Regulatory Guide 10.7

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Guide for Preparation of Applications for Licenses for Laboratory & Industrial Use of Small Quantities of Byproduct Material
ML003740382
Person / Time
Issue date: 08/31/1979
From:
Office of Nuclear Regulatory Research
To:
References
RG-10.7 Rev 1
Download: ML003740382 (20)


{{#Wiki_filter:Aep ft!m" 1171 U.S. NUCLEAR REGULATORY COMMISSION

                                        REGULATORY GUIDE
                                        OFFICE OF STANDARDS DEVELOPMENT
                                                                               REGULATORY GUIDE 10.7 GUIDE FOR THE PREPARATION OF APPUCATIONS FOR UCENSES
                                       FOR LABORATORY AND INDU1STRIAL USE OF SMALL                                                                                                         *R
                                                     QUANTmES OF BYPRODUCT MATERIAL
                                    1. INTRODUCTION                                                      10 CFR Part 170 to determine the amount of fee This guide describes the type of information                                                  that must accompany the application. Review of needed by the NRC staff to evaluate an                                                             the application will not begin until the proper appl               fee is received by the NRC.

cation for a specific license for laboratories and industries using millicurie quantities of by 3. FILING AN APPLICATION

     product material (reactor-produced radionu clides). This type of license is provided under Title 10, Code of Federal Regulations,                                          for             An applicant for a byproduct material Part 30. "Rules of General Applicability                                                          isotopes) license should complete Form (radio-j                           NRC
                                                                                    to Do              3131 (see the appendix to this guide).' AUl mestic Licensing of Byproduct Material items on the application form should be com Paragraph. 20 1(c) of 10 CFH Part 20. "Stand                                                  pleted in sufficient detail for the NRC to deter ards for Protection Against Radiation,"                                                           mine that the applicant's equipment, facilities, states             and radiation protection Program are adequate that      "    .   persons engaged                    in   activities           under licenses issued by the Nuclear Regulatory                                                         to protect health and minimize danger to life Com              and property.

mission pursuant to the Atomic Energy Act of

    19.54, as amended, and the Energy Reorganiza tion Act of 1974 should, in addition to comply                                                        Since the space provided on Form NRC-3131 ing with the requirements set forth in                                                            is limited, the applicant should append addi this          tional sheets to provide complete information.

part, make every reasonable effort to maintain radiation exposures, and releases of Each separate sheet or document submitted radio active materials in effluents to unrestricted with the application should be identified by a areas, as low as is reasonably achievable" heading indicating the appropriate item number (ALARA). Regulatory Guide R. 10, "Operating (on Form NRC-3131) and its purpose radiation, safety instructions). (e.g.,

   Philosophy for Maintaining Occupational Radia tion Exposures As Low As Is Reasonably Achievable,", provides the NRC staff position                                                         The application should be completed in trip on this important subject. License applicants                                                    licate. The original and one copy should be should give consideration to the ALARA philos                                                    mailed to the Division of Fuel Cycle and Mate ophy, as described in Regulatory 3uide                                                            rial Safety, Office of Nuclear Material
                                                                                   8. 10,                                                                                      Safety in the development of plans for work                                                              and Safeguards, U.S Nuclear Regulatory with                                                                                       Com licensed radioactive materials.                                                                   mission. Washington, D.C. 20555. One copy of the application, with all attachments, should be
                                 2. LICENSE FEES                                                    retained by the applicant since the license will require, ab a condition, that the institution An application fee is required for most types                                                 follow the statements and representations o)f Licenses                                                                                                                                                                     set The applicant should refer to                                         forth in the application and any supplement
  §170 31,                                                                                          it                                                                                to
                        "Schedule of Fees for Materials Licenses and Other Regulatory Services,"
                                                                                        of
                                                                                                       'Applications    (or" medical uses should be submitted on Form
    *1 "I*s '-n1dcate substantave changes from previoub                      .'.ue                 NRC-313M.       and applications for use of selled sources in rad- raphy should beasu               I.       1ri NRC-313R
                      USNRC REGULATORY GUIDES

ttagu0tory Guide -a-einu Comments should be sent to the Secretary of the Commen.

to "-,,be mndineao .a bleeto uRgulatory U.S tuim

"nothOd"acOc*ap to the NRC soft of C                                                                                                              Conomatin Wwa Wo               0 C 2066 Atteintion OoClea leamenting 'vec1fac prts of the                                                                                              SW
       ,    rsion's regulations. to deline*te *eh*MKK         used by the staff on evalu-           The guides we rilsuidm the foliowu       Itan hoad dairnons
"'lng   'pcftIc rippicants        W-11-16r~ Guides Regulatory        Or postulated ae rnt accidents, gubseaae orfor fto Proside guidance Pliecs with them is riot raqaujed Maihods and regulaions.    and corntt        I Power Reactors ookn       dffere f        fyro tmhose                                                         6 Products set out in fth guides will be erLcaputAte rf the provide                                          2 Resarch and Test Reactors                      7 Transoration requiste to the isuance or continuance of                        a basie for tie woiadngs         3 Fuels and Martialo Feotms a perrNt    or licanse by the           4 Enovrwnen'ta                                   8 OccuoiaaonWs and Sittru                          .          Health Coa'-mHaon
                                                                                                 5 M410"ifis am Plant Protection                  0 Gililrt     and Fiancial Revew Comnnts i tlrr*s an*d      suggestiOns andWu-des             tor nprOvernts    ,n thee guades are encouraged at             placement        an etutomat.c wet Uae resa     as s*pWoprAte.   to aCrorrmodante commentd             Requests foror s-g*e  copies ofd*'Uued   Iuades fivhaCh
                                                                                                                                     *r*butiorist  t*or aglerngy bi eWoduced, copaes            or for of ftureL guaee nO tO ref*i fcr'e      information or sotae                                                      n spi    fc dvisons should be nuide a wating This guide *awasred               mosta                                                             to the U S   Nuclear Regulefory ComrnmraTtn      Wasthington    D C 205Mu of  sobstant"     curnmrents re..a. ed fromr the public and addrtional                                                                              Alteanon     Deoitor.   ONvror,   of staf reiew              Tochn,~i into~rraitocn and Dorumlent Control

4. CONTENTS OF AN APPLICATION model number of each sealed or plated source should be specified It a source will be used in Most items of Form NRC-313r are self a gas chromatograph. gauge, or other device.

explanatory (see instructions with the form). the manufacturer and model number of the The following comments apply to the indicated device should be specified numbered items of the form.

Item 8E and Item 9 The use to be made of'

   Items 2 and 4. Specify the applicant corpo                            the radioactive        materials should be clearly ration or other legal entity by name and                                  described       Sufficient detail should he given to address of principal office. Individuals should                           allow a determination of the potential for expo be designated as the applicant only if the use                             sure to radiation and radioactive materials both of the byproduct material is not connected with                           of those working with the materials and of the the individual's employment with a corporation                             public or other entity               If the applicant. is an individual, the individual should be specified                                 Items 10 and 11.     Specify for each radiation by full name and address, including state and                              detection instrument the manufacturer's name zip code                                                                 -and model number, the number of each type of instrument      available,    the type of radiation Item 5. Specify the street address of the                             detected (alpha, beta, gamma, or neutron).

location of use if the address differs from the the sensitivity range (milliroentgens per hour one given in Item 4. If use is to be at more or counts per minute). the window thickness in

                                                                                    2 than one location, the specific address of each                           mg/cm . and the type of use. The type of use should be given             Describe the extent of use                    would       normally   be    monitoring,   surveying, and the facilities and equipment at each                                   assaying, or measuring.

location. A post office box address is not acceptable. Describe the instrument calibration proce dure. State the frequency, and describe the Item 6 Specify the names of the persons who methods and procedures for the calibration of will directly supervise the use of radioactive survey and monitoring instruments, as well as material or who will use radioactive material any other instruments and systems used in the without supervision radiation protection program, such as measur ing instruments used to assay sealed-source Item 7. Specify the name of the person who leak-test samples (see Item 15). contaminationi will be designated as the radiation protection samples (e.g.. air samples. surface "wipe"

 officer. 2 Thispj5erson should be responsible for                         samples), and bioassay samples (see Item 12)
 implementing the radiation safety program and therefore readily available to the users in case                               An adequate calibration of survey instru of difficulty and should be trained and experi                            ments usually cannot be performed with built enced in radiation protection and in the use                              in check sources         Electronic calibrations that

1 and handling of radioactive materials. In a do not involve a source of radiation are also small program not requiring a full-time not adequate to determine the proper function ing and response of all components of an radiation protection officer, the duties of the radiation protection officer may be assigned to instrument.

one of the persons named under Item 6 of Form I NRC-3131. Note, however, that it must be Daily or other frequent checks of survey instruments should be supplemented every established that the person acting as radiation protection officer will have the opportunity to 6 months with a two-point calibration on each devote sufficient time to the radiation safety scale of each instrument with the two points aspects of the program for the use of separated by at least 50% of the scale Survey radioactive materials. instruments should also be calibrated following repair. A survey instrument may be considered Items BA, B, C, and D. Describe the byprod properly caiibrated when the instrument read uct material by isotope, chemical and/or physi ings are within +/-10 percent of the calculated or cal form, and activity, in millicuries or micro known values for each point checked Readings curies A separate possession limit for each within +/-20 percent are considered acceptable if nuclide should be specified Possession limits a calibration chart or graph is prepared and requested should cover the total anticipated attached to the instrument inventory, including stored materials and If the applicant proposes to calibrate his waste, and shouid be commensurate with the needs and facilities for safe survey instruments, a detailed description of applicant's planned calibration procedures should be sub handling mitted The description of calibration proce dures should in(lude, as a minimum:

        If the use of sealed or plated sources is con tempiated,        the isotope, manufacturer,               and a The manufacturer and model           number of
      'The terms radiation protection   officer" and  "radioiogrcal each radiation source to be used, safety officer" are synonv.aoul
                                                                    10 7-2

b. The nuclide and quantity of radioactive milliroentgens, the frequency of reading, and material contained in each source, the procedures for maintaining and calibrating the devices should be specified.

