ML18204A412
| ML18204A412 | |
| Person / Time | |
|---|---|
| Site: | 03032242 |
| Issue date: | 07/03/2018 |
| From: | Hammond M M NRC Region 4 |
| To: | West Valley Medical Ctr |
| References | |
| 608670 | |
| Download: ML18204A412 (4) | |
Text
U.S. NUCLEAR REGULATORY COMMISSION MATERIALS LICENSE NRC FORM 374PAGE OF 1 4 Amendment No. 30PAGES 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 Caldwell, ID 83605 2.1717 Arlington Avenue 1.West Valley Medical Center, Inc.
4.Expiration Date:
September 30, 2022 Docket No.:
5.030-32242 License number: 11-27087-01 is amended in its entirety to read as follows: Reference No.:
3.In accordance with letter dated March 26, 2018.
6.7.8.Byproduct, source, and/or special nuclear material Chemical and/or physical form Maximum amount that licensee may possess at any one time under this license 9.Authorized use A.A.A.A.For use in uptake, dilution and excretion studies permitted by 10 CFR 35.100.Any As Needed Any byproduct material permitted by 10 CFR 35.100 B.B.B.B.For use in imaging and localization studies permitted by 10 CFR 35.200.
Any As Needed Any byproduct material permitted by 10 CFR 35.200 C.C.C.C.For any use permitted by 10 CFR 35.300.Any 500 millicuries total Any byproduct material permitted by 10 CFR 35.300 D.D.D.D.For any manual brachytherapy procedure permitted by 10 CFR 35.400.
Sealed Sources (Amersham , Model 6700 Series; Best Industries, Model 2300 Series) 400 millicuries total Any byproduct material permitted in 10 CFR 35.400 CONDITIONS License Number Docket or Reference Number U.S. NUCLEAR REGULATORY COMMISSION NRC FORM 374A MATERIALS LICENSE SUPPLEMENTARY SHEETPAGES OFPAGE 4 211-27087-01 030-32242 Amendment No. 30 10.Licensed material may be used or stored only at the licensee's facilities located at 1717 Arlington Avenue , Caldwell, Idaho.11.The Radiation Safety Officer for this license is Teri Steele , B.S., CNMT, RT (N).12.Licensed material shall only be used by, or under the supervision of:
A.Individuals permitted to work as authorized users in accordance with 10 CFR 35.13 and 10 CFR 35.14.
B.The following individuals are authorized users for the material and medical uses as indicated:
Authorized Users Material and UseLyndon Carlos Box, M.D.
10 CFR 35.100,10 CFR 35.200 Janet M. Cegnar , M.D.
10 CFR 35.100,10 CFR 35.200 Kimball Christianson, M.D.
35.100, 35.200, oral administration of sodium iodide I-131 Jared A. Chugg, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Michael A. Codina, M.D.
10 CFR 35.100,10 CFR 35.200 Carolyn Ely Coffman, M.D.
10 CFR 35.100,10 CFR 35.200 Curtis Coulam, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Ian Davey, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Neil Couchman Davey, M.D.
10 CFR 35.100,10 CFR 35.200Vicken Garabedian, M.D.
10 CFR 35.100,10 CFR 35.200 Anthony P. Giauque, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Reginald Joseph Gobel, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Cyle Goodman, M.D.
35.100; 35.200; Oral administration of sodium iodide I-131 Jeffrey T. Hall, M.D.
10 CFR 35.100,10 CFR 35.200 Benjamin K. Horn, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 License Number Docket or Reference Number U.S. NUCLEAR REGULATORY COMMISSION NRC FORM 374A MATERIALS LICENSE SUPPLEMENTARY SHEETPAGES OFPAGE 4 311-27087-01 030-32242 Amendment No. 30 Authorized Users Material and Use John A. Jackson, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Randy L. James, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Christopher R. Kauffman, M.D.
35.100; 35.200; Oral administration of sodium iodide I-131 John Q. Knochel, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Shane J. McGonegle, M.D.
35.100, 35.200, oral administration of sodium iodide I-131 Michael J. Modica, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Matt T. Moore, M.D.
35.100, 35.200, oral administration of sodium iodide I-131 in quantities less than or equal to 33 millicuries William Murray, M.D.
10 CFR 35.100,10 CFR 35.200 Mark R. Papenfuss, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Saeed Payvar, M.D.
10 CFR 35.100,10 CFR 35.200 Dallas D. Peck, M.D.
10 CFR 35.100,10 CFR 35.200 Jason Patrick Salber, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300Timothy Sawyer, M.D.
10 CFR 35.400 Lisa M. Scales, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Howard B. Schaff, M.D.10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Jeffrey Seabourn, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Loreli S. Smith, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 Bertram Jason Stremmler, M.D.
35.100, 35.200, oral administration of sodium iodide I-131 William L. Taylor, M.D.
35.100, 35.200, oral administration of sodium iodide I-131 Daniel John Wegner, M.D.
10 CFR 35.100,10 CFR 35.200,10 CFR 35.300 13.In addition to the possession limits in Item 8, the licensee shall further restrict the possession of licensed material to quantities below the minimum limit specified in 10 CFR 30.35(d) for establishing financial assurance for decommissioning.
License Number Docket or Reference NumberU.S. NUCLEAR REGULATORY COMMISSION NRC FORM 374AMATERIALS LICENSESUPPLEMENTARY SHEETPAGES OFPAGE44 1 1-27087-01 030-32242 Amendment No. 30 14.Except as specifically provided otherwise in this license, the licensee shall conduct its program in accordance with the statements, representations, and procedures contained in the documents, including any enclosures, listed below. This license condition applies only to
those procedures that are required to be submitted in accordance with the regulations. Additionally, this license condition does not limit the
licensee's ability to make changes to the radiation protection program as provided for in 10 CFR 35.26. The U.S. Nuclear Regulatory
Commission's regulations shall govern unless the statements, representations, and procedures in the licensee's application and correspondence are more restrictive than the regulations.A.Application dated April 27, 2012 [ML12128A495]B.Letter dated September 6, 2012 [ML12256A708]FOR THE U.S. NUCLEAR REGULATORY COMMISSION By: Date: Michelle M. HammondRegion July 3, 2018