ML20199C688
| ML20199C688 | |
| Person / Time | |
|---|---|
| Site: | 07000315 |
| Issue date: | 07/10/1985 |
| From: | Ely M NAVY, DEPT. OF |
| To: | |
| Shared Package | |
| ML20197E888 | List: |
| References | |
| NUDOCS 8606180226 | |
| Download: ML20199C688 (2) | |
Text
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' NRC FORM 313 UA NUCLE A A LElULATORY COMMIS$10N APPROVE MY OMS 11448 10 CFil 30,
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31641120 u sad ao,32,33,34 APPLICATION FOR MATERIAL LICENSE esp os:E 3m INSTRUCTIONS: SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION. SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE MRC OFFICE SPECIFIED BELOW, FEDERAL AGENCIES FILE APPLICAflONS WITH:
IF YOU ARE LOCATED IN:
U.S. NUCLE AR REGULATORY COMulS$10N IL U NOls,1NDI ANA, 00W A, MICHIGA N, MINN ESOT A, MISSOURI, OMIO, OR (IVISION OF FUEL CYCLE AND MATERIAL SAFETY,NMSS W'SCONSIN, SEND APPLICATIONS TO:
r,iASHINGTON,0C 20555 U S. NUCLE AR REGULATORY COMMIS$lON, REGION ill ALL CTHER PERSONS FILE APPLICATIONS AS FOLLOWS,lF YOU ARE MATERIALS UCENSING SECTION LOCATEDIN:
799 ROOSEVELT ROAD GLEN ELLYN,lL 60137 CONNECTICUT, DE L AWARE, DISTRICT OF COLUMSI A, MAINE, MARYLAND, M ASSACHUSETTS. NE W JE RSE Y, N EW YOR K, PENNSYLVANI A, RHODE ISLAND, A R K ANSAS, COLOR A DO, lDAHO. K ANSAS, LOUTSI ANA. MONTA NA, N E S R ASK A, OR VERMONT, SEND APPLICATIONS TO:
NEW MEXICO, NORTH DAKOTA, OKLAHOMA, SOUTH DAKOTA TEXAS, UTAH, OR WYOMING, SEND APPLICATIONS TO:
U S. NUCLE AR REGULATORY COMMISSION, REGION I NUCLE AR MATERIAL 8ECTION S U.S. NUCLE AR REGULATORY COMMISSION. REGION IV S31 PARK AVENUE MATERIAL RADI ATION PROTECTION SECTION KING OF PRUS$1A,PA 19400 611 RYAN PL AZA DRIVE, SulTE 1000 ARLINGTON.TM 76011 LLABAMA, FLORIDA, GEDRGIA, KENTUCKY, MIS $i%SIPP1, NORTH CAROUN A, 2
PUE _T $ RICO, SOUTH CAROUNA, TENNESSE E, VIRGINEA, VIRGIN ISLANDS, OR ALASKA, AltlIONA, CALIFORNIA, HAWAlt, N EVADA, OR EGON, WASHINGTON, WEST YlRGINIA, SEND APPLICATIONS TO:
AND U.S. TERRITORIES A ND POSSES $10NS IN THE PACIFIC, SEND APPLICATIONS TO:
U S. NUCLE AM REGULATORY CouplSSION, REGION 18 MATERI AL RADIATION PROTECTION SECTION U.S. NUCLEAM REGULATORY COMMIS$lON, REGtON V 10f MARIETTA STREET, SUITE 2900 MATERIAL FIADIATION PROTECTION SECTION ATLANTA,GA 30323 1450 MARIA LANE, SUITE 210 WALNUT CREEK,CA 94596 PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.E NUCLEAR REGULATORY COMMIS$10N ONLY BF THEY WISH TO POSSESS AND USE LICENSED MATERIAL IN STATES $UBJECT TO U.S. NUCLEAR REGULATORY COMMtS$10N JURISDICTION.
- 1. THIS 18 AN APPUCATION FOR (Check appropr.es nomJ
- 2. NAME AND MAluNG ADDRESS OF APPLICANT (ineAseleEse Codel DEPARTMENT OF THE PAVY A. NEW uCENSE
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NAVAL UNDERSEA MEDlCAL INSTITUTE
- e. AuENDutNT To uCENSE muMeER SNM-310 NAVAL SUBMARINE BASE NEW LONDON E
C. RENEWAL OF uCENSE NuusER GROTON, CONNECTICUT 06340
DEPARTMENT OF THE NAVY NAVAL UNDERSEA MEDICAL INSTITUTE NAVAL SUBMARINE BASE NEW LONDON GROTON, CONNECTICUT 06340 4 NAME OF PERSON TO GE CONTACTED ABOUT THl3 APPUCATION TELEPHONS NUMBER LCDR MELVIN J. ELY, MSC, USN 203-449-2875 SUOMIT ITEMS S THROUGH 11 ON 84 a ll* PAPER. THE TYPF AND SCOPE OF INFORMATION TO BE PROvlDED 15 DESCRIBED tN THE UCENSE APPUCATION GUIDE, S. CADIOACTIVE MATERIAL a E.ement and mese number, IL chemecal end/or physical fom., ' 11 c. men mum emount
- 6. PURPOSEIS) FOR WHICH UCENSED MATERI AL WILL BE L,$ED.
which win be possessed at any one alme.
