ML20128M166

Corrected Page to Registry of Radiactive Sealed Sources & Devices Safety Evalutaion of Device for Model Step. Certificate:NR-104-D-101-S

ML20128M166
Person / Time
Issue date:	09/16/1996
From:	NRC
To:
Shared Package
ML20128M155	List: ML20128M152 ML20128M166
References
SSD, NUDOCS 9610160015
Download: ML20128M166 (4)

Text

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I REGISTRY OF RADIOACTIVE SEALED SOURCES AND DEVICES SAFETY EVALUATION OF DEVICE (CORRECTED PAGE 1 - September 16, 1996)

NO.: NR-104-D-101-S DATE: April 28, 1995 PAGE 1 OF 8 DEVICE TYPE: TransmissionfLine Source Housing",

MODEL: STEP MANUFACTURER / DISTRIBUTOR: Picker International (Formerly Ohio Imaging)

Nuclear Medicine Division 595 Minor Road Highland Heights, OH 44143 SEALED SOURCE MODEL DESIGNATION: Isotope Products Laboratories:

Model 3409 ISOTOPE: MAXIMUM ACTIVITY:

Cobalt-57 29 mci (1.07 Gbq)

~

Isotope Product Code HEGL-0021 i

l Gadolinium-153 86 mci ( 3 . 2 Gbq)

Isotope Product Code HEGL-0022

! Technetium-99m (1) 23 mci (0.85 GBq) l l

l LEAK TEST FRI;OUENCY: 6 Months  !

PRINCIPAL USE: (B) Medical Radiography i I

j (1) Not a sealed source; user fabricated source at site.

9610160015 960919 PDR RC

• SSD PDR

PAGE1 NRC FORM 567 ca n) l,U,S i/) efUCIAAR 14 RE!OUMIOSYCOMMISSION la b /U REQUEST FOR A SEALED SOURCE OR DEVICE EVALUATION INSTRUCTIONS: Send this request AND a copy of all related letters /applicahons and drawings to: The Sealed Source Safety Section, ATTN: Chief, OWFN Mail Stop 6 H3. Change the Ucense Tracidng System rnilestone to 19 and assign to reviewer code B-5.

NOTE: Retain a copy of this request with the application and background files.

WEoVEsTE p g REGION / LOCATION:

y /MO 4N l1 U ll Ill IV V HQ U LFDCB TELEPHONE NUMBER DATE TYPE OF ACTION REQUESTED (Check as appropriate)

APPUCANT'S NAME SOURCE REVIEW AMENDMENT OF REGISTRATION SHEET MAIL CONTROL NUMBER (S) DEVICE REVIEW NUMBER (S) 1 LETTER /APPUCATON DATE UCENSE NUMBER (S) CUSTOM REVIEW ~/ 9 -/C /- d l

COMMENTS - F) i

[f[ hNW gg f.ffQ 0N WW3 l

,, FOR SSSS USE ONLY juCA d '

n t DATEMECEffED ' UATE ASSIGNED DATE TO FEES TYPE OF ACTION (Indicate the' number of each type) /

/

l COMMERCIAL DISTRIBUTION (FORMAL) l USE BY A SINGLE APPLICANT (CUSTOM)

SOURCE (9C) DEVICE (9A) SOURCE (90) DEVICE (98)

NEW NEW ~

NEW -

NEW AMENDMENT t, MdIEENDMENT AMENDMENT AMENDMENT j NO SAFETY EVALUATION REQUIRED NO FEES REQUIRED

] LICENSING ACTION REQUIRED IF KNOWN -

NO

] OTHER (Spec #y)

TOTAL NUMBER OF NOTES REVIEW HOURS NUMBER OF DEFICIENCY LETTERS NUMBER OF DEFICIENCY CALLS FOR BILLING PURPOSES ONLY - -

NAME CHANGE ADDRESS CHANGE ] NEW REGISTRATION - ] PRODUCT INACTIVE - , _

ADD TO BILLING REMOVE FROM BILLING FOR FEE USE ONLY , -

TYPE OF FEE FEE CATEGORY k'Mby9 9A 9B 9C U 9D

~ ~

v '

CMOUNT RECEIVED ,

f \ A _ g(@

] CHECM NUMBER MATANN UPDATED hi ~ AS REQUIRED - "

L

/,7O l h s _C W (

g e l r, [ _,$ pg DATE OF CHECK c LOD e

] MATSYS UPDATED " "

I Jt- AS REQUIRED moved er u DATE RETUR4 DATE

.F ' }

mt i < ,

NRr.eORM r,ar esa M!N N w

/ ]

PAGE1 NRC FORM 567 ,, U, S. NUCLEAR REGULATORY COMMISSION j pos) i J REQUEST FOR A SEALED SOURCE OR -

DEVICE EVALUATION  !

