ML20053B436
| ML20053B436 | |
| Person / Time | |
|---|---|
| Issue date: | 05/24/1982 |
| From: | Sreniawski D NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION III) |
| To: | Clary J, Hamidi M, Klucka T JACKSON NORTHWEST CLINIC, P.C., JACKSON, MI |
| References | |
| NUDOCS 8205280402 | |
| Download: ML20053B436 (4) | |
Text
P MAY 3 4 1982 Jackson Northwest Clinic, P.C.
License No. 21-17615-01 Thomas Klucka, D.O. and Licnese No. 21-20101-01 Mehdi Hanidi, D.0.
ATTN: James K. Clary, D.O.
Director 2200 Springport Road Jackson, Michigan 49202 Gentlemen:
This refers to the special safety inspection conducted by Ms. P. J. Whiston of this office on April 23, 1982, of activities authorized by NRC Byproduct Material Licenses No. 21-171615-01 and No. 21-20101-01 and to the discussion of our findings with you at the conclusion of the inspection.
The inspection was an examination of activities conducted under licenses of Thomas Klucka, D.O. and Mehdi Hamidi, D.O. as they relate to radiation safety and to compliance with the Commission's rules and regulations and with the conditions of their licenses. Since Dr. Klucka and Dr. Hamidi have left the clinic, and as a result the nuclear medicine program has not been active since January 1982, the inspection consisted of a selective examination of procedures, observations, independent measurements, and interviews with personnel concerning the disposition of any remaining byproduct material.
No items of noncompliance with NRC requirements were identified during the course of this inspection.
Enclosed are two copies of Form NRC-314, " Certificate of Disposition of Materials" to be completed and returned to the specified address.
On Form A, certify that all material licensed for use by T. J. Klucka, D.O.
License No. 21-17615-01 was transferred to Mehdi Hamidi, D.O. License No. 21-20101-01, and on Form B, line 2, certify that all material licensed for use by Mehdi Hamidi, D.O. was transferred to another licensed facility, and include that facility's name and NRC License No. on line 2.
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8205280402, g
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Jackson Northwest Clinic, P.C.
2 MAY 2 41982 We will gladly discuss any questions you have concerning this inspection and the enclosed Forms.
Sincerely, g,
- fon, D. J. Sreniawski, Chief Materials Radiation Protection Section 2
Enclosure:
Two Form NRC-314 Certificate of Disposition of Materials cc w/ enc 1:
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(9 761 B 180225 IRO374, E moires 5.'31/79 CERTIFICATE OF DISPOSITION OF MATERIALS 54 rr aecus uust st comperect A
LICENSEE N AME AND ADDRESS LICENSE NUMBE R Thomas J. Klucka, D.O.
21-17615-01 Jackson Northwest Clinic 2200 Springport Road LICENSE EXPIR AT8oN DATE l
Jackson, Michigan 49202 July 31, 1982 The f.annee or any ind.vedwet executing this artificate on behatt of the fecensee artify that. (Chece and/or compere appropreser sa O
i No mairriers heve been orocured by iimeine O
- 2. Att metee ats procured and/o' possessed by learnsee under licenir number shown above, hwe been transferred to' n
which has NRC lecensa number:
O 3 Att matees.+s procured ancs'or omirised by inan under incener number shown abcue h,ve been ironsterred to wh ch has license number issued try en Ag eement State pu suant to Section 274 of the Atom.c Energy Act of 1954,as amenced, end the Energy Reorgandation Ac1 of r
1974.
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Materiars heve been d,soosed of in the foiiewing manner. (oeser.oe spee,r,e e.soossiproecosres -,r saa,r,on,isoam,, n,,o,,,
une rearer s,ae 1 Amend to terminate license No. 21-17615-01 PLE ASE RETURN To CE RTIFYING OFFICI AL U.S. Nuclear Regulatory Coc: mission SicNATuRE Office of Inspection and Enforcement Region III 799 Roosevelt Road Glen Ellyn, Illinois 60137 D*"
hRC F oRM 3t4 (9 76) Supt alEOt.s PREvtOUS EDITIONS WHICM Am t Oe50LETE.
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's 5 0nM NR C 314 U S NUCLE AR flEGULATORY COMMISSION APPROVED By O AO (9 N B 18022$ (RO374, Espires S/31/79 CERTIFICATE OF DISPOSITION OF MATERIALS san aeces uusi BE ComporedI g
LICENSEE N AME AND ADDRE15 LICENSE NUMBE R Mehdi liaraidi, D.O.
,21-20101-01 Jackson Northwest Clinic 2200 Springport Road ucENsE EXPIRATION DATE Jackson, Michigan 49202 August 31, 1982 T he f.censee or any endeveduet esecuting this cert.ficate on beharf of the 1.censee certif y that: (Chece and/or compere approar,se sym(sf O
- 1. No maereats have been orocured by licensee.
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- 2. All rnaterials procured and'or ponnessed by lawnsar under license number shown above, have tren transferred to which has NRC lecense number; O 3 All materials procured and/or pmessed by limnare under licenar number shown obcwe have ben transf erred to which has license numter issued try en Ag tement State pursuant to Section 274 cf the Atomic Energy Act of 1954, as amended, and the Energy Reorganaation Act of 1974.
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Mater afs have been d>soosed of m the fol60wsng manner. (Descrrbe speedre d.sposstprocedures - if sadotronelsoom os neeced, userester suo,1 Amend to terminate license No. 21-20101-01 PLE ASE RETURN To U.S. liuclear Regulatory Co=nission SicN ATuR t Office of Inspection snd Enforcement Region III nE$1 Il n is 60137
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PsRC F ORM 314 (9 76) Supt ast DES Pat WOU3 EDIYsONS WHICM Amt Oe50LETE.
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