ML20211F285

Verifies Receipt of Completed NRC Form 483,dtd 990823. Requests That Asssigned Registration Number 9110 Be Ref When Making Changes to Any Info on Form

ML20211F285
Person / Time
Issue date:	08/27/1999
From:	Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS)
To:	Hogan J AFFILIATION NOT ASSIGNED
References
SSD, NUDOCS 9908300292
Download: ML20211F285 (3)

Text

r-August 27,1999 J&N Vet Lab, Inc.

ATTN: Joseph S. Hogan President 10 West Burnham Avenue Sapulpa, OK 74066

Dear Mr. Hogan:

This letter verifies the receipt of the completed NRC Form 483 dated August 23,1999. 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 9110. 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 J

Regulatory Commission, Washington, DC 20555.

If you have any questions or need further assistance, please contact me at (301) 415-8140.

Sincerely, l

4

/s/

Traci Kime, Registration Specialist Materials Safety and Inspection Dranch Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety l

and Safeguards DISTRIBUTION:

y IMNS r/f NEO3-DOCUMENT NAME: H:\\TRACl\\ Hogan.483 Te receive e copy of this document, Indicate in the box: "C* = Copy without attachment / enclosure

• E" = Copy with attachmentienclosure

• N* = No copy OFFICE MSIB l

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l l

NAME TKime d

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OFFICIAL RECORD COPY 9908300292 990827 PDR RC i

SSD PDR 1

E NRC FORM 483 U. S. NUCLEAR REGULATORY COMMISSION APPROVED BY OhR NO. 3150-0038 EXPLRES: 6-30-99 I

Esnmend taurden per response to comply with the mancatory ntormabon

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REGISTRATION CERTIFICATE --In vitro TESTING "w'""'"',',',.'n".'i"T.",w'".",.*"o'o',*"le,0,"'f;'O*;1"" *r,'l'7' O

'WITH BYPRODUCT MATERIAL UNDER Z ""' """"" W Ec"'"EsM"xA, ".'n "."',';

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Paperwork Reduchon Praiset (3154o036), Ofhce of Management and GENERAL LICENSE su e w hin ion. oc u,os wRc.n r noi.onouci-.n..

person a. not.equwed to rumpond to, a cr.nectica of informabon unless it displays a currently wahd oMB control number Szctan 31.11 of 10 CFR 31 estabhshes a general heense authonzing physicians, chnical laboratories, hospitals, and vetennarians in the practice of vetIrinary medicine to possess certain small quantities of byproduct matenal for in vitro chnical or laboratory tests not involving the intemal or extemal administration of the tr/ product material or the radiation therefrom to human beings or animals. Possessaan of byproduct matenal under 10 CFR D 1 is not cuthonzed until the physacian, chnicallaboratory, hospital, or vetenanan in the practice of vetennary medcine, has filed NRC Form 483 and received from the Commession a valk4ted copy of NRC Form 483 with a registration number.

1. NAME AND ADDRESSOF APPLICANT (See instruccon 3 8. below) -

.e ele &mePPLICATION (Checkoneboxonly)

I hereby apply for a registrahon number pursuant to 10 CFR 31, Section N & M Vet Lab [ C,..

31.11. for use of byproduct matenais for:

ATTN: Joe Hogan A. Myself, a duty bcensed physcian authortred to disperse drugs in 10 Went Dirnhan Avenue the practce of medcira Snnul m, T 74h66 2

B The abovecamed chnicallaboratory.

^

TELEPHONE NUMBER pnclude See Code)

C. The above named hospital.

MAM4W D Vetennanan in the practice of vetennary medicine

4. REGISTRATION 3.

INSTRUCTIONS:

I A.

Submit this form in dupicate to.

REGISTRATION NUMBER:

Medical, Academe and Commercial Use N10

/g* "E0g'o l

Safety Branch (T-8 FS)

Division of Industnal and Medcal Nuclear Safety m.,

,,7 3 pI Office of Nuclear Matenal Safety and Safeguards y"

U S. Nuclear Regulatory Commission

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e Washington, DC 205554)001 C

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(At NRC, a registration number wdl be assigned and a validated copy 3 NRC Form 483 wdl be retumed )

f dD Id7*

B. In the box above, pnnt or type the narne, address (including ZIP (If this an insdalrepstrabon, Jeave ftus space blank - number to be Codei, and telephone number of the registrant physcian, chncal assigned by NRC. //this is a change ofinformahon from a previously laboratory, hospital, or vetennanan in the practice of ve'ennary repstered peneraf #conse, indude your regrstradon number.)

medcine for whom or for whch this registration form is filed.

5, if place of use is different from address hsted above, give complete addrsss:

6, CERTIFICATION 1 hereby certify that:

A.

All informaten in this registration certificate is true and complete.

