ML20217H157
| ML20217H157 | |
| Person / Time | |
|---|---|
| Issue date: | 10/19/1999 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Olkhovsky A AFFILIATION NOT ASSIGNED |
| References | |
| SSD, NUDOCS 9910220066 | |
| Download: ML20217H157 (2) | |
Text
October 19,1999 Kern Hospital Laboratory ATTN: Alex Olkhovsky, Core Lab Manager 21230 Dequindre Warren, MI 48091
Dear Mr. Olkhovsky:
This letter verifies the receipt of the completed NRC Form 483 dated October 8,1999. This form is a condition of the general license under 10 CFR 31.11 authorizing in-vitro testing with byproduct material under general license.
i The form has been assigned registration number 9174. 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 r;eed further assistance, please contact me at (301) 415-8140.
Sincerely, 4
Traci Kime, Registration Specialist Materials Safety and inspection Branch Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards
)
DISTRIBUTION:
IMNS r/f NEO3 b DOCUMENT NAME: H:\\TRACl\\Olkhovsky.483 T, receive a copy of this document. Indicate in the box: "C" = Copy without attachment / enclosure
'E' = Copy with attachment / enclosure "N" = No copy OFFICE MSIB l
l l
NAME TKime 18 s
DATE' 10//f/99 OFFICIAL RECORD COPY h
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9910220066 991019 PDR RC SSD PDR
'OCT-07-99 THU 14:59 P.Ot Tac enna nas U.S. peuCLEA.3 LtLVLAT4 Y COMMISSION ~
Arrawassua are M6M3a 88 4M EtPipf.o. treeJ 4A oM L3 t h
$s e e W A
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. REGISTRATION CERTlFlCATE-in vitro TESTING
-e=n asasacrac evaom estmare to vns -cam,c WITH BYPRODUCT MATERI AL UNDER GENERAL UCENSE EtYlE4v'oYv"offisIWsUr'oa"oNs!
AND To TMt PAPEpwonK eEDVCTioso e4oJECT 131600013 o#PtCt or MaNaGtyggt Aho 6V0047. wAsMihCTom. D tobot.
Gaction 31.11 et 10 CFR 31 estoblisMs a generallicettee authorizing physiciens.elinicallaboretories. hospitals and veterinariens in the practka of aterinar.
medkina to possens certain small owantitles of byoroefuct meterial for h' r/tro clinkal or laboratory tests not involving she Internal or esternst admints retko-
[f the byproduct materlel or the redittlon therefrom to hWman treings or anlmels. Possession of byproduct materiel under 10 CFR 31.11 is not a.ithcrict; unt2 the Dhysition. ClinlCal laboratory, hospital, or veterinarlan its the practke of veterinary rnadicine,has fded NRC Form 483 end received from t e Con
- h miska c walknated Copy of NRC Forn) 483 reglstration number.
2, APPLICATION KG.E,fd ri M 7AL U M MoGy I hereby apply for a registration number pursuant to 10 CFR 31,
~
Nb W'Y Section 31.11, for use of Dyproduct mateflats for:
(Check one boat only)
M f'f%
M T_
@ Ol l A. Myself. O duly licensed physician authorized to dispente drup b @ # bDOMS'W2d
~
fti.Jrhe ebove named clinicallaboratory.
in the practice of medicine, m
T The above-named hospital.
D. Veterinarian in the Dractice of veterinary medicine.
- 1. INSTRUCTIONS:
A. Submit this form in triplicate to:
- 3. REQlSTRATION Medical, Academic and Commejr ial se Safety Branch (SH3)g/TN!
r; c.,
Division of Industrial and Medical uclear ety Office of Nuclear Material Safety and Safeguards REGISTRATION NUMBER:
U.S Nuclear Regulatory Commission q174 Washington. D C 20555 FOR TIIE U g,gCLEAR REGULATORY COMMISSTON (At NRC. a registration number will be snelgned k
and a validated copy of NRC Form 483 will be y
returned.)
p, e
o B. In the bom above pritit or type the name and addre1:
lincluding ZIP Code) of the registrant physician k. e[
clinicallaboratory, ho,pital. or veterinarian in the s
practice of veterinary medicine for whom or for ffg 1 which this registration form is fHed.
1ac1k(im., ~g C
October / /,1000 (If this is on initialregistration, leen this apace blank - number to be easigtsed by NRC. If this is e ebense ofinformation from apreviously registeredgenerallicense, lisclude your registration ttumber.)
. If place of use is different frc rn ad(tress listed above, give complete address:
I hereby cmify thet:
- 5. CERT 8 FICATION A.
All information in this registration ce.rtificate is true and complete.
S.
the general license of 10 CFR 31.11. The tests will be performed o meterial will be used under thi hindling of the byproduct materials.
I und:rtrand that Corr ~ssica n the use of the Instruments and in n
2.
certifieste be reported te the Oirector of Nuclear Material Safety and Safegua changt.
n e effective date of such 3
I have reed and understand the provisions of Section 31.11 of NRC r'egulations 10 CFR f2rm); and I understand acquires, possesses, uses.tnat the registrant is reoulted to comply witri those prowlsi n the reverse side of this e
or transfers under the general license for which this Registrattori Certificate is Regulatory Commission.
. uclear I
NTED OR TYPeO NAME AND fif[OP APPLtCANT lSIGNATUrtE O
- iiCANT ALE A OL% cVs ef GM (d Mme lDAT6
~
~- ~
' h AINisQ FALSE STATE. MEN 18 IN
/M %
EQulHE THAT SU3MIC$10NS TO THE NRC SE COMPLE.TE AND AC
' o CRIMINAL OFFINSI TO MAKE A WILLPULLY FALSE ETATEMENT OR RE MAL REsptcT3,19 U.E.C. SECTION foCf MAKt6 NALTIES. NAC REGULATIONS 4tTED STATES A3 70 ANY MATTER WITHIN ITS JURIs0lCTIOW PRESENTATION TO ANY OEPARTMENT su <es ne un H
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