c The accuracy of the source(s). The traceability of the source to a primary standard If personnel monitoring will not be used, the should be provided. applicant should submit calculations or docu mentation from radiation surveys demonstrating d The step-by-step procedures, including that it is unlikely that any individual will associated radiation safety procedures, and receive a dose equal to or greater than that indicated in 10 CFR Part 20.

e The name and pertinent experience of each perstin who will perform the calibrations. The applicant should show that the need for bioassays has been thoroughly considered and If the applicant intends to contract out the should establish the adequacy of the proposed calibration of instruments, the name, address, bioassay program in relation to the proposed and license number of the firm should be speci program of use of radioactive material. Bio fied together with the frequency of calibration. assays are normally required when individuals The applicant should contact the firm that will work with miUicurie quantities of hydrogen-3, perform the calibrations to determine if infor iodine-125, or iodine-131 depending on the mation concerning calibration procedures has type of work, equipment, and procedures fol been filed with the Commission. If information lowed Regulatory Guide 8.20, "Applications of concerning calibration procedures has not been Bioassay for 1-125 and 1-131," and a document filed, it should be obtained and submitted. entitled "Guidelines for Bioassay Requirements for Tritium"- may be consulted. Other mate Quantitative measuring instruments used to rials may also be used in physical or chemical monitor the adequacy of containment and con forms and under conditions that present an tamination control such as those used for mea opportunity for uptake by the body through suring leak test, air, effluent, bioassay, work area, and equipment contamination samples ingestion, inhalation,, or absorption A bio

 3hould usually be calibrated prior to each use.        assay program to determine and control the The procedures and frequency for calibration            uptake of radioaetive material should be con of such instruments should be submitted and             sidered and discussed in relation to each such material,      procedure, etc,              Regulatory Guide should include:                                        8 9, "Acceptable Concepts Models. Equations, a The name of the manufacturer and model          and Assumptions for a Bioassay Program."
                                                                                                                      may.

number of each of the standards to be used, he consulted.

b. The nuclide and quantity of radioactive The criteria tc be used in determining the material contained in each of the standard need for hiioassays, the type and frequency of bioassays that will be performed, and the sources, bio assay procedures should be specified and c A statement of the accuracy of each of the described in detail If a commercial bioassay standard sources. The source accuracy should service is u., be used, the name and address of be. as a minimum, +/-5 percent of the stated the firm should be provided.

value and traceable to a primary standard, such as that maintained by the National Bureau Bioassays may not be substituted for other of Standards. elements of a safety program such as air moni toring and dispersion control (hoods, glove d. Step-by-step calibration procedures and, boxes. etc ) and for well-thought-out and if appropriate, associated radiation safety pro well-executed handling procedures cedures, and T

                                                           Item 13     The facilities and equipment for e. The name and pertinent experience of           each site of use should be described in detail.

each person who will perform the instrument The proposed facilities and equipment for each "calibrations operation to be conducted should be adequate to protect health and minimize danger to life Item 12 Personnel monitoring is required to and property In describing available fa. ilities ensure .- mplianee with §§20 101 and 20 202 of and equipment. the following should be 10 ('FR Part 20. Personnel monitoring is also included, as appropriate: required if a person enters a high radiation area (greater than 100 millirems per hour). If a Physical plant, laboratory. or working p'.sonnel monitoring equipment will be used, area facilities Fume hoods glove boxes, waste the ndine of the organization furnishing film receptacles, spenjal sinks, ventilation and con badge or thermoluminescent do.<'imeter (TLD) tainment systems. effluent filter systems, and service and the frequer , for changing badges, dosumeter.-, etc sh,uld be specified jA copy may be obtained by a written request Nuclear Regulatory to hte U S If pocket chambers ur pocket dosimeters will be C'.mmision. Office .)f Nuclear ?ateruidJ

                                                      Safety and Safeguaro,        Div-tsaon of Fuel CycLe and Materi.la used.       the useful range of the devi(e.        in  Safety. Washington     !      20555, A:'enton    Director. office of Nuclear Material Saifet, ant Safeguards

arr permi.,sible The a,. hlc ju o,;it, .

  hd , pnf O  1 7'.I i  I I !;
                             '        d t ý , -i hl'   j~t .  .  o h n         upon *h- radionu-Lide '
                                                                                   d     Release into air or water in oncentrationf'
        A drawing or sketch should be submitted in conformance with §20 106 of 10 ('FR Part 20

showing the location of all such equipment and Possible exposure to persons offsite Limits the the relationship of areas where radioactive amount that may be released materi:is will be handled to unrestricted areas where rad'ioactive materials will not be handled e Treatment or disposal by incineration in In those programs where radioactive material conformance with §20 305 of 10 CFR Part 20 may become airborne or may be included in air This must be specifically approved by the br-ne effluents, the drawing or -ketch should Commission also include a schematic description of the ven tilation system annotated to show airflow rates, f Other methods specifically approved by differential pressures, filt ration and other

                                                                                'he Commission pursuant to §20.302 of 10 CFR

effluent treatment equipment and air and Part 20 effluent monitoring instruments Drawings or sketches should be drawn to a specified scale, Item 15 or dimensiLons should be included on each drawing or sketch. Each drawing or sketch a Survey Program. Commission regulations should be labeled to specify the location of the require that surveys be made to determine if facilitles and equipment depicted with respect radiation hazards exist in a facility in which to the address(es) given in Item 5 of Form radioactive materials are used or stored (see NRC-3131 §20.201 of 10 ('FR Part 20) A survey should include the evaluation of external exposure to F- C(ontainets, devices. protective clothing. personnel, concentrations of a-iruorne radio auxiliary shielding, general laboratory equip active material in the facility, and radioactive ment. a. r sampling equipment. etc . actually effluents from the facility Although a theoreti employed in the daily use of material Special cal calculation is often used to demonstrate provisions for shielding and containment to compliance with regulations regarding airborne minimize personnel exposure should be de or external radiation, it cannot always be used scribed Storage containers and facilities in Lieu of a physical survey should provide both shielding and security for materials Except for those cases where sources of radiation and radioactive material are well c The number. type. and length of remote known and accurately and precisely controlled, handling devices it will usually be necessary that a physical survey be made with appropriate detection and d If respiratory protective equipment will measurement instruments to determine the be used to limit the inhalation of airborne nature and extent of radiation and radioactive radioactive material, the provisions of §20.103 material or, as a minimum, confirm the results of 10 CFR Part 20 should be followed and of a theoretical determination appropriate information should be submitted A radiation protection program should include the following surveys for radioactive Item 14 The procedures for disposing of contamination and radiation.

byproduct material waste should be described Under NRC regulations, a licensee may dispose (I) In laboratory or plant areas (e g of waste in the following ways checking for contamination on bench tops, han dling and storage equipment, clothing, hands)

       a Transfer to a person properly licensed to receive such waste in conformance with para                                            (2) While work is being done with radiation graph 20.301(a)             of   10 CFR Part 20            The name             or radioactive materials (e.g , breathing zone of the firm (which should be contacted in                                       air surveys,           general air surveys, personnel Luncluding eyes and advance to determine any Limitations that the                                   exposure measurements.

firm may ,iave on acceptance of waste) should extremities, checking shutters and "'ontain ment)

   be given f, Release into a sanitary sewer in confor                                         (3) in areas associated with disposal or mance           With     §20 303          of      t0 CFR       Part 20           release of radioactive materials (e g . checking Depending on water usage. releases rf up to I                                      'The   NRC   has   proposed  an   amendment        .*hat would delete curie per year are permitted                                                    $20 304 of 10 CFlt Part 20 (43 F'R Ssi77        December 4. 19i 8)     If this amendent       is adopted.    all b,,ne.ls     of radionuclides in accord~ance with    120 304 of 10 CFR Part         20 wil require NRC
         c   Buria, i" soil in contformance with §20 304                            approval f    10 (-FR Part 20           Up to 12 hurials per year
                                                                           10 7-4

disposal containers and disposal sites; liquid, Agency's Technical Report Ses gas, and solid effluents, filters and filter-duct No 120,

                                                                                 "Monitoring of Radioactive Contamination am systems)                                                                     Surfaces. "'
         The frequency of surveys will depend on                                    b. Records Management Progrm. Provision the nature of the radioactive mrterials and for keeping and reviewing record of surveys;
    their use. However, surveys should be per materials inventories; personnel exposures;
   formed prior to the use of radioactive materials receipt, use, and disposal of materials, in order to establisl a baseline. The surveys                                                                                         etc.,
                                                                                 should be described. Persons responsible for should be repeated when radioactive materials keeping and reviewing records should be iden are present, when the quantity or type of tified.

material present changes, or when changes occur in their containment systems cr methods c Sealed-Source Leak-Test of use. Repetitive surveys may Procedures.

also be Sealed sources containing more than 100 micro necessary to control the location of radioactive curies of a beta or gamma emitter or more than materials in the handling system and in the 10 microcuries of an alpha emitter must be leak case of the use of sealed sources outside a tested at 6-month intervals. Leak testing of shielded container.

alpha-particle-emitting sources containing more For operations involving materials in gas, than 10 microcuries of an alpha emitter Is liquid, or finely divided forms, the required at 3-month intervals. If a commercial survey firm is to perform the leak tests, the program should be designed to monitor the name, adequacy of containment and control address, and license number of the firm of the should materials involved. "he program should be submitted If the tests are to be performed include using a commercial "kit," the nme of the kit air sampling, monitoring of effluents, and sur manufacturer or distributor and the kit moe veys to evaluate contamination of personnel, I facilities, and equipment designation should be given. If the applicant Physical effluent !measurements are essential to determine intends to perform his own leak tests without compli ance with Appendix B to 10 CFR Part 20. the use of a commercial kit, the following information should be submitted:

        The description of an air sampling program should include the area where samples                                                (1) Qualifications     of   personnel         who   will will be taken,     the frequency of sampling, and the                                perform the leak test, location of the sampler with respect to workers'
 breathing zones Assays performed to evaluate                                         (2) Procedures and materials to be used in air samples and the methods used to                                           taking test samples, relate results to actual personnel exposures should also be described                                                                    (3) The type, manufacturer's name, model number, and radiation detection and measure The      effluent       monitoring        program                      ment characteristics of the instrument for                                                                  to be releases to unrestricted areas should encom                                   used for assay of test samples, pass all airborne and liquid radioactive material releases        Theoretical evaluations                 should be                    (4) Instrument        calibration         procedures, supplemented by stack monitoring, water                                       including calibration         source characteristics.

sam pling, and other environmental monitoring make, and model number, and ap propriate for the planned and potential releases (5) The method, including a sample calcu lation, to be used to convert instrument read For operations involving only sealed ings to units of activity, e.g. . microcuries.

sources, a survey program should include evaluation and/or measurement of radiation levels for storage and use configurations. d. Instructions to Personnel.

