ML20126H803
| ML20126H803 | |
| Person / Time | |
|---|---|
| Site: | 07002678 |
| Issue date: | 05/24/1985 |
| From: | Kinneman J NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | Declement F ST. AGNES MEDICAL HOSP. PHILADELPHIA, PA |
| References | |
| NUDOCS 8506100418 | |
| Download: ML20126H803 (1) | |
Text
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o MAY 2 41985
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Docket No. 070-02678 Licen'se No. SNM-1767 St.!Agnes Medical Center ATTN:
Frederick A. DeClement, M.D.
Clinical Professor of Surgery 1900 South Broad Street Philadelphia,. Pennsylvania 19145 Gentlemen:
Subject:
Notice of Expired License This refers to your properly completed NRC Form 314 dated February 27, 1985, in response to our letter dated January 31, 1985.
Thank you for informing us concerning the disposition of your licensed material. Based on this information we will retire your license.
Your cooperation with us is appreciated.
Sincerely, Original Signed By:
Francis M. Costello John D. Kinneman, Chief Nuclear Materials Section A Nuclear Materials Safety & Safeguards Branch Division of Radiation Safety & Safeguards cc:
Public Document Room (PDR)
Nuclear Safety Information Center (NSIC)
Commonwealth of Pennsylvania bec:
Region I Docket Room (w/ concurrences)
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//RI:DRSS Taylor /djh Kinneman 4/9/85 4/a3/85 0FFICIAL RECORD COPY 817 - 0001.0.0 04/03/85 850524 INN PDR e
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NRC Form 314 U.S. NUCLEAR REGULATORY COMMISSION APPROYED BY OM8 (1142) o 3150 4028 10 t'f ' 3036WH tH.vl 10 42tdH1He;)
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CERTIFICATE OF DISPOSITION OF MATERIALS (All items MUST be completed, please print)
LICENSE E NAME AND ADDRESS LICENSE NUMBER Frederick A. DeClement, M.D.
SNM1767 Saint Agnes Medical Center
' ' ' ' ~ ' ' ' * " * ' ' ~ ^
1900 South Broad Street Philadelphia, PA 19145 THE LICENSEE OR ANY INDIVIDUAL EXECUTING THIS CERTIFICATE ON BEHALF OF THE LICENSEE CERTIFIES THAT:(Check and/orcomplete the mpecerinte item (s) below.)
A. MATERIALS DATA (Check one and complete, es necessary)
- 1. NO MATERIALS HAVE EVER BEEN POSSESSED OR PROCURED BY THE LICENSEE UNDER THIS LICENSE.
- 2. ALL MATERIALS PROCURED AND/OP POSSESSED BY THE LICENSEE UNDER THE LICENSE NUMBER CITED ABOVE HAVE BEEN TRANSFERRED ON DATE TO WHICH HAS NRC LICENSE NUMBER OR
] 3. ALL MATERIALS PROCURED AND/OR POSSESSED BY THE LICENSEE UNDER THE LICENSc NUMBER CITED ABOV DAtE TO WHICH HAS LICENSE NUMBER ISSUED BY THE STATE OF AN AGREEMENT STATE PURSUANT TO set 710N 274 OF THE ATOMIC ENERGY ACT OF 1954, AS AMENDED, AND THE ENERGY REORGANIZATION OR ACT OF 1974.
4.
MATERIALS HAVE BEEN DISPOSED OF IN THE FOLLOWING MANNE R. (Describe veci/r diposa/ procedures-itedditionat pace is needed, use the reverse of this form, or provide attachments)
One pacemaker uns implanted on 3/13/78, Modele 9000, Seriate SR00214 This was explanted on 3/5/79 because of erosion of the pocket.
Thc pacer was returned to Medtronic, Inc. on the same day as explant. A Lithium pacer modeu 5989 aus then implanted.
The above da:1 were confirmed by verbal communication with Mr. James Cox of Medtronic, Inc.
on 2/20/85.
T B OTHER DATA
- 1. OUR LICENSE HAS NOT YET EXPlRED; PLEASE TERMINATE IT.
