E14
E.2

E.3

E4

E.5

Special Exposure Cohort Petition
under the Energy Employees Occupational
llIness Compensation Act

Special Exposure Cohort Petition — Form B Pag

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
National Institute for Occupational Safety and Health

OMB Number: 0920-0639 Expires: 07/31/2010

Proposed Definition of Employee Class Covered by Petition — Complete Section E.
Name of DOE or AWE Facility: YitTRO MANUGALTURI wy

Locations at the Facility relevant to this petition: :
Locations at the Facility relevant oT NR. sometimes Atelped our tt)

Back LAB. Went Tro SCRAP Piles TO COLLECT SAMPLES,
SOMeTIMeS Pi@ked UP SPuMPLES FROM PLAwT
List job titles and/or job duties of employees includediin the class. In addition, you can list by

name any individuals other than petitioners identified on this form who you believe should be

included in this class: . -
LAR TECH ICIAW— DRiLLed ShAUINGS FROM SARA ec, AIVA L¥ aed

suAuings ANd SAMPLEs FROM THE FLANT ACCORDING TO
watever PROcedURE My SUPERVISOR WANTED.

Employment Dates relevant to this petition:

Start \G@s8 End 190

Start End

Start End

Is the petition based on one or more unmonitored, unrecorded, or inadequately monitored or
recorded exposure incidents?: OQ Yes @ No

If yes, provide the date(s) of the incident(s) and a complete description (attach additional pages
as necessary):



July 2 2002

To Whom It May Concern:

This to inform you that I, was employed at Vitro
Manufacturing Co. from 1952 to 1959. was a co-worker of mine
in the at Vitro Manufacturing Co. from 1956 to 1959.

Swore be Love ine
theo qed july ROO

WAC I? Carl

Notanal Seal
Wallace A, McCarrell, Notary Public
City Of Washington, Washington County
My Commission Expires Jan. 7, 2006

Member Pennsylvanis Association Of Notaries



Special Exposure Cohort Petition U.S. Department of Health and Human Services

under the Energy Employees Occupational Centers for Disease Control and Prevention
liness Compensation Act National Institute for Occupational Safety and Health

. OMB Number: 0920-0639 Expires: 07/31/2010
Special Exposure Cohort Petition — Form B Page 6 of 7

F.3. O IMWehave attached a report from a health physicist or other individual with expertise in

radiation dose reconstruction documenting the limitations of existing DOE or AWE records on
radiation exposures at the facility, as relevant to the petition. The report specifies the basis for
believing these documented limitations might prevent the completion of dose reconstructions for
members of the class under 42 CFR Part 82 and related NIOSH technical implementation
guidelines.

(Attach report to the back of the petition form.)

F.4 IWehave attached a scientific or technical report, issued by a government agency of the
Executive Branch of Government or the General Accounting Office, the Nuclear Regulatory
Commission, or the Defense Nuclear Facilities Safety Board, or published in a peer-reviewed
journal, that identifies dosimetry and related information that are unavailable (due to either a lack
‘of monitoring or the destruction or loss of records) for estimating the radiation doses of
employees covered by the petition. ‘

(Attach report to the back of the petition form.)

n(s) Submitting this Petitio!

All Peti im of three persons may sign the petition.
_ 7-2>JOolo
Date
Signature ~ Date
Signature Date
Notice: Any person who knowingly makes any false statement, misrepresentation, concealment of

fact or any other act of fraud to obtain compensation as provided under EEOICPA or who
knowingly accepts compensation to which that person is not entitled is subject to civil or
administrative remedies as well as felony criminal prosecution and may, under appropriate
criminal provisions, be punished by a fine or imprisonment or both. | affirm that the information

provided on this form is accurate and true.

Send this form to: SEC Petition
Office of Compensation Analysis and Support

NIOSH
4676 Columbia Parkway, MS-C-47
Cincinnati, OH 45226

Name or Social Security Number of First Petitione



Special Exposure Cohort Petition U.S. Department of Health and Human Services

under the Energy Employees Occupational Centers for Disease Control and Prevention
Iltness Compensation Act National Institute for Occupational Safety and Health
OMB Number: 0920-0639 Expires: 07/31/2010

Special Exposure Cohort Petition — Form B Pag

Basis for Proposing that Records and Information are Inadequate for Individual Dose —
Complete Section F.

je 5 of 7

Complete at feast one of the following entries in this section by checking the appropriate box and providing
the required information related to the selection. You are not required to complete more than one entry.