INSTRUCTIONS: Send this request AND a copy of all related letters / applications and drawings to: The Sealed Source Safety Sectxm, ATTN: Chief, j OWFN Mall Stop 6 H3. Change the License Tracking System milestone to 19 and assign to reviewer code I-5. .

NOTE: Retain a copy of this request with the application and background files.

REQUESTE r g REGION / LOCATION: 1 7/g M* _ /fMd ]I ll U lil IV V U HQ U LFDCB ,

TELEPHONE NUMBER DATE TYPE OF ACTION REQUESTED (Check as appropriate)

APPLCANT'S NAME SOURCE REVIEW AMENDMENT OF j REGISTRATION SHEET '

MAIL CONTROL NUMBENS) DEVICE 'tEVIEW

" I) o LETTER /APPLCATION DATE LCENSE NUMBER (S) CUSTOM REVIEW

~

) 40 /~d I

COMMENTS . .

f h M..,s Nf /

, FOR SSSS USE ONLY 5 / a 7 M R NUMBERS L gp NUMBER ASSIGN k j DATERECEIVED / DATE AS$1GNED DATE TO FEES

$b lY9N Yh2f$b

/ I TYPE OF ACTION (Indicate theinumber of each type) / / I, l COMMERCIAL DISTRIBUTION (FORMAL) l USE BY A SINGLE APPLICANT (CUSTOM)

SOURCE (9C) DEVICE (9A) SOURCE (9D) DEVICE (98)  ;

NEW NEW NEW NEW  !

AMENDMENT y dENDMENT ] AMENDMENT ] AMENDMENT

{

j NO SAFETY EVALUATION REQUIRED j LICENSING ACTION REQUIRED IF KNOWN -

NO FEES REQUIRED NO f

) OTHER (Specsty) ~

TOTAL NUMBER OF NOTES REVIEW HOURS NUMBER OF DEFICIENCY LETTERS ,

NUMBER OF DEFICIENCY CALLS i FOR BILLING PURPOSES ONLY - -

NAME CHANGE ADDRESS CHAN'GE ] NEW REGISTRATION - ] PRODUCT INACTIVE - , ,

ADD TO BILLING REMOVE FROM BILLING FOR FEE USE ONLY s - t TYPE OF FEE FEE CATEGORY '

( fM.- b9 9A

~ ~

V'

, ' U 9B 9C U 90 f AMoVNT RECElvED hf]

CHECK NUMBER f MATANN UPDATED

^

k( - AS REQUIRED ~ '

7 DATE OF CHECK (/ ~ ' ~, r

( ,

(o /) / .5 h ,pg ] MATSYS UPDATED " ,

/3 , 1CM- J/ //4-i /6 f AS REQUIRED APPROvg m DQ+,, cHy5 K DATE '

EfATERETURM7/W,/ 7 e6 - -

m e i i -

h NRC FORM $67 (6-93)

k. OfuGMATOftS COPY

.s - L w a

U. S. NUCLEAR REGULATORY COMMISSION

, FY 96 Annual Materials Fee Invoice Period 10/1/1995 - 9/30/1996 10 CFR 171.16 Invoice Date License Anniversary Month Invoice Number

====== ========================= ========

06/11/1996 April AM3193-96 g/

T//Je./'/j d tG J W 4 L.

PICKER - 2;;IC I M ^. C I N C- l20 C L c}* l- N W 0* # ' "' S ' ^' '

l}

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l ATTENTION: RADIATION SAFETY OFFICER h f30'O MTirc unan S 9 7 /19 A, efa. '#/+p 7j / ggy_] pts > y Q[

BEDFCCC "EIC"TS -GH 44ido~ $

lll$ H LWap ut7 6 M7'/* 6Y b

• • • • • Mark THIS COPY with any billing address changes *****

License / Approval /

Registration / Code Annual Fee Certificate Number AA905 Category (s) Fee Amount

============ ===== =========== =========

NR0104D101S ANN 9A $ 6,700.00 TOTAL: $ 6,700.00 TOTAL INVOICE: $ 6,700.00 Make Checks Payable To:

===========

U.S. Nuclear Regulatory Commission <=== This PO Box address is i 1

License Fee & Accounts Receivable Branch <=== for receipt of payments l F' O Box 954514 <=== only.

St. Louis, MO 63195-4514 For terms and conditions see attached.

Questions: call 301/415-7554.

• • • • • • • • • • • • x*******************

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• PA YME N T C0 PY *

• MM**%%%%%*MM%%%%%*%*K*%%%K%%%%M

> delayed if the invoice is not included. <

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