ML20129G125
| ML20129G125 | |
| Person / Time | |
|---|---|
| Site: | 07002281 |
| Issue date: | 09/26/1996 |
| From: | Michelle Beardsley NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | |
| References | |
| 123606, NUDOCS 9610070109 | |
| Download: ML20129G125 (10) | |
Text
E a L' NRC EORM '37
- A U.S '~; LEAR RE!ULATORY COMMISSION g 'N g PAGE 3 OF 3 PAGES N
V ucense Nun,j
- ~
g W SNM-1637 E N .
MATERIALS LICENSE occkei or Reference Numter E p SUPPLEMENTARY SHEET 070-02281 E ;
N N l g OFFICIAL RECORD COP V Amendment No. 07 E i
W E M Bryn Mawr Hospital E N 130 S. Bryn Mawr Avenue E N Bryn Mawr, Pennsylvania 19010 E N E N E N In accordance with the letter received August 26, 1996 and the letter dated August 28, E N 1996, License Number SNM-1637 is hereby terminated. E !l N E N E l)
N E N E ;,
N E L M N 'l N E N E E E N E N E R E N E N E N E l N E N E .
N E N E N E N E N E N E N E B E B E R E Ni s N 5 N E N E N E N E M E N E .
N E l N For the U.S. Nuclear Regulatory Commission E N E '
N Original Signed By:
N Date SEP 261996 By Michelle Beardsley l N Nuclear Materials Safety Branch E N Region I '
E N King of Prussia, Pennsylvania 19406 r) i E j N ~; E 1
l$k00 co0k ONO 1m m arrn m m m m m m m m m-m m m mun m m m Prmied on reevcled paper C
o
~
O SEP 261996 Mr. William McCune Vice President !
Bryn Mawr Hospital 130 S.'Bryn Mawr Avenue Bryn Mawr, PA 19010
Dear Mr. McCune:
Please find enclosed Amendment No. 07 terminating License No. SNM-1637 as 1 requested by the letter received August 26, 1996 and the letter dated August 28, 1996.
Your cooperation with us is appreciated.
Sincerely, Original Signed By:
Michelle Beardsley Division of Nuclear Materials Safety License No. SNM-1637 Docket No. 070-02281 Control No. 123606
Enclosure:
Amendment No. 07 DOCUMENT NAME: R:\WPS\MLTR\LSNM1637 To receive e copy of thle document, Indicate in the bos: "C' = Copy w/o attach /enci *E" = Copy w/ attach / encl "N" = No copy 0FFICE DNMS/RI l N. DNMS/RI ml NAME Stambaugh/jvs '-fM Beardsley \\V/
DATE 08/28/96 <//iM9c. 08/la/96 08/ /96 08/ /96 0FFICIAL RECORD COPY ML 10
. , . - . . .- . - ..~ . - ~ - - .-~.-- - --- - .-. . ..
MsM Z-/
I August 28,'1996 1
OYo ' g #1l fM# (6 l
U.S. NRC l
Region One 475 Allendale Road !
King of Prussia, PA 19406 t
Attention: Joanne Stambaugh ,
Dear Ms. Stambaugh,
Case Reference # 123606 I have enclosed copies of our documentation concerning the Coratronic Pacemaker Model # C 101 and Serial # 196.
The pacemaker was sent to our nuclear medicine department after explantation and forwarded to Biocontrol Technologies, 300 Indian Springs Road Indiana, PA 15701.
Documentation of the actual explantation surgery would have to come from Crozer-Chester Medical Center.
If I can'be of any further assistance please do not hesitate to call.
