ML20214K751
| ML20214K751 | |
| Person / Time | |
|---|---|
| Site: | 07000241 |
| Issue date: | 10/15/1986 |
| From: | Becker S BUCKNELL UNIV., LEWISBURG, PA |
| To: | |
| Shared Package | |
| ML20214K712 | List: |
| References | |
| NUDOCS 8612020446 | |
| Download: ML20214K751 (3) | |
Text
e U1 NUCLEAR KEGULATOtv COMMIS$104 NF.C FORM 313 APPIOVE3iV OMS 8bt 3154 0120 to CF A 30. 32,33. Ja, APPLICATION FOR MATERIAL LICENSE E. e ais?
n eo INSTRUCTIONS; SEE THE APPROPRIATE LICENSE APPLICATION GulOE FOR OETAILEO INSTRUCTIONS FOR COMPLETING APPLICATION SENO TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW.
FEDERAL AGENCIES FILE APPUCATIONS WITH IF YOU ARE LOCATED IN.
tLLINOIS. INDI ANA. IOWA MICHIGAN, RSE NNESOTA. MISSOURI, OHlo, OR U S. NUCLE AR REGULATORY COMMIS$10N OIVISION OF FUEL CYCLE AND MATERI AL SAFETY.NMS$
WISCONSIN, SEND APPL 4 CATIONS 70.
UCASHINGTON,DC 206S5 U S NUCLE AR REGULATORY COMutS$10N, REGION 11:
ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS, tr YOU ARE M ATE RI ALS LICENSING SECTION LOCATEDIN-799 ROOSEVELT ROAD GLEN ELLYN. lL 60137 CONNECTICUT DELAWARE. DISTRICT OF COLUMSIA. MAINE. MARvtANO.
MASSACHUSETTS. NEW HAMPSHIRE. NEW JERSEY. NEW YORK, PENNEYLVANIA.
AR K ANSAS. COLOR ADO, IDAHO, K ANSAS. LOutSI ANA. 40NT ANA. 4 ESR ASK A, RHODE ISLAND. OR VERMONT. SEND APPuCATIONS TO NEW ME XICO. NORTH D AKOTA. OKLAHOesA, SOUTH De (OTA, TEXAS, UTAH, OR WYOMING, SEND APPLICATIOPis 70.
U S. NUCLE AR REGULATORY COMMIS$10N. REGION l U S NUCLEAR REGULATORY COMutSS;ON. REGION IV NUCLE AR MATERIAL SECTION O MATERI AL R ADI ATION PROTECTION SECTION
$31 PARK AVENUE KING OF PRUSSI A, PA 19406 611 RV AN PLAZA ORIVE, SUITE 1mXI AR UNGTON. TM 76011 (LA8AMA FLORIDA. CEORQl A, K ENTUCKY. MISSl1SIPPf, NORTH CAROLINA.
PUE ~TO RICO. SOUTH CAROUNA, TENNESSE E, VIRGINE A, VIRGIN ISLANOS. OR ALASK A, Ani20N A. CAU FORNI A. HAWAal, NEVADA, OR E GON. WASHINGTON, ANO U.S. TERRITORIES AND POSSESSIOss$ IN THE PACIFIC, SEND APPUCAYtONS WEST vlRGaNEA, SEND APPLICATIONS TO:
70 U S. NUCLE AR REGULATOR Y COMMISSION. REGION il M ATERI AL R ADIATION PROTECTION SECTION U S NUCLE AR REGULATORY COMutSSON REGION V 101 MARIETTA STREET, SUITE 2900 MATERI AL R ADI AflON PROTECTION SECTION 1450 maria LANE. suite 210 K.TLANTA, GA 30323 WALNUT CREEK,CA 94596 PERSONS LOCATED IN AGREEMENT ST LTES SENO APPUCATIONS TO THE U S. NUCLEAR REGULATURY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL I4 STATES $uSJECT TO U1 NUCLEAR REGULATOR Y COMMISSION JURISDICTION.
- 1. THIS IS AN APPUCATION FOR (CPeet appropreere sesel 2.NAME AND MaluNG ADDRESS OF APPUCANT fractodele Copel X
A. NEW UCENSE Bucknell University 8 AMENoMENT TO uCENSE NeMSER Lewisburg, PA 17837
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- c. RENEWAL OF uCENSE nom 8ER
- 3. A.OUHESSiESI WHERE UCENSED MATERIAL WILL BE USED OR POSSESSEO.
Olin Science Bucknell University Lewisburg, PA 17837
- 4. NJ.ME OF PERSON TO BE CONTACTED A80UT THIS APPUCATION TELEPHONE NUMBER (717)524-1207 Stephen F. Becker
$USMlf ITEMS 5 THROUGH 11 ON 84 a 11" PAPER. THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDEO l$ DESCRIBED IN THE UCENSE APPuCATION GUIDE.
