ML20206H711

Matls Licensing Package for Amend 4 to License 50-29111-01 for Alaska Heart Institute.Control:467162

ML20206H711
Person / Time
Site:	03034474
Issue date:	05/03/1999
From:	Cammie Hernandez NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION IV)
To:
References
467162, 50-29111-01, 50-29111-1, NUDOCS 9905110293
Download: ML20206H711 (19)

See also: IR 05000291/2011001

Text

{{#Wiki_filter:. q , , U.S. NUCL R RE!ULAToRY Commission mendment No. 04 MATERIALS LICENSE Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93-438), and Title 10. Code of Federal Regulatinns, Chapter l, Parts 30,31,32,33,34,35,36,39,40, and 70, and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess. and tr nsfer byproduct, source, and special nuclear material designated below; to use such material for the purpose (s) and at the place (s) designated below; to deliver or trarsfer such material to persons authorized to receive it in accordance with the regulations of the applicable Part(s). This license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, cs amended, and is subject to all applicable rules, regulations, and orders of the Nuclear Regulatory Commission now or hereafter in effect and to any conditions specified below, ucensee in accordance with letter dated February 25,1999, 1. Alaska Heart institute, LLC 3. Ucense number 50-29111-01 is amended in ~ ~ . C its entirety to read as follows: r 2. 3260 Providence Drive, #537 . g.. ' 4. Eipiration date June 30,2002 ' Anchorage, Alaska 99508 - 5. Docket NoT030-34474 7 Reference No. C 6. Byproduct, source, and/or special?,, 7. Chemical and/or physical form 8. M$ximum amount that licensee may nuclear material g . C pos'sess at any one time under this w, /'. . 7 iian.se g i.

A. Any byproduct material li rad @armacebtical A. l.,ks needed . s Meritifiedin l Mxcep[ . 2 V identified in 10 CFR.35.200 h 1'O g g Q'a% ': E l - , ( aerosoistgases ndf,,< ,/, ' ,w l f <,/ g # O erators

g l W O/ (n , .. 9. Authorized use N' 44 "Q Cg y ' ' q.a j ,.l.% % A. Medical use described in:10.CFR 35.200 ed to nuclear cardiology. y ~v y h s,L .L in CONDITIONS 10. Licensed material shall be used only at the licensee's facilities located at 3260 Providence Drive, Suite 537, Anchorage, Alaska. 11. The Radiation Safety Officer for this license is Mark A. Selland, M.D. ] 12. Authorized Users: A. Mark A. Selland, M.D., for material identified in 10 CFR 35.200, restricted to nuclear card'iology, B. Robert Lee Pulliam, M.D., for material identified in 10 CFR 35.200, restricted to nuclear cardiology. 13. In addition to the possession limits in Item 8, the licensee shall further restrict the possession of licensed material to quantities below the minimum limit specified in 10 CFR 30.35(d) for establishing decommissioning financial assurance. JABQA 9905110293 990503 PDR ADOCK 03034474 p, P l C PDR d 0FFICIAL RECORD COPY .

E ' - - - . NRC FORM 374A u.S. NUCLEAR REOuLATORY COMMISSION PAGE 2 of 2 PAGES License Number 50-29111-01 MATERIALS LICENSE W or Reference Number a JPPLEMENTARY SHEET 030-34474 Amendment No. 04 > . ~ 14. Except as specifically provided otherwise in this license, the licensee shall conduct its program in accordance with the statements, representations, and procedures contained in the documents, including any enclosures, listed below, except for minor dianges in the medical use radiation safety procedures as provided in 10 CFR 35.31. The U.S. Nuclear Regulatory Commission's regulations shall govern unless the statements, representations, and procedures in the licensee's application and correspondence are more restrictive than the regulations. A. Application dated May 20,1997 G b C'N /- B. Facsimile dated . lune 23,1997# C. Letter dated December 2,;1997 h ~ D. Letter dated January 20;21998 O E. Facsimile dated April 15,1999 F. Facsimile dated Mayf,1999 g ,D k'S, u A[c ~ o 4 X' 1cc o ' dc. t -;.; ' > p'. '; ::71 - $ p (: / .:: g ,j' +4t%1t - y s' / w 'o c ,f )M N k,y ej - ' , ~.. t s .W 1- : 7 s w h e b ) ,. !"),. l Q s % . S' 23 ~ . A_ x kr f 14 ' FOR THE U.S. NUCLEAR REGULATORY COMMISSION 1 ~ Date By JAsr . . - Christi Hernandez 6 Nuclear Materials Licensing Branch Region IV Arlington, Texas 76011