When If a number of sources are used in devices having "on" individuals will use radioactive "off" positions, both positions and materials under should be eval the supervision of one or more of those persons uated at the tune of installation Supplemental named in Item 6 of Foim NRC-3131, written surveys should be performed following instructions should be prepared any and submitted changez. in operation, shielding, or use with the license application in the form in which they will be distributed to those working The types, methods, and frequency of with radioactive materials.

These instructions surveys should be described in the application should cover, but not necessarily .'*uidance may be obtained from the be limited to:

                                                          National Council on Radiation Protection Report                                               (1) The availability. selection, No     1

0. and use of

"Radiological Monitoring Methods and Instru laboratory apparel and safety-related ment-s,' and the International Atomic Energy equip ment and devices (e g. , laboratory gloves, and remote pipetting coats,

  'CopIes  may   be  ob asnedi devices).
                                 rrM    NCRp  P ublicaon,       P o Box 4867    Washun                                                               6Copies may be ohrain--
                      . D (    20008                                                                    from "'IPUiB    in.     P 0
                                                                            New .'jrx N"Y       0                                    Box 433,
                                                                                                                             'oei
                                                                     10 7-5

(2) Limitations and conditions to be met in (12) The use of radioactive materials in handling liquid or uncontained (unencapsu animals. If radioactive materials will be used in

                                          1asdioactive      animals,        instructions   concerning    such   use lated,         dispersible, or volatile)
                                                                         be   prepared   and   submitted   with  the materials and special laboratory equipment to                should license application.        Such instructions should be used in working with these types of mate rials. For example, the instructions should                  include (a) specification of the facilities to be explain when operations with materials should                used to house the animals, (b) instructions to be confined to a radiochemical fume hood or                  be provided to animal caretakers for handling animals,       animal wastes,     and carcasses, (c)

glove box and should specify the use of appro priate shielding and remote handling equipment instructions to appropriate personnel for clean when energetic beta- or gamma-emitting mate ing and decontaminating animal cages, and (d) rials are to be used. methods to be used to ensure that animal rooms will be locked or otherwise secured unless

        (3) The performance of radiation survey              attended by authorized users of radioactive and monitoring procedures           or each area in          materials. A description of animal handling and housing facilities should be included uLnd'.

which radioactive materials are to be used.

Item 13 of Form NRC-3131.

(4) Safely precautions to be observed in the movement of radioactive materials between (13) Emergency procedures. These instruc tions should be addressed to all persons in aV.

buildings, rooms, and areas within rooms.

laboratory or facility areas where radioactive!

                                                             materials will be used and should cover actions :
         (5) Safety requirements for storage of including labeling of           to be taken in case of such accidents involving!
 radioactive materials, radioactive materials as spills, fires, release or containers of radioactive materials and posting loss of material, or accidental contamination of and securing areas where radioactive materials                                                 these   instructions personnel.        Specifically, are to be stored. This should include the stor                                 specify immediate actions to be should (a)
 age of contaminated laboratory equipment such as glassware.                                                taken in order to prevent or limit the contami nation of personnel and areas, e.g.. the shut ting down of ventilation equipment, evacuation
          (6) Requirements for posting of areas in which radioactive materials are used.                        of contaminated and potentially contaminated i areas, containment of any spills of radioactive material, (b) give the telephone numbers of in
          (7) The availability and use of personnel dividuals to be notified in case of emergency.

monitoring devices, including the recording of and (c) instruct personnel in proper entry, radiation exposures and the procedures to be decontamination, and recovery operations for I

  followed for the processing of personnel moni contaminated facilities. (Note: Only properly toring devices such as thermoluminescent dosi trained individuals should attempt decontamina meters .and film badges in order to obtain per               tion and recovery operations. )
  sonnel monitoring results
                                                                     (14) Requirements and procedures for pick
           (8) Waste disposal procedures to be fol ing up, receiving, and opening packages (see lowed, including limitations on the disposal of              §20.205 of 10 CFR Part 20).
   liquid or other dispersible waste to the sani- tary sewer       and proceaures  for the LoUeLLLZI,
   storage, and disposal of other wastes                           Items 16 and 17.      A resume of the training and experience of each person who will directly
           (9) The maintenance of appropriate rec               supervise the use of material, who will use ords as required by 10 CFR Part 20 and                       material without supervision, or who will have
    10 CFR Part 30.                                             responsibilities for radiological safety should be submitted. The resumi should include the
           (10) The requirements for and the method             type (on-the-job or formal course work), loca of performing or having appropriate sealed                   tion, and duration of the training. Training source leak tests performed.                                should cover (a)        principles and practices of radiation protection, (b) radioactivity measure
           (11) Good radiation safety practices, in             ments, standardization,        and monitoring tech cluding the control of contamination, specifica             niques and instruments, (c) mathematics and tion of acceptable removable and fixed contami              calculations basic to the use and measurement nation levels tor both restricted and unre                  of radioactivity, and (d) biological effects of stricted areas, prohibition of smoking and the               radiation. The description of the use of radio consumption of food or beverages in areas                   active materials should include the specific iso where radioactive materials may be used, and                 topes handled, the maximum quantities of mate prohibition of the frequent transfer of poten                rials    handled,     where the     experience    was tially contaminated equipment between poten                  gained, the duration of experience, and the tially contaminated areas and unrestricted                  type of use The qualifications, training, and areas.

10 7-6

xiprrinr.* )4ýeach terson should be commensu

          ,I:- w~th J1, mnatriwl arnd its use                                             only have a background or, forma! traming r, as proposed          all areas described in T            ,     'TphPb-ation         The amount and type of                                                   tern 16 of F<orm NRý
                   'a:       ir'd      'xpe; ien(-'                                       3131 but should also h.ive -xten*,*ýn-- expe- with      radiation    and
                        ,e a raaterial.:                                                  working      with   rad*oactrve,     material     an i r1aliu1red to support a                                                                             a
     ,i('rrmIJ atin      I           ,f _ad-quauy by the Commission                       thorough working knowledge of the eqip

u. rmenrt

      .'.        ,,.r mar kru dly with (.,rtain factors                                   required to handle the material safely
             .             -      t -n:.ýh     c h as technical assistants
    :ir~i iab.--rit,;r-                 workers will use radioactive                              5.   AMENDMENTS      TO IhJENSES
    materials in the absenct: of persons specified
     *."*',            a. , specification of the                                            Licensees are required to cor.duct 4heir pr.

training of such persc.rne! ',hould include grams in accordance with statements, (a) instruction in renrý.

    I IAf , -, qs:             fr 1.                                                     sentations. and procedures contained In"udinr,       topics covered and                                                                 in ýtie by whom taught                         hb) on-the-job training in use                 license application and su.:P)>rtive aocuments
   ,-If radlio,-tivt materials, and                                                      The license must therefore be amended (c) determination.                                                                if the of compeienciy to work without                                                        licensee plans to make any changes the presence of                                                          in faclt supervisory (ersOnnel                                                                 ties, equipment (including. monitoring and sur vey instruments), procedures, personnel        or
        "The is' of mitrocurie quantities of a few                                       byproduct material t(; Le used nonvolaile radioactive materials by a person with a minimum of training                                                               Applications for license amendments may and experience                                                                        e under precisely specified and                                                         filed either on the applicatior form or roliled conditions subject to the carefully con                                     form.    The     application. should identify kn ler!tr surveillance of                                                                   1o
        -,Ompetent               and adequately trained radiation                       license by number and should clearly de ;,.r t-.
  protection officer may be justified.                                                  the exact nature of the charges, mum training and experience                                        Such mini                                                      additions, c"r may consist of a            deletions. References to previously e: hours of training and experience                                                                                                 submitted information and documents should
 ,f crne or more radioactive materials in the use                                      specific and should identify be clear and similar to                                                 the pertinent the use proposed in the -tpplication                                                  information by date, page. and under the                                                paragraph sýupervision and tutorship of a Licensed user.

6. RENEWAL OF A LICENSE

     Persons using millicuzri quantities of a num Oer of radionuclideq for general                                                         An application for renewal of laboratory                                                a License should tracer                work         under       unspecified                            be filed at least 30 days prior conditions                                               to the expiration should have more extensive training                                                   date This will ensure that and expe                                             the license does not rience and, depending on the                                                          expire until final action on the exact nature of                                                    application ha6 ih.. proposed program of use                                                          been taken by the NRC as of radionuclides,                                                  provided for in zay         need to have completed formal                                             paragraph :30 37(b) of i9 CFP
                                                                 course work                                                Part 30.

at !he college or university level covering the areas listed under Item i6 of Renewal applications .hould Form NRC-3131. Le filed on Form NRC-3131, appropriately The use of larger suppI-mented, and quantities of material should contain compjete (dpproaching a curie) under and up-to-date infor conditions where a mation about the applicant's potential exists for significant current program.

loss and inges uon. inhalation, or absorption In order to facilitate the review of the radio process, t+/-e a,-tive material by those working application for renewal should with rnal is normaUy done under carefuoly the mate without be submitte.j controlled reference to previously

onditionrs using specialized documents and information submitted equipment. A If such referene-5 person whO is to use radioactive cannot be avoided, they materials inde shoild be clear -ad pendently unnde these conditions should hot specific and should identify the per'tnp-.*.n information by date, page, and paragraph.