Fil @ IMWe have attached either documents or statements provided by affidavit that indicate that
radiation exposures and radiation doses potentially incurred by members of the proposed class,
that relate to this petition, were not monitored, either through personal monitoring or through area
monitoring. ‘

(Attach documents and/or affidavits to the back of the petition form.)

Describe as completely as possible, to the extent it might be unclear, how the attached
documentation and/or affidavit(s) indicate that potential radiation exposures were not monitored.
THERE |S NOELTERWAL OR WTERMAL MOomirorivg,
DATA EOR THe DcesiG@N ATED ResidUAL Peed
(ojo: [se fb 04/30/60) AT WiTRO MA NUEACTORING,

T PeRSOUAILY WAS NeveR MONITORED,
_IoR. Wweee Any OE My @0- WORKERS. Wwe

DI nor Weare Awy TYPE OF PROTECTION.

F.2. @ I/Wehave attached either documents or statements provided by affidavit that indicate that
radiation monitoring records for members of the proposed class have been lost, falsified, or
destroyed; or that there is no information regarding monitoring, source, source term, or process
from the site where the employees worked.

(Attach documents and/or affidavits to the back of the petition form.)

Describe as completely as possible, to the extent it might be unclear, how the attached
documentation and/or affidavit(s) indicate that radiation monitoring records for members of the
proposed class have been lost, altered illegally, or destroyed.

Name or Social Security Number of First Petitione __


Special Exposure Cohort Petition U.S. Department of Health and Human Services
under the Energy Employees Occupational Centers for Disease Control and Prevention
ness Compensation Act National Institute for Occupational Safety and Health

OMB Number: 0920-0639 Expires: 07/31/2010

Special Exposure Cohort Petition — Form B . Appendix — Continuation Page
Continuation Page — Photocopy and complete as necessary.

\ “REC Sr MY (lo-WoRkeRs WHOM = WoRKed

WITH HAVE DIED, EXCE PT FoR

_ WHO is A ;

CANGER URVIUOR AND BAB MEMBER GF THE
CURRENT sEGQ QLASs.

TL \WAS tHE LAST FMPLOYEE HIRED 1
AT VLTRO MANUJEAITURING RUD
— oeR KEN Uniri THe PiAbiur CLosekfh i 1Q60.
ee . Sor THe CoRReUT
Sea C@iass Beahyse oF THe AsO DAY
CRitreRIA.

Re Med jarioW OF ViTRa MADLU_E ACTUR (Og
(DAS COMUFLered inp (Q9s. ALL THE
PoptamiWiihtrioA) THAT WAS THE RE
is BuRied INA bACReE Diseos Al
Gell, COUERed UlitTH QRASS , SU e RQUMIEd
by A Cabin LivK Fevu@e Witt
RADIOACTIVE. S1d US posted

Name or Social Security Number of First Petitioner



\
|
|

AFFIDAVIT

1-99.
COUNTY OF WASHINGTON ) 10 A08:4, I

)
COMMONWEALTH OF PENNSYLVANIA )

. in connection with my Special Exposure Cohort Petition, being duly sworn,
hereby swear and affirm that the following statements are true and correct:

1. Iwas employed asi... ..._..... at the Vitro Manufacturing facility in Canonsburg, Pennsylvania from
1957 througt 1960.

2. During my emplovment at the Vitro Manufacturing facility after 1958 (the AWE residual
period), through 1960, the radiation exposures and radiation doses incurred by me at the facility
‘were not monitored, either through personal monitoring or through;area monitoring.

th .
This the A day of July, 2010.

Sworn and subscribed before me this

a
GF ‘Gay of Suly, 2010.