, .e guerg -- " , -g k, UNITED STATES ' y g NUCLEAR REGULATORY COMMISSION 3 l; j REGloN IV f 0,. i 611 RYAN PLAZA DRIVE, sVITE 400 %g****+ ,o*c ARUNGTON, TEXAS 76011 8064 May 5,1999 Alaska Heart Institute, LLC j ATTN: Joseph C. Bartz, R.T. Nuclear Technologist 3260 Providence Drive, #537 4 Anchorage, Alaska 99508 ' SUBJECT: LICENSE AMENDMENT - Please find enclosed License No. 50-29111-01, Amendment 04. You should review this license carefully and be sure that you understand all conditions. If you have any questions, you may " contact the reviewer who signed your license at 817-860-8217. 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 requirements, you must conduct your program involving radioactive materials in accordance with the conditions of your NRC license, representations made in your license application. and 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 Protection Against Radiation," and other applicable regulations. 2. Possess radioactive material only in the quantity and form indicated in your license. 3. Use radioactive material only for the purpose (s) indicated in your license. 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 corporation, 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 well as 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 formerly designated as restricted arecs as defined in

10 CFR 20.3(a)(14) or 20.1003.

r: l m 2 . . . Alaska Heart institute, LLC - -2- 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 : .i 30.50(b)(1) or (b)(4), including areas where subsequent cleanup procedures ! have removed the contamination. Specific locations and radionuclide contents of previous and current burial areas j

within the site, excluding radioactive material with half-lives of 10 days or less, depleted uranium used only for shielding or as penetrators in unused munitions, or sealed sources authorized for use at temporary 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 or termination request at least 30 days before the expiration date on your license. You will receive a reminder notice approximately 90 days before the expiration 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 involving radioactive material. You will be periodically inspected by NRC. FaLre to conduct your program in accordance with . NRC regulations, license conditions, and representations made in your license application and - supplemental correspondence with NRC will result in enforcement action against you. This could include issuance of a notice of violation; imposition of a civil penalty; or an order suspending, modifying, or revoking your license as specified in the " General Statement of Policy anJ Procedure for NRC Enforcement Actions" (Enforcement Policy), NUREG 1600, Rev.1. Thank you for your cooperation. Sincerely, W . , Christi Hernandez, Radiation Specialist Nuclear Materials Licensing Branch Docket:. 030-34474-

License: .50-29111-01 Control: 467162 ' Enclosure: As stated

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m i gY y . M{{L .___W . .. .. 3260 Ps midenci Dr. #537,1200 Airy;rt Heights C330,3340 Prmidents Dr #55 Akska He:rt Institute LLC , Antherage AK 99508 ' J () J (907) 562 7575 (907) 561 3211 yp'f - 31999 iM' VMf Specialists ofthe Heart . waa==com . Richard A Anothners AtD, TAC C Mmam P. binyer, km, F.A CC James A. Baldauf, MD, VA CC Paul A. Peterson. 34DcFA ec - 1,ro R Rusnef Am, FACC Robert L 1%ffiam 111ofD, FAC C CoMern M Ceughlin %fD Coorge S. Phynrer. hm, FA C C ' l John C 11nla, MD, TACC Afark A. Sriland, Am, F.A CC Thomas W. Kramer, MD, F.A CC Deved W. Sennet>orn. MD, F.A C C 506 L Krenn, MD. YA.C C j i l April 26,1999 l Nuclear Regulatory Commission VIA FACSIMILE 817 860 8217 ) RE: Docket 030-34474 Lie 50-29111-01 Control 467162 ' In response to your requests for additional information we provide the following: 1. All records, including those conceming the safe and effective decommissioning of the facihty, ' public dose, waste disposal and radioactive spills and onsite burials have been transferred from Alaska Cardiovascular Consultants to the Alaska Heart Institute LLC. 2. The Alaska lleart Institute agrees to abide by all commitments and representations previously , made by Alaska Cardiovascular Consultants. j 3. The Alaska Heart Institute agrees to the change in ownership and assumes the responsibility of - Alaska Cardiovascular Consultants to include open inspection items if any, and understands that enforcement actions would be brought against Alaska Heart Institute. - 4. Alaska IIcart Institute agrees to abide by all constraints, conditions, requirements, representations and commitments as identified by the existing license. I am attesting to the above for both the transferor and the transferee, I am Tom Davis the CEO of the Alaska Heart institute LLC and prior to March 1" 1999 the Practice Manager and senior management representative of Alaska Cardiovascular Consultants LLC, , _ . - - For Alaska CardpMscular sultants For Alaska Heart stitute ( /A - u - Tom Davis, Practice Manager Tom N ,CEO l W7/44

