ML20203N785
| ML20203N785 | |
| Person / Time | |
|---|---|
| Site: | 07000296 |
| Issue date: | 08/07/1986 |
| From: | Touma R FAIRLEIGH DICKINSON UNIV., TEANECK, NJ |
| To: | |
| Shared Package | |
| ML20203N778 | List: |
| References | |
| NUDOCS 8610200026 | |
| Download: ML20203N785 (5) | |
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NRC FO'AM 313 U.S. NUCLE AR KEGUL ATORY COMMISSION APPROVED BY OM8 gas 3154 0120 13 CFR 30,32. 33,34 3s end 40, APPLICATION FOR MATERIAL LICENSE E
S.3i-87 INSTRUCTIONS: SEE THE APPPOPRIATE LICENSE APPLICATION GUIDE FOR DETABLED INSTRUCTIONS FOR COMPLETING APPLICATION. SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW.
FEDERAL AGENCIES FILE APPLICATIONS WITH:
IF YOU ARE LOCATEDIN-U S. NUCLEAR REGULATORY COVMISSION ILLINOIS, INDI AN A, IOW A, MICHIG AN, MINN ESOTA, MISSOURI, OHIO, OR DIVISION O' ' EL CYCLE AND MATERI AL SAF ETY, NMSS WISCONSIN, SEND APPLICATIONS TO:
WASHINGTK OC 20555 U S NUCLE AR REGULATORY COMMISSION, REGION 111 t.LL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS. lF YOU ARE MATE RI ALS UCENSING SECTION LOCATEDIN:
799 ROOSEVELT ROAD GLEN ELLYN tL 6013T CONNECTICUT DELAWARE, DISTRICT OF COLUMBIA. MAINE. MARYLAND.
MA4SACHUSETTS. NEW HAMPSHIRE, NEW JERSEY. NEW YORK, PENNEYLVANIA.
AR K ANSAS, COLOR ADO, IDAHO, K ANSAS LOUISI ANA. MONTANA, NEBRASK A, f.HODE ISLAND, OR VERMONT. SEND APPLICAflONS 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 MATERI AL SECTION 8 U S NUCLEAR REGULATORY COMMIS$lON, REGION IV 631 PARK AVENUE MATERIAL RADIATION PROTECTION SECTION KING OF PRUSSI A, PA 19406 611 RY AN PLAZA DRIVE, SUITE 1000 ARLINGTON, TX 76011 ALABAMA. FLORIDA, GEORGIA, K ENTUCKY, MISS11SIPPl. NORTH CAROLINA.
PUERTO RICO, SOUTH CAROLINA TENNESSEE, VIRGINIA, VIRGIN ISLANDS, OR ALASK A, ARI2ONA, CALIFORNI A. HAWAll, N EVADA, OR EGON, WASHINGTON, WEST VIRGINIA, SEND APPLICATIONS TO:
AND U.S. TE RRITORIES AND POSSESSICNS IN THE PACIFIC, SEND APPLICATIONS TO:
U S. NUCLE AR REGULATORY COMMISSION, REGION 11 MATERI AL R ADI ATION PROTECTION SECTION U S NUCLE AR REGULATORY COVMISSION, REGION V 101 MARIETTA STREET,SutTE 2900 MATERIAL R ADIATION PROTECTION SECTION 1450 MARI A LANE, SUITE 210 ATLANTA GA 30323 WALNUT CREEK,CA 94596 F ELSONS LOCATED IN AGREEMENT STATES SEND APPUCATIONS TO THE U S. NUCLEAR REGULATORY COMMIS$10N ONLY IF THEY WlSH TO POSSESS AND USE LICENSED MATERIAL IN ST ATES SUBJECT TO U S. NUCLE AR REGULATORY COMMISSION JURISDICTION.
- 1. THis 15 AN APPUCATION FOR (Check appicpreemt efemt 2 NAME AND MAIUNG ADDRESS OF APPUCANT(Incfodela Codel Fairleigh Dickinson University A. NEW uCENSE Teaneck-Hackensack Campus 8 AMENoMtNT TO UCENSE NuM8ER T
SNM-275 140 University Plaza Drive C. RENEWAt OF UCENSE NUMBER _
Hackensack NJ 07601
- 3. AOORESSIES1 WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED.
