ML20035D250
| ML20035D250 | |
| Person / Time | |
|---|---|
| Site: | 07000920 |
| Issue date: | 02/10/1993 |
| From: | Ryan R RENSSELAER POLYTECHNIC INSTITUTE, TROY, NY |
| To: | |
| References | |
| 117812, NUDOCS 9304120345 | |
| Download: ML20035D250 (3) | |
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o 74- 00r24 NRC FORfA 314 U.S. NUCLE AR REGULATORY COMMi&SION APPROVED BY OMS: NO. 3150-0028 EXPIRES: 05/31/95 l
o tasossiem M 10 CFH 40 42tcK1 M ESTIMATED EURDEN PER RESPONSE TD CDMPLY VCTH TH!S MaMAT13N t o crR 70 3OcM1 *v)
CDLLECTlDN REDUIST. 30 MWUTES - FDFWARD r.cMMENTS REGARDING CERTIFICATE OF DISPOSITION OF MATERIALS suRDEN EsnMm 10 THt waMATm AND nCaDs MamMtNT untH IMNBB 7M41, U.S. NUCLEAR REGULATDRY CDMMISSIDN, VVASHNGTON DC INSTRUCTIONS: ALL iTITAS FAUST BE CotAPLETED - PRNT OR TYPE 205%-D00L AND TD THE PAPERWDM REDUCTIDN PRDJECT (31500028L SEND THE CotAPLETED CERTIFICATE TO THE t4RC OFFICE SPECIFIED ON THE REVERSE OFFICE DF MANAGEMENT AfdD BUDGIT, R ASHNGTON. DC 20503.
ICLt. Sit t*AME AND ADDPlbS OCENSEE NUtABER Rensselaer Polytechnic Institute SNM 910 i
Troy, New York 12180 UCENSE EXf9RATK)N DATE August 31, 1992 i
A. MATERIALS DATA (Chuck one and complete as necessary)
THE LICENS!E OR ANY INDIVIDUAL E AECUTING THIS CERTIFICATE ON BEHALF OF THE LICENSEE CERTIFIES THAT:
(Check undm compiere the appropnote stemts) belew )
1.
NO MATIRiALS H AVE EVER EEEN PROCURED OR POSSESSED BY THE LICENSEE UNDER THIS LICENSE.
OR 2.
A LL t/ ATE RIALS PPOCURED AND'OR POSSESSED BY THE UCENSEE UNDER THE UCENSE NUfABER CITED ABOVE HAVE BEEN D$ POSED OF IN %E FOLLOWING fAANNER. (if additionalwece os needed. use the reverse side or provode ettachments.)
Dewrtbe spou6c rWwsei tes%fe, achons erut, if there were rodeomettve westes generated in termerstmg ttus heerme, the desposal actions includirm the cespes: tion t 1 low leve! rechoactne weste maad weste. Greefer-than-Class-C waste, and see6ed sources af apphcable I
F u t ansims s:e9 9m date of the transfer, tw rarrw of the licetwed recipirit, ar.d the recipient's NRC hoeras rumber or Agreement $tste rarre and i-emmw Transfer of all remaining SNM to New York State Health Department License //1035 if rostenn6e were deposed ei drewy by the he.ermee rather than trenstwred to encther Lcensee hoensed desgo,el gagsteM
.,;or, describe the (pg))
speatic d4paal procMures re p. decay in sryagel
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OUR UCENEE H AS NOT YET E X P! RED. PLE ASE TERMINATE IT.
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WAS A RADIATION SURVEY CONDUCTED TO CONFlRM THE AESENCE OF UCENSED RADIOACTIVE MATERIALS AND TO DETEl$MINE WHETHER aoneb__.E.--
E-I ANY CONTA MiNATION REIA AINS ON THE PREMISES COVERED BY *HE LICENSE? (Ch NO (Attach expwner,on/
Transfer of material to NYSHD License #1035 YES THE PESULTS /Ched one!
9304120345 930210 uE AruCHED, o, PDR ADOCK 07000920 WERE FOM ARDED TO NRC ON /Dare/
C PDR 3 THE PERSON TO EE CONTACTED REGAPDING THE M OFM ATION PROVIDEL CN TH!S FDPfA Robert M.
Ryan (518)276-4014
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4 M Att A LL T UTUF E CORRESPONDENCE FEG ARD!NG THIS UCENSE TO
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4 Robert M.
