ML20133M989
| ML20133M989 | |
| Person / Time | |
|---|---|
| Site: | 07000859 |
| Issue date: | 05/23/1985 |
| From: | Heneghan H BRIDGEPORT, UNIV. OF, BRIDGEPORT, CT |
| To: | |
| Shared Package | |
| ML20133M900 | List: |
| References | |
| NUDOCS 8508130339 | |
| Download: ML20133M989 (2) | |
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NF)C FesRM 313 W
W U.S. NUCLE A2 7EIULJ.TOmV COMMISSION (144)
APP,.OVEJ BY OMB 10 CFa 30,32,33,34,*
31540120 35.nd 40 APPLICATION FOR MATERIAL LICENSE EsPw s.31v INSTRUCTIONS: SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR CO*APLETING APPLICATION. SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFlCE SPECIFIED BELOW.
FEDERAL AGENCIES FILE APPLICATIONS WITH:
IF YOU ARE LOCATED IN:
U S. NUCLE AR REGULATOR Y COMMISSION BL LINOIS, INDI ANA, IOWA, MICHIGAN, MINN ESOTA, MISSOURI, OHIO, OR DIVISION OF FUEL CYCLE AND MATERIAL SAFETY,NMS$
WISCONSIN, SEND APPLICATIONS TO:
LASHINGTON, DC 20555 U.S. NUCLE AR REGULATORY COMMISSION. REGION ill ALL T THER PERSONS FILE APPLICATIONS AS FOLLOWS,IF YOU ARE MATERI ALS LICENSING SECTION LOCAT ED IN:
799 ROOSEVELT ROAD GLEN ELLYN, IL 60137 CONNECTICUT, DE LAWARE DISTRICT OF COLUM81 A, MAINE, MARYLAND, MASSACHUEETTS, NEW JE RSEY, NEW YORK, PENNSYLVANI A, RHODE ISLAND, AR K ANSAS, COLOR ADO, lDAHO, K ANSAS. LOUISI AN A, MONT AN A, N EBR ASK A, OR VERMONT, SEND APPLICATIONS TO:
NEW MEXICO, NORTH DAKOT A, OKLAHOMA, SOUTH DAKOTA, TEXAS, UT AH, U.S. NUCLE AR REGULATOR Y COMMIS$10N, REGION 1 NUCLEAR MATERIAL SECTION 8 U S. NUCLE AR REGULATORY COMMISSION, REGION IV 631 PARK AVENUE MATERIAL RADIATION PROTECTION SECTION XING OF PRUS$1A, PA 19406 611 RYAN PLAZA drive, SulTE 1000 LLA8AMA, FLORIDA, GEORGIA, KENTUCK Y, MISSIS $1PP1, NORTH CAROLINA.
PUE TO RICO, SOUTH CAROLINA, TENNESSEE, VIRGINIA, VIRGIN ISLANDS, OR ALASK A, ARIZONA, CAllFORNI A, HAWAll, NEVADA, OREGON, WASHINGTON, WEST VIRGINIA, SEND APPLICATIONS TO:
AND U.S. TERRITORIES AND POSSES $10NS IN THE PACIFIC, SEND APPLICATIONS TO:
U.S. NUCLEAR REGULATORY COMMIS$10N, REGION 81 MATERIAL RADIATION PROTECTION SECTION U S NUCLEAR REGULATORY COMMIS$10N REGION V 101 MARIETTA STREET, SUITE 2900 MATERIAL RADIATION PROTECTION SECTION t.TLANTA, GA 30323 1450 MARIA LANE SulTE 210 WALNUT CREEK,CA 94596 PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR REGULATORY COMMIS$10N ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMIS$10N JURISDICTION.
THIS IS AN APPLICATION FOR (Casch appropreere treml
- 2. NAME AND MAILING ADDRESS OF APPLICANT (faciudele Codel A. NEW LICENSE University of Bridgeport T
SNM-794 B AMENoMENTTO uCENSE NuMBEa 219 Park Avenue C. RENEWAL OF LICENSE NUMBER Bridgeport, CT 06601
- 3. ADDRESSit$l WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED.
University of Bridgeport 169 University Avenue Bridgeport, Connecticut 06601
- 4. NAME OF PERSON TO BE CONTACTED ABOUT THIS APPLICATION TELEPHONE NUMBER Dr. James. V. Tucci 203-576-4271 a 90 9)
SUBMIT ITEMS 5 THROUGH 11 ON 8'4 s 11" PAPER. THE TYPE AND SCOPE OF INFORMATION TO BE PROvlDED IS DESCRIBED IN THE LICENSE APPLICATION GUIDE.
S. RADIOACTIVE MATERIAL
- s. Element and mass number, b. chemical and/or physecal form, and c. meomum amount
- 6. PURPOSEIS) FOR WHICH LICENSED MATERIAL WILL BE USED.
whach will be possessed at any one time.
