ML20202J033
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| ML20202J033 | |
| Person / Time | |
|---|---|
| Site: | 03034474 |
| Issue date: | 01/29/1998 |
| From: | Jonathan Montgomery NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION IV) |
| To: | |
| References | |
| 50-29111-01, 50-29111-1, 572597, NUDOCS 9802230067 | |
| Download: ML20202J033 (11) | |
See also: IR 05000291/2011001
Text
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NRC FORM 374 *
ll g U.S. NUCLEAR REGULATORY COMMISSloN uffETfdmET)fNo Q2
MATERIALS LICENSE
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l i Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93 438), and Title lo, Code of j
l Federal Regulations, Chapter I, Parts 30,31,32,33,34,35,36,39,40, and 70, and in reliance on statements and representations heretofore maue
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l by the licensee, a license is hereby hsued authorizing the licensee to receive, acquire, possess, and transfer byproduct, source, and special nuclear g
j material designated below; to use such material for the purpose (s) and at the place (s) designated below; to deliser or transfer such material to
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l persons authorized to receive it in accordance with the regulations of the applicable Part(s). This license . hall be deemed to contain the conditions 3lj
specified in Section 183 of the Atomic Encrgy Act of 1954, as amended, and is subject to al' applicable rules. regulations, and orders of the
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Nuclear Regulatuy Commission now or hereafter in effect and to any conditions specified below,
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Licensee In accordance with letter dated E
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Alaska Cardiovascular Consultants 50-29111-01 is amended in !
its entirety to read as follows: j
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3260 Providence Drive, #537 .
4, Expiration Dat
Anchorage, Alaska 99508 June 30, 2002 3
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6. liyproduct, Source, and/or
Reference No. 030-34474 j
B 7. Chemical and/or Physical 8. Maximum Amount that Ucensee (
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A. Any byproduct material A. Any A. As needed E
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identified in 10 CFR 35.200 radiopharmaceutical (
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I A. Mark A. Se11and, M.D. for material identified in 10 CFR 35.200 restricted to g
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MATERIALS LICENSE
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g In addition to the possession limits in Item 8, the licenseo shall further restrict g
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gl in 10 CFR 30.35(d) for establishing decommissioning financial assurance. g
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y 14. The licensee shall maintain records of information related to decommissioning at E
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4 3260 Providence Drive, #537, Anchorage, Alaska per the provision of 10 CFR 30.35(g) g
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15. Except as specifically provided otherwise in this licenso, the licensee shall
5 conduct its prograrn in accordance with the statements, representations, and l
N procedures contained in the documents, including any enclosures, listed below, E
5 except for minor changes in the medical use radiation safety procedures es provided E
5 in 10 CFR 35.31. The U.S. Nuclear Regulatory Commission's regulations shall govern E
unless the statements, representations, and procedures in the licensee's application E
l and correspondence are more restrictive than the regulations.
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3 A. t,pplication dated May 20, 1997 E
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B. Facsimile dated June 23, 1997 E
5 C. Ietter dated December 2, 1997 R
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g' #RC FORM 577 , U.S. NUCLEAR RE!ULATORY COMMISSION
UCENSE FEE AND DEBT COLLECTION BRANCH
DfVISION OF ACCOUNTWO AND FINANCE
LICENSE FEE REQUIREMENTS O*FICE OF THE CONTROLLER
t,r.5. NUCLEAR REGULATORY COMMISSION
WASHINGTON. DC 20566 4 001
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TYPE OF ACTION
NEW UCENSE
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RENEWAL OF LICENSE
ALASKA CARDIOVASCULAR CONSULTANTS
ATTN: JOSEPH C. BARTZ, R.T. @ AMENDMENT TO LICENSE
NUCLE sR TECHNOLOGIST REQUESTED DATE
3260 PROVIDEt6 2 DRIVE #537 12297
ANCHORAGE, AK 99508 UCENSE NUMBER
50-29111-01
CONTROL NUMBER
572597 ATTN: RITA MESSIER, LFARB, T9E10
8. APPLICATION FEE DUE IL FEE NOT REQUIRED
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Your request for a hcensing action is subject to the fee (s) in the category (ies)
noted below in accordance with Section 170.31 of the enclosed Federal ] Enclosed is Check No. which accompanied your
T,eg! ster notice. Payment of the fee is required nrior to the issuance of the request. The fee is not required because.
keense, renewal, or amendment.