Rvan, Director F '* 'r' I" I P r :U Office of Radiation and Nuclear Safety b
Rensselaer Polytechnic Institute, Troy, NY 1218 0 ' '/
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CE.RTIFYING OFFICIAL I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING 15 TRUE AND CORRECT PMNTED N AME AND TITLE SIGt ATURE DATE Ryan 310 030
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Robert M.
February 10, 1993 Director, ORNS WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO civil AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUAE THAT SUBMlSSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS.18 U.S.C. SECTION 1001 MAKES IT A CRIM;NAL OFFENSE TO MAKE A W1LFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGEfJCY OF THE UN;TED STATES AS TO ANY MATTER WITH;N ITS JURISD1CTION.
117812
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0 OFFICIAL RECORD COPY E10 MAR 01 E
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FILE CERTIFICATES AS FOLLOWS:
IF YOU ARE LOCATED IN:
IF YOU ARE A DtSTR!BUTOR OF EXEMPT PRODUCTS, SEND TO:
ILLINO!S, INDIANA, IOWA, MICHIGAN, MINNESOTA, MISSOURI, OHIO, OR W!SCONSIN, SEND APPLICATIONS TO:
DIVlSION OF INDUSTRIAL AND MEDICAL NUCLEAR SAFETY OFFICE OF NUCLE AR fAATERIAL SAFETY AND SAFEGUARDS MATERIALS UCENSING SECTION U S. NUCLEAR REGULATOR ( COMMISSION U.S. NUCLEAR REGULATORY COMM!SSION. REGION til W ASHINGTON. DC 20b65-0001 799 ROOSEVELT ROAD GLEN ELLYN iL 80137 ALL OTHERS, IF YOU ARE LOCATED IN:
ARKANSAS, COLORADO, IDAHO, KANSAS, LOUISIANA, CONNECTICUT, DELAWJkE,-QBTRtOTQCOLUMBIA, MAINE, MONTANA, NEBRASKA, NEW MEXICO, NORTH DAKOTA, MARYLAND, f4A&SACHUSETTSMdEW.fLAf4PSHIRE, NEW JERSEY, OKLAHOMA, SOUTH DAKOTA. TEXAS, UTAH, OR WYOMING, F6EW YORktENNSYLVANIA, RHODE ISLAND,\\0R VERMONT, SEND APPLICATIONS TO:
SEND APPLICATIONS TO:
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MATERIAL RADIATION FHOTECTION SECTION f
L4 CENSING ASSISTANT SECTION U.S NUCLE AR REGUL ATORY COMMISSION, REGION IV i NUCLEAR MATERIALS SAFETY BRANCH
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600 RYAN PLAZA DRIVE. SulTE 400
\\ U S. NUCLEAR REGULATORY COMM:SSiON/ REGION I ARLINGTON, TX 70011-8064 47b ALLENDALE ROAD
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KING OF PRUSS!A, PA 19406-1415f' ALASKA, ARIZONA, CALIFORNIA, HAWAll, NEVADA, OREGON,
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WASHINGTON. AND U.S. TERRITORIES AND POSSESS!ONS IN ALABAMA, FLORIDA, GEORGIA, KENTUCKY, MISSISSIPPl. NORTH THE PACIFIC, SEND APPLICATIONS TO:
CAROLINA,' PtJERTO RTCO, SOUTH CAROLINA, TENNESSEE, VIRGINlA. VIRGIN ISLANDS, OR WEST VIRGINIA. SEND NUCLEAR f>ATERiALS SAFETY SECTION APPLICATIONS TO:
U S. NUCLEAR REGULATORY COMMISSION, REGION V 1450 MARIA LANE NUCLEAR MATENALS SAFETY SECTION WALNUT CREEK, CA 94E 9& S368 U S NUCLEAR REGULATORY COMM:SSION. REGION 11 101 M ARfETTA SMEET NW. SUITE 2900 ATLANTA.GA 30323 N
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Licensing Assistant Section Nuclear Materials Safety Branch U.S. Nuclear Regulatoy Commission Region 1 475 Allendale Road King of Prussia, PA 19406-1415 I n illlii n il n lil n iill a n illili il o illili f ili u li f ililiii ll 19404-1415 23
D70-dW20 i
NRC FORM 310 U.S. NUCLE AR REOULATORY COMMISSION APPROVED BY OMB: NO. 3160-0028 I
san EXPIRES: 06/31/95 10 CFR 30.36eni nM 10 CFR 40 4 2tcH1 aM 10 CFR 70.38 catinvi (STIMATED BURDEN PER RESPlWSE TO COMPiY WITH THIS Wr0RMAT10N COLLECTION RfDUEST. 30 kWUTIS.. FORWARD COMMENTS REGARDMG CERTIFICATE OF DISPOSITION OF MATERIALS-suRotN isTiMATr Ta tur WroRMATiaN ann trCoRe: MANAGtMcNi sRANCN i
(MNBB 7714), U S. NUCLIAR RfGULATDRY COMM!:Sith, WASHMGTDN, DC l
(NSTRL'CTIONS: ALL ITEMS MUST BE COMPLETED - PRINT OR TYPE 2055541001. AND TO THE PAPERw3RK REDUCT10N PROJECT DM00c28L SEND THE COMPLETED CERTIFICATE TO THE NRC OFFICE SPECIFIED ON THE REVERSE OFRCf DF MANAGEMENT AND BUDGET WASHINGTON, DC 20503.
