ML20236S116
| ML20236S116 | |
| Person / Time | |
|---|---|
| Issue date: | 07/22/1998 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Yousif D AFFILIATION NOT ASSIGNED |
| References | |
| SSD, NUDOCS 9807240135 | |
| Download: ML20236S116 (2) | |
Text
-
l, p"
July 22,1998 c.
i
[
<7y9
'5
- D. Louis Yousif, M.D.
J 28437 Greenfield l
Suite 102 r'
T
- Southfield, MI 48076'
Dear Dr. Yousif:
f, I
e r
4 s..,
I e
..1 e.
g
- This letter verifies the receipt of,the completed NRC Form 483 dated July 6,1998. This form is a condition of the general license under 10 CFR 31.11 authorizing in-vitro testing with byproduct 9
- material under generallicenser c
I
' The form has been assigned registration number 9145. 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.
p K
If you have any questions or need furt'her assistance, please contact me at (301) 415-8140.
I c
Sincerely, L
/s/
Traci Kime, Acting' Registration Specialist Materials Safety Branch 1
Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards
/
- DISTRIBUTION
/
SBaggett; IMNS r/f '
NEO l: DOCUMENT NAME:
= T1 semelve a oew si this document h an the bos: *C" = Copy without attachment / enclosure
- E" = Copy with attachment / enclosure
- N' = No copy OFFICE MSB-l6 l
l l
l NAME TKimeD@
DATE-7/22/98
- OFFICIAL RECORD COPY l
t V
1 9907240135 990722 Tr PDR RC L
l-SSD PDR
[
u l.
,1
~
o EXPtHEs 2 2943 NF MuaT oN LECT N outsT 7=
oHW Co REGISTRATION CERTIFICATE-in vitro TESTING WITH BYPRODUCT MATERIAL UNDER GENERAL LICENSE g Ts,g gggpia,og y g gyne,=,ajj,7,o 7,ay,i=epaug g
wucata v.couuTom comumtio=. =assi=ovo=_ oc 2066-l7fc?o'r**ufhE"EE %"fu'EcET. EsIJ#="'S 20603.
Section 31.11 of 10 CFR 31 establishes a general license authorizing physicians, clinical laboratories, hospitels, and veterinarians in the practice of veterinary medicine 13 possess certain small quantities of byproduct material forin arirro clinical or laboratory tests not involving the internal or external administration cf 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, clinical isboratory, hospital, or veterinarian in the practice of veterinary medicine, has filed NRC Form 483 and received from the Com-mision a validated copy of NRC Form 483 registration number.
- 2. APPLICATION D. louis YOuSif,
,.D.
I hereby apply for a registration number pursuant to 10 CFR 31, A
28 0 7 Greenfie1ds Section 31.11, for use of byproduct materials for:
(Chack one box only)
Suite 102 SOuthfield, MI.
48076 A. Myself, a duly licensed physician authorized to dispense drugs Attn: Robin L. Mills 2
in the practice of medicine.
~, h ~fhe above-named clinical laboratory.
tf The above-named hospital.
D. Veterinarian in the practice of veterinary medicine, INSTRUCTIONS:
o Q. Submit this form in triplicate to:
- 3. REGISTRATION Medical, Academic and Commejr ial se Saf;ty Branch (6H3)g/Tp!
yy c.
Divisbn of Industrial and Medical uclear ety REGISTRATION NUMBER:
Office cf Nuclear Material Safety and Safeguards U.S. Nuclear Regulatory Commission 9145 Washington, DC 20555
[g nEog*l U.S. Nuclear Regulatory (At NRC, a registration number will be assigned t
y Commission and a validated copy of NRC Form 483 will be g
returned.)
3 aE
- 2. In the box above, print or type the name and address
,o (including ZIP Code) of the registrant physician
- e,*
clinical laboratory, hospital, or veterinarian in the St 7/
98 ep L.[Ba getQ practice cf veterinary medicine for whom or for t
4&MFI which this registration form is filed.
(if th is an initial ist tion, leave this space blank - number to be assigned by NRC. If this is a change ofinformation from a previously registered generallicense, include your registration number.)
If place cf use is different from address listed above, give complete address:
- 5. CE RATIFICATION hIreby certify tnat:
- 3. All information in this registration certificate is true and complete.
- 3. The registrant has appropriate radiation measuring instruments to carry out the tests for which byproduct material will be used under the general license of 10 CFR 31.11. The tests will be performed only by personnel competent in the use of the instruments and in the handling of the byproduct materials.
8.
I understand that Commission regulations require that any change in the information furnished by a registrant on this registration certificate be reported to the Director of Nuclear Material Safety and Safeguards within 30 days from the effective date of such change.
D, I hav) read and understand the provisions of Section 31.11 of NRC regulations 10 CFR 31 (reprinted on the reverse side of this f;rm); and I understand that the registrant is required to comply with those provisions as to all byproduct material which he receives, acquires, possesses, uses, or transfers under the general license for which this Registration Certificate is filed with the U.S. Nuclear Regulatory Commission.
JNTED OR TYPED NAME AND TITLE OF APPLICANT l SIGNA RE OF APPilCANT lDATE g
.s Robin L. Mills (Clinical Consultant) g/
f. hh K-EhNIN3: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL ANDIOR CRIMINAL PENALTIES. NRC REGULATIONS GQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS.18 U.S.C. SECTION 1001 MAKES 7 A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT Oh AGENCY OF THE CITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
JoMu 483 iMO)
____________A______________
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _