ML18241A184
| ML18241A184 | |
| Person / Time | |
|---|---|
| Site: | 03035131 |
| Issue date: | 08/28/2018 |
| From: | Casey C C NRC/RGN-III |
| To: | Providence Medical Group, Terre Haute, IN |
| References | |
| 608916 | |
| Download: ML18241A184 (3) | |
Text
NRC FORM 374 U.S. NUCLEAR REGULATORY COMMISSION MATERIALS LICENSE PAGE 1 OF 3 PAGES Amendment No. 13 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. Providence Medical Group 2. 2723 South 7th Street Suite A Terre Haute, IN 47802 6. Byproduct, source, 7. and/or special nuclear material A. Any byproduct material A. permitted by 1 O CFR 35.100 B. Any byproduct material B. permitted by 10 CFR 35.200 C. Any byproduct material C. permitted by 10 CFR 31.11 Any Any Prepackaged Kits In accordance with letter dated 4. Expiration Date: August 31, 2019 May 2~.' ?01 .... ij .-* ~t~t1;; H t------------.4_.,,...----'
- 5. Docket No.: 030-35131 Reference No.: ;Ii 3. License number: 13-32192-0Tf;f amended in its entirety to rea~~ follows: ". 1i ,g'l~~ 9. Authorized use *JJ~ed A. For use in uptake, dilution and '[' excretion studies permitted by 10 CFR i Ltit .)~ 35.100. N~ecleo B. For use in imaging and localization studies permitted by 10 CFR 35.200. C. 5 millicuries t~ C. For use in in-vitro studies. CONDITIONS
- 10. Licensed material may be used or stored at the licensee's facilities located at 2723 South 7th Street, Terre Haute, Indiana, 47802. 11. The Radiation Safety Officer (RSO) for this license is Nawar Mercho, M.D.
NRC FORM 374A U.S. NUCLEAR REGULATORY COMMISSION MATERIALS LICENSE SUPPLEMENTARY SHEET License Number 13-32192-01 Amendment No. 13 Docket or Reference Number 030-35131
- 12. Licensed material shall only be used by, or under the :~pervision~:
0 A. Individuals permitted to work as authorized
~ei\,ji;,,accordance with 10 C~~;,35.,,13 and 10 CFR 35.14. vi t A1fh;. ,&' B. The following individuals are authorize~;rs for the material and medical uses at~icated:
Authorized User{M.D.,D.0
.. etc.) Mate :ab d Use &' k George Bittar, M.D. 10 :IQ, 3~3e.Q and~' Bob F. Klingelheber, M.D. 35~200 and$ Nawar Mercho, M.D. Jean Yacoub, M.D. PAGE 2 OF 3 PAGES NRC FORM 374A MATERIALS LICENSE SUPPLEMENTARY SHEET U.S. NUCLEAR REGULATORY COMMISSION License Number 13-32192-01 Amendment No. 13 Docket or Reference Number 030-35131 PAGE 3 OF 3 PAGES 13. 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 acwcf\lc~if!'l3 ljQUlations.
Additionally, this license condition does not limit the licensee's ability to make changes to the radiation ll{of{ctt*oo-program as pr'&fifiled'""'for in 1 O CFR 35.26. The U.S. Nuclear Regulatory Commission's regulations shall govern unless ttiutMements, representations, "a1tifi ~ocedures in the licensee's application and correspondence are more restrictive than th~;r'!li~ulations.
f f~ A. Letter dated February 12, 2009 (ML09oqt)445)
- ",e1 B. Letter dated October 13, 2009 (ML0~0363)*
..** f ~1~:;'--'*Z,), C. Letter dated August 2, 2012 (ML 12~~222) *x ,{ D. Letter dated December 16, 2016 (~7010A062 E. Letter dated May 24, 2018 (ML 181~401) 1r-Date: August 28, 2018 FOR THE U.S. NUCLEAR REGULATORY COMMISSION By:~.~~' Colleen Carol Casey Region 3