Notary Public

My commission expires: _pSOMMONWEALTH OF PENNSYLVANIA
Wallace A. McCarrell, Notary Public
City of Washington, Washington County
My Commission Expites Feb. 2, 2014
Member, Pennsylvania Association of Notaries



during processing of ore, byproduct chemical precipitates
such as iron oxides and gypsum, process solutions, raw
unprocessed ore materials, and uranium mill tailings. The
total quantity of uranium/radium-bearing materials that were

+ processed at the Canonsburg site during the periods of
operation is not readily calculated based on the total
radioactive waste volumes reported in the literature for the
Canonsburg and Burrell sites. The uranium mill tailings were
initially stored in uncovered piles, and the tailings material
became dispersed by wind and water erosion. Some tailings
material were also removed from the mill site for use as fill in
local and regional construction projects. In 1956 and 1957,
about 11,600 tons of mill tailings from the Canonsburg. site
were relocated to a railroad property near Blairsville in
Burrell Township, Pennsylvania. After the Vitro uranium mill
was closed down in 1957, the site was used until about 1966
as a storage facility under a contract issued by the Atomic
Energy Commission. The land was purchased in 1967 by
private interests and eventually became the Canon Industrial
Park, a commercial park for light industrial use.

concentration trends within the unconsolidated strata
underlying the site, DOE will continue to perform annual
limited monitoring of groundwater and surface water
through 2003 as a “best management practice.” Monitoring
of groundwater for uranium is expected to continue in
perpetuity, with annual surface water monitoring to be
performed at three locations,

Back to Main Page Summary Table

Page Inst modified on 10/09/2005 22:80:46

Glossary References

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Fedstats USA.gov | Department of Energy

http://www.eia.doe.gov/cneaf/nuclear/page/umtra/canonsburg,_title] html

6/28/2010



ela U.S. Energy Information Administration
Independent Statistics and Analysis

Home > Nuclear > Canonsburg Mill

Canonsburg Mill Site

Glossary

Canonsburg Mill Site
Washington County, Pennsylvania

[Production
oan rents Ore
Status o i
‘Years of Operation ‘orPlant Site |} _ (Miilion Pounds
Short Te
one) 4,0)
[__te11-1022, 1990-1042, 1942-1087 _]] Decommissioned = -_|
spose Disposal Coll
eee Disposal Cell }) Average UMTRA
muuPiant || Disposal Cell] “Waste ‘Tota! Tallings Project
Area Area Volume Radloactivity || Radioactivity jj Final Cost
(Acres) |] (Acres) (litlion (ct, *Ray (ecu, || fen,
|Cuble Yards) | 28pa)
f« fe oe | im “|L_2t6_ JL #70

== The quanfily of uranium. and radium-bearing materials processed at the
| Canonsburg mill site is not availabl

ie.
Notes: Radioactivity from radium-226 in the stablized mill taiings is stated as total

curies (CG) and ae average picocuties per gram (pCilg) of talings. A picocurie Is 0.037
fadioactive disintegrations per second. Radium-226 (1620 year hatflfe) is a decay
product in the ‘series. It undergoes radioactive decay to produce radon-
222 (3.8 days hatte), a gas and the tons isotope of radon. UMTRA Project

igest-fived ‘
Final Cost includes the costs for the Canonsburg Mill Site and the Burrell Disposal Cell
Site.

trell Disposal CAll “snomne ees
se ae nD nal nn
mo,
a
afionsburg site.
Jen geek ATHAN MT,

Monaagahels 2A SOA a

Location: The Canonsburg mill site is located in the
Borough of ‘Canonsburg, Washington County, Pennsylvania.

