ML20217H713
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| ML20217H713 | |
| Person / Time | |
|---|---|
| Site: | 03034474 |
| Issue date: | 03/24/1998 |
| From: | Jonathan Montgomery NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION IV) |
| To: | |
| References | |
| 50-29111-01, 50-29111-1, 572628, NUDOCS 9804060033 | |
| Download: ML20217H713 (13) | |
See also: IR 05000291/2011001
Text
{{#Wiki_filter:u.s. NUCLEAR REGULATORY CoMZlssloN
m:ndm nt No. 03
MATERIALS LICENSE (Z{Tgv # .
Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93-438 and Title 10,
,
Cod 3 of Federal Regulations, Chapter 1 Parts 30,31,32,33,34,35,36,39,40, and 70, and in reliance on statements and
I
r:pr:sentations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess, and tr;nsfer byproduct, source, and specist nuclear material designated below; to use such material for the purpose (s) and at the place (s) d:signated below; to deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the cpplicable Part(s). This license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954,
l rs cmended, and is subject to all applicable rules, regulations, and orders of the Nuclear Regulatory Commission now or hereafter in l cffect and to any conditions specified below. !
ucensee in accordance with letter dated
- January 20,1998,
l 1, Alaska Cardiovascular Consultants 3. Ucense number 50-29111-01 is amended in
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Itientir.ety to read as foiiows:
2. 3260 Providence Drive, #537 4. Expirafio[n dat.e June 30,2002
Anchorage, Alaska 99508 h 5. Docket No. 03,0-34474
Reference No. k
6. Byproduct, source, and/or speciafD 7. Chemical and/or physical form 8. Idaximum amount that licensi e may
.
nuclear material 4/
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. 3, p6s~sess at any one time undt r this
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A. Any byproduct matenal A.f An radio]5harmaceutical A. gs needed
identified in 10 CFRj35.200 {ide tifie[:jl nj0 CFR 35.200 p
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(f) exceg aerosols [ gases and
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9. Authorized use W W [[g '
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A. Medical use described
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10. Licensed material shall be used only at ilities the$~ license
located at 3260~e's,f
Providence Drive,
Suite 537, Anchorage, Alaska.
11. The Radiation Safety Officer for this license is Mark A. Selland, M.D.
12. Authorized Users:
A. Mark A. Selland, M.D. for material identified in 10 CFR 35.200 restricted to nuclear cardiology.
B. Robert Lee Pulliam, M.D., for material identified in 10 CFR 35.200 restricted to nuclear cardiology.
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NRC FORM 374A * u.s. NUCLEAR REGULATORY Commission PAGE 2 of a PAGEs
License Number
i 50-29111-01
Docket or Reference Number
I MATERIALS LICENSE
SUPPLEMENTARY SHEET 030-34474
l l Amendment No. 03 i
13. In addition to the possession limits in Item 8, the licensee shall further restrict the possession of licensed
'
material to quantities below the minimum limit specified in 10 CFR 30.35(d) for establishing
decommissioning financial assurance.
