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Amend 19 to License 50-17838-01 for Providence Hosp, Authorizing Mj Coyle,Jj Kottra,C Sternhagen,D Farleigh, DA Moeller,Ka Fox & Dl Zellmer to Use &/Or Supervise Use of Listed Matls
	ML20147J380
Person / Time
Site:	03013426
Issue date:	07/13/1987
From:	Riedlinger B; NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION V)
To:	;
Shared Package
ML20147J382	List: ML20147J380; ML20148A021;
References
	50-17838-01, 50-17838-1, NUDOCS 8801220448
	Download: ML20147J380 (3)
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a8M Form 374 - U.S. NUCLE AR R EGULATORY COMMISSION

MATERIALS LICENSE Amendment No. 19

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Pursupnt to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93-438). and Title 10,

l Code of Federal Regulations, Chapter I, Parts 30,31,32,33,34,35,40 and 70, and in reliance on statements and representations

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l Jwretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess, and transfer byproduct, y

i source, and spccial nuclear material designated below; to use such material for the purpose (s) and at the place (s) designated below; to N

i deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the applicable Part(s). This E

U license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, as amended, and is N

subject to all applicable rules, regulations and orders of the Nuclear Regulatory Commission now or hereafter in effect and to any

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Ucensee

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l 1. Providence Hospital 3. Ucense number T-17838-01

i Radiation Safety Office

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g 2. 3200 Providence Drive, Pouch 6604s V'_'

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I Anchcrage, Alaska 99502 c t.7 -

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i 6. Byproduct, source, and/or 4 7 Chemical and/or physical (S. Maximum amount that licensee [!

special nuclear material

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form p. $may possess at any one time I

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A. Any byproduct material '

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i Any byproduct material

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C. Any byoroduct material .- ,C. M Any(radiopharinaceutical <%C. As needed I;

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N D. Any byproduct material ! D. ,b Anytbrachytherapy7 D. As needed i:

identified)in110;CFRsource 35i400M

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identified in 10 CFR 35.400

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l E. Any byproduct material 2 E. SeOe{dsourcesfor E. 1.5 curies

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F. F.I C5dmiu,mpl,atedimetal F. As needed L

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G. Strontium 90 G. Sealed source (Nuclear

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E H. Cesium 137 H. Sealed source (J.L. Shepherd H. 100 millicuries '

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U.S. NUCLEAR REcULATORY COMMISSION PAGE OF PAGES i

( License number i

g 50-17838-01 i

q MATERIALS L.lCENSE oocket or aererence number

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SUPPLEMENTARY SHEET 030-13426 k

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l . Amendment No. 19 l

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I 9. Authorized use: H

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I A. Medical use described in 10 CFR 35.100. l

l B. Medical use described in 10 CFR 35.200. p

q C. Medical use described in 10 CFR 35.300. 1

i D. Medical use described in 10 CFR 35.400, i

i E. Medical use described in 10 CFR 35.500. I

I F. Shielding in a linear accelerator.

G. and H. Instrument calibration, l

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yCONDITIONS v (j j i

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10. Location of use: ,l1 , gY S

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l A. ProvidenceHospithl- l

g 3200 Providence Drive- '

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< Anchorage, Alaska i i

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Licensedmate'ri$'1describ[dhs

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4 B. n. License; Conditions 6.E., 7.E. 8.E., and 9.E. h

l may also be used in Room 132'of the< Providence' Medical Office Building, h.

q 3340 Providence Drive, Anchorage,fAlaska, i

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4 11. Radiation Safety Officer: .DarwinlL.fZellmer,nPh.D.

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12. Authorized users: '

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A. Maurice J. Coyld, M.D. for maferialsLid tifiedin10MFR35.100,35.200, '

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35.400, 35.500;' Iodine 131 for treatmentiof. hyperthyroidism or cardiac

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<j B. John J. Kottra, M.D. 'for materials identified in*10 CFR 35.100, 35.200, g

35.500; Iodine 131 for trea,tment of,hyparthyroidism or cardiac dysfunction g

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% C. Charles Sternhagen, M.D. for materials identified in 10 CFR 35.300, and k

ij 35.400

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D. Denise Farleigh, M.D. for materials identified in 10 CFR 35.100, 35.200,

35.500; Iodine 131 for treatment of hyperthyroidism or cardiac dysfunction p

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E. David Allen Moeller, M.D. for materials identified in 10 CFR 35.100,

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35.200, 35.300, and 35.500.

F. Kenneth A. Fox, M.D. for materials 4dentified in 10 CFR 35.300 and 35.400.

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l G. Darwin L. Zellmer, Ph.D. for non-human uses of licensed material, k

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13. The licensee may use the Lineator device for doing linearity tests of its dose 8

calibrator provided it follows the procedures in the Atomic Products Corporation ['

q Lineator Instructions Manual dated June 20, 1983.

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i 14. The licensee may transport licensed material in accordance with the provisions !

N of 10 CFR Part 71, Packaging and Transportation of Radioactive Material". j

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l NRC Form 374 A U.S. NUCLE AR REGULATORY COMMISSION ,,,, ,,,,, 3

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License number I

q 50-17838-01 i !

q MATERIALS LICENSE oocket or nererence number i i

q , SUPPLEMENTARY SHEET 030-13426 >

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. Amendment No. 19 y

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CONDITIONS M

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15. Except as specifically provided otherwise in this license, the licensee shall y

conduct its program in accordance with the statements, representations, and i

procedures contained in the documents including any enclosures, listed below. i

The Nuclear Regulatory Comission's regulations shall govern unless the ly

statements, representations and procedures in the licensee's application and

correspondence are more restrictive than the: regulations. y

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A. Application dated Novemb'eri$0,1982 i

B. Application dated February 21, 1983 i i

C. Letter dated July 13,:1983 -

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D. Letter dated August 17, 1983 p

E. Letter dated January.20, 1984 ^'

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F. Letter dated February'13. 1984 jp

G. Telegram dated February 22', 1984 h

H. Letter dated March 6, 1984- ,

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I. Letter dated May 15, 1986 ,

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J. Letter dated July 28, 1986 .

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K. Letter dated September 18,1986 p

L. Letter dated June 3,1987 -

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4 FOR THE U.S. NUCLEAR REGULATORY COMMISSION )

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[4 original signed by B. A. Riedlinger l#

! Date July 13, 1987 By

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Beth A. Riedlinger p

I Health Physicist (LicensingT g

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Nuclear Materials Safety Section >

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