L {DIVIDUAL $
- 8. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS.
EP $ BL FOR RADIATION SAFETY PROGRAM AND THEIR 8606180226 86052Y
- 9. PLCIUTIES AND EC
'""^"'"8^"""'"^"-
MGS LIC70 SNMOO310 PDR
- 12. UCENSEE FEES #see r0 CFR 770eadsertson F10.37J AMOUNT
- 11. CASTE MANAGEMENT, lENCLOSED $
FEE CATEGORY
- 13. CE..TIFICATION. (Mustbe camp'etedbP apotaceart THE APPLICANT UNDERSTANDS THAT ALL ST ATEMENTS AND REPRESENTATIONS MADE IN THIS APPLICATION ARE BINDING UPON THE APPLICANT.
THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON 8EM ALF OF THE APPUCANT, NAMED IN ITEM 2. CERTIFY THAT THIS APPLICATION IE PREPARED IN CONFORMITY WITH TITLE 10, CODE OF FEDER AL REGULAflONS, PARTS 30,32,33,34,35, AND 40 AND THAT ALL INFORMATION CONTAINED HEr'flN.
13 TRUE ANO CORRECT TO THE BEST OF THElR KNOWLEDGE AND SEUEF.
FARNING.18 U S C. SECTION 1001 ACT OF JUNE 25,1948.82 STAT. 749 MAKES IT A CRIMIN AL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPREFENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISOtCTION.
SIGNATUR ERTIFYING OFF ER I TYPED / PRINTED NAME I TITLE IDATE I
I LCDR, MSC, USN l
/
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MELVIN J. ELY RADIATION HEALTH OFFICER 10 JULY 85 i
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te votuNTa av i CONowCDATA a ANNu aa NTs a/
- o. NUM8ER OF EMPLOV E Es iTotsi Por a WOULD YOU BE WILL'NG TO FUS*NsSM COST INFORMATION (Jotterand/orsaff Aourst
< S250K 81M4 SM
'"'***"'**d''***""*a**'-*'*'***'v-'a****a*'"a'd
c NOM 86R OF BEDS
$500K-750K
$7M-10M 8750K-t u
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(** P.&SPN f Q TYPE OF FEE FEELOG F EE CATEGORY COMMENTS "m
m.as L.4 e I 6 4 k
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AMOUNT RECEIVED CHECK NUMBER DATE PRlYACY ACT STATEMENT ON THE REVERSE
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PRIVACY ACT STATEMENT Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by section 3 of the Privacy Act of 1974 (Public Law 93-579), the follow-Ing statement is furnished to individuals who supply information to the Nuclear Regulatory Commission on NRC Form 313. This information is maintained in a system of records designated as NRC-3 and described at 40 Federal Register 45334 (October 1,1975).
- 1. AUTHORITY: Sections 81 and 161(b) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2111 and 2201(b)).
- 2. PRINCIPAL PURPOSE (S): The information is evaluated by the NRC staff pursuant to the criteria set forth in 10 CFR Parts 30,32,33,34,35 and 40 to determine whether the application meets the requirements of the Atomic Energy Act of 1954, as amended, and the Commission's regulations, for the issuance of a radioactive material license or amendment thereof.
- 3. ROUTINE USES: The information may be (a) provided to State health departments for their information and use; and (b) provided to Federal, State, and local health officials and other persons in the event of incident or exposure, for their information, investigation, and protection of the public health and safety. The information may also be dis-closed to appropriate Federal, State, and local agencies in the event that the information indicates a violation or potential violation of law'and in the course of an administrative or judicial proceeding. In addition, this information may be trans-
- ferred to an appropriate Federal, State, or local agency to the extent relevant and necessary for an NRC decision or to an appropriate Federal agency to the extent relevant and necessary for that agency's decision about you.
- 4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVID-ING INFORMATION: Disclosure of the requested information is voluntary. If the requested information is not furn-ished, however, the application for radioactive material license, or amendment thereof, will not be processed. A request that information be held from public inspection must be in accordance with the provisions of 10 CFR 2.790. Withhold-Ing from public inspection shall not affect the right,if any, of persons properly and directly concerned need to inspect the document.
- 5. SYSTEM MANAGER (S) AND ADDRESS: U.S. Nuclear Regulatory Commission l
Director, Division of Fuel Cycle and Material Safety
(
Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555 i
1 9
NR3 @ 019
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