ML20235M171
| ML20235M171 | |
| Person / Time | |
|---|---|
| Site: | 07002606 |
| Issue date: | 05/04/1987 |
| From: | Burg W ENVIRONMENTAL PROTECTION AGENCY |
| To: | |
| Shared Package | |
| ML20235M143 | List: |
| References | |
| 83506, NUDOCS 8902280151 | |
| Download: ML20235M171 (6) | |
Text
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f NRC soaM stt u t. NUCLEAa alautAfrav COMuiSSiON
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' APPLICATION FOR MATERIAL LICENSE -
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180STRUCTIO868: SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION. SEND TWO COPIES -
OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW.
APPLICATIOess FOR DioTRISUTION OF ENEMPT PRODUCTS FILE APPLICATIONS WITH.
IF YOU ARE LOCAf tD IN-U S NUCLEAR REGULATORY COMMISSON ILLINOIS. INDI ANA, IOWA, MICHIGAN, MINNESOT A. MISSOURI, OMIO, OR DIVillON OF FUEL CYCLE AND MATERIAL SAFETY, NMSS WISCONSIN, SEND APPLICATIONS TO:
WASHINGTON, DC 20005 U.S NUCLE AR REGULATORY COMMISSION. REGION 111 ALL OTHER PtRSONS FILE APPLICATIONS AS FOLLOWS.JP YOU ARE MATERIALS LICENSING SECTION LOCATED IN.
799 ROOSEviLT ROAD GLEN ELLYN,lL 80137 COesastCTICUT, DELAWARE. DISTRICT OF COLUMSIA MAINE. MARYLANO.
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P MASSACHUSETTS. NEW HAMPSHIRE. NEW JERSEY, NEW YORK, PENNSYLVANIA.
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LHAE ISLAND. OR VERMONT, SE800 APPLICATIONS TO NEW ME xlCO, esORTH DAKOf A. OK LAMOMA, SOUTH DAKOTA, TEXAS, UT AM, OR WYOMING, SENO APPLICAflONS 70; U.S NUCLEAR REGULATORY COMMISSION. REGION I NUCLEAR MATERIALS SAFETY SECTION 8 U S NUCLE AR REGULATORY COMMisslON. REGION IV S31 PARK AVENUE MATERIAL RADIATION PROTECTION SECTION KING OF PRUSSIA. PA 18406 811 RYAN PLAZA DRIVE, SulTE 1000 ALASAMA. FLOnlDA. GEOROBA. KENTUCKY. MISSIS $4PPI, psORTH CAROLINA.
i'UE;TO RICO. SOUTH CAROLl8tA, TENNESSEE, VIRGINIA. VIROIN ISLANDS. OR WEST VIRelNIA. SEND APPLICATIO8sS TO ALASKA, AR120e#A, CALIFORNI A. HAWAll, NEVADA, OREGON, WASHINGTON, AesD U.S. TERRITORIES A880 POSS4510s $ IN THE PACIFIC, SEND APPLICAflONS s
U S. NUCLEAR REGULATORY COMMIS$10N, REGION 11
. NUCIAR MATER 6ALS SAFETY SECTION 101 MARIETTA STREET, SulTE 2000 U.S NUCLEAR NEGULATORY COMMISSON, REGION V ATLANTA, GA 2023 NUCLEAR MATERIALS SAFETY SECTION 1400 MARIA LANE, SUITE 210 WALNUT CREEK, CA 94008 PSRSOest LOCATSO IN AGREEasENT STATES SE880 APPLICATIONS TO THE U.S. NUCLE AR REGULATDRY COMMISSION ONLY IF THEY WASH TO POSSESS Alf0 USE LICENSED MAf thlAL BA STATBS SUBJECT TO U.S. NUCLEAR REOULATORY COMMISSION JURISDICTION.
1.THIS 18 AN APPLICATION FOR (Caset appropraem nom!
- 2. NAME AND MAILING ADDRESS OF APPuCANT flacludehP CodeJ
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UeS. Environmental' Protection Agency A NEW uCt=st S. AMENDMENT To uCEN$8 NUMBER Andrew w. areidenbach Research Center x
C. RENEWAL OF uCeNsE NUMSER s= 1740 Attn
'Dr. We R. Burg, 26 W. Ste Clanr
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Cincinnati, OH 45219 '
}t Same 8902280151 890126 RE03 LIC70 SNM-1740 PNU h
- 4. NAME OF PERSON TO SE CONTACTED ASOUT THIS APPLICATION.
TELEPHONE NUMSER Dr.-William R.