LK.Ehs(( NAME AND ADDHISS UCENBEE NUMBER Rensselaer Polytechnic Institute SNM 910 Troy, New York 12180 August 31, 1992 A. MATERIALS DATA (ChecA me and complete as necessaryl 6
THE LICENSEE OR ANY INDIVIDUAL EXECUTING THIS CERTIFICATE ON BEHALF ft THE LICENSEE CERTIFIES THAT:
(Check and/or complete the appropnote nemis) below.I
] 1.
NO MATERIALS HAVE EVER BEEN PROCURED OR POSSESSED BY THE LICENSEE UNDER THIS LICENSE.
OR 2.
ALL MATERIALS PROCURED AND/OR POSSESSED BY THE LICENSEE UNDER THE LICENSE NUMBER CITED ABOVE HAVE BEEtu I
DISPOSED OF tN THE FOLLOWING MANNER. tiladditoonal space is needed, use the reverse side orprovide ettechinentsJ Describe spec 4f c metenet trenster actiore ered. if there were red oec1we westes generstod in terrruretmg the fecerme, the deposal actere cicludang tte disposition of low 4evel red 60ectrve weste mood weste. Greater tharvCisse-C Weste, and seeied sources, if appleceblo.
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Fe, tren.ter.. speaty the dote of tse iter.ter, the nome et the i. censed rec.p.ent. e.d the recipient's NHC t.conse ramiber or Age *ement State nemo end i,c,.e,*
Transfer of all remaining SNM to New York State Health Department License #1035 ff enstenele were d sposed of directiv by the licerwee rather then treneferred to erether licensee, leconood disposal este or weste contractor describe the specific disposal proced. area fe p., deoey ei erweget I
t B. OTHER DATA 1.
OUR LICENSE HAS NOT YET EXPlFiED; PLEASE TERMINATE fT.
2.
WAS A RADIATION SURVEY CONDUCTED TO CONFIRM THE ABSENCE OF LICENSED RADIOACTIVE MATERIALS AND TO DETERMINE WHETHER I
ANY CONTAMINATION REMAINS ON THE PREM!SES COVERED BY THE LICENSE 7 (Check onal NO
(. Attach explanationi Transfer of material to NYSHD LLCense #1035 YES. THE RESULTS (Chece onel ARE ATTACHED or WERE FORWARDED TO NRC ON (Detel 3.
THE PERSON TO BE CONTACTED REG ARDING THE INFORMATION PROVIDED ON THIS FORM Robert M. Ryan (518)276-4014 4.
MAIL ALL FUTUF'E CORRESPONDEtJCE REGARDING THIS LICENSE TO Robert M. Ryan, Director Office of Radiation and Nuclear Safety Rensselaer Polytechnic Institute. Troy, NY 12180 CERTIFYING OFFICIAL 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT I
PRIN TED N A ME A ND TITLE SIGP ATURE DATE Y""
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Director, ORNS
//
February 10, 1993 WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO' civil AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS.18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY j
OF THE UNITED STATES AS TO ANY MATTER WITH:N ITS JURISDICTION.
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117812 SECTION COPYa 14AR 01 WJ3 l
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