demonstrates ability to allow clearance when turning. Accelerates/Decelerates at gradual rate. Demonstrates ability to stop with a load. Demonstrates ability to maneuver turns with a load. Inspects and Wears all safety equipment (i.e. seat belt, harness, etc.) while operating equipment. Demonstrates ability to load and unload the equipment safely. Demonstrates knowledge and safe usage of attachments, if applicable. Demonstrates the ability to proper park and dismount the equipment. 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 1 QUALIFICATION CARD Page 3 of 3 CL-TN-PR-100-F7 Revision 1 QUALIFICATION CARD Page 1 of 3 EMPLOYEE NAME ___________________________________________ QUALIFICATION #: QUALIFICATION TITLE: QUALIFICATION APPROVAL: SCOPE: THIS DOCUMENT APPLIES TO PERSONNEL WHO ARE OR MAY BE REQUIRED TO OPERATE A DOZER THAT IS OWNED OR OPERATED BY ENERGYSOLUTIONS. PREREQUISITE TRAINING/QUALIFICATIONS: DATE COMPLETED INITIALS DEFENSIVE DRIVER TRAINING PREREQUISITE READING MATERIALS: DATE COMPLETED INITIALS CL-GF-4536 EQUIPMENT OPERATIONS CL-GF-GENERAL CELL WORK APPLICABLE EQUIPMENT OPERATORS MANUAL QUALIFICATION CRITERIA: Page No (if applicable) SME SIGNATURE DATE COMPLETED INITIALS CLASSROOM TRAINING WITH WRITTEN EXAM PASSED AT 80% OR HIGHER COMPLETION OF PRACTICAL EVALUATION & PRE-USE INSPECTION FORM PRACTICAL CRITERIA: Q1149 DOZER OPERATOR Task (Description) Satisfactory (Check Mark)SME Date (Completed)Initials Performs the Pre-Use Inspection correctly. Demonstrates ability to steer and turn smoothly. Demonstrates ability move and place a materials. Demonstrates ability to brake and stop appropriately. Qual Manager ___________________________ ___________________________ Date_________ PRINTED NAME SIGNATURE Radiation ___________________________ ___________________________ Date_________ Safety Officer PRINTED NAME SIGNATURE Yes Practical Evaluation (included) Yes/No This SECTION is filled out by DOCUMENT CONTROL. Effective Date: ______________ ________________ Revision No.: __2_ 3/24/2025 Roger Ekins Digitally signed by Roger Ekins Date: 2025.03.21 12:04:40 -06'00' Digitally signed by Thomas Brown DN: OU=Health Physics, O="EnergySolutions, LLC", CN=Thomas Brown, E=tabrown@energysolutions.comReason: I am approving this document Location: Clive Date: 2025-03-21 13:10:33 Foxit PhantomPDF Version: 9.7.5 Thomas Brown CL-TN-PR-100-F7 Revision 1 QUALIFICATION CARD Page 2 of 3 Sounds horn at all appropriate locations. Keeps components in the appropriate position while traveling. Demonstrates ability to maintain a safe travel speed. Demonstrates ability to allow clearance when turning. Accelerates/Decelerates at gradual rate. Demonstrates ability to stop correctly. Demonstrates ability to maneuver turns correctly. Inspects and Wears all safety equipment (i.e. seat belt, harness, etc.) while operating equipment. Demonstrates knowledge and safe usage of attachments, if applicable. Demonstrates the ability to proper park and dismount the equipment. 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 1 QUALIFICATION CARD Page 3 of 3 CL-TN-PR-100-F7 Revision 1 QUALIFICATION CARD Page 1 of 3 EMPLOYEE NAME ___________________________________________ QUALIFICATION #: QUALIFICATION TITLE: QUALIFICATION APPROVAL: SCOPE: THIS DOCUMENT APPLIES TO PERSONNEL WHO ARE OR MAY BE REQUIRED TO OPERATE A LARGE INTERMODAL ROLL-OVER THAT IS OWNED OR OPERATED BY ENERGYSOLUTIONS. PREREQUISITE TRAINING/QUALIFICATIONS: DATE COMPLETED INITIALS DEFENSIVE DRIVER TRAINING PREREQUISITE READING MATERIALS: DATE COMPLETED INITIALS CL-GF-4536 EQUIPMENT OPERATIONS APPLICABLE EQUIPMENT OPERATORS MANUAL QUALIFICATION CRITERIA: Page No (if applicable) SME SIGNATURE DATE COMPLETED INITIALS CLASSROOM TRAINING WITH WRITTEN EXAM PASSED AT 80% OR HIGHER COMPLETION OF PRACTICAL EVALUATION & PRE-INSPECTION FORM JHA-CL-LLRW-12826 Large Box Dumper (Bertha) Operations PRACTICAL CRITERIA: Q1159 LARGE INTERMODAL ROLL-OVER OPERATOR Task (Description) Satisfactory (Check Mark)SME Date (Completed)Initials Performs the Pre-Use Inspection