ML20245G083
| ML20245G083 | |
| Person / Time | |
|---|---|
| Site: | 07000277 |
| Issue date: | 12/01/1987 |
| From: | Daavettila D, Koepel E MICHIGAN TECHNOLOGICAL UNIV., HOUGHTON, MI |
| To: | |
| Shared Package | |
| ML20245G050 | List: |
| References | |
| 384540, NUDOCS 8902140295 | |
| Download: ML20245G083 (2) | |
Text
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3 96-U.S. NUCL EAR EEG UL ATOAY l'OMMISSION D' i alRC, FORM 313 '
APPROVED BY OMS gg 3160 0120
- o 10 C7R 30,32,33,34' '-.
34 Ead 40 :
' APPLICATION FOR MATERIAL LICENSE E** S 3in 4
INSTRUCTIONS: SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DET AILED INSTRUCTIONS FOR COMPLETING APPLICATION. SEND TWO COPIES OF THE ENilRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW, i
FEDEXAL AGENCIES FILE APPLICATIONS WITH:
IF YOU ARE LOCATED IN:
' U.S. NUCLE AR REQULATORY COMMISSION '
ILLINOIS, INDI ANA, IOWA, MICHIGAN, MINNESOTA, M18SOURl, OHlo, OR DIVISION OF FUEL CYCLE AND MATERIAL SAFETY,NMS$
Wl8CDNSIN, SEND APPLICATIONS TO:
~ WASHINGTON, DC 20568 -
U.$. NUCLE AR REGULATORY COMMIS$10N. REGION 111 '
ALL OTHER PERSONS FILE APPLICATIONS At FOLLOWS,lF YOU ARE.
M ATE RI ALS LICENSING SECTION LOCf.TED IN:
' 799 ROOSEVELT ROAD GLEN ELLYN,IL $0137
\\*,0NNECTICL'T, DELAWARE, DISTRICT OF COLUM8lA. MAINE. MARYLAND..
MASSACHUSETTS. NEW HAMPSHIRE, NEW JERSEY, NEW YORK, PENNSYLVANIA, ARKANSAS, COLORADO, IDAHO, KANSAS, LOUISl ANA, MONT ANA, NESRASKA,.
RHODE ISLAND, OR VERMONT, SENO APPLICATIONS TO: -
NEW MEXICO, NORTH DAKOTA, OKLAHOMA, SOUTH DAKOT4, TEXAS, UTAH, :
OR WYOMING, SEND APPLICATIONS TO:
' U S. NUCLE AR REGULATORY COMMIS$10N, REGION I ;
' NUCLE AR MATERIAL SECTION 8 U.S NUCLEAR REGULATORY COMMISSION, REGION IV.
631 PARK AVENUE MATERIAL RADIATION PROTECTION SECTION' KING OP PRUS$lA PA 19406 0 611 RY AN PLAZA DRIVE,SulTE.ICOO ARLINGTON,Tx 76011 ALABAMA, FLORIDA, GEORGIA, KENTUCKY, MIS $1481PPI, NORTH CAROLINA, F JExTO RICO, SOUTH CAROLINA, TENNESSE E, VIRGINlA, VIRGIN ISLANDS, OR -
ALASKA, ARIZONA, CALIFORNI A, HAWAll, NEVADA, OKEGON, WASHINGTON, 9 SST VIRGINIA,SIND APPLICATIONS TO:
AND U.S. TERRITORIES AND POSSESSIONS IN THE PACIFIC, SEND APPLICATIONS -
TO:
hts, NUCLE AR REGULATORY COMMISSION, REGION il
': MATERIAL RADI ATION PROTECTION SECTION
- U.S NUCLEAR REGULATORY COMMISSION, REGION V 01 MARIETTA STREET, SulTE 2900 MATERI AL R ADI ATION PROTECTION SECTIQN s
' ATLANTA, GA 30323 1450 MARI A LANE, SUITE 210.
WALNUT CREEK,CA 94596 PEFONS LOCATED IN AGREEMENT ST ATES SENO APPLICATIONS TO THE U.S. NUCLEAR REGULATURY COMM198 TON ONLY IF THEY Wl8H TO POSSESS AND USE LICENSED MATERIAL Q
lN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMIS$10N JURISDICTION, THl3 IS AN APPLICATION FOR Mheck @p'optare /lem/ -
- 2. NAME AND MAILING ADDRESS OF APPLIC ANT (include & CodD) j
^. NEW,.iCENS' Occupational Safety and Health Services.
Michigan Technological University '
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- 18. AMENDMENT TO UCENSE NUMBER SNM-256' C, RENEWAL OF LICENSE Ni.WBER Houghton, MI 49931.
1 Michigan Technological University 8902140295 880210 q
- Houghton,LMI' 49931 REG 3 LIC70 PNV SNM-02D6 a
4, NAME OF PERSON TO BE CONT ACTLD ASOUT THIS APPLICATION TEl,EPHONE NUMSER Donald A.'Daavettila or David G. Leddy (906) 487-2118 SUBMIT tTEMS S THROUGH 11 ON 84 It'* PAPER. THE TYPE AND SCOPE OF INFORMATION TO BE PROvlDED 18 DESCRISED IN THE LICENSE APPLICATION GUIDE.