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APPLICATION
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RENEWAL
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AMENDMENT
460.00
g We received your Check No.
the fee.
in payment of
S S S
s s s The Licensing staff has informed us that your request is to be
g g g considered as a continuation of your request dated
S 5 $ , Control No.
S $ $
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Your request was combined, prior to review, with your
g g g request, Control No.
$ f 5
llL CHECK RETURNED
FEE (s) DUE s 460.00
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PAYMENT RECEIVED
s 460.00
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AMOUNT DUE
INSUFFICIENT FUNDS
] Your request was received without the prescribed application
fee.
[ ACCOUNT CLOSED
] We received your Check No.
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In the amount of
Payment of the additional fee noted
above is required.
MAIL THE REPLACEMENT CHECK TO THE ADDRESS LISTED AT THE
] Your request willincrease the scope of your license program.
Therefore, your request is subject to the application fee (s) nuted above.
TOP OF THIS FORM AND REFERENCE THE ABOVE CONTROL
NUMBER.
Refer to Section 170.31 and Footnote 1(d)(2).
N. LICENSE ISSUED WITHOUT THE REQU'iED FEE
Your heense expired prior to the receipt of your application for renewal.
Therefore, your request i. subject to the application fee (s) noted above. C License No. , Amendment No. , issued on
Refer to Secton 170.31 and Footnote 1(a). was issued without the required fee being
collected. The 'ee required is noted in Section I of this form.
MAKE PAYMENT CF THE FEE (S)TO THE U.S. NUCLEAR
REGULATORY COMMISSION AND Mall THE PAYMENT TO THE ] The .; cope of your licensed program was increased. Therefore, your
request is subject to the application fee (s) noted in Section 1 of this form.
ADDRESS LISTED AT THE TOP OF THIS FORM. IF WE DO NOT Refer to Sc: tion 170.31 and Footnote 1(d)(2).
RELDVE A REDLY FROM YOU WITHIN 30 CALENDAR DAYS FROM
THE DATE LISTED BELOW, WE SHALL ASSUME THAT YOU DO NOT
WISH TO PURSUE YOUR APPLICATIOf+' AND WILL VOID THIS
ACTION.
] Bec
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suse ofofthe
theprescribed
urgencyfee of noted
your inrequest,
Section 1the license
of this form. was issued without
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SIGNATURE - UCENSE FEE ANALY;T **
LFDCB J / FDCB/ Dis h OC/DAF RP
REMessier W Pending Fee Fue OC/bAF/S If-3.2.7)
RITA MESSIER 12/15/97 4l Region if 12-15-97
LFARB RS F)
PeRC FORM 577 (1.e5) This form was e6ecennicas. produced tly Ehes Federal Forms. Inc i
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,* UNITED STATES
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[[*%' .j t NUCLEAR REGULATORY COMMISSION
REGION IV
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4 Walnut Creek Reid Office
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, 1450 Maria Lane, Suite 3oo
Walnut Creek, California 94596-5368
WAN 2 91998
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Alaska Cardiovascular Consultants
ATTN: Joseph C. Bartz
!_ 3260 Providence Drive, #537
Anchorage, Alaska 99508
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SUBJECT: LICENSE AMENDMENT
Please find enclosed amendment 2 to License No. 50-29111 ';1. You should review this *
1
license carefully and be sure that you understand all conditions. Please note that your old
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and new treadmill rooms are now considered authorized licensed materiallocations. Once
you have comrsleted your decommissioning surveys and submitted the results to this
pffigp, we willinen process an amendment to remove the old treadmill room (#1) as an
authorized use location. Until you receive this authorization, the old treadmill room (#1)
cannot be released for unrestricted use. The information we will r'eed from you cc. :erning
the decommissioning of the old room is contained in the enclosed document. If you have
,
any questions, please contact me at 510-975-0249.