Sincerely, fQ l
W Kate Jaanus RT N l
l i /L3606 i
~0FFICIAL RECORD COPY '
,?S[I)
SEP - 41996
e..uJ 44 % a_ a .<d.e.,w .AAAd s..%-*hdaAh gl_i,A46h.mt.am_~s.a...-wwam-W_. J 4A4. .e4a_a4-A4 .,hw a m. 4 Aa a. a _1 u_ AA m,JJ._Jr u s% hue _ .w mwa sh._4,rm.Asu,.,,3._a_=_6%,_
~
i
~
2 O O i
i l
! I I l l
.i 4
i
! 1 1
4 i.
4 m -,s x d< h l m e.ro ,
j i
j Lu) s'> 'y %
_m 7
nM % _.s i
i i
l l
li
_ r. E 4. - A k ..--- .uiam ..M= .m ,.m ,wi l
O rrn Y {& y de. A k L %) y Afrdd C/o/ l kSe-Wo. /fd f5L.W .234' x ig g M M 7S~~~
5$/S~
drrnk cexQ, &
s- /
-a ~
E..S n.
. E itei t A n./
u _-
kbu
[ 4 Q k . [a m :
ws y @ysvL. . _. . _
- WW WOM . M
- 4 *
"M h.'"N*** e.e." = mhwere m em m. w am ,, .,
- N * * * * *** * * * * =~e . , . , . , , -.- , _ , . , , ,__
k OO * " ** NN N* 6m he.g 4es g g amm ,e gagm j - , -- . - - - .. _ _ . . ._ _. . _ _ .
. .e .. . .-.. .. .. .- .. .. . .. -
D ^O '
9m es e gemmyenemaee ameee. peg,.e ,,, a g, , , ,.
Or W
l
.. x==== = = = n = ~ 7,, g k)- - -cl7h - - - ?h - - 4?154
- o,
-V QUESTIONS? CALL 800 238- L FREE. 1
_j 9?b3b47154 v +
- . >e...vae.< Aaca N.-
y __ g5ygSg5ggpy 9
,f .r i
- -(vour 8.ame) Please Pre't Your Phare Numoer ivery vngsorienti (Reccent s Name) Pease P,,r.: wo se s Prow *=mr a very meu,iers;
/ . . I .- - ,,
( )' ,
g
~
"".. ..s .
(
14)
N e Acorm # ""
h sidA'o dsNee{Amir 7'Ohuum W O[e5 G aml - ' "
9
' ~
- rr t y ,,p g
-' T e Q. pp ,,
. ..L / , f r a /) T i,, , . >t Ir -/-p in I:!TERNAL billing REFERENCE IhFORMATION (Fest 24 charactus asi spar art swone) If NOLO FOR PICK UP,14 sit FEDEK Aman New(No avenece e an ocasionn)
Street Acoross cE;yr i en scia., rg s.asco iesaE Aca No 3 e6 3ra P.try FedEa Aa:t No A B. eredit Card C4y Slate llP 4.Quireo D i= cwe-e.r.. ni a .:.: u - + LL SERVCES DELIVERY AND SPECIAL HANDLING mam, '
- f,,,,",' SERVCE CONDITIONS. DECLARE 0 VALUE Fnw E e n icneck only one boxb (Cneca serwces requee@ m, %.*Oi'*"
a ee AND LIMIT OF LIABILITY 9., c .,, . ,
0.m v m,,a c,.e<rym
, , ,, p gt ,an* y ,v.u,r y g g 7g,
== .:=ss , e - ,- '
q =,;", E : h = . =..= - - -
a .,
e..:.m =-~ o = . = = = . = = r ., e
.= - ~=r . , - , - - = = = = . = =
nSr*"J' '*Janua
,. e on ce ._. __ Ta T** 1a % W *=" ~~~ T -** "" M "~~ b" '
a
--~
e-,--,
m,m
- ===== !.,-
_ . . . _ _ . , - s e
= . , , , , _ m
- _e
= = .g. m i s._,_. _ _ . _
OMER $PECW HMt ,
m, cesTRucil0;!S ccne,:s onry one wl 1 - - - - --
o,.,,.,,.,u.
s, m n ,_- ca _. . _ SIGNATURE RELEASE UNAVAILABLE 10 4 \ .
b --- -
e uped .