-- d2+JMhtA14nnlManN@1AK d003 .. e- . . . ma ..._ ._r-yq/ u , [ i 'd C %[. ChristiHemandez lP ) Radiation Specialist N.R.C. [i g - 31999

i pl 1 Region IV, Nuclear Materials Licensing Branch d 6II Ryan Plaza Drive Suite 400 j Arlington, Texas 76011-8064 Phone # 817-860-8217 i Fax # 817-860-8263 ' t;um / Se-29H/-o/ bid # ole- W V W e,wux tr YHHt Ms. llemandez: ] Enclosed please find the addition to the amendment that we discussed. We would like to ' add one more treadmill room for use in our license. The floor plan enclosed shows the , i location of the new treadmill room, the other treadmill room will still be in use, and we will be injecting nuclear stress tests in both rooms. If any more information is needed { please contact me at your convenience Thank you very much for your help in this matter. , Sincerely; /J/ / oseph C. Bartz R.T. Nuclear Medicine Technologist Alaska Heart Institute LLC. 3260 Providence Dr. Suite 537 i Ancimrage, Alaska 99508 Phone # 907-562-7575 Fax # 907-563 9386 1 i .

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. . UNITED STATES 3' NUCLEAR REGULATORY COMMISSION o 5 l REGION IV og g 611 RYAN PLAZA DRIVE SUITE 400_ 4, * k k * * ,e ARUNGToN, TEXAS 76011-8064 FACSIMILE FORM DATE: April 20,1999 MESSAGE TO: Joseph C. Bartz _ Docket: 030-34474 ' Alaska Cardiovascular Consultants License: 50-29111-01 Control: 467162 MESSAGE FROM: Christi Hernandez, Radiation Specialist Nuclear Materials Licensing Branch Telephone number 817-860-8217 Facsimile number 817-860-8263 NUMBER OF PAGES: 1 PLUS TRANSMITTAL SHEET < FACSIMILE NUMBER: 907-563-9386 ' VERIFICATION NUMBER: 907-562-7575 l SPECIAL INSTRUCTION / ATTACHMENTS: Mr. Bartz: The purpose of this facsimile is to document our telephone conversation of April 20,1999. The items on the next page are the deficiencies which we discussed and that require your response. Please respond to this fax within 15 days. _ Our fax number is (817) 860-8263. If you have any _ questions regarding our discussion or this fax, please contact me at (817) 860-8217. When responding to this fax, please include the license, docket, and mail control numbers, located at the top of this page. Thank you. i . d. d d Christi Hernandez Radiation Specialist l c u 1 l t - !

l i ! - [* i P oq , 8 ~ , g" ' ' NUCLEAR REGULATORY COMMISSION ' ih j ,. 611 RYAN PLAZA DRIVE. SulTE 400 i REGION IV . % . ' ARLINGTON. TEXAS 76011-8064 e e - %*****' - l- $ - Please respond to the following items as they pertain to your facsimile dated April 15,1999: Based on the information provided, it appears that a transfer of control of licensed . ' activities from Alaska Cardiovascular Consultants to Alaska Heart Institute, L.L.C. has occurred. It is our understanding that as of March 1,1999, two groups of cardiologists (the licensee, Alaska Cardiovascular Consultants, and another unnamed group) combined assets and liabilities to form Alaska Heart institute, L.L.C.