14. The licensee shall maintain records of information related to decommissioning at 3260 Providence Drive,
#537, Anchorage, Alaska per the provision of 10 CFR 30.35(g) until this license is terminated by the
Com mis $i "-
pR req g
15. Except as specifically provided otherwise in this license, the licensee shall conduct its program in
accordance with the statementsj r$ presentations, and procedure's'iontained in the documents, including
any enclosures, listed below2except for minor changes in the medical 0,se radiation safety procedures as
provided in 10 CFR 35.3).,The U.S. Nuclear Regulatory Commission's. regulations shall govern unless
the statements, representations, and procedures in the licensee'.s.applicstion ~
and correspondence are
more restrictive than the'regul$ tion'sA /-i
b I. 3 ()
A. Application dated 1(ay i; ' 20,1997[b)-
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B. Facsimile dated June 23,1997' ,;
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C. Letter dated December 2,1997k.V.hf# d.O d . $
D. Letter dated Janunr'y 20, ip87 Y : %--}# " Y Alj/
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FOR THE U.S. NUCLEAR REGULATORY COMMISSION
Dcte By h ~
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Ifaterials' Branch 'u' f
Region IV
Walnut Creek, California
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u.s. NUCLEAR REGULATORY CoMZtssioN
m:nd in No. 03
MATERIALS LICENSE O
Pursurnt to the Atomic Energy Act of 1954, as amended, the Energy Reorganization A.ct of 1974 (Public Law 93-438), and Title 10, Code of Federal Regulations, Chapter I, Parts 30,31,32,33,34,35,36,39,40, and 70, and in reliance on statements and r: presentations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess, and tr:nsf:r byproduct, source, and special nuclear material designated below; to use such material for the purpose (s) and at the place (s) design: led below; to deliver or transfer such material to persons authorized to rec;;,!ve it in accordance with the regulations of the applicable Part(s). This license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, cs cmended, and is subject to all applicable rules, regulations, and orders of the Nuclear Regulatory Commission now or hereafter in effect cnd to any conditions specified below.
Licensee in accordance with letter dated
January 20,1998,
1, A!:ska Cardiovascular Consultants 3. Ucense number 50-29111-01 is amended in 2. 3260 Providence Drive, #537
pBE 6 entirety to read as follows:
4. Expiratio'n date June 30,2002
Anchorage, Alaska 99508 h 5. Docket No. 03,0-34474
Reference No. k
6. Byproduct, source, and/or special'd 7. Chemical and/or physical form 8. M$ximum amount thatlicensee may
nuclear material 4.lf Qy ,j, pots'ess at any one time under this
m ') . iQ '$
A. Any byproduct matehal kA.3,
:A. radiopharma,ceutical A. gs needed
identified in 10 CFRl35.200 bide tified,jn 30 CFR:35.200
(f) "exc'eptherdsoisfgss~ es1and 5
h en. era'tdrs / g
O h%. $lb!f :[f( /h '
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9. Authorized use W W '
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A. Medical use describedI10 CFR 35l200# cNd to n el ar cardhlogy.
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10. Licensed material shall be used only at the fiEensEe's f'acilities located at 3260 Providence Drive,
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Suite 537, Anchorage, Alaska.
11. The Radiation Safety Officer for this license is Mark A. Selland, M.D.
12. Authorized Users:
A. Mark A. Selland, M.D. for material identified in 10 CFR 35.200 restricted to nuclear cardiology.
B. Robert Lee Pulliam, M.D., for material identified in 10 CFR 35.200 restricted to nuclear cardiology.
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NRC FORM 374A -
U.s. NUCLEAR REGULATORY Commission PAGE 2 of 2 PAGEs
Ucense Number
50-29111-01
MATERIALS LICENSE Docket or Reference Number
SUPPLEMENTARY SHEET 030-34474
Amendment No. 03
13. In addition to the possession limits in item 8, the licensee shall further restrict the possession of licensed
material to quantities below the minimum limit specified in 10 CFR 30.35(d) for establishing
dscommissioning financial assurance.
14. The licensee shall maintain records of information related to decommissioning at 3260 Providence Drive,
#537, Anchorage, Alaska per the provision of 10 CFR 30.35(g) until this license is terminated by the
Commission.
pR req g
15. Except as specifically provided otherwise in this license, the licensee shall conduct its program in
accordance with the statementsjYdpresentations, and procedures'cohtained in the documents, including
any enclosures, listed below?except for minor changes in the medical {se radiation safety procedures as
provided in 10 CFR 35.3,13 The U.S. Nuclear Regulatory Commission's. regulations shall govern unless
the statements, representations,.and procedures in the licensee's applicstion ~
and correspondence are
more restrictive than t e' regulation'i?
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A. Application dated (ay .l ' 20,199{rU
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B. Facsimile dated J,une 23,1997t.. y
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C. Letter dated December 2,1,997"
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FOR THE U.S. NUCLEAR REGULATORY COMMISSION
Date By Ao
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Region IV
Walnut Creek, Califomia
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: INFORMATION FROM LTS
BETWEEN. .
