ML20204H097
| ML20204H097 | |
| Person / Time | |
|---|---|
| Issue date: | 03/24/1999 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Niemkiewicz J RIVERSIDE METHODIST HOSP. COLUMBUS, OH |
| References | |
| SSD, NUDOCS 9903290005 | |
| Download: ML20204H097 (2) | |
Text
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Ls March 24,1999 Riverside Methodist Hospital ATTN: John Niemkiewicz Radiation Safety Officer.
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3535 Olentangy River Road Columbus, OH 43214 3998
Dear Mr. Niemklewicz:
This letter verifies the receipt of the completed NRC Form 483 dated January 15,1998. 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 9160. When making changes to any of the i
information on the form, please reference the registration number and address the
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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, Traci Kime, Registration Specialist Materials Safety Branch Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards DISTRIBUTION:
IMNS r/f NEO3h i
DOCUMENT NAME: h:\\TRACllNIEMKIEW.483 Ta receive a cop r of this document, Inaleate in the boa:
"C" = Copy without attachment / enclosure
- E* = Copy wath attachrnent/ enclosure "N" = No copy OFFICE MSB 10 l
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NAME.
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DATE 3&//99 OFFICIAL RECORD COPY i
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REGISTRATION CERTlFlCATE --in vitro TESTING
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Sedion 3111 of 10 CFR 31 estatmahes a general scense authormng phyescanna, dhral Inhonskries, tweptain, and vetortnertene in the prec2ce of retergot medicme to poseets certain amas quantenes of tyyproduct modertal for er vitro carecal or laborumory tomes not lneMng the mesmal or esser el admewstration of the byproduct matenal cr the rare.nnn therefrom to human bemge or animale P====amn of byprodud meurtif inder 10 CFR 31.11 m rxt autfastred until the physscien. c#irmeel laboratory hoepital, or veterierten in the precece of vetevinary medcine, has ited NRC Form 483 and received from du Commianson a vahdated copy of NRC Form 483 with a reO miratica number l
- 1. NAME AfC ADDRESS OF APPUCA8tT (See instrucfon 18. bedow)
- 2. APPUCATION (Check one box only)
Riverside Methodist Hospital I hereby apely for a registration rweier puruunnt to 10 CFR 31, Section s
3535 Olentangy River Road
^ M 'em a duty sceneres phyunsin amartrud to emperne dmg. m Columbus Ohio 43214-3998 Y
the armake o medians r
ATTNt John Nieskiewicz, RSO a.Tw h m m y M@NWhMG @M.4 Au.C&J y
C. The above named hospGal (61M e66-5714 D. Vehwinertan in vie w=-:- + or vetertiary i
3.
DISTRUCTIONS:
- 4. RENTRATION A.
Submd the f:rm si duplicate to REGISTMATION NUMBER:
Med6eaa. Academe and commntaa une 9160 Safety Branch (T4 FS)
[9" %'o FOR ' DIE U.S. NUCLEAR REGULATO ov on of induetner and 9-,arw Nuo.er safety g
Omco of Nudeur Motstal Safety and Safeguents COMMISSION U S. Nucieer Reguistory Commmason Weehington, DC 20t' ism 001 g
(At NRC, a regretreDon number WWI be seeigned and a ve8deted copy 4,H *, 8 of NRC Form 483 we be retumed )
H in tne box above, pnnt or type the name. address (includmg ZIP aci 1'
C sde), and telephone number of the rega.rart phynacann, cunical Ofm ang@rne#0A leave thir space 99~ fc be
,aboratory hooptel, or vetennenen m the practco of vetennary asspned6) NRC. #thisis a cturope ofWbrmsson hem a preWousfy modseme for whom or for which the regenrebon form le fhed.
P'fonMr poneraf scense, mahide your repuessen num6er)
- 6. if pl='v of use a differert from addreae beted above, ghe cornpiele addrese
- 8. CERT 1FicATION
,__I hereepy c r4 that:
A All nformsbon in the registrahnn cartr' lente s true and complete G.
The regetrant has appropnale radssbon messunng metruments to carry out the tents for which byproduct rnelertel wG be used under the geners teenne of 10 CFR 3111. The tests unR be performed only by peraonnel competent n the use of the ristrumente and in the teneg of tw tryproduct metenals C.
I understand that Commason reguisbons requre that any change in the information fummhed by a regetrarit on this regetrafien cergmains tie reported to the Drector of Nucneer Metenal Safety and Safeguards wthm 30 days frian the effectrve date of norti ofenge D
I have reed and understand the proidosons of Secnon 31,11 of NRC requisbone 10 CFR 31 (reprinted on De rmensa onde of em form) erus t understand that the regletrant ha required to comply wth those provleione se to sa byproduct meterial vdiich he recahee. aegnes f.a====-a= un.a or transfers under the general hconae for vduch tfra Registraean Certificate le fled Wlh the U.S. Nucteer Regduoury Camrrtumson PRINTED OR TYPED NAME AND TITLE OF APPLICANT SIGNA 1 E OF PLICAN T DATI John Nietnkiewicz, 15 Jan 1998 uM u ;n wm n r r w.
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DARNING: FALSE STATEMENTS IN THIS CERTIFIC TE MAY BE SUBJECT TO Cid ANDOR CROMAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSONS TO THE NRC BE COWLETE AND ACCUR ALL MATERIA 1. RESPECTS,18 U.S.C. SECTION 1001 MAKES IT A CRNNAL OFFENSE TO MAKE A WR.LFULLY FALSE STATEWNT OR REPRESENTATON TO ANY DEPARTWENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHN ITS JURISDICTION.
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