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Please provide the following information and/or commitments: 1. A statement confirming that all records concerning the safe and effective decommissioning of the facility; public dose; and waste disposal by release to seers, incineration, radioactive material spill, and on-site burials, have been transferred to Alaska Heart institute, L.L.C. 2. A statement confirming that the transferee (Alaska Heart Institute, L.L.C.) agrees to abide by all commitments and representations previously made to NRC by the transferor (Alaska Cardiovascular Consultants). 3. Documentation that the transferor and transferee agree to the change in ' - ownership or control of the licensed material and activity, and the conditions of transfer; and the transferee is made aware of all open inspection items and its responsibility for possible resulting enforcement actions. (Note: documentation, [i.e., signature,] must be provided by a management representative for both the transferor and the transferee.) i 4.' Documentation of a commitment by the transferee (Alaska Heart Institute, L.L.C.) to abide by all constraints, conditions, requirements, representations, and co nmitments identified in the existing license. . -- %.m i g. ., b y- , 3 ' ' . 2 ( 1 - . i % s T i a >

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"""ll;,Pf;.7. e 1 [,.T 1, L c Don'd W'. Mnden HDJACC 1 -o c w 15 April 1999 @ W Chr.isti Iternandez APR I 51999 _b . .. Radiation Specialist ' N.R.C. - REGIONIV NMLB Region IV , Nuclear Materials Licensing Branch 611 Ryan Plaza Drive Suite 400 Arlington, Texas 76011-8064 Phone # 817-860-8217 Fax # 817-860-8263 Ms. IIernandez: , t Enclosed please find our responses to NRC Information notice 89-25, Revision 1 you have requested in reference to License; 50-29111-01, Docket; 030-34474, Control; 467162. 1. The new name is Alaska lleart Institute. LLC. 2. Contacts remain the same as do telephone numbers. 3. Three new Physicians are added having ownership of the LLC. They are George Ryneer, Seth Krauss, and James Baldauf they are all MD cardiologists and are each Fellows of the American College of Cardiology. They have been in practice in Anchorage under the name of Alaska IIeart Clinic LLC 4. There is no intent to carry on the business of Nuclear Medicine without a license 5. Two groups of cardiologists have combined assets and liabilities through a merger as ofMarch 1" 1999. Three new owner doctors named above joined with the six doctors who were owners of the license for the nuclear portion of the business. Four physicians are employees of the group. The machine and staff remain where and who they were prior to the merger. Except for normal turnover, the employees of both groups remain the same and are now employed under the new name and tax ID number. The merger agreement.provided for no exchange of stock or purchase capital. Each member has an equal share of ownership, stated on their IRS K-1s as 1111% of profits and expenses. NR , payables and long term debt became commonly owned as of the date of the merger. LM 7 /&

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15 April 1999 i Page Two - ! < 6. There are currently no firm pla.ns for changes in organization, location, eqmpment or ( j .. procedures. Location may be looked at in the future to co-locate the several existing

- offices should thra decision be made we would apply for a change at that time. 7. . No change in the use, possession, location or storage oflicensed materials.

] 8.- No changes. t 9. Name change only. All surveillance items and records are current. 10. No decommissioning required, only name change. I1. Name change only, no contamination present. 12. N/A ~- 13. Name change only. ' 14. N/A . ! 15. Name change only. .. , Please feel free to contact me if your have any further questions, or need any further information. I can be reached at the below fisted address and phone nurnber. I wo k hionday, Tuesday and Wednesday 6am to 6pra Alaska Time. - Sincerely; ! I de'pN artz .T. 'uclear hiedicine Technologist Alaska Henri Institute.11C 3260 Providence Drive Suite 537 Anchorage, Alaska 99508 Phone # 907-563-7575= 70 7' 54 4- 7f7C . Fax # 907 563-9386 , .. l. l' !'

