ML20217G251
| ML20217G251 | |
| Person / Time | |
|---|---|
| Issue date: | 10/18/1999 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Krishnan A AFFILIATION NOT ASSIGNED |
| References | |
| SSD, NUDOCS 9910210233 | |
| Download: ML20217G251 (2) | |
Text
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.>* . October 18,1999- +
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"Amba R. Krishnan, M.D.' >
,i.evan Medical Center ' .
r-15140 Levan Road '. 4 Suite 600' .
Livonia, MI 48154' '
Deaf Dr. Krishnan:
u . . .
l This letter verifies the receipt of the completed NRC Form ~483 dated October 12,1999. This p 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 9173. 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.
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' If you have any questions or need further assistance, please contact me at (301) 415-8140.
Sincerely, o
i Traci Kime, Registration Specialist Materials Safety and Inspection Branch Division of Industrial and Medical Nuclear Safety Office of Nuclear' Material Safety and Safeguards QMilRIBUTION:
IMNS r/f NEO j DOCUMENT NAME: H:\TRACl\Krishnan.483 -
T* escelve a copr of this document, Indcate in the boa: "C" = Copy without attachment / enclosure "E' = Copy with attachment / enclosure *N" = No copy OFFICE ~ MSlB - l l l l l NAME TKime DATE A 8/99 OFFICIAL RECORD COPY 1
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9910210233 991018 PDR RC
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, NIC Perm 483 U.S. NUCLEA2 CEIULATI AY COMMIS$PN Appr!ves by CAO
, adr$as CECISTRATION CERTIFICATE-IN VITR3 TE'8 TIN 3 a ae.nosso WITH BYPRODUCT MATERIAL UNDER GENERAL LICENSE Section 31.'11 of 10 CFR 31 establishes a general license authorizing physicians, clinicallaboratories, and hospitals to posseu certain small quantities of byproduct materi.1 for in ritro clinical or laboratory testa not involving theinternat or external admmistration of the byproduct material or the radiation therefrom to human beings or animals. Possession of byproduct material under 10 CFR 31.11 is not authorized until the physician chnical laboratory. or hospital has filed NRC Form 483 and received from the Commission a validated copy of NRC Form 483 with registration numbe
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AMBA R. KRISHNAN. H.D.
LEVAN HEDICAL CENTER 3. I hereby' apply for a registration number pursuant to 15140 LEVAN RO. STE 600 $31.11.10 CFR 31 for use of byproduct materials for LIVONIA, HICHIGAN 48154 (please check one block only) 734-464-7600 E a. Mpelf.a duly ticensed physician authorized to dispense drugs in the practice of medicine.
O b. The above-named clinicallaboratory. I O c. The above-named hospital.
, 4. To be completed by the Nuclear Regulatory Commission.
INSTRUCTIONS ~
- 1. Submit this form in triplicate to: Registration number:
Office of Nuclear Material Safety and Safeguards
'173 9
ATTN: Radioisotopes Licensing Branch FOR THE U.S. NUCLE !BQTORY COMMISSION l U.S. Nuclear Regulatory Comminion Washington. D.C. 20555 [a k g S e
- 2. Please print or type the name and address (includ-
- ing tip code) of the registrant phyrician, clinical laboratory, or hospital for whom or for which l
. this registration form is filed. Position the first letter of the address below the left dot and do Traci Kime 10// 99e e * * *[ .
j not eatend the address beyond the ryht dot. (At fif this is an infrialregistration. leave this space blank - number to be NRC, a resistration number will be assigned and assigned by NRC if this is a change ofinfortnarion from a previousiv a vabdated copy of NRC Form 483 will be re- registered generallicensee. include your registrarron number.)
turned.) '
- 5. If place of use is different from addrenin Item 1.please give c6mplete address:
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- 6. Certification:
I hereby corttfy that:
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- a. A!!information in this regiseau certificate is true and completc.'
, b. The registrant has appropriate cadiation measuring instruments to carry out the tests for which byproduct material will be used under the i general license of 10 CFR 31.1L TM tests will be performed only by personnel competent in the use of the instruments and in the l j handling of the byproduct materials.
l c. I understand that Commission regulations require thal'any change in the information furnished by a registrant on this registration certificate be reported to the Director of Nuclear Material Safety and Safejuards within 30 days from the effective date of such change.
l d. I have read and understand the provisions of Section'31.ll of NRC regulations 10 CFR 31 (reprinted on the reverse side of this forml; 4
and I ur.derstand that the registrant is required to comply with those provisions as to all byproduct material which.he receives, acquires.
I poneues, uses.or transfers under the general hcense for which this Registration Certificate is filed with the Nuc1 car Regulatory Commission.
t Dets 1O
- C' 9 b gy ren b d 'M Signature of person fihng form
[- k Mbu\h b btOfMm M Prmted name and title or position of person filing fo'rin 19tlo n WARNING-18 U.S.C..Section 1001; Act of June 25,1948; 62 Stat. 749;makes it a criminal of fense to make a willfuHy false statement or representation to any department or agency of the United States as to any matter within its jurisdiction.
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