-_ ,, o e, .
t 3763647154 "a ~ "" -
CHECK ONE => O 49 CFR
" ' " " =
C) LATA /ICAO
""~~=
(TYPE OR PRlNT) 4.
DANGEROUS GOODS IDENTIFICATION SUBS
OR OUANTITY AND PACKING AUTHOR-PROPER SHIPPING NAME $g OR ID NO R TYPE OF PACKING INST 12ATION g
't
" 'l.r '
3
-lc] M ,o y ~7, '
) t se 7 _,,,,,,0 , ,
s
'! g
%e i y .
/ I
, ,, /
- OTIONAL HANDLING INFORMATION TRANSPORT DETAILS THl$ SHIPMENT IS MTHIN THE UMITATIONS PRESCRIBED FOR g PASSENGER AIRCRAFT LaSGO A'RCAAr7 ny._y (DELETE-NONAPPUCABLE) h
? ORT OF DEPARTURE AIRPORT OF DESTINATION SHIPMENT TYPE F OM WOW NW%W IF ACCEPTABLE FOR PASSENGER AIRCRAFT, THIS SHIPMENT CONTAINS RADIOACTIVE MATERIAL INTENDED FOR USE IN, OR INCIDENT
<T O. RESEARCH. MEf"OAL DIAGNOstS OR TREATMENT.
I HEREBY DECLARE THAT THE CONTENTS OF THIS CONSIGNMENT ARE FULLY AND ACCURATELY DESCRIBED ABOVE BY PROPER SHIPPING NAME AND ARE CLASSIFIED, PACKED, MARKED, AND LABELED, AND ARE IN ALL RESPECTS IN PROPER CONDITION FOR TRANSPORT BY AIR e
' ACCORDING TO THE APPUCAELE INTERNATIONAL AND NATIONAL GOVERNMENT REGULATIONS.
ME AND TITLE OF SHIPPER y
, PLACE AND DATE g
- . f. _ . I i
?
o - r - f; , -
%nGENCY TELEPHONE NUMBER SIGNATURE .)F SHIPPER SEE WARNING
'. ~7 / - 7.-.,
('
ON BACK $
'V" t t t WV 94_WM % % % 9 R % % % % R T V t t 1 W T %L E W W P W R R d
) '
[ 1 NUCLEAR MEDICINE PERFORMANCE IMPROVEMENT REPORTS / MINUTES i RADIATION SAFETY MEETING Date: June 19,1996
! Attendance: Drs. M. J. Eymontt, R. J. Carella, E. Assarsson; W. McCune, L. Thompson, L. Quinn, V. Wright, nn na .,a i K. Jaanus, L. Mixon. -
i
^b sd ' .
' ( ' , (pg s fM ^
^ ' IDOL " ICHECK5 '?NCTE j .
4
! Approval of Minutes. Minutes approved from I 3/27/96 meeting.
f, Radiation Dosometry Reports. All badges were ALARA. Continue to check. Continue to monitor.
Mis-administration / Adverse No incidents of mis-Effects, administration to report for l
i Nuclear Medicine or Radiation j Oncology.
NRC license fee. $4,300.00 charge. Fee to be split between
! New Communications.
' Nuclear Medicine and i
Radiation Oncology Departments.
i Old Business Cancelpacemakerlicense j ~ Compose letter to NRC' with i s
l WImam McCune to sign L
. SNM-163. ( ' advising caN of j
g-----der Econee SNM-163.?]
New Business Discussed best way to fillin NRC comacted. Dr. Rauth gap of RSO coverage 6/28, will be delegating duties of '
l RSO and overseeing 29,30.
operations of Nuclear Medicine Department to Dr.
' Nancy Sherwin of Lankenau l Hospital for 6/28, 29, 30, 3
i 1996.
