ML20153C137
| ML20153C137 | |
| Person / Time | |
|---|---|
| Issue date: | 09/21/1998 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Kvetkosky W AFFILIATION NOT ASSIGNED |
| References | |
| SSD, NUDOCS 9809230352 | |
| Download: ML20153C137 (2) | |
Text
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Septcmber 21,1998 Wayne Kvetkosky Trinity Biotech P.O. Box 1059 Jamestown, NY 14702-1059
Dear Mr. Kvetkosky:
This letter verifies the receipt of the completed NRC Form 483 dated September 14,1998. This form is a condition of the generallicense under 10 CFR 31.11 authorizing in-vitro testing with byproduct material under general license.
The form has been assigned registration number 9148. When making changes to any of the information on the form, please reference the registration number and address the correspondence to Director, Office of Nuclear Material Safety and Safeguards, U.S. Nuclear Regulatory Commission, Washington, DC 20555.
If you have any questions or need further assistance, please contact me at (301) 415-7231.
Sincerely, N
Traci Kime, Secretary Materials Safety Branch Divicion of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety
- /
and Safeguards DISTRIBUTION:
NEO3jh SBaggett IMNS r/f DOCUMENT NAME: A:\\KVETKOSK.483 Ta receive a copy of this document. Indiuto in the box:
"C" = Copy without attachment / enclosure "E" = Copy with attachment / enclosure
- N" = No copy OFFICE MSB l
NAME TKime (f/L DATE 9/21/98 OFFICIAL RECORD COPY 9009230352 980921 PDR RC SSD PDR
NRC FORM 483 U, S. NUCLEAR REsULATORY COMMISSION APPROVED BY OMS,: NO. 3150-co38 EXPIREG: 6-30-99 c.es Esemated Imrden per response k compty eth th,s mandeery tr**macon conec6on request 7 mmutes. The validated reg,straton serw. es evidence
. REGISTRATION CERTIFICATE -In vl60 TESTING
- '""'lll* ".e'%"'T', *s',7,70',"e,#;,'l"%*e'," "ete ;' 7 u,, e a
t WITH BYPRODUCT MATERfAL'UNDER Eeg""e'*,y" '"o*,r%' "y'"*C7 U"'*didR ".*M c
Paperwerti Reduction Project (3150co38), Omco or Management and GENE. - L LICENSE Budget, Washington. DC 205o3. NRC may r st comfuct or sponsor, and e persen is not required b respond b. e coneccon or !nfbemation unfuss R i
displays a curroney val 6d OMS control r. umber.
Section 31.11 of 10 CFR 31 establishes a general Rcense authortzing physicians, clinical laboratories, hospitalsf and veterinariana in the practice of veterinary medicine to possess i,erta!n smail quar tities of byproduct material for b Wtro clinical or laboratory tests not irwoMng the intemal or extemal administradon of the byproduct material or the radiation therefrom to human beings or animals. Possession of byproduct material under 10 CFR 31.11 is not authorized until the physician, clinical laboratory, hospital, or veteriartan in the practice of veterinary medicine, has filed NRC Form 483 and received from the Commission a validated copy of NRC Form 483 with a registrat!on number.
- 1. NAME AND ADDRESS OF APPLICANT (See Instruc00n 3.E. below)
- 2. APPt.lcATION nece orie box onty) e g
4 Wayne.KVCtkosky.
- 4.,
l hereby.appfg.for.a Istration numbei,;ursuant to.10 CFR 31 Section Trinity Biotech 31.11, fw use of oct materials for PO Box 1059 A. Myself, a duly licensed physician authorized to disperse drugs in Jamestown, NY 14702-1059 the practice of medicine.
X B. The above-named clinicallaboratory.
TELEPHONE NUMBER thebde hoe Code)
C. The above named hospital.
D. Veterinarian in the practice of veterinary medicine.
3.
INSTRUCTIONS:
- 4. REGISTRATION A. Submit this form in duplicate to:
- REGISTRATION NUMBERi
- g Medical, Academic and Commercial Use i
/ g a88009 9148.
. Safeiy Branch (T-8 FS) f DMalon of industrial and Medical Nuclear Safety 3 Office of Nuclear Matertal Safety and Safeguards.
[
o,j, U.S. Nuclear Regulatory Commission g
g Washington, DC 20555 0001 g
\\
}
D 1c (At NRC, a registration number will be assigned and a validated copy
@~ (I of NRC Form 483 will be retumed.)
0.A. Nuclear tegula.
Comntission 41 l B. In the box above, print or type the name, address (including ZIP Code), and telephone number of the registrant physician, clinical-Pf MaMal'#gisM,9[a[Pe spaceblan - numb rWbe e
laboratory, hospital, fir veterinarian in the practice of veterinary assigned by NRC. If fNs is 4, change of h/brma#on / tom a preHously medicine for whom or for which this registratkon form ls filed.
registered generalIcense, hclude your registra00n number.)
- 6. If place o( use is different from address hated abcr.y. give complete address:
? SVn6sas'#,o1 above,'; S, N
~"
-n um t,
,.6
- 8. CERTIFICATION s
I hereby certify that:
/
' A.
AR Information in this regi5tration certificate is true and complete.
7y.
B.
The registrant has appropriate radia measuring' instruments to cak the tests for IcN oduct material win be used under the general license of 10 CFR 31.11. The tests win be performed only by persorMd cornpdcrit in the ura of the ine'ruments cnd in the hand!!ng of the byproduct matertals.
C. L i understand'that Comrniosion regulations require that any chlinge in t!$e ir/ormation fumished' by a registrant ori this ' registration certifcat'e be
' reported to the Director of Nuclear Material Safety and Safegua ulthin 30 days frorp the effective date of such change.' ~
D I have read and understand the provisions of Section 3Jd1Jof NRC regulations 10 CFR 31 (reprinted on the reverse side of this fonn); and I understsnd that the registrant is required to comply w!t)those provisions as to aR byproduct material which he receives, acquires, possesses, uses; or transfers under the Genera! !Icem,e for which this Registratx)n Certificate is filed with the U.S. Nuclear Pegulatory Commission.
PRINTED OH TYPED NAME AND TITLE OF APPLICANT SIGNATURE OF APPLICANT DATE Wayne A. Kvetkosky, 9egulatory Affairs Mgr.
ggg WARNING:
FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CML AND/OR CRIMINAL
~
y PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE,NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C. SECTION'1001 ~MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY
~
FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES ASTO ANY MATTER WITHIN iTS JURISDICTION.
NRuoRu.e3 cs.ee)
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