ML18178A420

Jackson Community College - Renewal Request. Dated 06/27/2018

ML18178A420
Person / Time
Site:	07001228
Issue date:	06/27/2018
From:	Demarco C Jackson Community College
To:	NRC/RGN-III
Forster S
References
609205
Download: ML18178A420 (3)

Text

JUN/27/2018/WED II :39 AM JACKSON COLLEGE NRC FORM 313 U.S. lllUCLl:;AR, REGUlATORY COMMISSION (10,,2017) loCFR.30,a2,

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,Ii' APPLICATION FOR MATERIALS LICENSE FAX No.517 796 8637 P. 002 APPROVED BY 0MB: NO. 3151H112D EXPIRES: 06/30/2018 ElllrDa1ad bulllan par iupon16 IO compjy lnlh ll,is mandalo,y calJeclian n:qu..t *.3 b<<J*ll', Sllbmitt.l of 1119 a1111llcldlon 19 necessary la delamlllc 1hat th* "l'Pf,m,nl i,i q*.dili<,d and lhat llleqm: prvClldv11, u~ ID PlllllCI Iha pullle Ulllll lllld lartly. Send oQllllllellfs n:gaali!Jg banlen 0$1inafe 1D lh* lnlinma6an Scrvic:a& 8ranc:h (T-2 F43),

U.S. Nldi:ar Regulalmy Comnmlc,n, W'l"hingl.on, DC l0~001, or by OfllU Cg lnlucolical.Ruouroa@n11:.11ov.

and lo u,,, lles1( otbr, Offia: of lnlo,mJliGn ~ ~cgwillllry.Afl~n, l'IEOS-10202, (315~0120), Olllce Of Managomo:al and Budge~ Washinglon, DC 20603. If ; m,1111, uMd lu inl"l'le w, infonnllllon colaCllon daaa not di;p~r a """""°' ~Ill 0MB c:11nbill nombsr, lhs NRC mil)' not condvll or &IIOllliOr, and a pe11an la not fl!quln!d lo n,spond!il, llloilllinnalian CD~On, INSlJWCJIONS: IEE 1ltE CURRENT VOLUMES OF THE NUREli-11i5111aCHNICAL REPORT SENES !"CONSOLIDATED GUIDANC! ABOUT MATl!RIALS UCl!NSE&") FOR DETAIL.ED INS'111,UCTIONS POil COMPLETING THIS FORM: blhtl'-1oe on; gpy/p:adlgp,rzg[dpc,ep(l£FIIAP1txlu1C8a&wtfta:! CC&!. Sl!ND TWO COPIE& OF '114E CONPL.!TED Al'PUCAllON TO THE NllC OFFICE &PECIFI~ IIEI.OVI.

APPLICATION FOR DIS1RIBU110N OF EXEMPT PRODUCTS FILE APPLICATIONS WITH:

MATERIALS SAFElY LICENSING BRANCH OIVl$JON OF MI\\TER)AJ.. 61\\F~, STATE, TR.IBAL. ANO RULE MAKING PROGAAMS OFFICE OF NUCLEAR MATERIALS 6AFlii:N Af',ICI 6~!3UARDS U.S. NUCLEAR REGULATORY COMMISSION WI\\SHINGTON, DC 20565-0001 Al. OTHER PERSONS fll.Ei APPUc:ATIONS AS FOLi.OW&:

IF YOU ME LOCATED IN:

ALAlilAMA, CONNECllC:UT, IIELAWARE, DISJRICT OF COWMIIIA, FLORIDA, Gl!ORGIA, KENllJCICY, MAINE, MARYLAND, MASSACHUSETTS, NEW HAMPIHIRI!,

NEW J!Rll!Y, Nl!W YORK, NORTH CAROLINA, Pl!NNSYLVANIA, PUl!RTO RICO, IVfOJlE l&µIND, &OUTI! ~IWUl'l/lo, 'JEIIINiEli&.EE, 1/Ell,MONT, \\IIRCII~ VIRGIN ISLANDS, DR WEST VIRGINIA, SENO APPLICATIONS TO:

