ML20205R079
| ML20205R079 | |
| Person / Time | |
|---|---|
| Issue date: | 04/20/1999 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Middleberg R NATIONAL MEDICAL SERVICES, INC., WILLIAM GROVE, PA |
| Shared Package | |
| ML20205R082 | List: |
| References | |
| SSD, NUDOCS 9904220172 | |
| Download: ML20205R079 (5) | |
Text
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April 20,1999 National Medical Services, Inc.
ATTN: Robert A. Middleberg, Ph.D.
Director of Record 3701 Welsh Road Willow Grove, PA 19090
Dear Dr. Middleberg:
i This letter verifies the receipt of the completed NPC Form 483 dated February 24,1999. This I
form is a condition of the general license under 10 CFR 31.11 authorizing in-vitro testing with byproduct material under general license.
I The form has been assigned registration number 8405. 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.
1 i
Sincerely, i
bl Traci Kime, Registration Specialist i
Materials Safety and Inspection Branch Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards
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DISTRIBUTION:
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DOCUMENT NAME: a:\\middleberg.483 j
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'E" = Copy eth attachrnent enclosure
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OFFICE MSB C
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NAME TKime s flC DATE 4/c10 /99 OFFICIAL RECORD COPY
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9904220172 990420 PDR RC i
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APR'19 '99 13f43 FR NATIONAL MEDICAL SVCS215 657 2972 TO 913014155369 P.02/02 NRC FORM 483 U. S. NUCLEAR REGULATORY COMMISSION APPHOVED BY CMS: NO. 3150 003a EXPRES: ti-30-93 I a
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REGISTRATlON CERTIFICATE -in vitro TESTING L', O ',0,7 1".%'1 7. Z '0 7 "' 2 " 1 *.*;* 1 Z-a*1",0 7."KT' lc'Mr_is,IE " *, ",*/. l WITH BYPRODUCT MATERIAL UNDER c
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p.rson ab not requia.J We f.6,Qfid 60. 8 Celi.ct0A or m'StrN,Lon untess it i desplays a GutteriOy waded OMS con 901 rWmb.,.
Section 31.11 of 10 CFR 31 establishes a general license authorizing physicians, clinical labonitories, hospitals, and vetennattans in the practme cf veterinary rnedsine to possess certain sman quant!tles of byproduct material for in vrtro clinkat or laboratory tests not involving the intemal or extemal addiv.Lun of the byproduct matertal or the radiation therefrom to human beings or animals. Possession of byproduct material under 10 CFR 31.11 is not authorized until the physician, clinicallaboratory, hospital, or votadattan in the practice of veterinary medicine, has filed NRC Form 483 and received from the Comrression a validated copy of NRC Form 483 with a registration number,
- 1. NAME AND ADDRESS OF APPLICANT (See lastruccon 3.8. below)
- 2. APPLICATION (Check one box only)
I hereby apply for a registrabon number pursuant to 10 CFR 31, Secbon ed. RODArLi. GidelarW ^,, Til..' "
31.11, for use of byproduct materials fur:
Dir0CCOf Of.}0COr'J A. Myself, a duly licensed physician authorued to cisperse drugs in 1.ational licc[1 Cal Service!;,
,a itc.
the practice of medicine.
NNedM,bvh0NA 1%M V B The abov amed ciintcanaboratory.
WLfPHCW2 NuMBfM (hetudd he Cod.)
C. The above named hospttal.
D. Veterinarien in the snictice of vetennary medicine 3.
INSTRUCTIONS:
- 4. REGISTRATION A.
Submd this form in dupicate to:
REGISTRATION NUMBER:
Medical. Academic and Cornmercial Use
..,Fi N
a nec Safety Branch (T 6 F5)
Dmsion of industrial and Medical Nuclear Safary
'd 2 E '3.F. 2'JCLC RIGd.W.TD offee of Nuclear Material Safety and Safeguards y
CCIM E,$I?"
n U.S. Nuclear Regulatory Comnnsion y
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'a Washington, DC 20555 0001 (At NRC, a registration number wig be assigned and a validated copy
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of NRC Form 483 wft! be retumed.)
b,.,,
2.5 eave thi$ Spa e blan l
2 /) i S.