correctly. Demonstrates ability to steer and turn smoothly. Demonstrates ability to brake and stop appropriately. Sounds horn at all appropriate locations. Qual Manager ___________________________ ___________________________ Date_________ PRINTED NAME SIGNATURE Radiation ___________________________ ___________________________ Date_________ Safety Officer PRINTED NAME SIGNATURE Yes Practical Evaluation (included) Yes/No This SECTION is filled out by DOCUMENT CONTROL. Effective Date: ______________ ________________ Revision No.: __2_ 3/24/2025 Roger Ekins Digitally signed by Roger Ekins Date: 2025.03.21 12:05:29 -06'00' Digitally signed by Thomas Brown DN: OU=Health Physics, O="EnergySolutions, LLC", CN=Thomas Brown, E=tabrown@energysolutions.com Reason: I am approving this documentLocation: Clive Date: 2025-03-21 13:10:04 Foxit PhantomPDF Version: 9.7.5 Thomas Brown CL-TN-PR-100-F7 Revision 1 QUALIFICATION CARD Page 2 of 3 Keeps components in the appropriate position while traveling. Demonstrates ability to maintain a safe travel speed. Demonstrates ability to allow clearance when turning. Accelerates/Decelerates at gradual rate. Demonstrates ability to stop correctly. Demonstrates ability to maneuver turns correctly. Inspects and Wears all safety equipment (i.e. seat belt, harness, etc.) while operating equipment. Demonstrates knowledge and safe usage of attachments, if applicable. Demonstrates the ability to proper park and dismount the equipment. 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 1 QUALIFICATION CARD Page 3 of 3 CL-TN-PR-100-F7 Revision 1 QUALIFICATION CARD Page 1of2 EMPLOYEE NAME ___________________________________________ QUALIFICATION #: QUALIFICATION TITLE: QUALIFICATION APPROVAL: SCOPE: THIS DOCUMENT APPLIES TO PERSONNEL WHO ARE OR MAY BE REQUIRED TO OPERATE A LOADER THAT IS OWNED OR OPERATED BY ENERGYSOLUTIONS. PREREQUISITE TRAINING/QUALIFICATIONS:DATE COMPLETED INITIALS DEFENSIVE DRIVER TRAINING SME WALK AROUND TRAINING PREREQUISITE READING MATERIALS:DATE COMPLETED INITIALS CL-GF-4536 EQIUPMENT OPERATIONS APPLICABLE EQUIPMENT OPERATORS MANUAL QUALIFICATION CRITERIA:Page No (if applicable)SME SIGNATURE DATE COMPLETED INITIALS CLASSROOM TRAINING WITH WRITTEN EXAM PASSED AT 80% OR HIGHER COMPLETION OF PRACTICAL EVALUATION & PRE-USE INSPECTION FORM PRACTICAL CRITERIA: Q1142 LOADER OPERATOR Task (Description) Satisfactory (Check Mark)SME Date (Completed)Initials Performs the Pre-Use Inspection correctly. Demonstrates ability to steer and turn smoothly. Demonstrates ability pickup, move, and place a materials. Demonstrates ability to brake and stop appropriately. Sounds horn at all appropriate locations. Qual Manager ___________________________ ___________________________ Date_________ PRINTED NAME SIGNATURE Radiation ___________________________ ___________________________ Date_________ Safety Officer PRINTED NAME SIGNATURE Yes Practical Evaluation (included) Yes/No This SECTION is filled out by DOCUMENT CONTROL. Effective Date: Revision No.: __2_ Roger Ekins Digitally signed by Roger Ekins Date: 2025.03.21 12:02:55 -06'00' Digitally signed by Thomas BrownDN: OU=Health Physics, O="EnergySolutions, LLC", CN=Thomas Brown, E=tabrown@energysolutions.comReason: I am approving this documentLocation: CliveDate: 2025-03-21 13:11:30Foxit PhantomPDF Version: 9.7.5Thomas Brown CL-TN-PR-100-F7 Revision 1 QUALIFICATION CARD Page 2 of 2 Keeps bucket at appropriate height while traveling. Demonstrates ability to maintain a safe travel speed. Demonstrates ability to allow clearance when turning. Accelerates/Decelerates at gradual rate. Demonstrates ability to stop with a load. Demonstrates ability to maneuver turns with a load. Inspects and Wears all safety equipment (i.e. seat belt, harness, etc.) while operating equipment. Demonstrates ability to load and unload the equipment safely. Demonstrates knowledge and safe usage of attachments, if applicable. Demonstrates the ability to proper park and dismount the equipment. 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***