As of July 1,1996, Dr. Rautle will resume duties of RSO and physician for the 1
s '
Nuclew Medicine
- .* - Departsnent.
- j. -
_ __ y _
o o
... i I I
- 1
) TELEPHONE CONVERSA1DN RECORD
! Date: y w-- '
lOMT401 No. /A%Cb %[2/%
- ' Person Called: /O% l Ostanhation: Telephone '
i Person Cahg:
Ks @~ %fZ^d ""Yan s ~
~
Zntwsk,
! subject: U
~YE w y u u t W
! s=-- q: i 1
1
- i i -
ipannu g& bkaa
- xL G h xx f4 W A ,U " & J N
i du h a&nu4 a u ~ A & d 4.
- 1 I
i !
l l
i l Lict M Ho. 50lh-lh57 j Action Requ.'..4/Taka-- boclet He. 0 7n-naas'I
(&
OfA <
%f98)96 -
9
)
ii 4 OFFICIAL. RECORD COPY ML 10 i i :
i 9
.i l
.a
.f[ . .
BitYN MAWII HOSPITAL
,, . 130 South Bryn Mawr Avenue n atat.ni sysnal Bryn Mawr, Pennsylvania 19010-3160 610/526-3000 Mr. Frank Costello, Chief ()7 0 '
Medical Licensing Section U.S. Nuclear Regulatory Commission Region I 475 Allendale Road King of Prussia, PA 19406 RE: License Number SNM - 1637
Dear Mr. Costello:
l l
This letter is sent to request the termination of the pacemaker license for the Bryn Mawr Hospital. Since the last pacemaker has been explanted, we are requesting that License ,
SNM-1637 be terminated immediately. !
This information is submitted in regard to the Bryn Mawr Hospital's commitment to maintain full compliance with its NRC license. We trust that this request will be acceptable to the Nuclear Regulatory Commission. Should you have any questions or require additional information or details, please contact us at any time.
Sincerely, d
William McCune Vice President ft EXEMPT '
12d60C
~ . .
OFFICIAL RECORD COPY.
. - -Q g, System hiembers: The Bryn Mawr Ho pital, The isnk nau Hospital, Paoli hiemorial Hospital, Bryn hiawr Rehab, Community Health Affdiates
. . x. .
O O
. : (FOR LFMS USE)
- INFORMATION FROM LTS BETWEEN. .
LICENSE FEE MANAGEMENT BRANCH, ARM = PROGRAM CODE: 22160 AND : STATUS CODE: 0 REGIONAL LIC ENSING SECTIONS : FEE CATEGORY: EX 7C
- EXP. DATE: 20020731
- FEE COMMENTS: PACEMAKER /37-07722-04
- 1. AP PLIC AT ION ATTACHED APPLICANT / LICENSEE: SRYN MAWR HOSPITAL RECEIVED D ATE: 9 60826 00CKET NO: 70322B1 CONTROL NO.: 123606 LICENSE NO.: S N M- 16 37 ACTION TYPE: T ERMIN AT ION
- 2. FEE ATTACHED AMOUNT: ___ ____
CHECK NO.: . _______
c
- 3. CO M M EN T S 'JI SIGNED h>
oATE _: __ _____s li2 / s :_____
_ g B. LICENS E FEE M AN AGEMENT BRANCH (CHECr y4tE g HL iJp Q IS ENTERED / 3 )
- 1. FEE CA TEGORT AND AMOUNT: _ _ _f , ,
[,,;______________
W
- 2. CORRECT FEE PAID-APJPIC ATION M AY BE PROCESSED FOR:
AMENDMENT _______ v______
RENEWAL ______________
LICENSE ______________
- 3. OTHER __________________________________
oATE
______$fs5_f3E# ___________________
RECEIVED BY LFDCB Date id Y l??l a,thalU_ sos ______
Dy_dE
______.~7~~~
Date Completed fy h_
_ - - _ _ _ - _