- 2. WAS A RADIATION SURVEY CONDUCTED TO CONFIRM THE ABSENCE OF LICENSED RADIOACTIVE MATERIALS AND TO DETERMINE WHETHER ANY
_ CONTAMINATION REMAINS ON THE PREfflSES COVERED BY THE LICENSE? (Check onel NO YES. THE RESULTS (Check onel ARE ATTACHED, OR WERE FORWARDED TO NRC ON (Date/
3.
THE PERSON TO BE CONTACTED REGARDING THE INFORMATION PROVIDED ON THIS FORM
";"'Dr. DeClement, St. Agnes Med. Cntr. or James Cox, Medtronic lTELEPH NE NUMBER 4.
EAll ALL FUTURE CORRESPONDENCE REGARDING THIS LICENSE TO N
Mgs'O b0103M RETURN TO:
N CERTIFYING OFFICIAL ID27/85 5' o" ^ t DIRECTOR. DIVISION OF FUEL CYCLE AND MATERIAL SAFETY
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OFFICE OF NUCLEAR MATERIAL SAFETY AND SAFEGUARDS U.S. NUCLEAR REGULATORY COMMISSION PRINTEO NAusf AND TITLE UASWNGTON, DC 20555 Frederick A. DeClement, M.D.
NRC Form 314 0142)
MAR 0 51985
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. NUCLEAR REGULATORY COMMISSION Ffg 7
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Docket No. 070-02678 License No. SNM-1767 Inquiry No.~ 85-01 Expiration Date: August 31, 1982
-St.Agnes Medical Center ATTN: Dr. Frederick DeClement Clinical Professor of Surgery 1900~S. Broad Street Philadelphia, Pennsylvania 19145 Gentlemen:
i
Subject:
NOTICE OF EXPIRED LICENSE This refers to the telephone discussion between Mrs. Marlene J. Taylor of this ooffice and yourself on January 8, 1985. The subject of the discussion was the fact'that NRC records show that the license identified above has expired and no renewal application.has been filed in accordance with Section 70.33 of Title 10, Code of Federal Regulations, Part 70.
.From this discussion we learned that you do not have any licensed material in your possession. -Therefore, you must take the following actions:
1.
Prepare.a statement which explains the method of disposal of the
-materials, including: what material was involved, how it was disposed of
-i or to who it was shipped, and when this was done. The enclosed Form
~NRC-314 may be used for this purpose.
2.
If the activities conducted under the expired license were subject to the reporting requirements of 10 CFR Part 20, Section 20.407, you.must submit i
the annual report required by 20.407 for the current _ calendar year and a termination report required by Section 20.408 for individuals engaged in activities under the expired Itcense. Those reports ap t be submitted to the Director of Management and Program Analysis, U. S. Nuclear Regulatory Commission,. Washington, D.C.
20555.
You are required to reply to this Notice within 30 days of the date above.
Address your reply to Region I U. S. Nuclear Regulatory Commission Attention _:
2 u
Chief, Nuclear Materia ~1rTecnon A, 631 Park Avenue,~ King of Prussia,-Pennsyl-vinta-19406 r
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,In accordance with Section 2.790 of the NRC's " Rules of Practice," Part 2,-
Title 10, Code of Federal Regulations, a copy of this letter and your reply will be placed in the Public Document Room.
The responses directed by this Notice are not subject to the clearance proce--
'dures of the Office of Management and Budget as required by the Paperwork-Reduction Act of 1980, PL 96-511.
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JAN 311985 3 s. -_.
St. Agnes Medical _ Center '
We request that you give prompt attention'to these matters. Should you have any questions regarding them, we would be pleased to discuss them with you.
Sincerely, Y
4/M ohn D. Kinneman, Chief s
uclear Materials Section A Division of Engineering and Technical Programs
Enclosure:
NRC Form 314 cc:
Public Document Room (PDR)
Nuclear Safety Information Center (NSIC)
Commonwealth Pennsylvania
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