r NRC expects licensees to conduct their programs with meticulous attention to detail and a
high standard of compliance. Because of the serious consequences to employees and the
public which can result from failure to comply with NRC requirerrents, you must conduct
your program involving radioactive materials in accordance with the conditions of your NRC
license, representations made in your license application, ar.d NRC regulations. In
particular, note that you must:
1. Operate in accordance with NRC regulations 10 CFR Part 19, " Notices, instructions
and Reports to Workers: Inspection and Investigations," 10 CFR Part 20,
" Standards for Prctection Aqainst Radiation," and other applicable regulations.
2. Possess radioactive material only in the quantity and form indicated in yeer license.
;
3. Use radioactive material only for the purpose (s) inoicated in your license.
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4. Notify NRC in writing of any change in mailing address (no fee required if the
location of radioactive material remains the same).
5. Request and obtain written NRC consent before transferring your license or any
right thereunder, either voluntarily or involuntarily, directly or indirectly, through
transfer of control of your license to any person or entity. A transfer of control of
your license includes not only a total change of ownership, but also a change in the
controlling interest in your company whether it is a corpcration, partnership, or
other entity, in addition, appropriate license amendments must be requested and
obtained for any other planned changes in your facility or program that are contrary
to your license or contrary to representations made in your license application, as
_ . . , - _ _ _ . . . .
_ _ __ _ _ _
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Aiatka Cardiovarcular Consultants -2-
wc!! es supplemental correspondence thereto, which are incorporated into your
license. A license fee may be charged for the amendments if you are not in a fee-
exempt category.
6. Maintain in a single document decommissioning records that have been certified for
completeness and accuracy listing all the following items applicable to the license:
*- Onsite areas designated or form.srly designated as restricted areas as defined
in 10 CFR 20.3(a)(14) or 20.1003.
,
* Onsite areas, other than restricted areas, where radioactive materials in
quantities greater than amounts listed in Appendix C to 10 CFR
20.1001-20.2401 have been used, possessed, or stored.
* Onsite areas, other than restricted areas, where spills or other unusual
occurrences involving the spread of contamination in and around the facility,
equipment, or site have occurred that required reporting pursuant to 10 CFR
30.50(b)(1) or (b)(4), including areas where subsequent cleanup procedures
have removed the contamination.
* Specific locations and radionuclide contents of previous ar'd current burial
areas within the site, excluding radioactive material with half lives of 10 days
or less, depleted uranium used only for shielding or at < enetrators in unused
munitions, or sealed sources authorized for use at ' ary job sites.
* Location and description of all contaminated equipment involved in licensed
operations that is to remain onsite after license termination.
.
7. Submit a complete renewal application with proper fee, or termination request at
lecat 30 days before the expiration date on your license. You will receive a
reminder notice approximately 90 days before the exp; ration date. Possession of
radioactive material after your license expires is a violation of NRC regulations.
8. Request termination of your license if you plan to permanently discontinue activities
'nvolving radioactive material.
You will be periodically inspected by NRC. Failure to conduct your program in accordance
with NRC regulations, licenso conditions, and representations mads in your license
application and supplemental correrpondence with NRC will result in enforcement action
- against you. This could include issuance of a notice of violation; imposition of a civil
.
4
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Alaska Cardiovascular Consultants 3-
penalty; or an order suspending, modifying, or revoking your license as specified in the
" General Statement of Policy and Procedure for NRC Enforcement Actions" (Enforcement
Policy), 60 FR 34381, June 30,1995.
Thank you for your cooperation. o
,
Sincerely,
.