License fee Management Branch. ARM Program Code: 02201
and : Status Code: 0
Regional Licensing Sections : : 7C s ,n
FeeCategor50020630
Exp. Date:
.
: Fee Comments:
h~.d t u 20 Pi 1: 211
: Decom Fin Assur Mega: N
:: :::::::::::.::::::: .::::::::.::: :
LICENSE FEE TRANSMITTAL
A. REGION d
1. APPLICATION ATTACHED
Applicant / Licensee: ALASKA CARDIOVASCULAR CONSULTANTS
Received Date: 980218
Docket No: 3034474
Control No.: 572628
License No.: 50 29111 01
Action Type: Amendment
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Check No.:
3. COMMENTS
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B. LICENSE FEE MANAGEMENT BRANCH Check wh6n milestone 0[
1. Fee Category and Amount: N
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2. Correct Fee Paid / Application may be processed for; U}n'4 3 MW //~~
-Amendment ,/
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License
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UNITED STATES
t NUCLEAR RE2ULATORY COMMISSION
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REGION IV
( 8 Walnut Creek Field Omce
9 , , , , , *# 1450 Maria Lane, Suite 3oo
Walnut Creek, California 94596-5368
March 24,1998
Alaska Cardiovascular Consu4 ants
ATTN: Joseph C. Bartz
3260 Providence Drive, #537
Anchorage, Alaska 99508'
SUBJECT: LICENSE AMENDMENT
Please find enclosed License No. 50-29111-01. You should review this license carefully and be
sure that you understand all conditions. !f you have (my ouestions, you may contact the
reviewer who signed your license at 925-975-0249.
NRC expects licensees to conduct their programs with meticulous attention to detail and a high
standard of compliance. Because of the serious consequences to employees and the public
which can result from failure to comply with NRC requirements, you must conduct your program
involving radioactive materials in accordance with the conditions of your NRC license,
representations made in your license application, and NRC regulations. In particular, note that
you must:
1. Operate in accordance with NRC regulations 10 CFR Part 19, " Notices, Instructions and
Reports to Workers: Inspection and investigations," 10 CFR Part 20, " Standards for i
Protection Against Radiation," and other applicable regulations.
]
2. Possess radioactive material only in the quantity and form indicated in your license.
3. Use radioactive material only for the purpose (s) indicated in your license.
4. Notify NRC in writing of any change in mailing address (no fee required if the location of
radioactive material remains the same).
5. Request and obtain written NRC consent before transferring your license or any right
thereunde',r either voluntarily or involuntarily, directly or indirectly, through transfer of
control of your license to any person or entity. A transfer of control of your license
includes not only a total change of ownership, but also a change in the controlling
interest in your company whether it is a corporation, partnership, or other entity. In
additic; sopropriate license amendments must be requested and obtained for any other
planned ciages in your facility or program that are contrary to your license or contrary
to representations made in your license application, as well as supplemental
correspondence thereto, which are incorporated into your license. A license fee may be
charged for the amendments if you are not in a fee-exempt category.
6. Maintain in a single document decommissioning records that have been certified for I
completeness and accuracy listing all the following items applicable to the license:
- Onsite areas designated or formerly designated as restricted areas as defined in
10 CFR 20.3(a)(14) or 20.1003.
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Alaska Cardiovascular Consultants - -2-
-' Onsite areas, other than restricted areas, where radioactive materials in
. quantities greater than amounts listed in Appendix C to 10 CFR 20.1001-20.2401
have been used, possessed,' or stored.
* Onsite areas, other than restricted areas, where spills or other unusual
occurrences involving the spread of contamination in and around the facility,
equipment, or site have occurred that required reporting pursuant to 10 CFR
30.50(b)(1) or (b)(4), including areas where subsequent cleanup procedures
have removed the contamination.
=. Specific locations and radionuclide contents of previous and current burial areas
within the site, excluding radioactive material with half-lives of 10 days or less,
depleted uranium used only for shielding or as penetrators in unused munitions,
or sealed sources authorized for use at temporary job sites.
