Text

Amend 20 to License 50-17838-01 for Providence Hosp, Authorizing Use of Any Radiopharm in 10CFR35.100,200 & 300 & Any Brachytherapy Source in 10CFR400 as needed,1.5 Ci Matl in 10CFR34.500 in Diagnostic Devices
	ML20155J436
Person / Time
Site:	03013426
Issue date:	10/28/1987
From:	Riedlinger B; NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION V)
To:	;
Shared Package
ML20155J442	List: ML20155J436; ML20155J524;
References
	50-17838-01, 50-17838-1, NUDOCS 8806200506
	Download: ML20155J436 (3)
	v • d • e

p=====W--mmmm==memmm-mmmmmmmmmmmmm- _

q

(NRC

3 83) Fjum 374.

__1

PAGE

___3

OF PAGES

g U.S. NUCLEAR REGULATORY COMMISSION

MATERIALS LICENSE Amendment No. 20 i

!

Pursuant 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 1, Parts 30,31,32,33,34,35,40 and 70, and in reliance on statements and representations

g

g heretofoie made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess, and tran

il source, and special nuclear material designated below; to use such material for the purpose (s) and at the place (s) designated below;to !g'g

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

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

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

g conditions specified below. l

p

Licensee

1. Providence Hospital 3. Ucense number 50-17838-01

g Radiation Safety Office p

i I

F.

2. 3200 Providence Drive, Pouch 66049 ,

p:

3 Anchorage, Alaska 99502 4. Expiration date August 31, 1988 k:

I

y S. Docket or

g Reference No. '030-13426 lkk:

N 6. Byproduct, source, and/or 7. Chemical and/or physical 8. Maximum amount that licensee !g;

>

N special nuclear material form may possess at any one time lE

l' s under this license

A. Any byproduct material 'A. .Any radiopharmaceutical A. As needed F;

l

g

u

identified in 10 CFR 35.100 '

-

identified in 10 CFR 35.100 [

p:

I B. Any byproduct material B . ' Any radiopharmaceutical . B. As needed g;

I identified in 101CFR 35.200 . identified?in 10 CFR 35.200

. IP:

1 i '

>:

C. Any byproduct material C. 5 Any radiopharmaceudical' -

C. As needed

l identified in 10 CFR 35.300- . identified in 10 CFR 35.300' [jg

g

i P:

1 D. Any byproduct materi'al 0. .

'

Any brachytherapy-source. D. As needed p;

i identified in 10 CFR>35.400 identified.in 10 CFR 35.400 R:

l IV

E. Any byproduct material ' E. Sealed' sources for E. 1.5 curies

-

l

g

identified in 10 CFR 35.500., diagnostic devices per source f;g

d

Uranium depleted in F., Cadmium plated tretal F. As needed g

i

1 F.

Uranium-235

lF:

,F:

I 'h-

l

y

G. Strontium 90 G. Sealed source (Nuclear

Enterprises reference

G. 10 millicuries

f

g source No. 2503/3) p;

i pc

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

4 and Associates Instrument 'E

l Calibrator Model 28-5)

, >[;

i $

8 jk

N .

i F

4 #

4 k

q 8806200506 871028 I} M

g REG 5 LIC30 V

g 50-17838-01 PDR / N

AW)

sxmmm----~x----A)

l

. .. . _ .

- _ - _ _ _

pmmmmm--mmmmmmmmmm--mmmmmmmmmmmmmmm-- ' * ' i ' ' ' * ' i ' i i ' i M mm m m my

U.S. NUCLEAR REIULATORY COMMISSION !

l NXC form 3MA PAGE OF PAGES

l *$6 "f7E*l8-01 l

l MATERIALS LICENSE I

I '

SUPPLEMENTARY SHEET 6W Nir * i

i

I -

Amendment Nc. 20 l

I

1

q l

u 9. Authorized use: I

I >

I

I A. Medical use described in 10 CFR 35.100.

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

g C. Medical use described in 10 CFR 35.300, i

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. >

I G. and H. Instrument calibration. I

I I

n nn -

~ ~~

g -C !

I r v\~0hblTIONS;

t -

w G%g {sf ,, i

l 10. Location of use: sV i i

I Q ; / l.. >

!

N

' A. Providence Hospitab d

, 'O

I

'

l

3200 Providence.DPive.

I l Anchorage Ala,s'ka

Uj

N.',;g 'A' , , ;,

..

'

Q !

y

4

, i B. Licensed material described (in, License Conditions' 6.E. , 7.E. 8.E. , and 9.E. >

!

