ML20129F451
| ML20129F451 | |
| Person / Time | |
|---|---|
| Site: | 07002894 |
| Issue date: | 04/25/1985 |
| From: | Catino A DELAWARE VALLEY MEDICAL CENTER, LANGHORNE, PA |
| To: | |
| Shared Package | |
| ML20129F225 | List: |
| References | |
| NUDOCS 8506060772 | |
| Download: ML20129F451 (1) | |
Text
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/erm 314 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY M 10 CF3 30.361dH1hl 10 CFi143 42kf H1h.rl '
f0 CF:4 70 38t=MtHwi MMMMM M WUMmM M MMMMM (All items MUST be completed, please print)
LICENSEE NAME AND ADDRES5 UCENSE NUMBER a
Delaware Valley Medical Center SNM-184S Nuclear Medicine Department
" ' ' ~ " ' * " ^ " **'
. 200 0xford Valley Road Langhorne PA 19047 January 31s 1984 o
THE LICENSEE OR ANY INDIVIDUAL EXECUTING THIS CERTIFICATE ON BEHALF OF THE LICENSEE CERTIFIES THAT: (Check arxf/or complete the morcpriate item (s) below.}
A. MATE RI ALS DATA (Check one and complete, as necessary)
- 1. NO MATERIALS HAVE EVER BEEN POSSESSED OR PROCURED BY THE LICENSEE UNDER THIS LICENSE.
- 2. ALL MATERIALS PROCURED ANDIOR POSSESSED BV YHE LICENSEE UNDER THE LIC5NSE NUMBER CITED ASOVE HAVE BEEN TRANSFERRED ON D ATE TO WHICH HAS NRC LICENSE NUMBER OR
- 3. ALL MATERIALS PROCURED AND/OR POSSESSED BY THE LICENSEE UNDER THE LICENSE NUMBER CITED ABOVE HAVE BEEN TRANSFERHED ON DATE TO llSSUED BY THE STATE OF WHICH HAS LICENSE NUMSEH AN AGREEMENT STATE PURSUANT TO SECTION 274 OF THE ATOMIC ENERGY ACT OF 1954, AS AMENDED, AND THE ENERGY REORGAf.12ATION OR ACT OF 1974.
] 4.
MATE RIALS HAVE BEEN DISPOSED OF IN THE FOLLOWING MANNER. (Describe speci/c diposalprocedures-// addition.' pace is needed, use the reverse of this form, or provide attachments) 8506060772 850524 REG 1 LIC'70 SNM-1845 PDR
- 8. OTHER DATA
- 1. OUR LICENSE HAS NOT YF T EXPIRED; PLEASE TERMINA(E IT.
2 WAS A RADIATION SURVf Y CONDUCTED TO CONFIRM THE ABSENCE OF LICENSED RADIOACTIVE MATERIALS AND TO DETERMINL' WHETHER ANY
_ CONTAMINATION REMAiriS ON THE PREMISES COVERED BY THE LICENSE? (oieck one)
NO YES, THE RESULTS (oMck one)
ARE ATTACHED, OR WERE FORWAHDt.D TO NRC ON (Dete) 3.
THE PERSON TO BE CONT ACTED REGARDING THE INFORMATION PROVIDED ON THIS FORM l TE LEPHONE NUMBER NAME Annette Catino, Assistant Administrator (215) 750-3108 4.
Mall ALL FUTURE CORRESPONDENCE REGARDING THIS LICENSE TO Annette Catino Assistant Administrator e
RETURN TO;
[
CERTIFYING OFFICIAL I
DIRECTOR, DIVISION OF FUEL CYCLE AND MATERIAL SAFETY OFFICE OF NUCLEAR MATERIAL SAFETY AND SAFEGUARDS
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f f' U.S. NUCLEAR REGULATORY COMMISSION pg,yygg g,y, afat' no, Assist. Admin.
4 24/85 7,
Annette
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C ASHINGTON, DC 20555 NRC Form 314 (1942)