10) 7-7

APPENDIX A Form NRC-31 3 (I) Form Apifroed by GAO

                                                                                                                                           B- ll32S(1tOS79)
                                                    U.S. NUCLEAR REGULATORY 0O111611ON
  iO CFR 30
                                                   INSTRUCTIONS FOR PREPARATION OF
                                           APPLICATION FOR BYPRODUCT MATERIAL LICENSE
                                                                    FORM NRC-313 (I)
                                                                GENERAL INFORMATION
      An applbcant lot a "Byproduct Material (Radioisotopes) License."                   3  Broad License (research and development)-"Laceingm               Guie should complete Form NRC-313 (1) m detail and submit in duplicate                         for Type-A Licenses of Broad Scope for Resmarch and )evelop to the U.S Nuclear Regulatory Commission. The applicant should                            ment ,"
  endeavor to cover his entire radmastope program with one application, if possible. However, separate applhcationk should be submitted for                   4. Licensing Guides for the performance of well l            g eperatsoaa.

gamma irradiators. Applicatmlos for medical uses should be submitted

  ^n Form NRC-313 (M) aad applications for use of scaled sources m                       S  Licunrin guide to: the use of scaled sourcs in portable and stint radiography should be submitted on Form NRC-313R. Supplemental                            portable gauging devices'
  sheets may be appened when necessary to provide complete mfoi mation. Item 18 must be completed on all applicatsios. Submission                     The Comm!son charges fees for filing of appblcaloa for hveoaes as of an incomplete application will often result en a delay in issuen*u ,t/         specified in Section 170 12, Title 10 Code of Fedwal Regitleioma.

the license because of the correspondence necessary to obtain inhr Part 170. The applicant should refer to Section 170.31, Scaleduh. uf rnrionrequested on the applicatron fees Ior materialsIlc'n srs. to determine what fee should accompany the application No action can be taken on applications until fees are NOTE When the application incldde: one oi the special sises listed paid. ('hecks or money orders should be made payable to the U.S.

below the applicant should request tihe appropruate pamphlet wlhch Nuclear Regulatory ( ommassion.

provides additionul instructions rwo ,opr," of the ,ompleted Irorm NR(-313 (e) and two copies of I Industrial Radiography "'LIcensitng Requirements for Industrial ea.h atticlimeni thlicc-o should he eCnito the Division of I rael Cycle Radiography'" (use. application I orm NRC'-31 3R for Radi mnd i*iterial Silely. Ottice of Nuclear Material Safety and Safeguards.

ography). IS Ni.lcat Regpilatury Commilsion Washington. DC 20555 One sopy liukiu bc retained for the appliLant's file Applications may

       2 Laboratory and Industrial Uses i Small Quantitis-"G(uidc for               Ji.s be hited in person at the Comnitssion's office at 1717 H Street.

Preparation ol Applications for Liboratory and Industrial N %,. Wishington. D C or at 7915 1 astern Avenue. Silver Spring.

Uses of Small Quantities of Bypr-rduLt Material." M*r5 land EXPLANATION OF FORM NRC-313 (1)

      I-orm NR('-313 fl) is desgned for use in supplying information Thc actual s*ies of use should be listed as indicated. Per on program, nt varying complesty          fhc applicant should provide                         tijnent A[A  ilihlie such as field oflfis lot portable gauges or complete information on his proposed program or the possession devicei should be identified in Item S by Street. Address.

and use of licensed material I or those items that do not apply. indicati.

City and Stait Temporar, field locations of use should As N.A (not appli.able)

                                                                                               be specified as "'temporary job sites of the pplicani" and list the States throughout which the tempora i job sites will Item No he h1,laed       Attach additional properli, keyed sheet if miort spas   is needed I      Sell -exphndlory The -applicant'" i Ilhe organil.ation ii person legall ivc,                6      Sell    \'eplanatory ponibk for possession and ue of the licensed materials specified in the application
                                                                                        7       rhc "Radiation Protection Officer' is the nanied uilividual sho is expected to coordinatc the safe use of the licensed
      3       Sell-explanatory materi~al spekilied in the application and who will ensure srmphanme w!lh the applicable parts of Title 10. ('ode of
     4       SelU-tiplanalory I cderal Regulations I0 7-9

A List by name Ca,1iraditisotope it, he pose-r*ned and ised Attach .red~bonsa pi.perl% keyed sh-,.tsit 11 a '

           under the license 1, ample                                                             needed
                                                                                           1I     Stale tile u      itf  cacti II, cnsed material hlated in 9 V 8..
                                                           B                                      and D
               l)    lodtne-I31        (l)    Iodide t21   lodassc-
  • t
                                       12)    lodinated Humani Scruti Albunpin I* etcript1ion ti
                                                                                                   .Urct*
                                                                                                                    c tllcmtainre* an*d/or device% in ,vJjjh sealed e in Iltem h will be stored or uted. I %ample listd i
               13)   Krypton-85        13)   (.as
              141   Cesium-I 7         (4l   Sealed SouC1.

A

                                                                                                          II I 1      Source housing               Io Curp D)
              0I)   Nof Appliuable     41) 10     mihd:icurie..
              (2)   N   A                     I aillicurnic                                                      Model 1-278 I,)                      (2)
                    N   A                     I inillIhuric I4)                      (4)    2 sou*icul ISO                              10 18      SeIf-.xplanatory         (I at those items that do not apply Model Z-78               mitlit. tolne Cacti                                   indicate a* N A (not applicable)
                                                                PRIVACY ACT STATEMENT

Pursuant to 5 U S.( 55 2af*l(3). 'niacted into law by set,.lon 3 of the I'IVaLvy Act of 1974 (Public: Law 93-579). the Iollowing .-titcileti IS furrnishcd to rndividual% who surply information to the Nuclear Regulatory Commis*ion on I orms NRC-313M, NR(-3 13A, NR(-3131 or NR(_'- 313R I his mformalion is mainiained in a system of re!eoid designated as NRC-3 and descrihed at 40 1 ederal Register 45 114 (Otlober I. 1975) I AUTHORITY SIio n,81 and 1614b) of the Atomic Inerpy Act of 1954. a, amended (42 U.S.( 2111 and 2201ib(1 2 PRINCIPAL PURPOSI"S) The informatmon is e:valuated It, the HKC staif pursuant to the ritleria set forth in 10 ( I R Parts 30-36 to determine whether the application meet, the requircmenti of the Atomic I nergy Act uo 1954. as amctindsd. ap the C('ommisoon's rclgulsaions. lot the issuanice of a byproduct maleril license or amendment thereof 3 ROUTINF tjSI S "he informawn itay be:used (0; to provide reuord& to State heaithk c.kpirtmeusi fop the intormpaipanand useand 4h)to provide intformation t4 I ederal. Stiart. and k),.al heafth officials and other p*;rsons in the event of incident of xposutic por thiir trifortnatilon, mvemiwzliarn.

ind protection (it the publitc health and safety The nfotinalicn ma, dlv) be ditslotd to approptiate I .Jeral. Stile and local ait.ticies in the event that the information indicale* a vio~Ltioon of ptenlti viol*iAt of law and in the course of in ad"ministrative o luli cuialproceeding In Addition. this inlormation ri ay be transfeared to An approprate IFederal. State. or kical agency to i'c esxhint relevant and neest*,.ry f>r a NR(

  dn, ison or to an appropriate I ederal agnev to the .xtent relevant and ne                   lot that afenty'%dcJtioun about sou
                                                                                         ,LcesAfy                                             A npli tit the hin"sc issued will routinely he placed in the NRC's Puhlic Doument Room. 1717 H Street. N W, Washington. DA

4 WHI T1,11II DIStLOSLRI. IS MANDATORY OR VOLUNTARY AND. III FCT ON INDIVIDUAL 01 NOT PROVIDIN(; INI.ORMA rION

   Dit..losurc of the requested infrrmnation is voluntary It the request information is not furnished. hno*,w.vr. ti apptiation   "           horiI, producl mat 'rial lhcense or 3mendmenl thereof, will not he proceied

5 SYSTIM MANAGFRISI ANI) ADDRI SS Dir."tor Division ti I ucl (Clee .aid Matarial Sat*t*. Ofti, ol Nu, tear Material Saetly a4ad S.afeguidf,.

   ki S Nuclear Regulallory ( ommission. Washington. D ( 2055
                                                                               10 7-10

FORM NRC-313 I -U.S. NUCLEAR REGULATORY COMMUON 1. APPLICATION FOR:

       (1-79)
                                                                                                                           (Chec* and/or conYiDe a             opeteJ
       10 CFH 30
                  APPLICATION FOR BYPRODUCT MATERIAL LICENSE
                                                       INDUSTRIAL                                                                   

a. NEW LICENSE

      See erached 'nsrucrt,os for details b. AMENDMENT TO.

L ICEiNSE NUUMBE

      n'fli)leted .p* is-i,,tins are tlile' in d(i/*     otre with the Division of FIuel C'*rle and Material Safetr,.
    Offit r I'f Nit, lear Material Safetv. o.in Safeguards U.S. Noclear Regulatory Commisusion.

Washington. DC 20555 or app/i,.*i5 'nay he, fed in person at the Comnrnision's office at c RENEWAL OFF

    I77 H Strepr NýW. Washinqtol/ 0             ,'" or 7915 Fastern Avenue. Silver Sprinq. Marylayri.

2. APPLICANT'S NAME (institution. firm, person, etc.)

3. NAME OF PERSON TO B

E. CONTACT

ED REGARDING THIS

                                                                                           APPLICATION
      TELEFPHONE NUMBER            AREA CODE - NUMBER EXTE.NSION.                            LEPNONE NUMBER            AREA CODE -- FJUMBER EXTENSION
  4APPLICANT'S MAILING ADDRESS (Include Zip Code)B                                         STREET ADDRESS WHERE LICENSED MATERIAL WILL BE USED
                                                                                           fIncludeO EECode)
                     (IIF MORE     SPACE IS NEEDED FOR ANY ITEM. USE ADDITIONAL PROPERI y                                        V'lVV%       bAfICC
  6. INDIVIDUAL(S) WHO WILL USE OR DIRECTLY SUPERVISE THE USE OF LICENSED MATERIAL
        (See Items 16 and 77 for required Frainingand experience of ech indjividul n4,,d              be low)
                                     FULL NAME                                                                              TITLE
 Ib C.