- 5. F;AOiOACTIVE MATERI AL
- e. Eiement ead mass numeer, tt chemecei and/or phys cel form, and C manimum amou t
- 6. PURPOSEISI FOR WHICH LICENSED MATERIAL WILL SE U$tO.
n usmca e. 44 ee possened at any one time
- 7. INDIVIDU4U$1 RESPONS'8LE FOR R ADIATION SAFETY PROGRAM AND THElR
TWAINsNJ AND EMPFRIENCE.
- 8. FACILIT.ES AND EQUIPMENT.
- 10. MAQlATION SAFETY PROGRAM 13 LICENSES >EES t$oe t0 CFR t/0endSectron t/031s AMOUNT
- 11. WASTE MANAGEMENT.
F EE CATEGORY l ENCLOSE D $
(Must se compresod er acor centf THE APPUCANT UNDERST ANDS THAT ALL STATEMENTS AND REPRESENT ATIONS MADE IN THis APPLICATION ARE 13 CERTIFIC A TION e
SINO NG LPON THE AP8UCANT THE APPUCANT AND ANY OF FICIAL EXECUTING THi$ CERTIFICATION ON SEM ALF OF THE APPLICANT, NAMED IN. TEM 2. CERTIFY TH AT THe$ APPUCATION is PREPARED IN CONFORVITY WITH TITLE 10. CODE OF FEDER AL REGULATIONS. PARTS 30,32,33. 34. 33, AND 40 AND TH AT ALL INFORMATION CONTAINED HEREiN.
15 TRUE AND CORRECT TO THE 8EST OF THEIR KNOWLEDGE AN3 SELIEF W ARNiNG 13 U S C. SECTION 100t ACT OF JUNE 75.1948 62 STAT 749 UAKES 17 A CRiviNAL OFFENSE TO M AKE A WILLFULLY F ALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATds AS TO ANY MATTER WITHiN ITS JURISDICTION TYPED PFilNTED NAME TITLE DATE SIGN ATuflE -CjgTIF ring OF FICER d L l~
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DATE 8612020446 861128 REG 1 LIC70 E
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s PRIVACY ACT STATEMENT Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by section 3 of the Privacy Act of 1974 (Public Law 93-579), the follow-irg statement is furnished to individuals who supply information to the Nuclear Regulatory Commission on NRC Form 313. This information is maintained in a system of records designated as NRC-3 and described at 40 Federal Register 45334 (Oct;ber 1,1975).
- 1. AUTHORITY: Sections 81 and 161(b) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2111 and 2201(b)).
- 2. PRINCIPAL PURPOSE (S): The information is evaluated by the NRC staff pursuant to the criteria set forth in 10 CFR Parts 30,32,33,34,35 and 40 to determine whether the application meets the requirements of the Atomic Energy Act of 1954, as amended, and the Commission's regulations, for the issuance of a radioactive material license or amendment thereof.
- 3. ROUTINE USES: The information may be (a) provided to State health departments for their information and use; and (b) provided to Federal, State, and local health officials and other persons in the event of incident or exposure, for their information, investigation, and protection of the public health and safety, The information may also be dis-cl sed to appropriate Federal, State, and local agencies in the event that the inforrrati(n indicates a violation or potential vi;tation of law and in the course of an administrative or judicial proceeding. In addit on, this information may be trans-ferred to an appropriate Federal, State, or local age' icy to the extent relevant ani r9cessary for an NRC decision or to an appropriate Federal agency to the extent relevant and necessary for that agency't 6 cision about you.
- 4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT f aN INDIVIDUAL OF NOT PROVID.
ING INFORMATION: Disclosure of the requested information is voluntary. If 'ne requested information is not furn-ished, however, the application for radioactive material license, or amendment th, reof, will not be processed. A request that information be held from public inspection must be in accordance with the provisions of 10 CFR 2.790. Withhold-ing from public inspection shall not affect the right,if eny, of persons properly and directly concerned need to inspect the document.
- 5. SYSTEM MANAGER (S) AND ADDRESS: U.S. Nuclear Regulatory Commissior Director, Division of Fuel Cycle and Aaterial Safety Office of Nuclear Material Safety an 1 Safeguards Washington, D.C. 20555 NRC FORM 313
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BCCKNELL
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Bucknell University Department of Physics Lewisburg, Pennsylvania 17837 Phone (717) 524-1207 October 15, 1986 ADDENDUM TO APPLICATION FOR MATERIAL LICENSE The maximum amount of material on hand at any one time will be a) 80 grams encapsulated as Pu239-Be neutron sources b).02 microcurie plated alpha sources The material is to be stored -- not used -- in a Nuclear Chicago Model NH-3 neutron howitzer until we can properly dispose of it (which we have been trying to do for two years). The howitzer is in a locked room.
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