Bura 513/569-7269
$USMIT ITEMS 6 THROUGH 11 ON 84 a 11" PAPE R THE TYPE AND SCOPE OF INFORMATION TO SE PROv10ED 18 DESCRiSE D IN THE LICENSE APPLICATION OUIDE.
S. RA0lOACTIVE MATERIAL
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e Element end moes number,11. chem cel endsor ohys.ce' lorm. eaa a moomum amowat S. PURPOSEl81 FOR WHICM LICENSED MATERIAL WrLL SE U$ED.
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N H I AINI GA E E CE S TR AINING FOR INDIVIDUAL 8 WORKING IN OR FREOutNTING RESTRICTED Amt A8.
S. F ACILITit$ AND ROVIPMENT.
- 10. RADI ATION SAFETY PROGRAM
- 12. LICENSEE F EES (see #0 CFR f /0ena aerreon t/0.781 FEE CATEGO8 Y Exempt
$cEEo 5 None
- 11. WASTE MANAGEMENT,
- 13. CERTIFICATION. (Must ee comp #emder eootscent/ TME APPLICANT UNDER$7 ANDS TMAT ALL $TATEMENTS AND REPREltNT ATIONS MADt IN TMIS APPLICATION ARE SINDING UPON THE APPLICANT THE APPLICANT AND ANY OFFICIAL EXECUTING TMit CERtlFICAtlON ON SEM ALF C8 THE APPLICANT, NAMED IN ITEM 2. CERTIFY TH AT TMi$ APPLICATION IS FREPARED IN CONFORMITY WITH TITLE 10. CODE OF FEDtRAL REGULATION $. PARTS 30. 32,33. 34. 36, AND 40 AND TMAT ALL INFORMATION CONTAINED MEREIN.
IS TRUE AND CORRECT TOTHE SEST OF THEin KNOWLEDGE AND SELIEF WARNING. IS U S C. StCTION 1001 ACT OF JUNE 26.1948. 82 STAT. 749 MAK E$ IT A CRIMINAL OF FEldSE TO MAKE A WILLPULLY F ALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO AF'Y MATTER WITMIN 17$ JURISDICTION SIGNATURE-ERTIF YING OF FICE R TYetD/ PRINTED NAME TIT LE DATE
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v2a William R.
Buro Safety Officer 5/4/87
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FOR NRC USE ONLY TYPEOFFEt FEELOG FEECATEGORv gDMME NT S APPHOVED S '
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DATE AMOUNT RECEIVED
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a)
Plutonium b)
In liquid solution c) 22 microcuries total 6.
To be used for research and development as defined in Section' 70.4 (j) 10 CFR Part 70 1
7 Dr. William R.
Burg, Safety Officer, U.S.
EPA, Cincinnati, OH 8.
Training for individuals working with licensed material is provided by or under the supervision of the Radiation Safety Committee.
9.
The facilities and equipnent are in accordance with statements representations and procedures contained in letter with attachments dated June 3, 1982.
10.
The Radiation Safety Program is managed under the Radiation Safety Comraittee by the Radiation Safety Officer Dr. William R. Burg and the Deputy Radiation Safety Officer, Contractor Christa V. Bercz, M.S. Health Physicist.
(See attached qualifications),
11 The Radioactive Waste Disposal is handled by ADC0 Services, Inc.
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,p William R.-Burg,-Safety Officer, U.S. Cincinnati, OH 1.
' Undergraduate Course, Atomic Physics Nebraska State Teachers College (1956) 3 Semester hours 2.
Oak Ridge Traveling Laboratory Course Eastern New Mexico University (1965)
Approx. 50 hours5.787037e-4 days <br />0.0139 hours <br />8.267196e-5 weeks <br />1.9025e-5 months <br /> 3.
Review of Principles for American Board of Industrial Hygiene ( ABIH) Self-study -(1974)
Approx. 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> 4.
Attended lectures on Principles of Ionizing Approx. 2 hours2.314815e-5 days <br />5.555556e-4 hours <br />3.306878e-6 weeks <br />7.61e-7 months <br /> Radiation, " Review for comprehensive Practice" (1982) 5.
Served on Radiation Saf ety Committee, Department of Public Safety, University of Cincinnati (1983) 6.
Participated in laboratory evaluation with University of Cincinnati Radiation Safety Officer Ken Fritz (1983 ) ~
7.
Served as the U.S. Environmental Protection Agency Cincinnati, OH, Safety Officer, (19 84-p re s e nt ).
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_. L CURRICULUM VITAE Christa V. Bercz, M.S.
Health Physicist 2812 Saddleback Drive Cincinnati, Ohio. 45244 (513) 232-8018
. Citizenship:
U.S. Citizen L -
Family Status:
Married, three children.
General Health:
Excellent, no handicaps.