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l James L. Montgomery H
Senior Health Physicist
Materials Branch
Docket: 030-34474
f.icense: 50 29111-01 ~
Control: 572597
Enclosures: As stated
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Alaska Cardiovascular Consultants -4-
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Docket Fiis
WCFO Insper. tion File
LFARB, T 9 E10
State of Alaska (License Only)
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DOCUMENT NAME: G:\572597.JM
To iteelve copy of documen:, Indicate in box: "C" = Copy without epciosures "E" = Copy wit.: enclosures "N" = No copy
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'Alacka Cardiovascular Concultanto
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3260 Providence Dr. #537
1200 Airport Heights #330 q
Anchorage, AK 99508
(907) 562 7575 * Fax (907) 563 9386
Practice Limited to Cardiovascular Diseases
Rkhstd A. Anschuet2. M D., FA C.C.
John C. Finlef, M D., FA.C C.
Thomas K. Kramer, M D., FA C.C.
- Wuham P. Meyer, M D.. FA.C4C.
Pcui A. Peterson. M D,
Robert L Puntam, til. M [L FA C C.
Mark A. Senand, M D.
DevtlW Sonnebom, M D., FA C.C.
Jim Montgomery
Nuclear Regulatory C omm.ssion
Nuclear Materials Lierwng Region IV
Walnut Creek Field Office
1450 Maria Lane
Walnut Creek, California 94596
Date December 2,1997
Ref License number 50 29111-01 Docket number 030-34474
-
Dear Jim:
,
We would lil:e to amend our NRC license referenced above to include a room that is
used for injections of radioisotopes. Please see the enc'osed drawings off the treadmill room we
are currently using for injections and the new room we will be using beginning Dec 15th,1997,
We will be decommissioning the room marked treadmill # 1 as of Dec 12th,1997 and we will
begin using the new room marked room # 6 on the enclosed drawings. The old treadmill room
number # 1 will be closely surveyed afler decommissioning and complete documentation will be
kept of the decommissioning and surveys in the decommissioning file as directed by the
regulations and as per the instruction ofyour inspector Mr. Emilio M. Garcia during his visit with
us.
We would also like to add a new physician to our Nuclear License as an authorized user,
he is, Robeit Lee Pulliam M.D. He will bejoining the practice and begin work on Dec.15th,
1997. Enclosed please find a copy of his State of Washington Radioactive Materials License
N.imber WN-M0209-1, I have been instructed by you that this can be done as an official notice
under CFR 35.14. It was also stated that if an amendment was to be added that he could be
included in that amendr ent. Please add Dr. Pulliam in the most appropriate manner. Thank you.
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522597
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I am not sure of the cost of this amendment, please let me know as soon as is convenient
and we will send a check immediately, if there is any other information you will need for this
amendment please call me at 907 562-7575. Thank you for your assistance in this matter.
Sincerely:
hf<
ih C. Bdrtz R.T.
Nuclear Technologist, Alaska Cardiovascular Consultants "
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BTATE OF WA8EING143N
RADIOhCTIVE MATERIAL 8 LICENSE
PAGE 1 OF 1
License Number: WM-40209-1
Amendmen* No.1
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LOWER COLUMBIA PATHOLOGISTS, P.S.
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Suite 100 .
1606 Rast Kessler Boulevard
Longview, Washington 98632
Attention: Herbert G. Alexander, M.D.
Radiation Safety officer
In accordance with letter and attachments dated 30 october 1997, Radioactive
Materials License Number WN-M0209-1 is amended as follows:
License Conditions 13.D and 27.C are addeds
.
13.D. Robert Lee Pulliam, M.D.; subitems A & B of Items 6, 7, and 8
nuclear cardiology studies only.
.
27.C. Letter & attachmente dated 30 October 1997. RE: Addition of new AUR.
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FOR THE STATE OF wasHDdGTON DEPAfmBENT OF RTH
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Radioactive Materiale; Licensing
DOM 322413a (MEV 1044)
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