140 University Plaza Dr.
Hackensack, NJ 07601
- 4. NAME OF PERSON TO OE CONT ACTED A80uf THIS APPLICATION TELEPHONE NUM8ER
.Dr. Thomas S. Freund (Biohazard Safety Officer) 201-692-2628 SUSMIT ITEMS S THROUGH 11 ON 81 a 11 ~ P APER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED 15 DESCRIBED IN THE UCENSE APPUCATION GUIDE.
6 R ADIOACTIV E. MAT E RI AL e Eiement end maSe numhet, it chemical and/or phys <a* larm, and c ensurmum amount
- 6. PURPOSEISI FOR WHICH UCENSED MATERIAL WILL BE USED.
which will be ponessed at saw one time
'Na',v',0,u,A,L;Sg REgg,S;8tE FOR R ADIATiON SAFE TY PROGRAM AND THEiR
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- 9. F ACILITIES AND EQUIPMENT.
10 RADIATION SAFETY PROGRAM 12 UCENSEE F E ES (See IO CFR I?Q and 5ectron 170.11)
AMOUNT t t. WASTE MAN AGEMENT.
FEE CATEGORY ENCLOSED $
13 CE RTIFICATION iMust De comp'efed by sopheenr1 THE APPLICANT UNDEPST ANDS THAT ALL STATEMENTS AND REPRESENT ATIONS MADE IN THl3 APPLICATION ARE SINDING UPON THE APPLICANT THE APPUCANT AND ANY OF FICI AL E xFCUTING THIS CERTIFICATION ON SEM ALF OF THE APPUCANT NAMED IN ITEM 2. CERTIFY TH AT THIS APPUCATION l$
PREPARED IN CONFORMITY WITH TITLE 10. CODE OF FEDER AL REGULATlONS PARTS 30,32. 33,34. 35 AND 40 AND TH AT ALL INFORMATION CONTAINED HEREIN, IS TRUE AND CORRECT TO THE OEST OF THEIR KNOWLEDGE AND SEUEF W ARNING 18 U S C. SECTION 1001 ACT OF JUNE 751948. 62 STAT 749 M AK ES IT A 091 VIN AL OFFENSE TO MAKE A WILLFULLY F ALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY M ATTER WITetiN ITS JURISDICTION S'
ATURE rERTi ING FICER TYPED PRINTED NAME TITLE DATE As Richard Touma Associate Dean 8-7-86 14 VOLUN r Aa v t CCNNC D A T A a ANNO itP' CE # Y S O N(rM8k H OF g MPLO W k E $ (fofer for d WOULD YOU SE WILLING TO FUNNtSH COST INFOMM ATION (Joner and/or aran *oursi entere fen,ty enc 40,ng co rssde contractors)
ON THE ECONOMIC IMPACT OF CURRENT NRC REGULATION 10R ANY FUTURE
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$1M-3 SM PROPOSED NRC REGULAflONS THAT MAY AFFECT YOUP INRC reguistrons permit SmvuoK Sssu.rM 337 n**r ~ c ~ '.*..~*e,c ~ **r'~ ~ + *ror~r ~ ' ~ c " ~ ~dto me e,,en,.n co.
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$500K - 750K
$7M 40M N/A l "5
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>SioM FOR NRC USE ONLY
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8610200026 860904 REG 1 LIC70 SNM-1970 PDR AMOUNT RECEIVED CHECK NUMBE R DATE AUG 141986 PRiv ACY ACT ST ATEMENT ON THE REVERSE
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O 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 (Oct:ber 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 Director, Division of Fuel Cycle and Material Safety Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555 s
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'1 RENEWAL OF NRC LICENSE SNM - 275 Sa. Byproduct, source, nuclear' material:
A. Plutonium 5b.
Chemical'and/or physical form:
A. Encapsulated as Pu-Be neutron source I
Sc.
Maximum possession limits:
A.
16 grams 6.
To store material until it can be properly dispossed of.
Previously, this material was used in a.Universial Nuclear-Eowitzer for teaching and training of students.
It is proposed, with this license application, to move the Universal Nuclear Howitzer from the Nucleonics Laboratory of the Physics Department to the storage facility (first floor waste storeroom) located in the College of Dental Medicine.
This requires a change of location from 1000 River Rd in Teaneck to 140 University Plaza Dr. in Hackensack,NJ.
7.