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,,., e . DATE: h/[-7 7 ApH 151999 ,,, T0: Ch Kkir' /htsewwe Ndk!- FROM: Soc /AMff- Jf//E 4 TOTAL PAGES SENT (including Cover Sheet): 3 , FAX TRANSMITTAL MEMO: /?e rAuuvf fa /WAC lwfot *wrNH Amfic e f 7- 2 6 ~ & o;atus / t/b/< Acn n s s/e 1 . ' s' . 6c fWL . i CONFIDENTIAUTY NOTICE: This facsimile transmission contains confidential information and is limited to the use of the Intended reciplent, You are hereby nottfled that any divulgence to other parties without consent of the patient constitutes a breach of confidentiality. If you have received this transmission in error, please notify us immediately by telephone to arrange for the return of the documents. 3260 ProvWewe Dr.. #3374907)S62 7573/ Fan (907154).9196 3340 reovWerwe Dr.,#522 A 2848 Defien RJ.,#1(4907)$68 321t/ Fat (907)S68 4452 4200 AirportileigNs.F).104907)258 345&tas(907)258 3904 . Arwbfoge. AK 99504

' . . f~%*, ' - . UNITED STATES . ,p .. NUCLEAR REGULATORY COMMISSION " .< J 3 - REGION IV ^ ' 611 RYAN PLAZA DRIVE, SUITE 400 ARLINGTON. TEXAS 76011-8064 . , ' FACSIMILE FORM ~ j . . $' D TE: ' April 7,- 1999 , MESSAGE TO: . Joseph C. Bartz Docket: 030-34474' ' + Alaska Cardiovascular Consultants License: 50-29111-01 Control: 467162 t- MESSAGE FROM: Christi Hernandez, Radiation Specialist 4 Nuclear Materials Licensing Branch i Telephone number 817-860 8217 , l Facsimile number 817-860-8263 l NUMBER OF PAGES: 9 PLUS TRANSMITTAL SHEET 1 FACSIMILE NUMBER: 907-563-9386 VERIFICATION NUMBER: 907-562-7575 j < SPECIAL INSTRUCTION / ATTACHMENTS: Mr. Bartz: The purpose of this facsimile is to document our telephone conversation of April 7,1999. NRC Information Notice 89-25, Revision 1, attached contains the items we discussed and that i' require your response. Please respond to this fax within 15 days. Our fax number is ! (817) 860-8263. If you have any questions regarding our discussion or this fax, please contact me at (817) 860-8217. When responding to this fax, please include the license, docket, and

mail control numbers, located at the top of this page. Thank you. l . . Christi Hernandez Radiation Specialist .. , V 3 \\ r _: t

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(907)562 7575 Fax (907) 563 9386 l Practice Limited to Cardiovascular Diseases www.alaskacardiac.com Richard A. Auchuett., MD, F.A.CC Paul A. Peterson, MD, F.A.CC John C Finley, MD, F.A.CC Robert L Pulliam tilMD, F.A.CC Thomas K. Kramer, MD, F.A.CC Mark A. Selland, MD, F.A.CC WM-- P. Maver. MD. FACC David W Son::L:u. MD. F.A.C C ' February 25,1999 Nuclear Regulatory Commission Region III

611 Ryan Plaza Dr., Suite 400 Arlington, TX 76011-8064 License # 50-29111-01 Docket #03-34474 l Dear Sir, ' We request an amendment to our current license. The amendment we request is a name change only. All other information remains the same, including address and location use. Our name will be changed from Alaska Cardiovascular Consultants to Alaska Heart Institute, LLC. The name change is effective as of March 01,1999. Please notify us of the cost of amendment. If you have any questions, please contact me at 1-907-562-7575. Thank-you for assisting us in this matter. Sincerely,

If/ ' J eph C. Bartz I i 1 ! l !- 1 ! Ih A n7182

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D a . , .. . ~ ALASKA HEART INSTITUTE, LLC . 3200 PROVIDENCE Dr., SUITE 537 ANCHORAGE, AK 99508 . (907)562-7575 To Whom It May Concern, Effective March 1,1999, Alaska Heart Institute became a new Limited Liability Corporation. The tax ldentification number assigned to the new corporation is 92-0165692. The following providers are affected by this change: Richard A. Anschuetz, MD John C. Finley, MD Thomas K. Kramer, MD William P. Mayer, MD , Paul A. Peterson, MD Robert Lee Pulliam, Ill, MD Mark A. Selland, MD David W. Sonneborn, MD These providers were previously part of Alaska Cardiovascular Consultants,3260 Providence Dr., Suite 537, Anchorage, AK 99508. That tax identification number was 92-0156783. Additional providers are: James A. Baldauf, MD Lco B. Bustad, MD Colleen M. Coughlin, MD George S. Rhyneer, MD Seth L. Krauss, MD . These providers were previously part of Alaska Heart Clinic,3340 Providence Dr., Suite 552, Anchorage, AK 99509. That tax identification number was 92-0161227. Any bills previously sent to the above providers should now be sent to: ) ALASKA HEART INSTITUTE, LLC Attn: Accounts Payable 3260 Providence Dr., Suite 53) Anchorage, AK 99508 If you have any questions, please contact me immediately. j j Sincerely, , b WAAY Valerie Marcinok, Accounting Manager (9071550-2233 k\\s. WM ^CQ , ' M @*T"

