ML20196H593

Ack Receipt of Completed Form 483 Dtd 990629.Form Has Been Assigned Registration Number 9168

ML20196H593
Person / Time
Issue date:	06/29/1999
From:	Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS)
To:	Bhagat R AFFILIATION NOT ASSIGNED
References
SSD, NUDOCS 9907060393
Download: ML20196H593 (2)

Text

Juno 29,1999 e

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M.D. Labs, Inc.

ATTN: Rajesh J. Bhagat Supervisor 2816 Route 73 North Maple Shade, NJ 08052

Dear Mr. Bhagat:

This letter verifies the receipt of the completed NRC Form 483 dated June 29,1999. This form is'a condition of the general license under 10 CFR 31.11 authorizing in-vitro testing with byproduct material under general license.

The form has been assigned registration number 9168. 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) 415-8140.

Sincerely, N

Traci Kime, Registration Specialist Materials Safety and Inspection Branch Division of industrial and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards grpjjg DISTRIBUTION:

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t NRC FORM 463 U. S. NUCLEAR REGUL.ATORY COMMISSION APPROVED BY OMB: NO. 3150 0038 EXPlRES: 6-30-99 d

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collecten request 7 mmutes. The vahdoted rogstraton serves as owdence JtEGISTRATION CERT!FICATE - In vitro TESTING

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Peporwork Reducten Protect (3150.0038), omco of Managernent end b h5 Budest, Washington, De 20603 NRC fney not conduct or sponsor. end e

:.m' porton a not required b respond W. e collecbon or mfurmetmn unless it 4

deploys a cuneney vehd OMB control number Section 31.11 of 10 CFR 31 establishes a general license authorizing physicians, clinical laboratories, hospitals, and veterinarians in the practice of veterinary medicine to poseees certain small quantities of byproduct material for in vifro clinical or laboratory tests not invoMng the intemal or extemal administratiotrof the byproduct material or the radiation therefrom to human beings or animals. Possession of byproduct rmdertal under 10 CFR 31.11 is not authorized until the physician, clinical laboratory, hospital, or veenarian in the practice of veterinary medicine, has filed NRC Form 483 and received from the Commession a vari,w rf copy of NRC Form 483 with a registration number.

1. NAME AND ADDRESS OF APPLICANT (See instruccon 3.8. bebw)

E. APPLICATION (Check one box only)

M. p. L. A (3 5',' I N c I hereby apply for a registraten number pursuant to 10 CFR 31, Section 31.11, for use of byproduct materials for.

cOS I 6 ROOTE 73 NO ATH A. Myself, a duty Icensed physician authorized to Mtsperse drugs in the pmchce f rnedcine.

MAPLE SHADE.NJ oeoM s/ B. The above-narned chncallaboratory.

TELEPHONE NUMBER (McAsde has Code)

C. The above named hospital.

l CS563 7c2 7 1400 0 veterinanan in the pr.ctice of veterinary medicine 3.

INSTRUCTIONS:

4. REGISTRATION A.

Submit this for'n in duplicate to:

REGISTRATION NUMBER:

Medcal, Academc and Commercsal Use 9M

/g8 "f%q'o,7.,ry;p Safety Branch (T-8 F5)

Division of Industrial and Medcal Nuclear Safety y"

Offee of Nuclear Material Safety and Safeguards n, q ', vt rj,p og^y,w pq I

U.S. Nuclear Regulatory Commisse g

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Washington, DC 205554001 e

C (At NRC, a registrabon riumber will be assigned and a validated copy e

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• of NRC Form 483 will be retumed )

wmL li/[ /0)q B.

In the box above, print or type the name, address (including ZIP 1raCl 8.Ine Code), and telephone number of the registrant physician, clinical (if this an iniDalrepstradon, lesve #ws space blank - number to be taboratory, hospital, or vetennarian in the practce of vetennary assigned by NRC. If fhis is a change ofinformacon from a previously j

medicine for whom or for which thes registrabon form is filed.

repsfered generalicense, include your regrsfraDon number.)

5. If place of use is different from address listed above, grve complete address:

8. CERTIFICATION I hereby certify that:

A.

AH information in this regentrabon certifcate is true and complete.

l B.

The registrant has appropeiste radiation rneesunng instrurnents to carry out the tests for which byproduct material will be used under the general l

license of 10 CFR 31.11. The tests wul be performed only by personnel competent in the use of the instruments and in the handling of the l

byproduct materials.

C.

I understand that Cornr'isesion regulebons require that any change in the information fumished by a registrant on this registrabon certificate 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 provisione of Section 31.11 of NRC regulabons 10 CFR 31 (repnnted on the reverse side of this form), and I understand that the regsstrant is required to comply with those provisions as to aH byproduct material which he recerves, acquires, possesses, uses, or transfers under the general license for which this Registration Certifcate is flied wtth the U.S. Nuclear Regulatory Commission.

PRINTED OR TYPED NAME AND TITLE OF APPLICANT SIGNATU E OF P(I ANT DATE PAJEcH J. 13 H A & AT S V PE R v'50R 06 is,l m WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJh!GT)TO CML AND/OR CRIMINAL 1

PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS.18 U.S.C. SECT lON 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.

NRC FORM es3 (s Se)