In the box above, print or type the name, address (including ZIP s'anE.,
numcer/ n std 8'o i
r regAttra d Code). and telephone number of the registrant physician, clinical
(
laboratory, hospital, or veterinarian in the practice of veterinary assigned by RC. If f is a change of ' formadon from a previously medicine for whom or for wilich this regustration form is filed.
regstered g eral # cense, include yout rog!stration number.)
- 5. If place of use is different from address ksted above, give complete address:
- 8. CERTIFICATION l hereby certify that' A.
AllInformation 16 tNs registration certificate is true and compicts.
B.
The registran: has appropriate r=4=nn,1 measunng instruments to carry out the tests for wNch byproduct matortal Will be used under the Deneral license of 10 CFR 31.11. The tests wiX be performed only by personnel competent in the use of the instruments and in the handling of the byproduct rnatedals.
C.
I understand that Commission regulations require that any change in the information fumished by a registrant on this regtstrabon certifcate be reported to the Director of Nuclear Material Safety and Safeguards within 30 days from the effective date of such chance.
D i have read and understand the provtsions of Section 31.11 of NRC regulations 10 CFR 31 (reprinted on the reverse side of this form); and I understand that the registrant is requtred to comply with those provisens as to all byproduct matertal which he receives, acquires, possesses, uses, or transfers under the general heense for which this Registration Certifcate is filed with the,U.S. Nuclear Requiatgyommission, PRINTED OR TYPED NAME AND TITLE OF APPUCANT SIGNAT PAPPJ.tC'A DATE t',R L
/
W7:n :. Vi&tlehoq., "h.D.
20 bort h. GiM QWCS, M C-
/,/77 WARNING:
FALSE STATEMENTS IN THIS CERTIFICATE MAY BEA36BJECT TO CML AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS THE NRC BE COMPLETE AND ACCURATE IN ALL MTERLAL RESPECTS. 18 U.S.C. SECTION 1001 WKE T 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 JURISDlCTION.
N8tC I;ORM.63 (496)
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UNITED STATES s
j NUCLEAR REGULATORY COMMISSION WASHINGTON, D.C. 20656-0001
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l February 24,1999 l
National Medical Services, Inc.
ATTN: Robert A. Middleberg, Ph.D.
Director of Record 3701 Welsh Road Willow Grove, PA 19090
Dear Dr. Middleberg:
This letter verifies the receipt of the completed NRC Form 483 dated February 24,1999. T is form is a condition of the generallicense under 10 CFR 31.11 authorizing in-vitro testing witn byproduct material under general license.
The form has been assigned registration number 8405. 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, Traci Kime, Registration Assistant Materials Safety Branch Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards l
1
February 24,1999 National Medical Services, Inc.
ATTN: Robert A. Middleberg, Ph.D.
Director of Record 3701 Welsh Road Willow Grove, PA 19090
Dear Dr. Middleberg:
This letter verifies the receipt of the completed NRC Form 483 dated February 24,1999. 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 8405. 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, 1
Traci Kime, Registration Assistant Materials Safety Branch Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards DISTRIBUTION:
IMNS r/f NEO3 DOCUMENT NAME: a:\\middleberg.483 To receive a cope of this document, indicate in the boa:
"C" = Copy without attachment /enclostre "E* = Cope with attachment /enclosu,e ' N' = No copy OFFICE MSB NAME TKime DATE 2/ /99 OFFICIAL RECORD COPY
,APR 19 '99 13:43 FR l ATIOt AL MEDICAL SUCS215 657 2972 TO 913014155369 P,01 '02
- This Fax infonnation is Furnished to You By NATIONAL MEDICAL SERVICES, INC.
3701 Welsh Road Willow Grove, Pennsylvania 19090 Phone: (215) 657-4900 - (800) 522-6671
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FAX: (215) 657-2972 Date 4 1947 l
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PLEASE DELIVER THE FOLLOWING TO:
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1 NAME:
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