Background: From 1911 to 1922, the Standard Chemical
Company operated a radium extraction plant on a 19-acre site
in Canonsburg. Between 1930-1942, uranium and radium
salts were extracted at the Canonsburg plant from residues
‘and uranium ore. From 1942 to 1957, Vitro Manufacturing
Company (later the Vitro Corporation of America) operated a
mill at the site to recover uranium and rare metals from
various ores and onsite residues, government-owned uranium
ore, process concentrates, and scrap materials. The uranium,
concentrates produced by Vitro were sold to the US.
Government. The waste products that accumulated at the site
over its long history include residues generated by the
incomplete extraction of radium, uranium, and other metals

http://www.eia.doe, gov/cneaf/nuclear/page/ ‘umtra/canonsburg_ title! html

UMTRA Surface Remediation: Remedial action began in
October 1983 and was completed in December 1985. The
expanded Canonsburg (Vitro) mill site, located in a
residential area, includes a 34-acre tract that incorporates the
former property used by the Vitro mill and also several
adjacent private properties, Detailed radiological surveying
of the site revealed that large quantities of radioactive
wastes generated during radium and uranium recovery
operations remained on the site. Contamination by radium
materials’ extended locally to more than 16 feet below the
surface. In response to local public concern, most of the
site’s radioactively contaminated materials were stabilized
in place. Remediation work at the Vitro mill site included
stabilizing about 192,000 cubic yards of onsite radioactive
materials and the decontamination and cleanup of nearby
vicinity properties including several residences. In all, 163
vicinity properties were identified and cleaned up:
radioactively contaminated soil was excavated and clean
backfill material was used in grading the properties for
proper drainage. Contaminated material removed from
vicinity properties was returned to the Vitro mill site and
stabilized there along with the in situ residual material.

Disposal Area: At the Vitro site, the residual radioactive
materials were consolidated into a 6-acre disposal cell
in1985. The cell is lined with a one-foot thick clay layer
designed to minimize percolation of water through the cell
and thereby protect local groundwater reservoirs. The
engineered, multilayered cap of the disposal cell is six-feet
thick and consists of: a three-foot-thick soil and clay barrier
designed to prevent the escape of radon gas; a riprap layer
up to two feet thick covers the radon barrier and serves as
erosion protection; and a one-foot-thick soil layer planted
with native grass species covers the cell.

Responsibility for Remediation: U.S. Government, 90
percent, and Commonwealth of Pennsylvania, 10 percent.

Stewardship: The Canonsburg site is being managed under
the U.S. Department of Energy’s (DOE) Long-Term
Surveillance and Monitoring Program (LTSM) in
accordance with the approved site specific plan.

Groundwater Program: In 1996, the Canonsburg site
was placed under the general license issued by NRC for
custody and care of residual tadioactive disposal sites, and
the site was transferred to the LTSM Program. Groundwater
covering an area of about 78 acres in the vicinity of the
Canonsburg site is contaminated with wastes from ore
processing. There are no known human uses of groundwater
in the vicinity of the disposal site. Surface water is the major
water source used by public water systems in Washington
County, Pennsylvania. To evaluate contaminant

6/28/2010



Special Exposure Cohort Petition U.S. Department of Health and Human Services

under the Energy Employees Occupational Centers for Disease Control and Prevention

{iIness Compensation Act National Institute for Occupational Safety and Health

OMB Number: 0920-0639 Expires: 07/31/2010

Special Exposure Cohort Petition — Form B Page 7 of 7
Public Burden Statement

Public reporting burden for this collection of information is estimated to average 300 minutes per response,
including time for reviewing instructions, gathering the information needed, and completing the form. If you
have any comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, send them to CDC Reports Clearance Officer, 1600 Clifton
Road, MS-E-11, Atlanta GA, 30333; ATTN:PRA 0920-0639. Do not send the completed petition form to this
address. Completed petitions are to be submitted to NIOSH at the address provided in these instructions.
Persons are not required to respond to the information collected on this form unless it displays a currently
valid OMB number. :

Privacy Act Advisement

In accordance with the Privacy Act of 1974, as amended (5 U.S.C. § 552a), you are hereby notified of the
following:

The Energy Employees Occupational Illness Compensation Program Act (42 U.S.C. §§ 7384-7385)
(EEOICPA) authorizes the President to designate additional classes of employees to be included in the
Special Exposure Cohort (SEC). EEOICPA authorizes HHS to implement its responsibilities with the
assistance of the National Institute for Occupational Safety (NIOSH), an Institute of the Centers for Disease
Control and Prevention. Information obtained by NIOSH in connection with petitions for including additional
classes of employees in the SEC will be used to evaluate the petition and report findings to the Advisory
Board on Radiation and Worker Health and HHS.

