ML20207G324

Verifies Receipt of Completed NRC Form 483,dtd 990529 & Assigned Registration Number 9166 to Form

ML20207G324
Person / Time
Issue date:	06/10/1999
From:	Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS)
To:	Abbasi A AFFILIATION NOT ASSIGNED
References
SSD, NUDOCS 9906110114
Download: ML20207G324 (2)

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June 10,- 1999 3

Ali A. Abbasi, M.D.

D.B.A.: Diabetes & Endocrinology Center 1771 Woodward Avenue Bloomfield, MI 48302

Dear Dr. Abbasi:

This letter verifies the receipt of the completed NRC Form 483 dated May 29,1999. This form is a condition of the genc'/allicense under 10 CFR 31.11 authorizing in-vitro testing with byproduct material under general license.

The form has been assigned registration number 9166. 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.

j Sincerely, j

3-Traci Kime, Acting Registration Specialist Materials Safety Branch Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards 1

DISTRIBUTION:

SBaggett IMNS r/f NEO3 DOCUMENT NAME: H:\\TRACl\\ABBASI.483 Ta receive a copt of this document, Indicate in the box: 'C' = Copy without ettschrnent/ enclosure

• E' = Copy with attachrnent/ enclosure

• N" = No copy OFFICE MSB lC l

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l NAME-TKime t 12 DATE 6/10/99 i

OFFICIAL RECORD COPY l

9906110114 990610 PDR RC

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WITH BYPRUDUCT MATERIAL UNDER GENERAL t.lCENSE

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Seetion 31.11 of 10 CFR 31 establishes a general lisensa a~ thorning phynciacs, clinica 11aboratories, and hospitals ts Posess certain small quanaties cf byproduct material for in vitro clinical cr laborst ry rests not involvmg theinternalcr i

external administration of the byproduct material or the radianos therefrom to human beings or animals. Possesmon of byproduct statorial under 10 CFR 31.11 is not authorised until the physican, clinical laboratory. or hospital has filed NRC Form 483 and received from the Comunismon a validated copy of NRC Form 483 with registration number.

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ALI Ae ABB AS I, I. D.

D.B.A.:. DIABETES

3. I hereby apply for a registranon number pursuant to ENDOCRINOLOGY CENTER 931.11.10 CFR 31 for use of byproduct materials for gfP'"8' cl"'* *"'uce*n*n*d phnunan authonaed to dis bl oal l 1771 WOODWARD AVE.

1. 112

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a. Wymit.:duir BLOOMFIELDr MICHIGAN drugs in the practice of medicine.

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48302-O b. ne abovemamed clinical tabaratory.

O c. The above-named hosottal.

4. To be comp 6eted by the Nuclear Regulatory Commazion.

INSTRlJCTIONS.

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1. Submit this form in triplicate to:

Registranon number:

l Office of Nuclear Matenal Safety and Safeguards 9166 neo l

ATTN: Radioisotopes Ucensas Branch FOR THE U.S. NUCL REGkORYCOMMISSION l

U.S. Nuclear Regulatory Commusaon i

Washir,6 ton, D.C. 20333 y

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2. Please pnnt or type the name and address (includ.

f ing zap code) of the registrant raysician, clinical g+9 * * * * * #e 9(p l

laboratory or hospital for whom or for which this regutrauon form is filed. Posation the first l

letter of the address below the left dot and do yy'}hf,N,j,h,0,g, f,,,,,,,,,,,,, 3,,,, _,,,3,,,, 3, not extend the address beyond the right dot. (At NRC a registranon number wsit be asugned and escaned by NRC. If thrs is e change ofinformerson front a previously

,,,,,,,,,g y,,,,ellicensee. include your regrstrenon number.)

a validated copy of NRC Form 483 wd1 be re-turned.)

d S. If place of use is different from address in Item 1. please give complete addres-l l

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6. Cert 2ficauon:

I hereby certify that:

a.' Allinformation in this registranon certtficate is true and compiete.

b. The registrant has appropriate radiation messunns instruments to carry out the tests for which byproduct matertal mil be used under the t

l general license of 10 CFR 31.11. The tests wtil be performed only by personnel competent in the use of the instruments and in the l1 handling of the byproduct matenals.

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c. I understand that Commusten regulacons require that any :hange in the information fumished by a registrant on this res:stranon certificate be reported to the Director of Nuclear Matenal Safety and Safeguards wthin 30 days from the effecuve date of such change.

d. I have read and understand the provisions of Section 31.1! of NRC regulations 10 CFR 31 (repnnted on the reverse nde of this form);

l and I understand that the registrant is required to comply with those provisions as to all byproduct material which he receives, acquires.

j possesses. uses, or transfers under the generallicense for which this Registrauon Certificate is filed with the Nuclear Regulatory Commismos.

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.Det.:

ay A T.T A.

AB_ BASI,M.D, Signanare of person filing form Physician / Owner Prmted name and title or posuon of person filing form WAftNING-le US.C, Section 1001: Act of June 25,1948: 62 S tat. 749: mehee it a enmanal offense to meme a vnHfuny farse statement or representsoon to any ooperiment or agency of tne Unitec States as to any matter witnan its jurisciction.

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