7. RADIATION PROTECTION OFFICER I Attach e resume of person's trainingend exper.ence a outline if items I 16 and 17 and describe his responsib*t*tievs under Item 15.

_____S. LICENSED MATERIAL I L ELEMENT CHEMICAL NAME OF MANUFACTURER MAXIMUM

                                I   N                             NIRAND                                        ,               MILLICURIES AJ4DOMMEALED
    N                MASS NUMBER                            PHYSICAL FORM                      MODEL NUMBER                    SOURCES AND MAXIMUM ACTI.

(if Sealed Source) VITY PER SOURCE WHICH WILL

 NO.                         A                                                                           CO                   BE POUSESSED AT ANY ONE TVME I
                                                                            UC                                                                       0
                                            _                                                                                                                       -4

!(31 DESCRIBE USE OF LICENSED MATERIAL (21 I 17

                                                                                                                                                         _33 F*IMNRC     313 i 1 -791---
                                                                                                                                                       _  ____
                                                                                10.7-11

9. STORAGE OF SEALED SOURCES

   SCOftTAINtSR       AND/OR DEVICE IN WHICH EACH SEALED                    NAME OF MANUFACTURER                       MODEL NUMefifR

It SOURCE WILL BE STORIED OR USED I A. B. C.

12) (3) (4)

                                           10. RADIATION DETECTION INSTRUMENTS

- TYPE MANUFACTURER'S MODEL NUMffR RADIATION SENSITIVITY L OF NAME NUMIBR AVAILABLE DETECTED RANGE M INmsTRMmNT (alpha.beta. (fnbllfoenr.mrno/hour S gamma. neurron) or counts/mmnure)

                  A                                       C                   D                     E                           F

121 (31

                                      11. CALIBRATION OF INSTRUMENTS LISTED IN ITEM 10

0E. CALINRATDO NY SERVICE COMPANY [0b. CALIBRATED BY APPLICANT

       NAME. ADORESS. AND FREQUENCY                                      Attach a Speorate sheet describing method, frequency Mnd staMdards used for caibratinginhtrumwen.

12. PERSONNEL MONITORING DEVICES

                       TYPE                                            SLPPLIER                                  EXCHANGE FREOUENCY
       fCheft* and/of cran)te as ^wP(OP-o-                         (Seiwce Company)                                           C
                                                                                                                              C
                         A,

0111 FIL*ISADIGE 0 MONTHLY D12) THERMILUVMINESCENCE

                                                                                                                 0 QUARTERLY
          DO1308ITTER (TLD0
                                                                                                                  D OTHER (Specdy)
   S0011  OTHiER  (Sw,_y)
           13. FACMILTtMS AND EQUIPMENT (Check          were appropriate and attch      annotated sketch(es) and description(s).
                                                                                             dMany). ETC
 0    a LABORATORY FACILITIES. PLANT FACILITIES, FUME HOODS (Include foltreon, CONTAINERS.   SPECIAL SHIELDING   (fixed and/lor teorpoarry), ETC
 D    bý STORAGE     FACILITIES
 0    c REMOTE HANDLING TOOLS OR EQUIPMENT. ETC
  0l d RESPIRATORY PROTECTIVE EQ4JIPMENT. ETC
                                                         1q. v1 PaiLr.IK .   ,GMl_
     Na
      --.     OF CONMERCIAL WAST6 DISPOSAL SERVICE EMPLOYED
                                                                                 A DETAILED DESCRIPTION OF METHODS WHICH WILL
 b tF COMMtRCIAL WASTE DISPOSAL SERVICE IS NOT EMPLOYED. SUBMIT
                                                                              OF THE TYPE AND AMOUNT OF ACTIVITY INVOLVED IF
     "85  US6D FOR D46POSING OF RADIOACTIVE WASTES AND ESTIMATES
                                                                                      BE RETURNED TO THE MANUFACTURER. SO STATE.

TE APPLICAlION IS FOR SEALED SOURCES AND DEVICES AND THEY WILL FO"M NOC 313 0 1-794

                                                                  10.7-12

INFORMATION REOUIRED FOR ITEMS 15, 16 AND 17 Describe in detail the information required for Items 15, 16 and 17. Begin each item on a separate page and key to the application as follows:

          15.  RADIATION PROTECTION PROGRAM. Describe the radiation protection program as appropriate for the material to be used including the duties and responsibilities of the Radiation Protection Officer, control measures, bioassay procedures fit needed), day-to-day general safety instruction to be followed.

etc If the application is for sealed source's also submit leak testing procedures, or if leak testing will be performed using a leak test ki0, specify manufacturer and model number of the leak test kit.

16. FORMAL TRAINING IN RADIATION SAFETY. Attach a resume for each individual named in Items 6 and 7 Describe individual's formal training in the following areas where appliable. Indude the name of person or institution providing the training, duration of training, when training was received, etc a. Principles and practices of radiation protection.

b Radioactivity measurement standardization and monitoring techniques and instruments.

c. Mathematics and calculations basic to the use and measurement of radioactivity d Biological effects of radiation.

17. EXPERIENCE. Attach a resume for each individual named in Items 6 and 7. Describe individual's work experience with radiation, including where experience was obtained. Work experience or on the-job training should be commensurate with the proposed use. Include list of radioisotopes and maximum activity of each used.

1

8. CERTIFICATE

                                                    (This trem must be completed try appiicant)
                    Th e .ippl* canr and any official exocurJng this Ofril',cate on behalf ot the applicant named in /rem 2, certify that this application is prepared in confotmitry with Title 10, Code of Federal Regulations Parr 30I and that all 'nformation contained herein including any suPplements atrtached hereto is true and correct ro the best of our knowleade and belief.

WARNING 18 U.S.C Section 1001, Act of June 25. 1948; 62 Stai 749; makes it a crimnal offense to nmke a willtully taiae stltemt or repreentation to any department or agency of the United States as to any matter within its ourisdiction.

LII. FNSE FEE REQUIRED

   (See Secton 170.3? 10 CFR                                               j0    ERTIFYING OFiCiAL
                                                                            c. NAME (Type or print)
 11 LICENSE    FEE CATEGORY                                                 d  TITLE

12; LICENSE FEE eNC.:LOSED $ e DATE F0RM NRC-313 1 11 791

                                                                      10 7-13

_1..

        .                              UN TED STATES
            0                NUCLEAR REGULATORY COMMISSION
                                   WASHINGTON, D. C. 20555 July 1984
                                           [[kRATA
                            REGULATORY GUIDE 10.7,      Revision 1 GUIDE FOR THE PREPARATION OF APPLICATIONS
                                                                      FOR
                 LICENSES FOR LABORATORY AND INDUSTRIAL USE
                                                                    OF SMALL
                            QUANTITIES OF BYPRODUCT MATERIAL
  Regulatory Guide 10.7, Revision 1, provides directions for using Form NRC-313I
  in preparing applications for licenses for laboratory and industrial use of small quantities of byproduct material.

The NRC is now using a new NRC Form

  313 for all byproduct material applications Form NRC-313I.                                    and is discontinuing the use of The NRC is developing Revision 2 of Regulatory conform to the new NRC Form 313.                                         Guide 10.7 to Until Revision 2 is issued, this errata sheet provides the information needed to use the new NRC Form 313.

The new NRC Form 313 does not have space for providing the information requested in Items 5 through 11. Please provide the information on 8-1/2 x

                                                                             11 inch paper.

In the left-hand column of the following table are listed items of the old Form NRC-3131, most of which are also called out in Regulatory Guide 10.7, Revision 1. The right-hand column identifies the corresponding item of the new NRC Form 313 in which responses should be made.

Guide and Old Form NRC-3131 New NRC Form 313 Item 1* Item Item 1

      2 Item                                                       Item 2
      3 Item                                                       Item 4
      4 Item                                                       Item 2
      5 Item                                                        Item 3
      6 Item                                                        Item 8
      7 Item   8                                                    Item 7 Items 5 and 6 Item 9 Item 10                                                     Item 9 Item 11                                                     Item 10
                                                           Item 10

itei 12 Iter; 10 Item 13 Item 9 Item 14 Item 11 Item 15 Item 10 Item 16 Items 7 and 8 Item 17 Item 7 Item 18* Items 12 and 13

  • Not called out in Regulatory Guide 10.7, Revision 1.

The following cross-reference table may be helpful to you: New NRC Form 313 Old Form NRC-3131 Item 1 Item 1 Item 2 Items 2 and 4 Item 3 Item 5 Item 4 Item 3 Item 5 Items 8A, B, C, and D Item 6 Item 8E Item 7 Items 7, 16, and 17 Item 8 Items 6 and 16 Item 9 Items 9 and 13 Item 10 Items 10, 11, 12, and 15 Item 11 Item 14 Item 12 Items 18a(1) and (2) Item 13 Items 18b, c, d, and e ,,L_ Item 14 N/A

                                       2

NRC 'OPV 313

           8'               32 33 34                                                                                                                                            US. NUCLEAR REGULATORY COMMISSION
                                                                                                                                                                                                      APPROVED BY OM8
                                                                                                                                                                                                      3150-0120
                 ...                                                                APPLICATION FOR MATERIAL LICENSE                                                                                  Elxpir,. 5-31-87 NSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR
                                                                                                                                                               COMPLETING APPLICATION           SEND TWO COPIES
        )' 'HE ENTIRE COMPLETED APPLICATION TO THE NRC
                                                                                              OFFICE SPECIFIED BELOW.

