ML20235X188
| ML20235X188 | |
| Person / Time | |
|---|---|
| Site: | 07001994 |
| Issue date: | 01/20/1987 |
| From: | Sylvester S STEVENS INSTITUTE OF TECHNOLOGY, HOBOKEN, NJ |
| To: | |
| Shared Package | |
| ML20235X167 | List: |
| References | |
| 106689, NUDOCS 8707240078 | |
| Download: ML20235X188 (1) | |
Text
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NIC F DFIM 313 U S. NUCLEAR KEGULATO2Y COMMISSION 17tSt v
APPROVED BY OMB l
V t0 C8 R 30,32. 33. 30 3i80 0120 3*aa APPLICATION FOR MATERIAL LICENSE EeP.m. S.3i.e7 I
INSTRUCTI@NS: SEE THE APPRC'PRI ATE LICENSE APPLICATION GutDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION SEND TWO COPIES OF THE ENTIRE COMPLF.TED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW.
APPLICATIONS FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH IF YOU ARE LOCATED IN-U S NUCLEAR REGULATORY COMMISSION IL LINOIS. INDI ANA. 80WA. MICHIGAN. MINNESOTA. MISSOURI, Ohio. OR DIVISION OF FUEL CYCLE AND MATERIAL SAFETY. NMSS wtSCONSIN, SEND APPLICATIONS T0' WASHINGTON. DC 20566 U S NUCLE AR REGULATORY COMWSSION. REGION ut j
A.LL OTHER PERSONS FILE APPL! CATIONS AS FOLLOW 147 YOU ARE MATE RIALS LICENS>NG SECTIOl6 i
LOCATEDIN 7p9 ROOSEVELT ROAD 1
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CONNECTICUT. DELAWARE. DISTRICT OF COLUMBIA. MAINE. MARYLAND.
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ARK ANSAS. COLOR ADO, lDAHO, K ANS AS. LOUtBIANA. MONT ANA. N E BR AbK A.
i KHODE ISLANO. OR VERMONT, SEND APPLICATIONS TO NE W ME XICO. NORTH DAKOT A. OKLAHOMA, SOUTH DAKOT A. TE KAB, UTAH, O S NUCLEAR REGULATORY COMMIS$10N REGION I NUCLEAR MATERAS SAFETY SECTION B U $ NUCL E AR REGULATORY COMMISSION, REGION IV 3 -,$31 PAAA AVENUE MATE RI AL RADIATION PROTECTION SE.CTION KING OF PRUSSIA, PA 19406 611 RYAN PLAZA DRIVE, SUITE 1000 tC[; /' "
t, LAB AMA. FLORtDA. GEORGIA. MENTUCKY. MIS $1881PPl. NORTH CAROLINA.
3 PUEATO RICO, SOUTH CAROLINA. TENNESSEE, VIRGINIA VtROIN ISLANDS. OR AL ASK A, ARI2ONA, CALIFORNI A. HAW Alt, NEVADA, CREGON. WASHINGTON.
WEST VIRGINIA, SEND APPLICATIONS TO AND U.S. TERRITORIES AND POSSES $lOtis IN THE FIC, SEND APPLICAT8ONS hO M U S NUCLEAR REGULATORY COMMISSION REGION 11 NUCEAR MATERIALS SAFETY SECTION U.S. NUCLEAR REGULATORY COMbil5'SION, RE180N V 101 MARIETTA STREET, SulTE 2900 NUCLEAR MATERIALS SAFETY SECIICrh ATLANT A, GA 30323 1460 MARIA LANE. SUf7E 210 W ALNUT CREEK. CA 9461!6 i C. FE I b q q TEISONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH 10 POSSESS AtID USE LICENSED MATERIAL q
4N STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMIS$10N JURISDICTION.
- 1. THIS IS AN APPLICATION FOR (Check oppropriem emm/
- 2. NAME AND MAILING ADDRESS OF APPLICANT /tactua#Ie Codel Stevens institute of Technology q
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. AuENDMENT TO uCENSE NUM.ER Castle Point Station j
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- 3. ADDRES$iES) WHERE LICENSED MATERIAL WILL SE USED OR POSSE SSED Stevens Institute of Technology Castle Point Station Hoboken, NJ 07030
. Nm er Pineh TO.E Ca7 ACTED.wui TH,5 APPuCATION lmEPHONE NuM.ER Steven C e Sylvester (201) 420-5230 SUOMIT ITEMS 6 THROUGH 11 ON Sw a 11
- PAPE R THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED is DESCRtBE0 IN THE LICENSE APPLICATION GulOE.
6, RADIOACTIVE MATERIAL j
- a. Element and mass numtzer, it enemical and/or phvecat form, and c monimum amou t
- 6. PURPOSEISI FOR WHICH LICENSED MATERI AL WILL BE USED, n
men e me im.e..a si.% one iime 8 TRAINING FOR INOtVIDUALS WORKING IN OR FFIEOVENTING RESTRICTED AREAS.
RAI NG ER E CE 9 F ACILITIES AND EOulPMENT.
- 10. RADI ATION SAFETY PROGRAM.
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EE CATEGOaY 13 CE RATIFICATION (Must se compresaby spohrent/ T HE AP"LICANT UNDE RST ANOS THAT ALL ST ATEMENTS AND REPRESENT ATIONS MADE IN THIS APPLICATION ARE 8INDING UPON THE APPLICANT THE APPLICANT AND ANY OFFICIAL E MECUTING THIS CERTIFICATION ON BEHALF OF THE APPLICANT,NAMEO IN ITEM 2. CERTIFY THAT THt$ APPLICATION is PREPARED IN CONFORMITY WITH TITLE 10. CODE OF FEDERAL REGULATIONS, PARTS 30. 32. 33. 34,38. AND 40 AND THAT ALL INFORMATION CONTAINED HEREIN.
18 TRUE AND CORRECT TO ThE BEST OF THEIR KNOWLEDJE AND BELIEF WARNING 18 U S.C. SECTION 1001 ACT OF JUNE 25198. $2 ST AT 749 MAKES IT A CRtMiN AL OFFENSE TO MAK E A WILLFULLY F ALSE STATEMENT OR FIEPRESENTATION TO ANY DEPARTMENT OR AHNCY OF THE UNITED ST ATES AS TO ANY MATTER WITHIN ITS JURISDICTION SIGNATUR) CEF.TIF YING OF FICLP TYPE D' PRINT ED N AME TIT LE DATE
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