- 7. INDIVIDUALIS) RESPONSIBLE FOR R ADIATION SAFETY PROGRAM AND THEIR
- 8. TRAINING FOR INDIVIDU ALS WORKING IN OR FREOUENTING 'tESTRICTED AREAS.
ToAINING ANO EXPERIENCE.
- 9. F ACILITIES AND E 8508130339 050710
- 10. RADI ATION SAFETY PROGR AM.
REG 1 LIC70 SNM-1952 pop
- 12. uCENSEE FEES isee ro cFa uroendsect,an uro an
- 11. WASTE MANAGEMENT.
MOUNT
- 13. CERTIFICATION. (Must becompieredby appIscent) THE APPLICANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENTATIONS MADE IN THl3 APPLICATION ARE SINDING UPON THE APPLICANT.
THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEH ALF OF THE APPLICANT, NAMED IN ITEM 2. CERTIFY THAT THIS APPLICATION IS PREPARED IN CONFORMITY WITH TITLE 10. CODE OF FEDERAL REGULATIONS. PARTS 30.32,33,34. 35, AND 40 AND THAT ALL INFORMATION CONTAINED HEREIN, 13 TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF.
WARNING 18 U S C. SECTION 1001 ACT OF JUNE 25,1948. 62 STAT. 749 MAKES IT A CRIMIN AL OFFENSE TO MAKE A WILLFULLY F ALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION SIGNATURE-CER TIF YI CF FICE R
/
TYPED, PRINTED NAME TITLE DATE
/
~btg 4 */ W dr Henry J. Heneohan. Jr.
Vice President & Treasurer 5/23/85
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- 14. VOt UN T A R Y E CONOWC D A T A 1
m ANNu LL Ri cO*Ts O. NUM8ER OF EMPLO VEES (Tored for
- d. WOULD YOU SE WILLING TO FURNISH COST INFORMATION Oonerend/or sreff hours /
- '##* #*'#'ry encIwamp oursx88 contractoral ON THE ECONOMIC IMPACT OF CURRENT NRC REGULATlONS OR ANY FUTURE
< $ 250K SIM 4 SM PROPOSED NRC REGULATIONS THAT MAY AFFECT YOUP (NRC reputerions perm /r
$250K-500K
$3 5M-7M
'**'*'****6'**************'~*'**'*'*'Y~*'*'*******'*"**'*
c NUM8ER OF BEDS
$500K-750K
$7M-10M
$750K-1M
> $10M YES NO FOR NRC USE ONLY
- I TYPE OF FEE LOG TEE CATEGORY COMMENTS APPROVED BY (H P L. ~ VM Q lK n'~T2(
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- 4. tid L
K, DATE AMOUNT RECEIVED CHECK NUM8ER A
jlIn )M) ~
MAY 2 8 N85 0
(f8 PRIVACY ACT STATEMENT ON THE REVERSE
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PRIVACY ACT STATEMENT Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by section 3 of the Privacy Act of 1974 (Public Law 93-579),the follow-ing statement is furnished to individuals who supply information to the Nuclear Regulatory Commission on NRC Form 313. This information is maintained in a system of records designated as NRC-3 and described at 40 Federal Register 45334 (October 1,1975).
- 1. AUTHORITY: Sections 81 and 161(b) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2111 and 2201(b)).
- 2. PRINCIPAL PURPOSE (S): The information is evaluated by the NRC staff pursuant to the criteria set forth in 10 CFR Parts 30,32,33,34,35 and 40 to determine whether the application meets the requirements of the Atomic Energy Act of 1954, as amended, and the Commission's regulations, for the issuance of a radioactive material license or amendment thereof.
- 3. ROUTINE USES: The information may be (a) provided to State health departments for their information and use; and (b) provided to Federal, State, and local health officials and other persons in the event of incident or exposure, for their information, investigation, and protection of the public health and safety. The information may also be dis-closed to appropriate Federal, State, and local agencies in the event that the information indicates a violation or potential violation of law and in the course of an administrative or judicial proceeding. In addition, this information may be trans-ferred to an appropriate Federal, State, or local agency to the extent relevant and necessary for an NRC decision or to an appropriate Federal agency to the extent relevant and necessary for that agency's decision about you.
- 4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVID-ING INFORMATION: Disclosure of the requested information is voluntary. If the requested information is not furn.
ished, however, the application for radioactive material license, or amendment thereof, will not be processed. A request that information be held from public inspection must be in accordance with the provisions of 10 CFR 2.790. Withhold-ing from public inspection shall not affect the right, if any, of persons properly and directly concerned need to inspect the document.
- 5. SYSTEM MANAGER (S) AND ADDRESS: U.S. Nuclear Regulatory Commission Director, Division of Fuel Cycle and Material Safety Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555 P-N C
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