ML18198A063
| ML18198A063 | |
| Person / Time | |
|---|---|
| Site: | 03010475 |
| Issue date: | 07/16/2018 |
| From: | Forster S A NRC/RGN-III |
| To: | Daviess Community Hosp |
| References | |
| 608975 | |
| Download: ML18198A063 (4) | |
Text
NRC FORM 374 U.S. NUCLEAR REGULATORY COMMISSION MATERIALS LICENSE PAGE 1 OF 4 PAGES Amendment No. 27 Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93-438), and Title 10, Code of Federal Regulations, Chapter I, Parts 30, 31, 32, 33, 34, 35, 36, 37, 39, 40, 70 and 71, and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess, and transfer byproduct, source, and special nuclear material designated below; to use such material for the purpose(s) and at the place(s} designated below; to deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the applicable Part(s). This license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, as amended, and is subject to all applicable rules, regulations, and orders of the Nuclear Regulatory Commission now or hereafter in effect and to any conditions specified below. Licensee 1. Daviess Community Hospital 2. 1314EWalnutSt.
P.O. Box 760 Washington, IN 47501 6. Byproduct, source, 7. and/or special nuclear material A. Any byproduct material A. permitted by 10 CFR 35.100 B. Any byproduct material B. permitted by 10 CFR 35.200 C. Any byproduct material C. permitted by 10 CFR 35.300 Any Any Any In accordance with letter dated 4. Expiration Date: April 30, 2021 May 29, 2018. ti"*. h,) 1\ r, I . & 5. Docket No.: 030-10475
- 3. License number: 13-16138foa"""i'S I Reference No.: amended in its entirety to re~d,iHa$)
follows: ,ld? C. 1 curie total CONDITIONS
(") ount that lice~e at any one ti'3e> 9. Authorized use A. For use in uptake, dilution and excretion studies permitted by 10 CFR 35.100. B. For use in imaging and localization studies permitted by 10 CFR 35.200. C. For any use permitted by 10 CFR 35.300. 10. Licensed material listed in Subitem Nos. 6.A. through 6.C. may be used at the licensee's facilities located at 1314 E Walnut St., Washington, Indiana, 47501.
NRC FORM 374A MATERIALS LICENSE SUPPLEMENTARY SHEET U.S. NUCLEAR REGULATORY COMMISSION License Number 13-16138-01 Amendment No. 27 Docket or Reference Number 030-10475
- 11. The Radiation Safety Officer (RSO) for this license is Jonathon Berger, M.D. 12. Licensed material shall only be used by, or under the ~~nfl ... ,., r,c ( . * <it -1;;:mi" "P'J(_ A. Individuals permitted to work as authoriz,;$)sers in accordance with 10 CFR 3ff'. la:,,rnd 1 O CFR 35.14. -1 1'1, *~** *:>>. B. The fol.lowing individuals are authorize~iusers~~F,l~
material and medicalt*~
1~es as imir~ated:
Authorized User(M.D.,D.0.,etc.)
Matenall.!f~:,Use James A. Arata, M.D. 10 CFRa: .*. 0'?10 9FR Jonathon Berger, M.D. John L. Bormann, M.D. Daniel Branam, M.D. Joseph R. Decamp, M.D. Brett A. Hagedorn, M.D. Eric V. Heatwole, M.D. David B. Janizek, M.D. Shawn Johnson, M.D. Christopher Michael Kowalski, M.D. John C. Lacunza, M.D. 10 CFR 10 QFR 3 <d~ ,, " 1 o CFR35.1 Ou r) ,*.l** / ~.,,, 10 CPR,~.100 , .. .. *1* .***111 ,, .. , *~1, *,).,:W cFR i5!2'too.
1,0¢~Rrss.200
- ,;1,.EJ)i,FR 35.100, fo*d~JR 3t200 1 a'~~ 35.1 oo. 1 o cFR ~5.200 10 CF~ 35:.1Q0,10 CFR 35,200 ,' ,f <<'(' ,,' J\a 0 o/ ' 10 CFR 35.1bo,1ociR 3~:ioo 10 CFR 35.100, 10 CFR 35.200 PAGE 2 OF 4 PAGES Vasdev Lohano, M.D. 10 CFR 35.300 (limited to the oral administration of sodium iodide 1-131 in quantities less than or equal to 33 millicuries)
Michael E. Parker, M.D. John Pasalich, M.D. Dakshesh S. Patel, M.D. Randall J. Phillips, M.D. 10 CFR 35.100, 10 CFR 35.200 10 CFR 35.100,10 CFR 35.200 10 CFR 35.100, 10 CFR 35.200 10 CFR 35.100, 10 CFR 35.200 NRC FORM 374A MATERIALS LICENSE SUPPLEMENTARY SHEET Authorized User(M.D.,D.0
.* etc.) John Rock, M.D. Eugene Shih, M.D. Richard W. Sibley, M.D. Rik Stephens, M.D. Andre Byard Stovall, M.D. Pamela Lee Strange, M.D. Marc Thomas, M.D. James C. Wehrenberg, M.D. U.S. NUCLEAR REGULATORY COMMISSION License Number 13-16138-01 Amendment No. 27 Material and Use 10 CFR 35.100, 10 CFR 35.200 Docket or Reference Number 030-10475 10 CFR
~~(/ J 10 CcF~.i~~100, 10 CFR 35.200 ,ii ** 1011 }, ~)FR 35.100,10 CFR 35.200 ' ~'1:" CFR 35.100, 10 CFR 35.200 10 CF)R, "fI 10 CF PAGE 3 OF 4 PAGES t'(iki ,,>:/:: 13. Except as s_pecifically provided otherwi~l'Jn
_this li~~nse;'if'.fr~"l!::
1 ;; ffl(j~ffduct its pr~g~ in accord_an~e with the ~t~temen~s, representations, and procedures conta1nea in the 1:lpcuments, 1 I <Iliff ~ny enclosures, llstl; below. This license cond1t1on applies only to those procedures that are required to bee~p.mitt~ai~ccorgt:J:."'
- i ~it.N\,~egu
.. lations. Agg:~ionally, this license condition does not limit the licensee's ability to make changes to the r~~Jation prol~ction:,ff~~i~
a~Jtovif,fed for inl/~,CFR 35.26. The U.S. Nuclear Regulatory Commission's regulations shall govern unle~pe statemei:its,<rep~S~f'\tations, and pr~dures in the licensee's application and correspondence are more restrictive than the*1 f~L1lations.
' * ).
- 11 .,*,,;1*?
C ff $ A. Application dated October 4, 2010 (ML 102950531) 1 B. Letter dated March 30, 2011 (ML 110900230)
C. Letter dated October 27, 2015 (ML 15306A562)
NRC FORM 374A U.S. NUCLEAR REGULATORY COMMISSION PAGE 4 OF 4 PAGES MATERIALS LICENSE SUPPLEMENTARY SHEET License Number 13-16138-01 Amendment No. 27 D. Letter dated February 23, 2016 (ML 16056A509)
E. Letter dated June 28, 2018 (ML 18179A410)
Date: July 16, 2018 Docket or Reference Number 030-10475 FOR THE U.S. NUCLEAR REGULATORY COMMISSION By: ;AOflta, a , d6ld;;J Sara A. Forster Region 3