' Permanent address: As above.
Education:
Primary and high school: Hungary.
Undergraduate studies: 1958-1961 Denison University Granville, Ohio. Bachelor of Science Degree in Chemis-try, date conferred June 1961.
Graduate school: 1969-1970 Temple University Health Sciences Center, Philadelphia Pa. Master of Science degree in Health Physics, date conferred June 1970.'
t Wesis:" Synthesis of C-14 Labeled Meperidine."
Advisor: Rodney D. Ice, Ph.D._
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State of Ohio Teacher Certificate,1984.
Employment and work experience:
1986-present Self employed health physicist, and principal contrac--
tor for providing health physics and radiation safety services to the U.S.
Environmental Protection Agency, AWBERC Research Facility, 26 W. St Clair St, Cincinna-ti Ohio 45268. We contractual duties includes serves in the role of deputy radiation safety officer and member of the radiation safety comittee. Responsible for maintaining institutional NRC license. Interprets NRC regulations, reviews and approves research proto-cols involving radioisotopes.
Cor r:ts wipe test e
surveys, conducts instrument calibration and evalua-tion. Arranges for and organizes regular radiation waste disposal services. Maintains institutional in-ventory of research isotopes and sealed sources.
l Teaches radiation safety courses annually twice, writes and constructs manuals and standard operating procedures for radiation safety techniques.
EPA project officer for contract: Dr. William Burg, Safety Officer, EPA contract officer: Mr.
Steven Enninger, Contract Specialist.
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'l a- _ _
~ (,' y CURRICULUM VITAE, C.V.Bsrcz l'
(
-2 1979-1983 Senior instructor in. Chemical Laboratory Sciences and Technology at the certified laboratory technician.
i program of' the Scarlet' Oaks. Vocational Schools, 3254 E.Kemper Rd. Cincinnati, Ohio 43241.
1977-1979 Istructor of radiation physics, X-ray and isotope technology for nuclear medicine technicians. Booth Hospital, Department of Nuclear Medicine.
1975-1979 Part time instructor in science. Forest Hills School District, Cincinnati, Ohio.
1970-1975 Health physicist in charge of radiation safety asso-cisted with ionizing radiation sources and isotope utilization in research and diagnostics. Temple Uni-versity Hospitals, Philadelphia Pa.
1969-1970 Graduate student in health physics,' Temple University Department of Health Sciences, Philadelphia Pa.
1966-1969 Home maker.
1964-1966 Research chemiet, Gutenberg University, Mainz Germany.
Duties: Research in Coordination Chemistry.
1961-1964 Research assistant, Miami Valley Laboratory. The
=
Procter and Gamble Company, Cincinnati Ohio.~
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Professional
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Hembership:
Member, Health Physics Society.
Professional Activities:
Advisory Board Member, U.S. Achivement Academy 1982-present.
Publications :
"A new geometrical isomerism in Ruthenium Complexes" J. P. Berez, C.V. Bercz, L. Horner Liebige Annalen 703 17-30 (1967)
"A Novel Synthesis of C-14 Labelled Meperidine" C. V. Bercz, R. D. Ice J. Pharm. Sci. 61,1316 (1972)
Pertinent Experience:
I have been trained in, and/or I and have over six years of working experience in the following areas:
Practical and regulatory aspects of radiation safety in radio isotope use and methodology in research, in human diagnostics and in radiotherapy.
e e
________________.____m_
h, e
3-Curricu' lum Vitae, C.V. Bercz, M.S.
. Pertinent n
Experience:
I have been trained in, and/or'have over six years of working experience in the following areas:
- Practical and regulatory aspects of radiation' safety in radio isotope use and methodology in' research, diagnosis and therapy.
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- Dosimetry, containment, shielding, decontamination procedures.
- Snergency procedures, personnel protection.
Exposure monitoring, risk assessment procedures.
- Facility design for using and storing radio isotopes.
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- Disposal and transport of radiation wastes, DCyr and state. regulations governing transportation.
- Dosimetric instrument calibration and certification.
- Documentation and' record keeping in compliance with NRC regulations.
- Development of institutional radiation safety proto-cols and manuals, procedural reviews and safety connittee agenda.
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- Diagnostic and therapeutic X-ray-and gamma-ray safety, shielding, patient and. employee protection.
- Calibration and certification of diagnostic instru -
ments and sources for therapy.
- Radiation safety and dosimetry of industrial and house-hold microwave ovens.
- Structured instruction of radiation topics in short course format, or in regular curriculum programs, covering theory and laboratory practices, safety considerations, regulatory issues for end users of I
radiation sources.
- General chemical laboratory practices, instrumentation and chemical safety.
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