The registrant has sporopnre radiation measuring instru nents to carr) out the tests for whch byproduct material w21 be used under the gene B.

heense of 10 CFR 31.11. The tests. Will be performed only by personnel competent in the use of the instruments and in the handhng of the byproduct matenals I understand that Cornmessaan regulations require that any change in the lnformahon fumeshed by a regestrant on this registration certificate be C.

reported to the Director of Nuclear Matenal Safety and Safeguards within 30 days from the effective date of such change.

l I have read and understand the provisaons of Section 3111 of NRC regulations 10 CFR 31 (repnnted on the reverse side of this form), and l l

D understand that the registrant is requved to comply with those provisions as to all byproduct material which he recetves, acquires, possesses, uses, l

or transfers under the general hcer'se for whch this 81egtstration Certifcale isTiled with the U.S. Nuclear Re0ulatory Commission.

j F APPLICANT DATE l

SIGNA, R n

PRINTED OR TYPED NAME AND TITLE OF APPLICANT v.:

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FALSE STATEMENTS IN THIS CERTIFICAIE MAY BE SUBJECT TO CML AND/OR CRIMINAL l

WARNING:

PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND A ALL MATERIAL RESPECTS.18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WI FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED ST ANY MATTER WITHIN ITS JURISDICTION, wenonM.ss pes >

4 NRC FORM 483 U. S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB; NO. 3150 0038 EXPlRES: 6-3o 99 1

ro oe Estmated burden per response e comply with the mandatory mformahon cohechon request 'r mmutes The valsdated regstration sonres as evioence REGISTRATION CERTIFICATE -in vitro TESTING

",%*'*,ni','a"1"T*"L",ne' n"ts $1*,l *u'0*e' "l*C y

s, WITH BYPRODUCT MATERIAL UNDER Po,"%' y" c*fn'" Ea"s"*% E"'"2O IE "a'd m %

GENERAL LICENSE Paperwork Reducson Propect (31sooo33), othee of Management end suo,et wes

n. oc 20 sos NRc mar noi.onduct o, soo,so, and a person o not reouared to respond to. a collechon of mformat>on unless it desplays e currently vahd OMB control number Section 31.11 of 10 CrR 31 establishes e general license authonzing physicians, clinical laboratories, hospitals, and vetennarians in the practice of vstennary medicine to possess certain arna:T ouantities of byproduct mate 1al for sn vrfro chnical or laboratory tests not involving the intemal or extemal administration of the byproduct matenal or tne radiation therefrom to human beings or animals Possession of byproduct material under 10 CFR 31.11 is not authonzed until tne phytJcian, clinica! laboratory. hospital, or vetenanan in the practice of vetennary medicine, has filed NRC Form 483 and received from the Commission a validated copy of NRC Form 483 with a registration number.

1. NAME AND ADDREES OF APPUCANT (See instruccon 3.8. below)

-. 4 2. APPLICATION (Check one box only) g I hereby apply for a registration number pursuant to 10 CFR 31, Section g;

31.11, or use of byproduct materials for:

A. Myself, a duly licensed physician authorized to disperse drugs in the practice of medicine.

8. The above-named clinicallaboratory.

TELEPHONE NUMBER Pnclude kee Codel C. The above named hospital D Vetennanan in the practice of veterinary medicine 3.

INSTRUCTIONS:

4. RECISTRATION A.

Submit this form in occlica^e to:

gg g

Medical. Academic and Commercial We Div,sion of industnal and Medical Nt.c: ear Safety

/peR Rf og'o,^

Safety Branch (T-6 F5)

Office of Nuclear Ma enal Safety and Safeguards J"

U S. Nuclear Regulatory Commiss.cr E

o Washington, DC 20555-0001 E

%}

\\*****8 (At NRC, a regtstration number w41 t:e essigned and a validated copy of NRC Form 483 will be retumed )

B.

In the box above, pnnt or type the name, address (including ZIP l

Code), and telephone number of the registrant physician, clinical (if this an inadal regtstrabon, leave this space blank - number fo be f

laboratory, hospital, or veterinanan in the practice of vetennary assigned by NRC. If this is a change ofinformaton from a previously medncine for whom or for which this regtstration form is filed.

regmtered general Gcense, include your registradon number)

5. If place of use is different from address hstea soove, grve complete address-

6. CERTIFICATION I hsfeby certify that:

A.

All information in this registraticn certificate is true and complete.

B.

The registrant has aopropnate radiation measunng instruments to carry out the tests for which byproduct material will be used under the general license of 10 CFR 31.11. The tests will be performed only by personnel competent in the use of the instruments and in the handling of the byproduct materials C.

I understand that Commission regulations &* quire that any change in the information fumished by a registrant on tnis registration certificate be reoorted to the Director of Nuclear Matenal bafety and Safeguarcs within 30 days from the effective date of such change.

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 I understand that the registrant is required to compty with those provisions as to all byproduct matenal which he receives, acquires, possesses, uses, or transfers under the gererallicense for which this Registration Certificate is filed with the U S, Nuclear Regulatory Commission.

PRINTED OR TYPED NAME AND TITLE OF APPLICANT SIGNATURE OF APPLICANT DATE

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gs 3"

/

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 WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.

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