ML20207F537

Certificate of Disposition of Matls:All Activities Authorized by License SNM-1996 Have Ceased & All Matls Procured &/Or Possessed by License Disposed,As Indicated in .License Should Be Terminated

ML20207F537
Person / Time
Site:	07003077
Issue date:	03/25/1999
From:	Zavada Y MEDICAL COLLEGE OF PENNSYLVANIA & HOSP., PHILADELPHIA
To:
References
NUDOCS 9906090018
Download: ML20207F537 (2)

Text

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NRC FORW314' U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OM8: NO. 3160 0020 EXPIRES: 06/30/98 (6 95) to CFR 30.36(c)(1)(lv)

E8DMATED lluRDEN PER RESPONSE 10 COMPtf WITH THl$ MANDATORY MORMAfl0N COLLECDON to cFR 40. A2(e)(1)(tv3 RE0ufst, 20 neNuTEs THis suiinsTTAL is usE0 er NRC As Pant GF rHE BA3l8 FOR iT5 10 CFR 7o.3a(c)(1)(tv)

DETERMINATION THAT THE FACluTY HA$ KEN C1 EARED OF RA0iOACTIVE MATERIAL EFORE DIE FACluTV 15 RELEA$f D FOR UNRESTIUCTED USE. FORWARD CDMMENTS RIGARDING BURDIfJ ESUMArE CERTlFICATE OF DISPOSITION OF MATERIALS Ml',""",'A," %"',"C l',,s,'""'"4,"*,",' " ',,'L",', "L'(",,",,^4";

Ol60-0028L OFFICE OF MANAGEnENT AND BUDGEI, WASHINGTON, DC 20503. AN AGENCY MAY NOT INSTRUCTIONS: ALL ITEMS MUST BE COMPLETED - PRINT OR TYPE CMDUCT M BPM AND A PERSM 18 NOT REQUIRIO 70 RESPOND 10. A COLLECHON OF SEND THE COMPLETED CERTIFICATE TO THE NRC OFFICE SPECIFIED ON THE REVERSE MpManm ulaEss n oisnav A CamNnnAun oms Camm Nm utEh6EL AAME AND ADDRESS UCENSE NUMBER MEDICAL COLLEGE OF PENNSYLVANIA HOSPITAL SNM-1996 g7o O 7 07 7 3300 HENRY AVENUE ucEnsE EmMATION DAM PHILADELPHIA PA 19129 September 30, 2002 A. MATERIALS DATA (Check one and complete as necessaryl THE LICENSEE OR ANY INDIVIDUAL EXECUTING THIS CERTIFICATE ON BEHALF OF THE LICENSEE CERTIFIES THAT:

f (Check and/or complete the appropriate item (s) below.)

]1. NO MATERIALS HAVE EVER BEEN PROCURED OR POSSESSED BY THE LICENSEE UNDER THIS LICENSE.

OR (2. ALL ACTIVITIES AUTHORIZED BY THE LICENSE HAVE CEASED AND ALL MATERIALS PROCURED ANDIOR POSS LICENSE NUMBER CITED ABOVE HAVE BEEN DISPOSED OF IN THE FOLLOWING MANNER. (If additionalspace is needed, use the i

'*TE'EN Y LYffYOf"T /11/97 Describe specific matenal transfer actions and, if there were radioactive wastes generated in terminating this license, the disposal actions mcluding the disposition of low-level radioactive waste, mixed waste, Greater-than-Class C waste, and sealed sources, if appkcable.

For transfers, specify the date of the transfer, the name of the license recipient, and trie recipient's NRC license number or Agreement State name and license number.

J if matenals were disposed of directly by the licensee rather than transferred to another licensee, licensed disposal site or waste contractor, desenbe the specific disposal procedures (e.g., decayin storage) 9906090018 990325 PDR ADOCK 07003077 C

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8. OTHER DATA d 1. OUR LICENSE HAS NOT YET EXPIRED; PLEASE TERMINATE IT.