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ATTN: RITA MESSIER 301 4164067 u.s. Nuclear Regulatory Comminion LICENSE FEE REQUIREMENTS ueen= Fe. and Account Receivahie eranch P. O. Box 944814 St. Louis, MO 63194 4814 TYPE OF ACTION O NEW LICENSE RENEWAL OF LICENSE ALASKA CARDIOVASCULAR CONSULTANTS Q AMENDMENT TO LICENSE ATTN: JOSEPH C. BARTZ 3260 PROVIDENCE DRIVE,#537 REQUESTED DATE / NCHORAGE, AK 9950s 02/25/1999 LICENSE NUMBER 50-29111-01 CONTROL NUMBER 467162 L APPLICATION FEE DUE IL FEE NOT REQUIRED Your request for a licensing action is subject to the fee (s) in the category (les) Check Encioned is your check which noted below in accordance with Section 170.31 of 10 CFR Part 170. Number accompanied your request. The P2yment of the fee is required prior to the issuance of the license, renewel, or fee is not required because: amendment c/sb APPLICATION RENEWAL AMENDMENT C r th 7C s s s 450.00 $ $ $ Date of The Licensing staff has informed Request us that your request is to be g g g Control considered as a contmation of the g g I Number request ilsted. S $ $ $ $ 5 Date of Your request was combmed, prior g g g Request to review, with the request listed. Control . 8 8 $ Number S $ $ l lit. CHECK RETURNED

FEE (s) DUE s 450.00 o Check Enclosed is your check which was PAYMENT RECElVED s LJ Number retumed to us by the bank for: AMOUNT DUE s 450.00 NSUFFICIENT FUNDS ( Your request was received without the prescribed application ACCOUNT CLOSED OTHE' C We received your check listed below. Payment of the additional fee Mall THE REPLACEMENT CHECK TO THE ADDRESS LISTED AT THE Check Number noted above is required TOP OF THIS FORM AND REFERENCE THE ABOVE CONTROL $ Arnount NUMBER. Your request wie increses the scope of your license program. N. LICENSE ISSUED WITHOUT THE REQUIRED FEE Therefore, your request is subject to the application fee (s) noted above. Lh TM W h m W Refer to Section 170 31 and Footnote 1(d)(2). b Number without the required fee being , W Your licones expired prior to the receipt of your application for renewal ~ Therefore, your request is subsect to the application fee (s) noted above. Date 1 Refer to Section 170.31 and Footnote 1(a). luued ' MAKE PAYMENT OF THE FEE (S) TO THE U.S. NUCLEAR The scope of your licensed program was increased. Therefore, your KEGULATORY COMMISSION AND MAllTHE PAYMENT TO THE 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 Section 170.31 and Footnote 1(d)(2). l CECEIVE A REPLY FROM YOU WITHIN 30 CALENDAR DAYS FROM THE DATE LISTED BELOW, WE SHALL ASSUME THAT YOU DO NOT Because of the urgency of your request, the license was issued wthout WlSH TO PURSUE YOUR APPLICATION AND WILL VOID THIS remittance of the prescribed fee noted in Section 1 of this form. ACTION. /) q SIGNATURE-UCENSE FEE ANALYST LFDCB j IJQCB_ Distribution: DATE Pending Cy NNRB RF (LF-3.2.7) OC/DAF/LFARB S/F REMessier V' cc: RegionIV 03/05/1999 l RITA MESSIER 3/5/99 , l NRC FORM 577 (5-1906) PRINTED ON RECYCLED PAPER This form van designed using informs

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