ML20039H187
| ML20039H187 | |
| Person / Time | |
|---|---|
| Site: | 07002488 |
| Issue date: | 12/04/1981 |
| From: | Cathcart T MERCY HOSP., PORTLAND, ME |
| To: | |
| References | |
| 28049, NUDOCS 8201190697 | |
| Download: ML20039H187 (1) | |
Text
0-M68 APPROVED BY GAO RM HSC.314 U.S. NUCLE AR REGULATORY COMMISSION B-180225 (RO374)
Empires 5/31/82 CERTiflCATE OF DISPQSlION OF MATERIALS (All B!ocks MUST BC Completed) h_.
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- 'T bO N M I 3 94 - 55 LICENSE NUMBER LICENSEE NAME AND ADDRESS SNM - 1709 MERCY HOSPITAL y S.gcLUR REG.
144 State Street COMMM10H LICENSE EXPlRATION DATE Portland, Maine 04101 x"SS Mall SECilIN 2-28-82 Th2 licensee or any individual executing (his certificate on behalf of the licensee certify that: (ChecA and/or complete approperate stirm(s) below.)
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- 1. No materiais have been procured by licensee.
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- 2. All materials procured and/or possessed by bcensee under hcense number shown above, have been transferred to:
N/A which has NRC license number:
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- 3. A'l materials procured and/or posectsed by bcensee under hcense number shown above have been transferred to:
N/A which has hcense number:
essued by an Agreement State pursuant to Section 274 of the Atomic Energy Act of 1954,as amended, and the Energy Reorganization Act of 1974.
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- 4. Materials nave been disposea of in the f oItowing manner. (Describe specific disoosalprocedures - of additional space is needed, use reverse sace.)
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820219 Ohoh AD PDR CE RTIFYING OFFICI AL
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PLEASE RETURN TO:
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Of fice of Nuclear Material Saf ety and Saf eguards Thomas W. CathCart Washington D.C. 20555 DATE December 4, 1981
,enns q N;C FORM 314 (7 79) SUPERSEDES PREVIOUS EDITIONS WHICH ARE OBSOLETE.