LICENSING ASSISTANCE TEAM DIVISION OF NUCLEAR !AATERIALS SAFE1Y U.6, NUCl.$R Rli.13UIA'TORY COM"1165ION, ReOION I 2100 RENAISSANCE BOULEVARD, SUITE 100 KING OF PRUSSIA, PA 11WD&-2713 ll'YOIJ ARI! LOCATl!D IN:

IWNOlll, INEMANA, IOWA,, MICHIGAN, MINNESIJTA, MISSOURI, OHIO, OR WISOON&IN, SEND APPLICATIONS 10:

MATERIAJ.S LICENSING IIR.,ANOH U,6. NUCLEAR REGULATORY COMMISSION, REGION IU 244S WARRENIIIUE ROAD, SUITE 210 USL.E. IL eo&aMa62 IF YOU ARE LOCATED IN:

ALASKA, ARIZONA, ARKANSAS, CALIFORNIA, COLOJIADO, IIAWAll, lbAffO, KANSAS, LOUISIANA, MIISIISIPPJ, MONTAl'l4, J\\IEBRASKA, l'IEVAD,11, Nl>W MEXICO. NORTH OAl(CITA. 0111.AttOMA, OREGON, PACl'IC TRUST llaRRITORIES, SOUTH DAKOTA, TEX.A.&,

UTAH, WASHINOTON, OR Wl'OMING.

&EI\\III ""1'LICATION5 TO:

NUCLEAR MATERIALS LICENSING BRANCH U.S. NUCLEAR REGULATORY C0MMIS610N, IU:13lON IV 161lD ~- I.AMAR BOU~evARO ARLINGTON, TX 79011-4511 PERSONS LOCATED IN AGREEMENT STA11a9 S.END APPLICATIONS 101HE U.S. NUCLl!AR REllllll.ATOR'f COMNl&SION ONI.Y IF THEYWl9H TO POSSESS AND use UCl!NS!D M.A.TERlAL IN STAllal SUBJEiCTTO U,L NUCU:AR REGULATORY COMMISSION JUJUSDICTIONS.

1, 1HIS IS AN APPLICATION FOR (Chll<I/< app,riptll,(e IIRmJ D A. NEW LICENSE D B. AMENDMENT TO LICENSE NUMBER It] C. RENEWAL OF LICENSE NUMBER SNM-1171

3. ADDRESS WHERE UCENSEO MATERIALS WILL E!E USED OR. PO$SE88£D 2111 Emmons Road, Jackson, Ml 49203 2, NI\\ME AND MALING ADDRESS OF APPLICANT (lndurte zip codel Jackson Community College, 2111 Emmons Road, Jackson, Ml 49203

,4,. NANE OF PERSON TO BE CONTACTEO ABOUT THIE! APPLJCATION Chris J. DeMarco IIU61Nlt&6 TEI.EPHONE NUMBER 517-796-8583 BUSINESS 6.MAjL AllDI\\E$$

demarcochrisj@jccrnl.edu I

BUSINESS CELW).AR TELEPHONE NUMBER SUBMIT ITEMS 5 THROUGH 11 ON B-1/2 X 11* PA,PER. THE lYPE Al'lt> 6COPE OF INFORMATION TO BE PROVIDED IS DESCR.IIIEO IN THE WCENBE APPLICATION GUIDE.

5. RADIOACTIVE MATERIAL

&, PURP08E(B) FOR WHICH UCENSEO MATERIAL Will. BE USED, a, el*m*nt a"d mua num~r, >>. Clltmlcel tnll/ol"phyvlQll rGIIII; and c. ma.lClmum a1110Uht

7. INDMPUAJ.(S) R.l.6PONS1et.E FOR RADIATION SAFETY PROGRAM AND THEIR ~NINO ANO WIIICII Wffl lie P0888888CI Bl 811Y one um&.

EXPERIENCE.