FEDERAL AGENCIES FILE APPLICATIONS WITH

                                                                                                                          IF YOU ARE LOCATED IN:
              "I S NUCLEAR           REGULATOR Y COMMISSION
                                                                                                                          ILLINOIS, INDIANA, IOWA. MICHIGAN, MINNESOTA, MISSOURI
              3)IVISION       OF FLEL CYCLE AND MATERIAL SAFETY. NMSS                                                                                                                         OHIO, OR
                                                                                                                          WISCONSIN. SEND APPLICATIONS TO
            WASHINGTON               DC 20555 U S. NUCLEAR REGULATORY COMMISSION, REGION III
      ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS,
                                                                                    IF YOU ARE                                MATERIALS LEIUCENSTNG
      LOCATED IN                                                                                                                                           SECTION
                                                                                                                              799 ROOSEVELT ROAD
     CONNECTICUT. DELAWARE, DISTRICT OF COLUMBIA, MAINE, MARYLAND,                                                            GLEN ELLYN. IL 60137 MASSACHUSETTS, NEW JERSEY, NEW YORK, PENNSYLVANIA,
     On VERMONT. SEND APPLICATIONS TO,                                                    RHODE ISLAND.                   ARKANSAS, COLORADO, IDAHO, KANSAS, LOUISIANA, MONTANA,
                                                                                                                          NEW MEXICO, NORTH DAKOTA, OKLAHOMA, SOUTH DAKOTA,                        NEBRASKA
                                                                                                                                                                                              TEXAS, UTAH,
                 S NUCLEAR REGULATORY COMMISSION. REGION I
            NUCLEAR MATERIAL SECTION B                                                                                    OR WYOMING, SEND APPLICATIONS TO:
           63! PARK AVENUE                                                                                                    U.S. NUCLEAR REGULATORY COMMISSION. REGION IV
           KING OF PRUSSIA. PA 19406                                                                                         MATERIAL RADIATION PROTECTION SECTION
                                                                                                                             611 RYAN PLAZA DRIVE. SUITE 1000
     ALARAMA FLORIDA GEORGIA KENTUCKY, MISSISSIPPI, NORTH CAROLINA,                                                          ARLINGTON, TX 76011 PUERTO RICO, SOUTH CAROLINA, TENNESSEE, VIRGINIA, VIRGIN
     WEST VIRGINIA. SEND APPLICATIONS TO:                                                      ISLANDS. OR               ALASKA, ARIZONA, CALIFORNIA, HAWAII, NEVADA, OREGON,
                                                                                                                         AND U.S. TERRITORIES AND POSSESSIONS IN THE PACIFIC, SEND            WASHINGTON,
                                                                                                                                                                                                 APPLICATIONS
           'J.S NUCLEAR REGULATORY COMMISSION, REGION
                                                                                 II
                                                                                                                         TO:
           MATERIAL RADIATION PROTECTION                       SECTION
              'I MARIETTA STREET, SUITE 2900                                                                                 U.S NUCLEAR REGULATORY COMMISSION, REGION V
                                                                                                                             MATERIAL RADIATION PROTECTION SECTION
          ATLANTA. CA 30323
                                                                                                                             1450 MARIA LANE. SUITE 210
                                                                                                                             WALNUT CREEK, CA 94596 PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS
                                                                                              TO THE U.S. NUCLEAR REGULATORY COMMISSION ONLY IF THEY
                                                                                                                                                                       WISH TO POSSESS AND USE LICENSED MATERIAL
    IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION
                                                                                                JURISDICTION.

I THIS IS AN APPLICATION FOR [Chock o'opritare itEm)

                                                                                                                      2. NAME AND MAILING ADDRESS OF APPLICANT (Includ.Zip Code)
                 A     NEW LICENSE
                 B AMENDMENT TO LICENSE NUMBE9
  ? AJDRESSiES! WHERE LICENSED MATERIAL WILL
                                                                            BE USED OR POSSESSED.

4 NAME OF PERSON TO B

E. CONTACT

ED ABOUT THIS APPLICATION

                                                                                                                                                                               TELEPHONE NUMBER
 SUBMIT ITEMS 5 THROUGH II                         ON  EN , 11  PAPER      THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED
                                                                                                                                             IS DESCRIBED IN THE LICENSE APPLICATION GUIDE
 E      RADIOACTIVE MATERIAL
                    Er'iinlband      5 nunibr aort.    b Ihencal]
                                                      tft      andlor OnyIsciI         and c.   mano'" ionn            6.   PURPOSEIS) FOR WHICH LICENSED MATEPIAL WILL
       ,.rlcn wi,' be oo$$s~sec at any onn tinie                                                                                                                                      BE USED
        'NDIVIDUALiSi RESPONSIBLE FOR RADIATION SAFETY
       TRA        'ýING AND EXPER:ENCE                                               PROGRAM AND THEIR
                                                                                                                      8. TRAINING FOR INDIVIDUALS WORKING IN OR FREOUENTING
                                                                                                                                                                                                RESTRICTED AREAS
          ACILITIES AND EQUIPMENT                                                                                    10.   RADIATION SAFETY PROGRAM
         WASTE MANAGEMENT                                                                                            12 LICENSEE FEES (Saw ro CFR           I70nd  S*eefon 170.31)
                                                                                                                                                                             WAMOUNT
                                                                                                                     FEE CATEGORY                                             ENCLOSED $
          C'ERTIFICATU0N               !AMiistbecornolotedbyaDphcandJ THE APPLICANT UNDERSTANDS
                                                                                                               THAT ALL STATEMENTS AND REPRESENTATIONS
                                                                                                                                                                         MADE IN THIS APPLICATION ARE
          Hl -ING .PO.,             Tn5 APPLICANT
          "-.E APPLICANT AND ANY OFFICIAL EXECUTING THIS
         cRyFPARLD :N CONFORMITY WITH TITLE                                         CERTIFICATION ON BEHALF OF THE APPLICANT NAMED
                                                                   I0. CODE OF FEDERAL REGULATIONS,           PARTS 30,32, 33,34,35. AND 40 AND      IN ITEM 2, CERTIFY THAT THIS APPLICATION IS
                                                                                                                                                          THAT ALL INFORMATION CONTAINED HEREIN
            'S'RI E AND CORRECT TO THE BEST OF THEIR KNOWLEDGE
                                                                                           AND BELIEF
         PIARNING I6 ý                 -C SECTION I001 ACT OF JUNE 25 1948.62 STAT 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY
                 T-AY DEPARTMENT OR AGENCY OF THE UNITED STATES                                                                                                       FALSE STATEMENT OR REPRESENTATION
                                                                                          AS TO ANY MATTER WITHIN ITS JURISDICTION
         .',R*J-'EH*T ...                  I.%GO:CSR                       TYPEDIPRNTEO NAME                                          IIL                                                         DT
         $SOO.

-,-I * TMIO

                                                                    8NUMBER OF EMPLOYEES (Totalio d WOULD YOU BE WILLING TO FURNIH COST
                                                                 $  ~ ittrn aciityPx~iJ~nECJttdfCflt*Ct,,)
                                                                                                                        ON THE ECONOMIC IMPACT OP CURRENT NRC REGULATIONS
                                                                                                                                                                             INFORMATION ('Jolls, anditeho,,
                                                                                                                                                                                             OR ANY FUTURE
       I 251K -500K                          S'5V35   7M                                                                PROPOSED NRC REGULATIONS THAT MAY AFFECT
                                                                                                                        it t0O1eCitip,~lCn YDU? (NRC iwecilationn,'pi.n4 nena o iera~r~i,,.,ion.i,                 e-r,Ihld to
   :      5520K - 50K                        s7m - 1M             c NUMBER OF BEDS                                      th poyin        contidenlcs)
         S-50K            V>NO
                            V,..A               J                                                                            YES
                                                                                                        FOR NRC USE ONLY
           3           i             'SE LOG   0P5                FEE CATEGORY                COMMENTS                                                                                  APPROVED By
                    2

4.', " . ECE .'C CHECK NUMBER

                                                                                                                                                                                        DATE
        ;'v"""*ACT         S
                           A
                           S       AT. T
                                  Y>TIE'T   0O4 THE E REVERSE
                                                       REV

PRIVACY ACT STATEMENT Pjrsuant to 5 U.S.C. 552a(e)(3), enacted into law by section 3 of the Privacy Act of 1974 JPublic Law 93-579), the follow

!ng statement is furnished to individuals who supply information to the Nuclear Regulatory Commission on NRC
                                                                                                                          Form

313. This information ;s maintained in a system of records designated as NRC-3 and described at 40 Federal Register

                                                                                                                         45334 (October 1, 19751.

1 AUTHORITY: Sections 81 and 161(b) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2111 and 2201 (bll 2 PRINCIPA

L. PURPOSE

(S): The information is evaluated by the NRC staff pursuant to the criteria set forth ;n 10

                                                                                                                           CFR
   Parts 30, 32, 33, 34, 35 and 40 to determine whether the application meets the requirements of the Atomic Energy Act of
   1954, as amended, and the Commission's regulations, for the issuance of a radioactive material license or amendment thereof.

3. ROUTINE USES: The information may be (a) provided to State health departments for their information and use, and (b) provided to Federal, State, and local health officials and other persons in the event of incident or exposure, for their information, investigation, and protection of the public health and safety. The information may also be d1,s closed to appropriate Federal, State, and local agencies in the event that the information indicates a violation or potent:ai vwo'at~on of iaw and !n the course of an administrative or judicial proceeding. In addition, this information may be trans ferred to an appropriate Federal, State, or local agency to the extent relevant and necessary for an NRC decision or to an appropriate Federal agency to the extent relevant and necessary for that agency's decision about you.

4ý WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVID

    ING INFORMATION: Disclosure of the requested information is voluntary. If the requested information is not furn ished, however, the application for radioactive material lik.ense, or amendment thereof, will not be processed. A request that :nformation be held from public inspection must be in accordance with the provisions of 10 CFR 2.790. Withhold ing from public inspection shall not affect the right, if any, of persons properly and directly concerned need to inspect the document.

