Text

Amend 12 to License 50-17838-01 for Providence Hosp,Revising Condition 12 Re Authorized Users
	ML20155E417
Person / Time
Site:	03013426
Issue date:	08/12/1982
From:	; NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS)
To:	;
Shared Package
ML20155E328	List: ML20155E417;
References
	50-17838-01, 50-17838-1, NUDOCS 8604170601
	Download: ML20155E417 (5)
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LICENSE

STATE 01 VEllMONT

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The board grants this

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STATE OF VERMONT

BOARD OF MEDICAL PRACTICE

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THIS IS TO CERTIFY

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a graduate of . .h, .. ,,.t.hp#iaiC..h4 Ita[...(EniGF3.hijFaCUSE 3 f..f...

in the year .1977.. having successfully qualified as a practitioner in medicine before this Board has

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Certificate No. .7006. .

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STATE OF VERMONT

Office of Secretary of State

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Received 9 N ?.1984

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Signed. Secretary of 5 tate

and duly recorded.

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, bel .JE Eh : William O. Mi r. Chief

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John E. Glenn. Chief

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Division of Engineering and

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LICENSE FEE TRANSMITTAL -

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A. REGION

1. APPLICATION ATTACHED

Applicant / Licensee: Olc;chtak Ccnhf Wmdnk cP VermCrk

Application Dated: ~~lf7_fSP:5

Control No.: 04086

License No.: 4 4-lOl% ~l-C)'1

2 FEE ATTACHED

Amount: 2 \@ C'C'>

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Check No.: Q9TFQ / of 9'f6D

3. COMMENTS

Signed ' 10m$n 93n-bN

Date q QC;

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B. LICENSE FEE MANAGEMENT BRANCH

1. Fee Category and Amount: ~74-

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2. Correct Fee Paid. Application ney be processed for:

Amendment

Renewal /

License

Signed Oh

Date $h/

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REGION I FORM 213

(MARCH 1983)

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ML20155E417

Text

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