Records containing identifiable information become part of an existing NIOSH system of records under the
Privacy Act, 09-20-147 “Occupational Health Epidemiological Studies and EEOICPA Program Records.
HHS/CDCINIOSH.” These records are treated in a confidential manner, unless otherwise compelled by law.
Disclosures that NIOSH may need to make for the processing of your petition or other purposes are listed
below.

NIOSH may need to disclose personal identifying information to: (a) the Department of Energy, other federal
agencies, other government or private entities and to private sector employers to permit these entities to
retrieve records required by NIOSH; (b) identified witnesses as designated by NIOSH so that these
individuals can provide information to assist with the evaluation of SEC petitions; (c) contractors assisting
NIOSH; (d) collaborating researchers, under certain limited circumstances to conduct further investigations,
(e) Federal, state and local agencies for law enforcement purposes; and (f) a Member of Congress or a
Congressional staff member in response to a verified inquiry.

This notice applies to all forms and informational requests that you may receive from NIOSH in connection
with the evaluation of an SEC petition.

Use of the NIOSH petition forms (A and B) is voluntary but your provision of information required by these
forms is mandatory for the consideration of a petition, as specified under 42 CFR Part 83. Petitions that fail to
provide required information may not be considered by HHS.

Name or Social Security Number of First Petition _



Special Exposure Cohort Petition U.S. Department of Health and Human Services
under the Energy Employees Occupational Centers for Disease Control and Prevention
illness Compensation Act Nationa! Institute for Occupational Safety and Health
OMB Number: 0920-0639 Expires: 07/31/2010
Exposure Cohort Petition — Form B Page 3 of 7
Labor Organization Information — Complete Section D O if you are a labor organization.
D.1_ Labor Organization Information:
Name of Organization
Position of Contact Person
D.2 Name of Petition Representative:
D.3 Address of Petition Representative:
Street Apt # P.O. Box
City State Zip Code
D.4._ Telephone Number of Petition Representative: ( ) -
D.5 Email Address of Petition Representative:
D.6 Period during which labor organization represented employees covered by this petition
(please attach documentation): Start End
D.7 Identity of other labor organizations that may represent or have represented this class of
employees (if known):
ee - “|

Name or Social Security Number of First Petitioner


Sp

B.2
B.3

B4
B.5
B6

Special Exposure Cohort Petition
under the Energy Employees Occupational
{liness Compensation Act National Institute for Occupational Safety and Health

ecial Exposure Cohort Petition — Form B

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

OMB Number. 0920-0639 Expires: 07/31/2010
age 2 of 7

Survivor information — Complete Section B if you are a Survivor or representing a Survivor.

Name of Survivor:

Mr/Mrs/Ms. First Name Middle Initial Last Name
Social Security Number of Survivor:

Address of Survivor:

Street Apt # P.O. Box

City State Zip Code
Telephone Number of Survivor:  ( ) -

Email Address of Survivor:

Relationship to Employee: Q Spouse Q Son/Daughter Q Parent
Q Grandparent Q Grandchild

C.2

C3
C4

C5
C6
C7
C.7a
C.7b
C.7¢
C.7d

C.7e

Name oi

First Name Middle Initial Last Name
Former Name of Employee (e.g., maiden name/legal name change/other):

Mr./Mrs./Ms. First Name Middle initial last Name
Social Security Number of Employee:

Street Apt # P.O. Box

wy ' State 7in Cane
Telephone Number of Employee: _____

Email Address of Employee:

Employment information Related to Petition:
Employee Number (if known): —

Dates of Employment: Start 1957 End_ 1960
Employer Name: VITRO MANUEACTURINVG

Work Site Location: QO ADNONS BURG ;PenesvivANLA
- FRohir Lact

Supervisor's Name:

Name or Social Security Number of First Petitione


Special Exposure Cohort Petition U.S. Department of Health and Human Services

under the Energy Employees Occupational Centers for Disease Control and Prevention
Illness Compensation Act National Institute for Occupational Safety and Health
OMB Number: 0920-0639 Expires: 07/31/2010

Page 1 of 7

General Instructions on Completing this Form (complete instructions are available in a separate packet):
Except for signatures, please PRINT all information clearly and neatly on the form.