Dr. Thomas S. Freund as the Biohazards safety Officer of the University and Radioisotope Safety Officer of the College of Dental Medicine is responsible for license 29-16049-01. He is the only one having access to the storage facility (locked at all times).
His Training and Experience are listed on the attached form.
8.
No one else will have access to the storage facility.
9.
Material is to be stored in first floor storage room in the College of Dental Medicine (140 University Plaza Dr.).
10.
The Universal Nuclear Howitzer is to be leak-tested prior to to its transfer to the storage facility and, since it is not in use, will be leak-tested every six months until it is finally properly dispc,ed of. Leak-test by smear and measurement to 0905juci.
11.
No waste is anticipated since the unit will not be in use.
However, Teledyne Isotopes of Westwood,NJ handles our waste disposal.
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aond NRC313M $UPPLEMENT A U.S. NUCCEAR REGULATORY COMMISSION TRAINING AND EXPERIENCE AUTHORIZED USER Set RADIATION SAFETY OFFICER
- 1. NAME OF AUTHORIZED USER OR RAQlATION SAFETY OFFICER
- 2. STATE OR TERRITORY IN WHICH LICENSED TO Thomas S. Freund, Ph.D.
PRACTICE MEDICINE
- 3. CERTIFICATION SPECIALTY 80ARD CATEGORY MONTH AND YEAR CERTIFIED A
B C
- 4. TRAINING RECEIVED IN BASIC RADIOISOTOPE HANDLING TECHNIQUES TYPE AND LENGTH OF TRAINING LECTURE /
SUPERVISED FIELD OF TRAINING LOCATION AND DATEISI OF TRAINING LABORATORY LABORATORY A
B COURSES EXPERIENCE jHours)
(Hours)
C D
Iehigh University, Pa.,1964-5 18 6
- s. RADIATION PHYSICS ANO Colunbia Univ., N.Y., 1969-70 6
1 year INSTRUMENTATION Univ. of Conn., Ct., 1970-1975 12 5 years Iehigh University, Pa., 1964-5 24 6
- b. RADIATION PROTECTION Colunbia Univ., N.Y., 1969-1970 6
1 year Univ. of Conn.,Ct., 1970-1975 12
-5 years Ishigh University, Pa. 1964-5 12 12
' " 5 N OMEASURE (blunbia Univ., N.Y., 1969-1970 0
1 year HE E
OF RADIOACTIVITY Uhiv. of Conn. Ct., 1970-1975 8
5 years Lehigh University, Pa. 1964-5 18 6
l
- d. RADIATION BIOLOGY Colunbia Univ., N.Y., 1969-1970 0
1 year Chiv. of Osnn., Ct. 1970-1975 6
5 years
- e. RAOlOrwARMACEuTICAL Chiversity of Connecticut, Ct.
0 1 year CHEMISTRY
- 5. EXFERlENCE WlTH RADIATION (Actualuse af Radioisotoaan or Equivalent Experience)
ISOTOPE l MAXIMUM AMOUNT l WHERE EXPERIENCE WAS GAINED l DURAT14 al OF EXPERIENCE l TYPE OF USE 3
/
1 H
20 mci f
Ishigh Univ. PA 1 year invitro biochem, 14 analysis and C
10 mci Colunbia Univ. MY.
1 year invivo animal P
10 mci h
Univ. Of Conn., Cr 5 yearr i
i 45 47 C a 10 mci Trinity Cbilege, C2 2 years l
125 5 9.?e 5 nci
( Fairleich Dickinsci Univ.
since 1975 7
807tM NRC-313M Swoosement A s-7si Paoe5.
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Office of Adelaistration John E. Glenn. Chief Nuclear Baterials Section 8 Division of Engineering and Technical Programs LICENSE FEE TRAN5MITTAI.
A.
REGION 7-p 3.
APPLICATION ATTACHED Applicant /ttcensee: k6 r\\cloh DicKm%nn ( WTmk\\l a
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Application Dated:
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Contrel No.:
106010
- License No.:
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FEE ATTACHED Amount:
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COW.ENTS, S
signed bRomrko O kedb Date
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LICENSE FEE MANAGEMENT ERANCH
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Fee Category and Amount:
2.
Correct Fee Paid.
Application nuy be processed for:
iv.endment Renewal License N Signed V-ls 9/7tfYb u
Date I
N I FORM 213
_ _ _____ __.