ML20236W171
| ML20236W171 | |
| Person / Time | |
|---|---|
| Issue date: | 07/28/1998 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Check AFFILIATION NOT ASSIGNED |
| References | |
| SSD, NUDOCS 9808050128 | |
| Download: ML20236W171 (2) | |
Text
_ _ _.
4 July 28,1998 Endocrine Testing, Ltd.
7447 Old York Road Melrose Park, PA 19027
Dear Dr. Check:
This letter verifies the receipt of the completed NRC Form 463 dated July 22,1998. This form is a condition of the general license under 10 CFR 31.11 authorizing 'in-vitro testing with byproduct material under general license.
The form has been assigned registration number 8454. 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 t:ny questions or need further assistance, please contact me at (301) 415-8140.
Sincerely, 3
Traci Kime, Acting Registration Specialist Materials Safety Branch Division of Industrial and 1
Medical Nuclear Safety t
Office of Nuclear Material Safety and Safeguards I
DISTRIBUTION:
SBaggett IMNS r/f
~.
l NEg3' y
DOCUMENT NAME: a:\\ check.483 T2 receive a copy of this doc *.snent. Indicate in the box:
'C" = Copy without attachment / enclosure
- E" = Copy with attachmem/ enclosure "N" - No enp1 OFFICE MSB l
l l
f NAME TKimed DATE 7/28/98 OFFICIAL RECORD COPY l
C EM 8M e 9808050128 980728 PDR RC SSD PDR y
1
a i
1 NRC FORF485 U. S. NUCLEAR REGUt.ATORY COMMISSION APPROVED W ONEL NO. 31500038 EXPlRES: 6-30-t (9 98)
Eshmeted tuden per response to comply with this enandatory mformat-colisction requerit 7 mmutes. The vahdeted rogstraban serves es eviden REGISTRATION C'ERTIFICATE -In vitro TESTING
- J",d1"', 'e't%"fo,w*",e ""O'*'"';"l " *J","" *m'"e ";"'
WITH BYPRODUCT MATERIAL UNDER 0""llll'" *c"o'm,".*d' W E"**JJ.E "e'd tn i Paperwok Reduction Propect (31540036). oflice of Managernent a GENE L LI SE Budget, Washmgton, De 20$o3 NRC may not conduct or sponsor, enc
/
person a not required W respond W e collechon of mformabon unless duplays a ca.rrendy vehd OMB contros number f
Section 31.11 of 10 CFR 31 estabbshe[a general license authorizing physicians, cunical laboratories, hospitals, and veterinarians in the practice veterinary medicine to poseees certain oman quantities of byproduct material for in Wtro chnmal or laboratory tests not involving the intemal or ext l
Administration of the byproduct matenal or the radiation therefrom to human beings or animals. Possession of twoduct matenal under 10 CFR 31.11 is r authorized until the phyacien, clinical laboratory, hospital, or veteriarlan in the practice of veterinary medicine, has filed NRC Form 483 and received from tl Commeason a vandated copy of NRC form 483 with a registration number
- 2. APPUCATION (Check one box only)
- b i NAME AND ADDRESS OF APPLICANTr (see instrucourirSE. Debvf "
.A
^
..t I hereby apply for a registration number pursuant to 10 CFR' 31, Secti.
gidoc..,-rine Test.ing 'Lt'd. -
s 31.11, for use of byproduct materials for.
7447 Old York Road A.
YeeN, e duly been8ed n eNd diSpmugsin ;
Melrose Park' PA 19027 the practce of medicine.
g B. The above-named clincallaboratory.
M PHONE NUMBER (include Area Code)
C. The above named hospital.
(215) 635-4882 D vetennarian in the practc. or veterinary medicine.
- 4. REGISTRATION 3.
INSTRUCTIONS:
A.
Submit this form in duphcate to:
, REGISTRATION NUMBER:
Medcal, Academic and Commercial Use
.\\
ga Rfgg g#o,/
Safety Branch (T-8 FS) p i.;. ;,. iix br' <Ew Ia Nrj Dtvision of industrial and Medcal Nuclear Safety V
g974g 5 ; j g g; Oftce of Nuclear Material Safety and Safeguards o
U.S. Nuclear Regulatory Cv,nn,;. uni E
fE Wantungton, DC 1
O f
l SJ.
wkbef4; g{g, r
(ft NRC,a reg '
00
- C 8M
%*****4 and a lidated copy of NRC Form 483 will be retumed.)
fj
,M B.
In the box above, pnnt or type the name, address (including ZIP
/
Code), and telephone number of the registrant physician, chnical (1/this api #alte
- hfve, blank - numberfo be thboratory, hospital, or veterinarian in the practce of vetennary assigfnby NRC. If this e change ofinformadon from a previously rhedicine for whom or for which the rogstrabon form is filed.
repsysted gegetal #conse, indugyour repstra#on pumber.)
- 5. If place of use is different from address listed above, give comp 6ste address:
e 6\\j
.a
- 8. CERTIFICATION I hereby certsfy that:
A.
All informahon in this registration certifcate is true arvi comp 6ete.
registrant has appropnote redishon messunng instruments to carry out the tests for which byproduct material will be used unde B.
lipense of 10 CFR 31.11. The tests win be performed only by personnel competent in the use of the instruments and i byproduct materia 6s.
l understand that Comnvesson regulations require that any change in the information fumished by a registrant on this registrabon certifica C.
reported to the Director of Nuclear Meterial Safety and Safeguards within 30 days from the effecttve date of such change.
resa and understand the provleions of Sechon 31.11 of NRC regulabons 10 CFR 31 (reprinted on the reverse side of this form), a l
D i understand that the registrant is required to comply with those provisions as to su byproduct material which he receives, acquires, possesses, u or.trans*s's under the general license for which this Regetrabon ("r'Ifcate is filed with the U.S. Nuclear Regulatory Commesion.
PRINTED OR TYPED NAME AND TIT ~E OF APPLICANT S
ATURE OF A CA T DATE
^
Jerome 11. Check, M.D., Ph.D.
(
g
/
WW m rector FALSE STATEMENTS IN THIS CERTIFICAMMAY BE SUBJECT TO CML AND/O WARNING:
PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLE ALL MATERIAL RESPECTS.18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UN ANY MATTER WITHIN ITS JURISDICTION.
f NRc FORM 483 (See)