ML20207E914
| ML20207E914 | |
| Person / Time | |
|---|---|
| Issue date: | 03/09/1999 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Xu A AFFILIATION NOT ASSIGNED |
| References | |
| SSD, NUDOCS 9903110107 | |
| Download: ML20207E914 (2) | |
Text
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March 9,1999 c<
Keystone Analytical Labs,Inc.
ATTN: Allan Xu, President 113 Dickerson Road, Unit B North Wales. PA 19454
Dear Mr. Xu:
This letter verifies the receipt of the completed NRC Form 483 dated March 3,1999. This form is a condition of the generallicense under 10 CFR 31.11 authorizing in-vitro testing with byproduct material under general license.
The form has been assigned registration number 9164. 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 rieed further assistance, please contact me at (301) 415-8140.
Sincerely, Traci Kime, Registration Assistant Material.s Safety Branch Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety l
and Safeguards DISTRIBUTION:
IMNS r/f NEO3 d
! DOCUMENT NAME: a:\\xu.483 l In reed,e a cop'r of this document, Indicate in the boa: *C' = Copy without attachrnent enclosure "E* = Copy wsth attachment / enclosure
- N* = No copy OFFICE MSB l
l NAME TKime @C DATE 3/'/ /99 OFFICIAL RECORD COPY i
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f 9903110107 990309 PDR RC SSD PDR
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NRC FORM 483 U. S. NUCLEAR REGULATORY COMMISSION APPROVED BY OREl. NO. 31504o38 EXPIRES: 6-30-99 4
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m Estwnsted tNrden per fGSpanGe iD Comply vnih eus marwsatory informabon conecson,equest 7 rrunutes The vehdated reentranon sarwes as endence REGISTRATlON CERTIFICATE -in vitro TESTING
"/,,"o'O, 's',s*,"'"f,,"e"n*, "f,"s%,C,u*,e"e"n*la*ne.s"' O
'WITH BYPRODUCT MATERIAL UNDER
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"*"*'*"'""**"'*"""'""o3' **' n'o't conduct or's'ponser, and e
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L LIVCM'C GENC Budget. Weefungbn. DC 205 NRC may person a not regured to respond to. e -m-am or adormanon uniese at
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displays a curroner vehd oMB control number S4ction 31.11'of 10 CFR 31 establishes a general license authortzing physician's,iclinical laboratories, hospitals, and veterinarians in the practice of
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vderinary medicine to possess certain smaH quantities of byproduct material for in Wfro clinical or laboratory tests rx4 invoMng the intemal or extemal administration of the byproduct material or the radiation therefrom to human beings or animals Possessson of byproduct material under 10 CFR 31.11 is not authonzed until the physician, chnicallaboratorYl hospital, or veteriartan in the practce of veterinary medicine, has filed NRC Form 483 an:f ecerved from the Commission a validated copy of NRC Form 483 with a registration number
- 1. NAME AND ADDRESS OF APPUCANT (SeeIns*ruc00n 3 8 below)
- 2. APPUCATION (Check one box only) k y hory
[ p a,# -f k o / y/g' i hereby apply for a registrabon number pursuant to 10 CFR 31, Section 31.11, for use of byproduct matenals for:
I/ 3 DiCWeYSon %7d Unit 6
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A Mysel'. a duly hcensed physictan authorized to disperse drugs in
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& I2 5 Pn m ra
- "'"c" V B. The above-named chncallaboratory.
rtuPWNE NUMBER (include kne Code)
C The above named hospital.
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O/$) [ 7 7-M99
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D Vetennanan in me practee of vetennary medmine
- 4. REGISTRATION 3.
INSTRUCTIONS:
A.
Submit this form in duphcate to.
REGISTRATION NUMBER:
Medcal, Academic and Commercial Use Safety Branch (T-8 FS)
[ "'Gug
,g.,
Drvisson of industrial and Medcal Nuclear Safety o
Ofice of Nuclear Material Safety and Safeguards WD2D U.S. Nuclear Regulatory Comrnission j
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Washington, DC 20555-0001 g
(At NRC, a registration number will be assigned and a vahdated copy of NRC Form 483 will be returned )
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B in the box above, pnnt or type the name, address (including IP Code). and telephone number of the registrant physcian, chnical (If this an snabalregrstrabon, leave this space blank - number to be laboratory hospital, or vetennanan in the piactice of veterinary assigned by NRC. //this is a change o/in/brma0cn from a previously medscene for whom or for which this regtstration form ts ! led registered general Dcense, include your registrabon number)
- 6. If place of use is different from address listed above, give complete address'
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- 6. CERTIFICATION
]
j l hereby certify that l
A All information in this registration certificate is true and complete.
2 B The registrant has appropriate radiation measunng instruments to carry out the tests for which byproduct material wiu be used under the general j
hcense of 10 CFR 31.11. The tests win be performed only by personnel competent in the use of the instruments and in the handling of the
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byproduct materials C.
I understand that Commission regulations require that any change in the information fumished by a regrstraat on this registration certificate be i
reported to the Director of Nuclear Matenal Safety and Safeguards within 30 days from the effectrve date of such change l
D 1 have read and understand the provisions of Section 31.11 of NRC regulations 10 CFR 31 (repnnted on the reverse side of this form); and l understand that the registrant is required to comply with those provisions as lo al' byproduct matertal which he recerves, acquires, possesses, uses, or transfers under the general license for which this Registration Certificate la flied with the U.S. Nuclear Regulatory Commission.
PRINTED OR TYPED NAME ANL' TITLE OF APPLICANT SIGNATURE OF APPLICANT DATE
~h. A Il n n )( 4, p e Q,, f f
Qj WARNING:
FALSE STATEMENTS IN THIS CERTIFICATE MAY,BE SUBJECT TO CML AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS.18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A NILLFULLY 1
FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
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