. l'
a~ Location and. description of all contaminated equipment involved in licensed
. operations that is to remain onsite after license termination.
7. . Submit a complete renewal application with proper fee, or termination request at least
30 days before the expiration date on your license. You will receive a reminder notice
. approximately 90 days before the expiration date. Possession of radioactive material '
after your license expires is a violation of NRC regulations.
8. ' Request termination of your license if you plan to permanently discontinue activities
involving radioactive material.
Ycu will be periodically inspected by NRC. Failure to conduct your program in accordance with
. NRC regulations, license conditions, and repretentations made in your license application and
supplemental correspondence with NRC will result in enforcement action against you. This
; could include issuance of a notice of violation; in) position of a civil penalty; or an order
suspending, mdifying, or revoking your license as specified in the " General Statement of
Policy and Piocedure for NRC Enforcement Actions" (Enforcement Policy), NUREG 1600.
Thank you for your cooperation.
!
Sincerely,
&
James L. Montgomery
c=
Senior Health Physicist
Materials Branch
Docket: 030-34474
License: 50-29111-01
Control: 572628 .)
Enclosures: As stated !
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i L , Alaska Cardiovascular Consultants -3- l ,
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LFARB, T-9, E10
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Docket File '
j State of Alaska (License Only) i- i , l
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DOCUMENT NAME: G:\572628.JM ,
~- To receive copy of document, Indicato in box: "C" = Copy without enclosures "E" = Copy with enclosures "N" = No copy I
RIV:MB l
JLMontgomery b l
7 /M/98 -l
OFFICIAL RECORD COPY
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Alacke Ccrdisveccular Cancultento .
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3260 Providence Dr. #537
1200 A*r port Heights #330 i
Anchorage, AK 99508 Cj3 [ [ -2 N b b
(907) 562-7575 * Fax (907) 563-9386
Practice Limited to Cardiovascular Diseases
- Rded A. Anachusu, MD, FA.C.C.
John C. Finley, M.D., FA.C.C.
Thomas K. Kramer, M.D., FA.C.C. -
WWiem P. Meyer, M.D., FA.C.C.
Paul A. Peterson, M.D. ,
Rabort L. Pumam, lil, M.D., FA.C.C.
Mark A. Seitend, M.D.
David W. Sonnebom, M.D., FA C.C.
. Jim Montgomery
Nuclear Regulatory Commission
Nuclear Material licensing Branch Region IV
Walnut Creek Field Office
1450 Maria Lane
Walnut Creek, California 94596
Date 1-20-98
Ref License number @-01 Docket number 030-34474
Jim:
Enclosed please find the information you needed for the decommissioning of the treadmill room
! marked # 1 on the enclosed drawings. The following as per the enclosed list you faxed to me.
1 T1210 and Tc99M was used from Sept 1Ith 1997 thru Dec 15th 1997. 3-4 injections per day.
less than 30 mci Tc99m and less than 3.5 mci TL201 per injection.
l- 2. Physical form injectable TL210 and Tc99m for cardiac nuclear medicine studies. ! [- 3. No major spills occurred. l
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4. No sealed sources were stored in the room.
5. All areas as marked on the enclosed drawings surveyed and measured by calibrated survey
meter were less that 0.3 mr/hr and were at average background levels for that area.
All wipe tests as noted on the drawings and wipe test of equipment in room (see enclosed
list)
were less than 2000DPM as documented by our wipe test counting device. !
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6. Survey meter is the Ludlum model # 14C by Biodex, calibration 'is included, and the wipe
test counter is the Victoreen Nuclear Associates model # 05-578.
7. Drawings of room and locations of wipe' tests and surveys included. ;
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8.' No residual contamination was found.
'9. As above
10.N/A-
11. . No radioactive waste was found or remover from the room.
Please inform us if any more information is needed in this regard. Thank you for your help in
this matter.
Sincerely;
'[seph C. Bartz R T.