8.,....,NINO FOR INDMOUAL,S WORl<IN0 IN OR FREQUENTINe RESTRICTED AREAS.

a. FACIL.t'IIE5.ANt> EQUIPMENT,

10. RADIATIONSAFETYPROGRAM.

11. WASTE MANAGEMENT.

(Sm,a CFR 170 and Sedan 17DP11 CAtmDRY

/\\MOUNT $

12. LICENSE FEES (Feee reqUltwd only fw nllW <1pplic6no, wilh few *llC<Pllan,:")

FEe I I

I "Amcnd11JCOISIRcnmwala ~1111-111* -*

oraia *ia.lln!I De.nee II>* noworhlph~rl'H aalllgo,y~I,.'1111,a a Ille.

El'<<:l~EO PER THE DEBT COu..ECTION -ROWMl!NT ACT OP 1898 (PUBUC LAW 1114-1'41, YOU ARE REQIIIREO TO PROVIDI! YOUR TA1IP"-'l'l=l\\1Jll;N11Flc:Al10N NUMBER. PROVIDI! THI&

INPORMATIDN BY COMPU!'l'ING NR.C F0R.M Ht: !l\\!Pl~~VU!ldJDA:1DJlslqc.5Pllc51ipg'5/burn'iJQm§!11nro.hcrnl, 1ll, CERTIFICAnON. (Ml/Sf I>> comfl/ilfld by epp/iel,nl) THE APPLJCANTUNOERSTANOS THAT AU. STATEMENTS AND REPRESENTATIONS MAO.I!' 11'1 '17-11$ APFUCAT/ON ARE BINDING UPON THE APPLJCIWT.

THE Al'PlJOANI' ANCI ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEIW-F OF 'ti-IE Al'PUCAJlfT, NAMED JN ITEM 2. CEiUIFYTHAT THIS Al'l'IJC.A'l'ION 16 PREPARED IN CONFORMITY \\/I/ITH TITLE 10, CODE OF FEDERAL REGULATIONS, PARTS aa, :,2, 33, 34, 35, 36, '37, 39, AND 40, AND THAT.A.LL INFORMATION CONTAINED HEREIN IS lRUE AND CORREiCT TO THE BEST OF THEIR KNOWLEDGE AND BELJEF, WAANING: lB U.S.C. SisO'rJON 1001 /J&T OF JUNE 25, 1~ 82 STAT. 749 MAKES 1T A CRIMINA,1., OFFf!IQ;E TO MAKE °A WILLFUU.Y FALSE STATEMENT QR, RSPREIIENTATION TO

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DEPAR'l'MEil'IT' OR AGENCY OF THE UNITED STATES AS TO ANY MATIER WITHIN ITS JURISOJCT10N.

CERTIFYING OFFICER - 1YPEDIPRINTED NA.ME AN(> Yln..E Prof. Chris J. DeMarco (RSO)

NRC FORM 313 (1~2017)

RECEIVED JUN 2 7 2018

JUN/27/2018/WED II :39 AM JACKSON COLLEGE Materials Licensing Branch U.S. Nuclear Regulatory Comnrission Region III 801 Warrenville Rd.

Lisle, IL 60532-4351 To whom it may concern:

FAX No.517 796 8637 P. 003 June 27, 2018 I am writing to request a renewal of Materials License #SNM-1171 currently held by Jackson Community College. I am the authorized user of the material listed on that license, and the Radiation Safety Officer.

The sole item on the latest amendment of the license (Amendment No. 12) is a Cobalt-60 source that is sealed in glass. This source has not been used in many years, and the license is currently only for possession and storage until the source can be disposed of. We hope to arrange for disposal during the upcoming academic year.

Thank you for your assistance in this matter. If you require more infonnation, please feel free to call my office at (517) 796-8583, fax me at (517) 796-8637, or e-mail me at:

demarcochrisj@jccmi.edu

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Prof. Chris J. DeMarco Physics Department Jackson Community College

JUN/27/2018/WED II :39 AM JACKSON COLLEGE FAX No.517 796 8637 TO:

J acl<son...-........

COLLEGE C,e,ntrsl Cempus I Jeek$on MCDIVITT HALL FAX TRANSMISSION FAX (517) 796-8637 FROM: &1s Ur///f~

Number of pages including cover:

s Date:

Comments:

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