ML20247G786
| ML20247G786 | |
| Person / Time | |
|---|---|
| Issue date: | 05/17/1998 |
| From: | Kime T NRC (Affiliation Not Assigned) |
| To: | Ryan Alexander AFFILIATION NOT ASSIGNED |
| References | |
| SSD, NUDOCS 9805200343 | |
| Download: ML20247G786 (2) | |
Text
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g May 17,1998 Robert L. Alexander, M.D.
4029 Plainfield, NE Grand Rapids, MI 49525
Dear Dr. Alexander:
I This letter verifies the receipt of the completed NRC Form 483 dated April 28,1998. This form is a condition of the general license under 10 CFR 31.11 authorizing in-vitro testing with
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byproduct material under general license.
The form has been assigned registration number 9138. 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 any questions or need further assistance, please contact me at (301) 415-8140.
Sincerely, l
Traci Kime, Acting Registration Specialist Materials Safety Branch Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards DISTRIBUTION:
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DOCUMENT NAME: P:\\ALEXANDE.483p:\\ chambers.483 Ta receive a copy of this document, indicate in the box: "C" = Copy without attachment / enclosure "E* = Copy with attachment / enclosure "N" = No copy OFFICE MSB l
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N AC Poem a43 U.S. NUCLEAR REGULATO AV COMMiS5tCN A m c.ec or M O 1 76 lo cen 31 REGISTRATION CERTIFICATE-IN VITRO TESTING WITH BYPRODUCT MATERIAL UNDER GENERAL LICENSE Section 31.!! of 10 CFR 31 establishes a general license authorizing phyuetans. clinical laborator:es. ed hospea.s 'a possess certain small quantities of byproduct material for in virro cisnical or lacoratory tests not involor g tre internal cr external administration of the byproduct matettal or the radiation therefrom to human beiras or animais. Possessun cf byproduct material under 10 CFR 31.11 is not authorised until the physician, :lirucal laboratary. or hospital has Lied NRC Form 483 and received from the Commission a validated copy of NRC Form 483 with registration number.
e ROBERT L. ALEXANDER, M.D.
e 4029 PLAINFIELD, NE GRAND RAPIDS, MI. 49525
- 3. I hereby apply ror a registration number pursuant to
$31.!! 10 CFR 31 for use of byproduct matert:Js for please check one block only)
E (a. Myself.a duly licerised physician authorised to dispe drugs in the practice of medicine.
O b. The above-named clinicallaborniory.
O c. The above named hospital.
- 4. To be completed by the Nue: car Regulatory Commission.
INSTRUCTIONS
!. Submit this form in triplicate to:
Registration number:
Office of Nuclest Material Safety and Safeguards 9138 n aeou
[o S
ATTN: Radioisotopes Licensing Branch o
U.S. Nuclear Regulatory Commission
- t Washington, D.C. 205 55 2
ft USNuclearRegql Assion-
- 2. Please print or type the name and address Gnclud.
ing tip code) of the registrant physician, climcal p),?
[
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e laboratory, or hospiral for whom or for which fy[
'j % g* * * * *2 this registration form is filed. Position the first I
j.ghimrial ryi
$/ @ /gg (fffs atto. leave thss space blank - numoer to be letter of the address below the left dot and do not catend the address beyond the right dot. (At NRC, a registration number will be assigned and arTrgned by MC. /f this is a change ofinformarion frorrt.s ;renously a validated copy of NRC Form 483 will be re-returered generallicensee. include your regrstrarson numrer i turned.)
- 3. If place of use is different from address in Item 1. please give co:npiste addresar i
- 6. Certification:
I hereby certify that:
- a. Allinformation in this registration certificate is true anil complete.
- b. The registrant has appropriate radiatiortmeasuring instruments to carry out the tests for which byproduct materist 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.
- c. I understand that Commission regulations require that any change in the information furnished by a registrant on this registration oeridicate be reported to the Director of Nuclear Material Safety and Safeguards within 30 days from the effective date of such enar ge.
- d. I have read and understand the provisions of Section 31.!! of NRC regulations 10 CFR 31 (reprmted on the reverse side of this form);
and I understand that the registrant is required to comply with those provisions as to all byproduct material which he receives acqui:es.
possesses.uses.or transfers under the generallicense for which this RegistrationCertificate is filed with the Nuclear Regulatory Commission.
Data 4/28/98 En MM sy
'" Signature 6f person (ding form Pnnted narne and tatte or position of person filing form WARNING-18 U.S.C Section 1001: Act of June 25,1945; 62 Stat. 749; makes it a enmmal offense to make a =lifully f am statement or representation to any oepartment or agency of the United States as to any matter utnm its tunsdiction.
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