Nuclear Imaging 1
Alaska Cardiovascular Consultants
{
3260 Providence Drive # 537 ;
: Anchorage, Alaska 99508
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TREADMILL ROOM NUMBER 1 EQUIPMENT LIST:
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1.' QUINTON TREADMILL.
2. QUINTON COMPUTER CONTROL.
3. TREATMENT TABLE.
'4. DEFIBRILLATOR.
5. ROLLING METAL CART.
6. ROTATING FAN.
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8. SHARPS CONTAINERS.
< l- 9. PULSE OX MACHINE.
10. GRASLEY SYRINGE PUMP. j
1 l 11. : IV POLE. l i l
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* Designer and McProcture ' LUDLUM MEASUREMENTS, INC.
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POST OFFICE BOX bio
scienunc and h*nkkd PH. 915-235-5494
CERTlflCATE OF CAU8 RATION 501 OAK STREET FAX NO. 915-235-4672
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SWEETWATER, TEXAS 79556. U.S.A.
CUSTOMER BIODEX MEDICAL SYS ORDER NO. 967129
Mfg. Lu@m MegmpmentidDg. Model 14C Serial No._.lNd 73
Mfg. . Lb@U1MO.QMementsJac. Model 44-7 SerialNo. F8M/857
Col. Dota _ _05/2?/97 Col D>e Date 05/29/98 Col. Interval 1 Year _ Metertoce 202-330
Check .amk dopplies lo applicable instr. and/or detector IAW mfg. spec. T. 77 'F RH 49 % Alt 7016 mm Hg
[QJ Newinstrument instrument Received O Within Toler. +-10% 010-20% 0 Out of Tol. O Requiring Repair O Other-See commen's
[f Mechanicalck. [d MeterZeroed O BackgroundSubtract 0 input Sens. Linearity
[f F/S RIsp.ck [f Reselck. O windowOperoflon Ed Geotropism
[d Audiock. O Aiorm Setiing ek. [d Boti. ct. (Min. voit) 2.2 vDC
O Colibrated in accordance with LMI SOP 14.8 rev 12/05/89. 7Colibrated in occordance with LM1 SOP 14.9 rev 12/19/89.
Threshold m'
trittument Voll Set 900 V Input Sens. _._'10 mV Det.Oper. 900 V of 30 mV Dio! Rotio =
0 HV Readoul(2 points) Ret./ Inst. / V Ref./ inst. / V
COMMENTS:
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REFERENCE INSTRUMENT REC"D INSTRUMENT j
RANGE /MULilPLIER CAL POINT "AS FOUND READING" METER READING * q
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_X1000 _ 1500mR/hr _/ F
_X1DQO 500mR/hr QT
__.X100 150mR/hr /,S
X100 50mR/hr O. '/5
_K.10 15mR/hr _/5
X 10 hmR/hr OM
X1 1.5mR/hr= '2 95Dcm '
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j _ XQJ '/2 cpm O. 5 j *0neart.,Inty within i 10% C.f.within 1 ;o , XOJ Range (s)Collbrated Electronicotty
REFERENCE INSTRUMENT INSTRUMENT REFERENCE INSTRUMENT INSTRUMENT
CAL. POINT RECEIVED METER READING * CAL. POINT RECEIVED METER READING *
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Ludlurn Mooturements. he. certlfles tint We above instrument Pos been coltwated by sfondords traceable to Itw National tutitute or standards and lectriology. or to tie Colbrotlan focNMes of
other hiemollonal standards ()gorhtion membert, or teve been derived trom occepted values of natural physical corutants or have been dertved by the rollo type of coIbroflon techniques.
nn coloroison system conforms to its requ6ements or Mit stD45M2A and ANsl PG23-t978. sione of texos Colbration Ucense No.10-1963
Reference Instruments and/or Sources:
Cs-i37 GarnrnoS/N [dll62 O Gii2 O us65 0sios MTioos O1879 O Ess2 O Essi O seuiron Arn 24i se s/s T.ao.
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[f m 5005/N 63888 0 oscilioscope s/N .- ._ O Multimeter$/N
Calibrated By:
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Date
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