5. SYSTEM MANAGER(S) AND ADDRESS: U.S. Nuclear Regulatory Commission Director, Division of Fuel Cycle and Material Safety L

                                                Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555 NRC FORM 313

I NRC

                                                                                                                                                                     US NUCLEAR REGULATORY COMMISSION
       84 APPROVED BY OD4E
         C F 1,4"3,        ý    1                                                                                                                                                            3150-0120
                                                                             APPLICATION FOR MATERIAL LICENSE                                                                                E-pis    55-31.87 NSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING
                                                                                                                                                                      APPLICATION       SEND TWO COPIES
     )l THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED
                                                                                                            BELOW.

[

    "FEDERALAGENCIES FILE APPLICATIONS WITH
           - S NUCLEAR REGULATORY COMMISSION
         ilVISION O FUEL CYCLE AND MATERIAL SAFETY. NMSS
         WNASHINGTON.            DC 20555 IF YOU ARE LOCATED IN
                                                                                                                   ILLINOIS, INDIANA, IOWA, MICHIGAN. MINNESOTA. MISSOURI, OHIO. OR
                                                                                                                   WISCONSIN. SEND APPLICATIONS TO:
                                                                                                                       U S. NUCLEAR REGULATORY COMMISSION. REGION III
   ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS. IF YOU ARE                                                          MATERIALS LICENSING SECTION
   LOCATED IN                                                                                                          799 ROOSEVELT ROAD
   CONNECTICUT. DELAWARE. DISTRICT Ol- COLUMBIA. MAINE. MARYLAND.                                                      GLEN ELLYN. IL 60137 MASSACHUSETTS, NEW JERSEY NEW YORK. PENNSYLVANIA, RHODE ISLAND,
   OPRVERMONT. SEND APPLICATIONS TO.                                                                               ARKANSAS COLORADO, IDAHO, KANSAS. LOUISIANA, MONTANA, NEBRASKA,
                                                                                                                   NEW MEXICOO,NORTH DAKOTA, OKLAHOMA, SOUTH DAKOTA. TEXAS, UTAH.

OR WYOMING. SEND APPLICATIONS TO:

             S NUCLEAR REGULATORY
        NUCLEAR MATERIAL SECTIONCOMMISSION.         B
                                                                   REGION IO
                                                                                                                      U.S. NUCLEAR REGULATORY COMMISSION, REGION IV
        631 PARK AVENUE
        KING OF PRUSSIA. PA 19406                                                                                     MATERIAL RADIATION PROTECTION SECTION
                                                                                                                      611 RYAN PLAZA DRIVE, SUITE 1000
   ALABAMA. FLORIDA, GEORGIA. KENTUCKY. MISSI.SIPPI, NORTH CAROLINA,                                                  ARLINGTON.TX 76011 PUERTO RICO, SOUTH CAROLINA. TENNESSEE, VIRGINIA, VIRGIN ISLANDS,
                                                                                                 OR               ALASKA, ARIZONA, CALIFORNIA, HAWAII, NEVADA. OREGON, WASHINGTON.

WEST VIRGINIA. SEND APPLICATIONS TO

                                                                                                                  AND U.S. TERRITORIES AND POSSESSIONS IN THE PACIFIC, SEND APPLICATIONS
        'J S NUCLEAR REGULATORY COMMISSION. REGION II                                                             TO:
       MATERIAL RADIATION PROTECTION                      SECTION
        ',71 MARIETTA STREET. SUITE 2900                                                                              U.S. NUCLEAR REGULATORY COMMISSION REGION V
                                                                                                                      MATERIAL RADIATION PROTECTION SECTION
       ATLANTA GA 30323
                                                                                                                      1450MARIA LANE, SUITE 210
                                                                                                                      WALNUT CREEK. CA 94596 PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE
                                                                                              U.& NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS
                                                                                                                                                                                 AND USE LICENSED MATERIAL
  IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION JURISOICTION.

THIS IS AN APPLICATION FOR lChoek aWmpriste it")

                                                                                                               2. NAME AND MAILING ADDRESS OF APPLICANT (OncludeeZ Code)
             A NEWLICENSE
             8     AMENDMENT          TO LICENSE NUMBER_
             C RENEWAL OF LICENSE NUMBER
     A--A)DRESSIES! WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED

4 NAME OF PERSON TO B

E. CONTACT

ED ABOUT THIS APPLICATION

                                                                                                                                                                   J TELEPHONE NUMBER

SUBMIT ITEMS S THROUGH 1 I ON E'i 11 - PAPER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED

                                                                                                                                                    IN THE LICENSE APPLICATION GUIDE

5 RADIOACTIVE MATERIAL

     a E emeni and mass 'iunibet" b cýhen,cal end/or physlcls for,. end c.

n*,binusn 60.mn 6 PURPOSEIS) FOR WHICH LICENSED MATERIAL WILL BE USED

      ýt,'       -C 11b5, Qosssed at anv one ti-e NIDIVNIUAL(S, RESPONSIBLE
                                                  FOR RADIATION SAFETY PROGRAM
     TRA,.,ING AND EXPERIENCE                                                          AND THEIR
                                                                                                                8    TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS
        SACITIES AND EQUIPMENT
                                                                                                               10    RADIATION SAFETY PROGRAM
"     W
      WASTE MANAGEMENT
                         N12.

LICENSEE FEES (See I0CFR 170andSection 170.31/

                                                                                                                                                                   iAMOUNT
                                                                                                               FEE CATEGORY                                        jENCLOSED      $
        ""ErTIF'CATION              (Must beomo/eredby*Phl/cAntJ THE        APPLICANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENTATIONS
                                                                                                                                                                MADE IN THIS APPLICATION ARE
       8,,'E NGNUPON T.IE APPLICANT
          "iE    APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION
      PRFPAIIED ;N CONFORMITY WITH TITLE 10, CODE OF FEDERAL
                                                                                               ON BEHALF OF THE APPLICANT NAMED IN ITEM 

2. CERTIFY THAT

                                                                                                                                                                        THIS APPLICATION IS
                                                                                     REGULATIONS, PARTS 30.32 33. 34 35. AND 40 AND THAT ALL
      ýS TOIJE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND                                                                                               INFORMATION CONTAINED HEREIN
                                                                                        BELIEF
         .ARNINC. IS, U SC SECTION 1001 ACT OF JUNE 25. 1948, 62 STAT
                                                                                         749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE
      Tr A%' ULEPARTMENT OR AGENCY OF THE UNITED STATES AS                                                                                                           STATEMENT OR REPRESENTATIO.N
                                                                                     TO ANY MATTER WITHIN ITS JURISDICTION
              .i" i      E.(*T'     'NTI OFFICER                     I TYPED/PRINTED NAME                                       ITITLE                                                    DATE
                                            P                                              14 V       UNTAAY ECONOMIC DATA
                                    N'..
                                     R      Pb                 NUMBER OF EMPLOYEES        (Tote/i'1o,         d WOULD YOU BE WILLING TO FURNISH COST INFORMATION
                                         SIM    I SM           ...      fre                                                                                                         r(JOI8e,.doCImffh., ,
                                                                                             .                    ON THE ECONOMIC IMPACT OF CURRENT NRC REGULATIONS                                        5 OR ANY FUTURE
          25271K                         S35kEV7M                                                                 PROPOSED NRC REGULATIONS THAT MAY AFFECT YOU' (NRC mru1/tionsjDenrmt It to Dfrorect coifdent"e1 Commn'itl or finncil-Drorietli/--,iiOrmet~on furniShod to S5OOK          /501K                 M   1DM             NUMBER OF BEDS                                              c
      5j 'ýOK IV                         -ISIOM
                                                                                                                        E
                                                                                                   FOR NRC USE ONLY
  ' p             I(F             (FE LOG                    FEE CATEGORY            COMMENTS                                                                                   APPROVED     BY

AV. ".-FCEiTE TO CHECK =NUMBER

                A'ý    S     TMENT Ory THE REVERSE

PRIVACY ACT STATEMENT

                                                                            Privacy Act of 1974 (Public Law 93-579), the follow Pursuant to 5 U.S.C. 552a(e)(3). enacted into law by section 3 of the to the Nuclear Regulatory Commission on NRC Form

,g statement is furnished to individuals who supply information as NRC 3 and described at 40 Federal Register 45334 313. This information is maintained in a system of records designated (October 1, 1975).

                                                                      Act of 1954, as amended (42 U.S.C. 2111 and 2201(b)).

1, AUTHORITY: Sections 81 and 161(b) of the Atomic Energy CFR

                                                                  by the NRC staff pursuant to the criteria set forth in 10

2. PRINCIPA

L. PURPOSE

(S): The information is evaluated of the Atomic Energy Act of the application meets the requirements Parts 30, 32, 33, 34, 35 and 40 to determine whether material license or amendment for the issuance of a radioactive

   1954, as amended, and the Commission's regulations, thereof, information and use;
                                                    (a) provided to State health departments for their

3. ROUTINE USES: The information may be of incident or exposure, and other persons in the event and (b) provided to Federal, State, and local health officials The iformation may also be dis of the public health and safety.

for their information, investigation, and protection irdicates a violation or potential in the event that the information closed to appropriate Federal, State, and local agencies this information may be trans or judicial proceeding. in addition, violation of law and in the course of an administrative necessary for an NRC decision or to to the extent relevant and ferred to an appropriate Federal, State, or local agency about you.

and necessary for that agency's decision an appropriate Federal agency to the extent relevant NOT PROVID

                                                          VOLUNTARY AND EFFECT ON INDIVIDUAL OF

4. WHETHER DISCLOSURE IS MANDATORY OR the requested information is not furn information is voluntary. If ING INFORMATION: Disclosure of the requested will not be processed. A request material license, or amendment thereof, ished, however, the application for radioactive the provisions of 10 CFR 2,790. Withhold must be in accordance with that information be held from public inspection and directly concerned need to inspect if any, of persons properly ing from public inspection shall not affect the right, the document.