- 8. RADIOACTIVE MATERIAL 8 PURPOSEIS) FOR WHICH LICENSED MATERIAL WILL SE USED.
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- a. Element and mass number, it chemecal and/or phYsecal tone, and e. mesimym amount
. which will be possessed et any one 16me.
ND VIDUA S EP S EL FOR RADIATION SAFETY PROGRAM AND THEIR
- 8. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS.
- 8. FACILITIES AND EQUIPMENT, 10, RADIATION SAFETY PROGRAM.
I2. LICENSEE FEES t5ee 10 CFR 170enitSectron 1/0.31)
- 11. WASTE MANAGEMENT, AMOUNT FEE CATEGORY
' ENCLOSED $
- 13. CERTIFICATION. (OstbecomsWefsa6 epheenff TllE APPLICANT UNDERST ANDS THAT ALL STATEMENTS AND REPRESENTATIONS MADE IN THl3 APPLICATION ARE BINDING UPON THE APPULANT, THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON SEMALF OF THE APPLICANT, NAMED IN ITEM 2 CERTIFY THAT THf8 APPLICATION lE PREPAAED IN CONFORMITY WITH TITLE 10. CODE OF FEDERAL REGULATIONS. PARTS 30,22.33,34. 35, AND 40 AND TH AT 6LL INFORMATION CONTAINED HEREIN, IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF.
W ARNING-is U S C. SECT;ON 1001 ACT OF JUNE 25.1948.62 STAT. 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY F ALSE STATEMEft? OR REPRESENTATION
. TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITSJURISDiCTION SIGN ATUR E -C E R TI VINO OFFICER TYPED / PRINTED NAME TITLE DATE f
Edward J. Koepel V.P. Operationa & Finance 12/1/87
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- n. NUMBER OF EMP OrEES (7eres for d WOULD YOU 86 WILLING TO FUF<NiSH COST INFORMATION (Jouer end/or sis # Acurs)
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- '# ##'" ****8'ns outside contractors 1 i
ON THE ECONOMIC IMPACT OF CUFIRENT NRC REGULATIOgoR ANY FUTURE
<S260K :
StM-3 SM PROPOSED NRC REGULATIONS THAT MAY AFFECT YOU? (
C regutetsons permit
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$250K-SbOK S3SM~1M it to protect con ntd conwner i et knencMowWonfonnetron hornsshed to
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I s NUMBER OF BEDS
$600K+760K.
$1M-10M
$750K-1M -
> $ 10M YI8 NO b %,._.
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_ _FOR NRC USE ONLY
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APPROVED 8 v fMJ Q fS O,TEGORYW gg ),
AMOUNT RECalVED CHECK NUMBER DATE
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PRIVACY ACT STATEMENT l
Pursuant to 5 U.S.C. 552a(el(3), enacted into law by section 3 of the Privacy Act of 1974 (Public Law 93 579),the follow-
>j Eing statement is furnished to individuals who supply information to the Nuclear Regulatory. Commission on NRC Forrn 313. This information is maintained in a system of records designated as NRC 3 and described at 40 Federal Register 45334
. (October 1,1975).
11 ' AUTHORITY: Sections 81 and 161(b) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2111 and 2201(b))..
I
. 2. PRINCIPAL PURPOSE (S): The information is evaluated by the NRC staff pursuant to the criteria set forth in 10 CFR. Parts 30,32,33,34,35 and 40 to determine whether the application meets the requirements'of the Atomic Energy Act of
'1954, as amended, and the Commission's regulations, for the issuance of a radioactive material license or amendment I
D thereof.
' 3. ROUTINE USES: The information may' be (a) provided 'to Siete health departments for their'information and use;
.and (b)'provided to Federal, State, and local health officials a d other persons in the event of incident or exposure; for.their information, investigation, and protection of the public health and safety. The information may also be dis-closed to appropriate Federal, State, and local agencies in the event that the information indicates a violation or potential i!
violation of law and in the course of an administrative or judicial proceeding. In addition,this information may be trans-
~
ferred to an appropriate Federal, State, or local agency to the' extent relevant and necessary for an NRC decision or to '
an appropriate Federal agency to the extent relevant and necessary for that agency's decision about you..
- 4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVID-ING INFORMATION: Disclosure of the requested information is voluntary, if the requested information is not furn-1shed, however/ the application for radioactive material license, or amendment thereof, will not be processed. A request that information be held from public inspection must be in accordance with the provisions of 10 CFR 2.790. Withhold-j ing from public inspection shall not affect the right, if any, of persons properly and directly concerned need to inspect I
the document.
- 5. SYSTEM MANAGER (S) AND ADDRESS: U.S. Nuclear Regulatory Commission
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Director, Division of Fuel Cycle and Material Safety.
.j Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555
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