2. A RADIATION SURVEY WAS CONDUCTED BY THE I.lCENSEE TO CONFIRM THE ABSENCE OF LICENSED RADIOACTIVE MATERIALS AND TO DETERMINE WHETHER ANY CONTAMINATION REMAINS ON THE PREMISES COVERED BY THE LICENSE. (Check one)

NO (Attach explanation)

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YES, THE RESULTS (Check one) l' ie

_1 ARE ATTACHED, or REFER TO LETTER OF 11/11/97 WERE FORWARDED TO NRC ON (Date)

3. THE PERSON TO BE CONTACTED

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REGARDING THE INFORMATION Theodore Villafana, Ph.D.

215-P',66U66 PROVIDED ON THIS FORM

4. Mall ALL FUTURE COnRESPONDENCE REGARDING THIS LICENSE TO Yvonne Zavada O

Chief Oneratine Officer CERTIFYING OFFICIAL O

I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT CO PHINTED NAME AND TITLE SIGNATUNE DATE Yvonne Zavada 3

Chief Operating Officer Q

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CNI WARNING: FALSE STATEMENTS IN THIS CERTIFICAT,Ej MAY BE SUBJECT TO CIVIL AND/OR CRIMINhL PEN ALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRCLBE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C

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l SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRFSEF IOg TO ANY DEPARTMENT OR AGENCY OF THE UNITE,DSTATP MR ANYggER WlppfJ 13 JURpfllCQW.,,,,, _

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FILE CERTIFICATES AS FOLLtWS:

IF YOU ARE LOCATED IN:

IF YOU ARE A DISTRIBUTOR OF EXEMPT PRODUCTS, SEND TO:

ILLINOIS, INDIANA, IOWA, MICHIGAN, MINNESOTA, MISSOURI, OHIO, OR WISCONSIN, SEND APPUCATIONS TO:

DIVISION OF INDUSTRIAL AND MEDICAL NUCLEAR SAFETY OFFICE OF NUCLEAR MATERIAL SAFETY AND SAFEGUARDS U.S. NUCLEAR REGULATORY COMMISSION MATERIALS LICENSING SECTION WASHINGTON, DC 20566-0001 U.S. NUCLEAR REGULATORY COMMIS$10N, REGION lil 801 WARRENVILLE ROAD LISLE. IL 60532-4361 ALL OTHERS, IF YOU ARE LOCATED IN:

ALASKA, ARIZONA. ARKANSAS, CAUFORNIA, COLORADO, CONNECTICUT, DELAWARE, DISTRICT OF COLUMBIA, MAINE, HAWAll, IDAHO, KANSAS, LOUISIANA, MONTANA, NEBRASKA, MARYLAND, MASSACHUSETTS, NEW HAMPSHIRE, NEW NEVADA, NEW MEXICO, NORTH DAKOTA, OKLAHOMA, JERSEY, NEW YORK, PENNSYLVANIA, RHODE ISLAND, OR OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, VERMONT, SEND Al PLICATIONS TO:

TEXAS, UTAH, WASHINGTON, OR WYOMING, SEND APPUCATIONS TO:

LICENSING ASSISTANCE SECTION NUCLEAR MATERIALS SAFETY BRANCH MATERIAL RADIATION PROTECTION SECTION S. NUCLEAR REGULATORY COMMISSION, REQlON l U.S. NUCLEAR REGULATORY COMMISSION, REGION IV 611 RYAN PLAZA DRIVE, SUITE 400 KING OF PRUSSIA, PA 19406 1415 ARLINGTON, TX 70011-8064 ALABAMA, FLORIDA, GEORGIA, KENTUCKY, MISSISSIPPI, NORTH CAROLINA, PUERTO RICO, SOUTH CAROUNA, TENNESSEE, VIRGINIA, VIRGIN ISLANDS, OR WEST VIRGINIA, SEND APPUCATIONS TO:

NUCLEAR MATERIALS SAFETY SECTION U.S. NUCLEAR REGULATORY COMMISSION, REGION 11 101 MARIETTA STREET NW, SUITE 2000 ATLANTA, G A 30323-0199

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