U.S. Nuclear Regulatory Commission

 5. SYSTEM MANAGER(S) AND ADDRESS:
                                                   Director, Division of Fuel Cycle and Material Safety Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555 NRC FORM 313

NRBC *'*RM 313 US NUCLEAR REGULATORY COMMISSION

       '84C-I 3C 32 33 34 APPROVED BY Om B
                                 ...    0APPLICATION                                              I        FOROR MATERIAL
                                                                                                                      M31M0-0120            LICENSE                                                  E ....   5-31-87 NSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS
                                                                                                                                                       FOR COMPLETING APPLICATION               SEND TWO COPIES
    )I THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW.

FEDERAL AGENCIES FILE APPLICATIONS WITH

                                                                                                                       IF YOU ARE LOCATED IN
                 NS  U'CLEAR REGULATORY COMMISSION                                                                    ILLINOIS. INDIANA. IOWA, MICHIGAN, MINNESOTA. MISSOURI. OHIO, OR
         'JIVISION OF FUEL CYCLE AND MATERIAL SAFETY. NMSS
                                                                                                                      WISCONSIN, SEND APPLICATIONS TO
        WASHINGTC!q. DC 20555 ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS. IF YOU ARE                                                               U S. NUCLEAR REGULATORY COMMISSION. REGION III
                                                                                                                            MATERIALS LICENSING SECTION
  LOCATED IN
                                                                                                                           799 ROOSEVELT ROAD
                                                                                                                           GLEN ELLYN, IL 60137 CONNECTICUT. DELAWARE, DISTRICT OF COLUMBIA, MAINE. MARYLAND,
 MASSACHUSETTS. NEW JERSEY,                       NEW YORK, PENNSYLVANIA. RHODE ISLAND,                              ARKANSAS. COLORADO, IDAHO. KANSAS, LOUISIANA, MONTANA, NEBRASKA.

OR VERMONT. SEND APPLICATIONS TO. NEW MEXICO, NORTH DAKOTA. OKLAHOMA. SOUTH DAKOTA, TEXAS, UTAH.

.S NUCLEAR REGULATORY COMMISSION, REGION I OR WYOMING, SEND APPLICATIONS TO:

        NUCLEAR MATERIAL SECTION B
                                                                                                                           U.S. NUCLEAR REGULATORY COMMISSION. REGION IV
        631 PARK AVENUE
                                                                                                                           MATERIAL RADIATION PROTECTION SECTION
        KING OF PRUSSIA. PA               19406                                                                            611 RYAN PLAZA DRIVE. SUITE 1000
                                                                                                                           ARLINGTON, TX 76011 ALABAMA FLORIDA GEORGIA. KENTUCKY, MISSISSIPPI, NORTH CAROLINA.

PUERTO RICO, SOUTH CAROLINA. TENNESSEE, VIRGINIA, VIRGIN ISLANDS, OR

 WEST VIRGINIA. SEND APPLICATIONS TO                                                                                 ALASKA, ARIZONA, CALIFORNIA, HAWAII, NEVADA. OREGON, WASHINGTON,
                                                                                                                     AND U.S. TERRITORIES AND POSSESSIONS IN THE PACIFIC, SEND APPLICATIONS
        'J S NUCLEAR REGULATORY COMMISSION, REGION It                                                                TO:
        MATERIAL RADIATION PROTECTION SECTION
        101 MARIETTA STREET. SUITE 2900                                                                                    U.S. NUCLEAR REGULATORY COMMISSION, REGION V
                                                                                                                           MATERIAL RADIATION PROTECTION SECTION
       AILANTA. GA 30323
                                                                                                                           1450 MARIA LANE. SUITE 210
                                                                                                                          WALNUT CREEK. CA 94596 PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR
                                                                                                               REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL

IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION JURISOICTION.

1 THIS IS AN APPLICATION FOR (Chock a'Copioreewt*t* , 2. NAME.AND MAILING ADDRESS OF APPLICANT (Includ.Zip Code)

             A      NEW LICENSE
             B    AMENDMENT TO LICENSE NUMBE_
             C    RENEWAL OF LICENSE NUMBER
    ADORESSIESI WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED

4 NAME OF PERSON TO B

E. CONTACT

ED ABOUT THIS APPLICATION

                                                                                                                                                                          jTELEPHONE    NUMBER

SUBMIT iTEMS S TIROUGH 11 ON 8' , 11 'PAPER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED IN

                                                                                                                                                               THE LICENSE APPLICATION GUIDE.

S R-ýDIOACTIVE MATERIAL

                 aEcment ecll mass numbe.     b checal eImnd/orDfhys,Col 1orm.Iad    c  mTlS-.n,    anooIt          6.    PURPOSEBS) FOR WHICH LICENSED MATEPIAL WILL BE USED
         h    .ch
                -Ii,    o oos$ese4 at a"ny one tlme INDIVIDUALIS, RESPONSIBLE FOP
                                                     RADIATION SAFETY PROGRAM AND
     TRA 'IG             AND EXPERIENCE                                                          THEIR
                                                                                                                    8, TRAINING FOR INDIVIDUALS WORKING IN OR FREQUEN'ING RESTRICTED AREAS
        AC:IITIES AND EQUIPMENT
                                                                                                                  10.     RADIATION SAFETY PROGRAM
                                                     WASTE~~~     MNGMT
                                                                                                                    "12 LICENSEE FEES (See ?0CFRt 1tTOrsdlSteor, 170.31)
                                                                                                                  FEE CATEGORY                                             AMOUNT
                                                                                                                                                                         lENCLOSED   $
 j     '7EPTIFICATION               fMus'beomplvridbVyliclnrJ THE APPLICANT UNDERSTANDS THAT Al L
                                                                                                                           TATEMENT              R*          ....       .        .           -
        BIN' -. 3 -PTEN                APPLICANT                                                                                        . AND       tP1EUNTI          MADE IN THIS APPLICATION ARE
        -'E APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEHALF
                                                                                                              OF THE APPLICANT. NAMED IN ITEM 2. CERTIFY THAT THIS APPLICATION IS
            AEPARED :% CONFORMITY WITH TITLE 1

0. CODE OF FEDERAL

                                                                                         REGULATIONS, PARTS 30.32.33, 34, 35. AND 40 AND THAT ALL INFORMATION
       ,F'IJ           AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF                                                                                                      CONTAINED HEREIN
      VARNINC                16 u S C SECTION 1301 ACT OF JUNE 25. 1948, 62 STAT 749 MAKES IT A CRIMINAL
       "TC,   ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER
                                                                                                                             OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION
                                                                                                            WITHIN ITS JURISDICTION
   SNn.*                'E*T .         C
                                       GOFliCS                       'TYPEDIPRINTED NAME                                              TITLE                                                         DATE
                                                                                                  14VLUNTARY ECONOMIC DATA
                         A. A   ,*:- R CE'PTS          I      NUMBER OF EMPLOYEES (Tor               for al          d    WOULD YOU BE WILLING TO FURNISH COST INFORMATION                                  o rtIOII. -noo      stfhow,,,
                 1
                "'SI'K                       vM 5v            emt,     fci,ty  -excluoingOrsdi   conftrlcrors         ON THE ECONOMIC IMPACT OF CURRENT NRC REGULATIONS OR ANY FUTURE
       S251K          NOOK                                                                                            PROPOSED NRC REGULATIONS THAT MAY AFFECT YOU' (NRCmoIlerio$s S 5MS    ?M                                                                  Irt ro votcr                                                                          pe-.r confidenrti& commerns*I Or frinolal-oroorrr. --*t,,tofrnltton f-rnlthld to
       $5500K - 750K                     S7M -0M           c NUMBER OF BEDS                                                   py   ,nConfidrce)
       S 50K          'V                    S
                                            '0M                                                                 F          YES                                                           NO
                                                                                                     FOR NRC USE ONLY
     "PE-         F6.             FEEFOG                   PEECATEGORY                  COMMENTS                                                                                     APPROVED By
      .      . T... CE "'E.D                    CHECK NUMBER
    .4    .     A'T STATEMFNT ON THE REVERSE

PRIVACY ACT STATEMENT

                                                                                                                 93-579), the follow Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by section 3 of the Privacy Act of 1974 (Public Law Commission     on NRC Forrr inq staxement is furnished to individuals who supply information to the Nuclear Regulatory described at  40  Federal Register 45334

313. This information is maintained in a system of records designated as NRC-3 and (October 1 1975).

                                                                                                 (42 U.S.C. 2111 and 2201(b)).

1. AUTHORITY: Sections 81 and 161(b) of the Atomic Energy Act of 1954, as amended staff pursuant to the criteria set forth in 10 CFR

2. PRINCIPA

L. PURPOSE

(S): The information is evaluated by the NRC

                                                                                    the requirements of the Atomic Energy Act of Parts 30, 32, 33, 34, 35 and 40 to determine whether the application meets of a radioactive material license or amendment
   1954, as amended, and the Commission's regulations, for the issuance thereof.

health departments for their information and use; 3. ROUTINE USES: The information may be (a) provided to State other persons in the event of incident or exposure, and (b) provided to Federal, State, and local health officials and and safety. The information may also be dis for their information, investigation, and protection of the public health that the information indicates a violation or potential closed to appropriate Federal, State, and local agencies in the event In addition, tt'fs information may be trans violation of law and in the course of an administrative or judicial proceeding.

relevant and necessary for an NRC decision or to ferred to an appropriate Federal, State, or local agency to the extent that agency's decision about you.

an appropriate Federal agency to the extent relevant and necessary for AND EFFECT ON INDIVIDUAL OF NOT PROVID 4, WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY

                                                                          is voluntary. If the requested information is not furn ING INFORMATION: Disclosure of the requested information amendment thereof, will not be processed. A request ished, however, the application for radioactive material license, or with the provisions of 10 CFR 2.790. Withhold that information be held from public inspection must be in accordance persons properly and directly concerned need to inspect ing from public inspection shall not affect the right, if any, of the document.

5. SYSTEM MANAGER(S) AND ADDRESS: U.S. Nuclear Regulatory Commission Director, Division of Fuel Cycle and Material Safety Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555}}