Please read each of Parts A — G in this form and complete the parts appropriate to you. If there is more
than one petitioner, then each petitioner should complete those sections of parts A — C of the form that apply
to them. Additional copies of the first two pages of this form are provided at the end of the form for this pur-
pose. A maximum of three petitioners is allowed.

Kf you need more space to provide additional information, use the continuation page provided at the end of
the form and attach the completed continuation page(s) to Form B.

If you have questions about the use of this form, please call the following NIOSH toll-free phone number and
request to speak to someone in the Office of Compensation Analysis and Support about an SEC petition:
1-877-222-8570. ‘

“Ta A Labor Organization, — Start atD on Page3
ifyou @ An Energy Employee (current or former), Start atC on Page 2
are: QA Survivor (of a former Energy Employee), StartatB on Page2
QA Representative (of a current or former Energy Employee), StartatA on Page 1

Representative Information — Complete Section A if you are authorized by an Employee or
Survivor(s) to petition on behalf of a class.

A. Are you a contact person for an organization? © Yes (Go to A.2) No (Go to A.3)
A.2 Organization Information:

Name of Organization

Position of Contact Person
A3 Name of Petition Representative:

Mr/Mrs./Ms. First Name Middle Initial Last Name

A4 Address:
Street Apt # P.O. Box
City State Zip Code

A.5 Telephone Number: ¢ ) -
A6 Email Address:

A. Check the box at left to indicate you have attached to the back of this form written authorization to
petition by the survivor(s) or employee(s) indicated in Parts B or C of this form. An authorization

.Ihyou are representing a §

vor, go to Part B; if you are representing an Employee,.go'to Part C..

Name or Social Security Number of First Petitio:


Appendix A-2 Residual Radioactivity Evaluations for Individual Facilities

FACILITY NAME: Vitro Manufacturing (Canonsburg)
Canonsburg, Pennsylvania

ALSO KNOWN AS: Vitro Rare Metals Company

TIME PERIOD: 1942-1957; Residual Radiation 1958-1996

FACILITY DESCRIPTION:

DOE Office of Health, Safety and Security Website:

Starting in 1948, Vitro was under contract to recover uranium from scrap. In the ‘period from
1954-1956, Vitro had a contract to process production quantities of radioactive material
(UF4) for National Lead of Ohio (Fernald). Vitro also received uranium scrap from the
Tyson Valley Powder Farm sometime in 1949. After 1957 the site was used only for storage.
Canonsburg was a major uranium milling facility and although the EEOICPA definition of an
Atomic Weapons Employer excludes mining and milling, this site is covered because of its
scrap processing activities performed under contract to the Atomic Energy Commission.

A 1948 document indicates that General Electric shipped scrap containing beryllium to the
Canonsburg site. The Canonsburg site is one of 24 former uranium mill sites designated for
Department of Energy remediation by the Uranium Mill Tailings Radiation Control Act
(UMTRA).

DISCUSSION:
In 1976, an ERDA survey identified “excessive radium contamination” at the facility. The

Canonsburg site was designated for DOE remediation by the Uranium Mill Tailings Radiation
Control Act

Documentation reviewed indicates that there is significant residual contamination outside of
the period in which AWE production occurred. Documentation from the Energy Information
Administration reports that surface contamination remediation was completed in December of
1985. Material was disposed of on-site and groundwater monitoring will continue in
“perpetuity”.

INFORMATIONAL SOURCES:
The sources of information used in this evaluation included:

e DOE Office of Health, Safety and Security
e Energy Information Administration Canonsburg Mill Site, October 9, 2005

EVALUATION FINDINGS:
Documentation reviewed indicates that there is a potential for significant residual
contamination outside of the period in which weapons-related production occurred.

PERIOD OF POTENTIAL RESIDUAL CONTAMINATION

TENMIOD OF RIESE

1958 -1985

Page 222 of 239