I may also be used in Room-132;of the:Providen'ce Medical Office Building, F

V

~

N 3340 Providence Drive, Anchorage, Alaska. \ r- J l

y p- 1 y V -- 7j

-

, 7;- p

11. Radiation Safety Officer ( LAnthony.Chung-Bin,iPh 0;

'

a

W g% .jgrity'f.

<

,'p,.- A

p

j 12. Authorized users: g 7

'

l[ qj + {

' '

Maurice J. Coyle,\ M.D.ifor$tbralkidentif'iedLin10CFR-35.100,35.200,

'

l A. l

g 35.400, 35.500;'Iodjne 131 for treatment 3of,hyperthyroi.dism or cardiac y

>; LC

'

i dysfunction 4 ,

1

,% ~

ii

( // n sU g

4 B. John J. Kottra, M.D. for materials identified in'10 CFR 35.100, 35.200,

35.500; Iodine 131 for treabnent of , hyperthyroidism or cardiac dysfunction l

f

4

g

>

4

C. Charles Sternhagen, M.D. for mat'erials identified in 10 CFR 35.300, and p

4 35.400 >

4 >

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

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

ql

4 P

3.i

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

4 35.200, 35.300, and 35.500. I

f I

I

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

l g

4 i

q G. Anthony Chung-Bin, Ph.D. for non-human uses of licensed material. p

4 P ,

4

"

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

4 calibrator provided it follows the procedures in the Atomic Products Corporation h

Lineator Instructions Manual dated June 20, 1983. l

l

1

14 The licensee may transport licensed material in accordance with the provisions p

g3]f10CFRPart71,"Packagingagd,TransportationofRadioactiveMaterial"fy.[. ]

--- f v' rest

M @u'CrDi2sKt fin 5W3Cr;h'WM MBE'Wird Tmr 're wMh_

- - - - - - - - - - - - . - - - - -hD

'y = ~AMG i 4

_ - _ _ _ _ _ _ - _

r = rw = = = = = = = = = = = = = = = == == === = = = Jerunemeremur- ---- - - -- -- - .-- y l

l NZC form 37EA U.S, NUCLEAR RE!ULATORY COMMISSION

PAGE OF PAGES I

l ""SD"i7b8-01 !

l MATERIALS LICENSE

ce number I

q SUPPLEMENTARY SHEET

g

,

Doc 0 *3Ur

-134nererE6 1

- p

l Amendment No. 20

,

-

l

,

I I

CONDITIONS I

>

(continued)

l

15. This license is based on the licensee's statements and representations in the i

following documents: i

I

A. Application dated November 30, 1982 -

>

B. Application dated February 21, 1983

C. Letter dated July 13, 1983 n a f; f3 l

, y

D. Letter dated August 177l.19831 * * 6 U: It, y

E.

F.

LetterdatedJanuarh20;'1984

Letter dated February 13, 1984

"( ^d

r,

'

i

I

G. Telegram dated' February 22, 1984 J

,.s i

H. Letter datedd4 arch E, 1984 d E

I. Letter dated May;15, 1986 9

J. Letter dated 7 July'28,'1986 '

1,

l

y

K. Letter date'd September 18,1986 /J- p

L. Letter da'ted June 3,:-1987's -

/ [i >

Letter dated October 15,11987. '

M. '

i o '

-, >

v ;

'

( f

l (. , - '

\ '

: ,

,

l

,n 7 ,7s.

<

c y

s ,< -

,

, ,i - ,

7. , .

,

"

j!!!if[!, y 1 I

a:

,

, cs, s. p

,'

c3

-

,

p

'. '1

,7, h

,

,.

>

. n B

>> < p

Zs . k

..

V. g

p

'

.

W

p

+

>

FOR THE U.S. NUCLEAR REGULATORY COMMISSION p

>

original signed by B. A. Riedlinger >

lDate October _28, 1987 N

I By ~Teth' F.~kiedlinger ~ ~ ' " ~ ~ ~

k,

Health Physicist (Licensing) p

Nuclear Materials Safety Section p >

Region V i

1-

8

1

Iil

I

'

< (

i ,

4

I 9 )

'

k,

l,- =

, .a\ , !* .. -E '

b

l

"" " " "iT&T. ETAT TATJLTR'&TRDEN'W?E'.TEATJLTEE&TiEATAT "W*

-

,

& :k??u ?!N.& ,

ML20155J436

Text

Navigation menu

Search