ML20195D251
| ML20195D251 | |
| Person / Time | |
|---|---|
| Issue date: | 06/08/1999 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Behenna D AFFILIATION NOT ASSIGNED |
| References | |
| SSD, NUDOCS 9906090104 | |
| Download: ML20195D251 (2) | |
Text
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June 8,1999 Quest Diagnostics Clinical Laboratories, Inc.
ATTN: Donald B. Behenna, RSO 400 Egypt Road Norristown, PA 19403 This letter verifies the receipt of the completed NRC Form 483 dated May 24,1999. 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 2219. 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, pleasa contact me at (301) 415-8140.
Sincerely, I
Traci Kime, Registration Specialist Materials Safety Branch l
Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety l
and Safeguards DISTRIBUTION:
IMNS r/f NEO I
l-DOCUMENT NAME: h:\\traci\\behenna.483 Ta receive a copy of this document, Indicate in the box: 'C" = Copy without attachment /enclostere
'E' = Copy with attachmentlenclosure "N" = No copy j
OFFICE MSB l
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j NAME TKime d DATE 6/ f/99
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OFFICIAL RECORD COPY 9906090104 990600
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NRC FORM 483 U. S. NUCLEAR REEULATORY COMMISSION APPROYED BY OMB: NO. 3150-oo38 EXPtRES: 6-30 99 (o ee)
Estimated burden per response b comply with this mandatory informaban collecbon request 7 rrunutes The veladated registrabon serves as eviderice REGISTRATION CERTIFICATE --In vitro TESTING
",,'"O* "' *",""'fo,u"*7*d'*' n'"t.,"l.%',l "su*,0*' ",0*C WITH BYPRODUCT MATERIAL UNDER lC'.'",," 'a,"*""I v"vC"' E"EsisIE "a'd ""*%
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GENE
.L LICENSE Paperwork Reduchon Protect (315o.0o38), omco of Management and Budget, Washengton, DC 2o5o3. NRC may not conduct et spoemor, and,a person as not requved b respond b, e collachon of informahon unions it emplays a cunendy valed oMB control number.
S:cten 31,11 of 10 CFR 31 establishes a general license authorizing physicians, clinical laboratories, hospitals, and veterinarians in the practice of veterinary medicine to possess certain small quantities of byproduct material for in Wtro clinical or laboratory tests not invoMng the inte/nal or extemal administration of the byproduct material or the radiation therefrom to human beings or animals. Possession of Nproduct material under 10 C'FR 31.11 is not su'hnrtzed until the physcian, clinical laboratory, hospital, or veterierten in the practice of veterinary medicine, o es filed NRC Form 483 and received from the Cornmission a validated copy of NRC Form 483 with a registration number.
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- 1. NAME AND ADDRESS OF APPUCANT (See InstrucDon 3.B. below) 2.. APPLICATION (Check one box onty)! r Quest Diagnostics Clinical I heNby apply for a registration number pursuant to 10 CFR 31, Section Laboratories, Inc.
31.11. for use of byproduct materials for-t *
'400 Egypt Road A. Myself, a duly licensed physician authorized to disperse drugs in Norristown, PA 19403 the practce of medicine.
X B. The above-named clinicallaboratory.
fREPHoNE NUMBER pnetude hoe Cade)
C. The above named hospital.
D Veterinarian in the practice of vetennary medeine.
3.
INSTRUCTIONS:
- 4. REGISTRATION A.
Submst this form in duplicate to REGISTRATION NUMBER:
e Medcal. Academic and Commercial Use 2219 Safety Branch (T-8 FS) e 880uq a
Division of industrial and Medcal Nuclear Safety
- p MR THE r!.S. NTTCMAR DNiLATOW Offce of Nuclear Material Safety and Safeguards
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ggyc;cgng o
U.S. Nuclear Regulatory Commission 5
y
'i Washington, DC 20555 0001 e
4 4'
(At NRC, a registration number will be assigned and a validated copy
% N***#
. un of NRC Form 483 will be retumed.)
Code), and telephone number of the (egistrant physician, clinical Of this an afregistra g, h ve&.,
Nab (i/ ~ E /nts B. In the box above, print or type the name, address (including ZIP Tra i 1(Ira viis s numbdrto be laboratory, hospital, or veterinanan in the practice of veterinary assigned by NRC. If this is a change ofinfonnadon from a previously medicine for whom or for which this registration form is filed.
registered generalIcense, include your registrabon number.)
- 5. If place of use is different from address listed above, give complete address:
Same as above
- 8. CERTIFICATION 1 hereby certify tnat:
A.
All information in this registration certifcate is true and complete.
B.
The registrant has appropriate radiation measuring instruments to carry out the tests for which byproduct material will be Osed undet the general license of 10 CFR 31.11. The tests will be performed only by personnel competent in the use of the instruments and in the handling of the byproduct materials.
C.
I understand that Commission regulations require that any change in the information.fumished by a registrant on this registration certifcate be reported to the Director of Nuclear Material Safety and Safeguards within 30 days from the effective date of such change.
D i have read and understand the provisions of Section 31.11 of NRC regulations 10 CFR 31 (reprinted or' the reverse side tuYf'orm)', and I understand that the registrant is required to comply with those provisions as to all byproduct material which he receives, acq possesses,uses, or transfers under the general license for which this Registsaton Certificate is filed with the U.S. Nuclear Regulatory Comp on.
PRINTED OR TYPED NAME AND TITLE OF APPUCANT SI URE OF APPUCANT DATE be 3.3dem (3o c
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sw/n.
WARNING:
FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL 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 AS TO ANY MATTER WITHIN ITS JURISDICTION, eceoRM ass ( + 3 o
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