ML20207F531
| ML20207F531 | |
| Person / Time | |
|---|---|
| Issue date: | 06/07/1999 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Leszkowicz D AFFILIATION NOT ASSIGNED |
| References | |
| SSD, NUDOCS 9906080311 | |
| Download: ML20207F531 (2) | |
Text
p June 7,1999 David Lesz(owicz, D.O.
9178 Highland Road White Lake, MI 48386
Dear Dr. Leszkowicz:
This letter verifies the receipt of the completed NRC Form 483 dated May 20,1999, 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 9165. 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, 8
Traci Kime, Registration Specialist Materials Safety Branch Division of Industrial and
/
Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards DISTRIBUTION:
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NEO3 DOCUMENT NAME: a:\\ burgess.483 Ts receive e copy of thle document, Indcate in the box: "C" = Copy without attachment / enclosure
- E* = Copy with attachment / enclosure
- N' = No copy OFFICE MSB b/
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".eetim 3111 of 10 CFft 31 establishes a genetet license authortring phystelsns. Clintent htwwntories, ho.rlists, and veterinnelens h the pn+
er vatmbgry enedicine to possess certeln small quardlHee of typtoduct maletinf for h Wrio reinleal et labotsfory t**In not inveMng Itw trdeenal er e.e....
=<Sii,dehntinn of the bypoduct materlat or the radiation therefrom to human beinpg or animik I'e eeteon of byrenduc1 mateflui urrlar 10 CF ft 31 I1 h ad j
s*dtwvtreef tFdl the physlelan, ellnlC9t lAbotalNy, hospflpl, of VetMtmhn ln fl* Pactice fif balNin19 Inedi lne, hnt f%f fiftC Iorm 4fl3 9'rj tetehswt f*fwn the C
i Crrnmisslan a volldeted copy of NRC Form 483 Mth a registration number.
- 9. FJAME APJD ADDRESS OF APPLICAtdf (Seeinstrucean 3 ft fielow)
- 2. ArrLICAllotJ (Check one teu any I heveby npfy for a legistration msmber pursumed to 10 NIIY b'wi David Leszkowicz, D.O.
31.1 t. Im v*e of heroduct materin's in:
9178111ghland Rd.
A f.Yatt, n ddy licensed phyMehn nuttantred to hi=U[ sot M Uhlte Lake, Michigan the rt actl<-* of 'nedicine 48386
] o. 1ha ndova named clinient hboratory
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seie nnet tcJuntn p,wase k cefal C.1he above named hospital O veteilnarbn in the practice of vete Inery medrine 3.
ItJSIRUCitoldS:
- 4. REOtSIRA100Pd A-Submit this form in dupticate to' REGIST RAlloit tJUMnr ft Ma< tent, Academic and Commercial Use 9165 DMslan of Industrial and Medical IJucient Safety
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Safety Branch (6 f t3) e n FOR THE U.S. NUCLEAR RFCULA-Office t,f Nuclear Materlat Safety and Safeguards O *.
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TORY CnMMISSInN ninlJ E
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l) 5. Nutient Reguistory Commission 0
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washington, DC 20555 0001
"$ ["a (Al NRC, a registration number will be essigned and a vatkisted copy 1,
of f1RC Form 463 Wil be tetumed )
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/')9 (ff this art htelreptfration. feeve this spero til[4 - nurnfier to n in H. em.tm.. pine a tyn. ihe n.me..d+e.. Oneluding zin Ctwie), and telephone number of the tegletrard phynnelen, cfledeel intwwntory, hospitat, or veterInstlen in the pnetlee of vetertnery es9%ried t'y fvRC ff this is a change of hfbimeson Arm e avoWou.8y tredleine im vAiom et im which this registration fcwm le filed repetered panetsf #conse, hefurfe your repstregon numt er)
- 6. W reve eif use is effeterd ftom addreen D9ted eteve, gNe complete address'
- 8. CERtitlCAllute I
et y rettfy that'
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A All Inftwmition in this teg%tt ation t evtifieste is true and compc8e.
It tha regktrard has appnpthte en fiSlon enengurlng in*trurrweds to enety e=d Itta ta-' 0= vAdr h ht"n4"' in*mht w4 le tr*~1 trvlar tha ca - *'
5<ense of to Cril 31.11, the teds will be performal cedy by parsnewial re-ope'ent h H* U*e of Pia in*tiuma*We nevt h the twvewwi et n a l'ypewixi ma'etinit l unclerstand that Commission teg'Jfations require that any thange in the info tn&i fianlehat by a tea 4tened tai tids legkhn've e esti'-e. t.
C reprwted to the Director of Nucteer Materlaf Safety and Safegu1rds wfthin 30 days fram the effe< fl.e dite of nuclichnnpe.
Il I timve tend and understand the provklons of Section 31.11 of HRC tegutfir*n tD 1:8 ft 31 freprin'~1 on tha teverse airla cf Poe f w 9 ew I tewaarstand Itml the reg %trerd is teq'stred to compy wth ttme povhkwim ps to sti t-)T"r*'"' t mWerint yAi th he f eceivet, trvy Wree, gv.eenen, tr...
l tw tennstees twidat the ganeral f! cense for which this Reg %trathn Certificate k filed with th+ ti S fluctant De ' 4tne einn iniUilliiiiiivrtolinME Atau litLEDi%TLicAfil SIGtJ%TUlIIof Pt I '
Dhl t.
David Leszkowicz, D.O.
5 go.rgg j
WARNING: FALSE ST ATEMENTS IN THIS CERTIFICA1E MAY DE SUfbEC1 10 civil At40/OR CRh " l l
PE f JAl.1IES.
NRC REGULAllONS REQUIRE lilAT SUBMissitilP1 10 lilE 11RC DE COMPLETE Allo l
ACCURATE IN ALL MATERIAI. RESPEC1S, 10 U.S.C, SECilott 1001 f.iAKE", it A CRIMINAL OrrEN"E It s I
MAKE A WillTUt LY FAl.SE SI ATEMENT OR REPRESEf1TAllON 10 Ativ DEPARTMENI OR AGrHCY Or Ilif l if fi t I'll ".1 A llI A" I t i A t e,* i t g g I rft Wi t t lit t I t " 11 litt"t str' 18# d e