ML20247H051
| ML20247H051 | |
| Person / Time | |
|---|---|
| Issue date: | 05/17/1998 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Kuffa R AFFILIATION NOT ASSIGNED |
| References | |
| SSD, NUDOCS 9805210054 | |
| Download: ML20247H051 (2) | |
Text
- *
- May 17,15,98 Robert K. Kuffa, D.O.
6061 N. Saginaw Mt. Morris, MI 48458
Dear Dr. Kuffa:
This letter verifies the receipt of the completed NRC Form 483 dated February 10,1998. This form is a condition of the generallicense under 10 CFR 31.11 authorizing in-vitro testing with byproduct material under general license.
The form has been assigned registration number 9134. 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 rne at (301) 415-8140.
Sincerely, d
Traci Kime, Acting Registration Specialist Materials Safety Branch Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards f)
DISTRIBUTlQN:
[j SBaggett IMNS r/f NEO3 DOCUMENT NAME: P:\\KUFFA.483 To receive a copy of this document, indicate in the box:
- C" = Copy without ettechment/ enclosure
'E' = Copy with attachment / enclosure
'N' = No copy OFFICE MSB l
l NAME TKimet 2/[_
5 67r"
DATE 5F7/98 u "
OFFICIAL RECORD COPY m 0 C.20 9005210054 990517 PDR RC i
SSD PDR
e6 4 NnC Form da3 U.S. NUCLEAn nCQULATO n v COMMsSSION Aporoved by GAO go[pn 3:
REGISTRATION CERTIFICATE-IN VITRO TESTING 3 "01" WITH BYPRODUCT MATERIAL UNDER GENERAL LICENSE Section 31.11 of 10 CFR 31 estabhshes a general license authorizing physicians, clinical laboratories, and hospitals to possess certain small quantities of byproduct material for in nrro chnical or laboratory tests not involving the internalor external administration of the byproduct tr.ateral or the radiation therefrom to human beings or animals. Possesuon of byproduct material under 10 CFR 31.11 is not authorited until the physician, clinical laboratory, or hospital has filed NRC Forrn 483 and received from the Commission a vahdated copy of NRC Form 483 with registration number.
e ROBERT K.
- KUFFA, D.O.
6061 N.
SAGINAW
- 3. I hereby apply for a registration number pursuant to MT. MORRIS, MI. 48458
@.11.11,10 CFR 31 for use of byptoduct materials for please check one block only)
$ (a. Myself.a dulylicensed physician authorized todispense drugs in the practice of rnedicine.
O b. The above named chnicallaboratory.
O c. The above-named hospital.
- 4. To be completed by the Nuclear Regulatory Commi sion.
1 INSTRUCTIONS
- 1. Submit this form in triplicate to:
Registration nurnber:
9134 Office of Nuclear Matenal Safety and Safeguards
[amneog ATTN: Radioisotopes Licenung Branch A
/
o U.S. Nuclear Regulatory Comenisuon
=
Washington, D.C. 2055 5
[
o
- 2. Please print or type the name and address (includ-00 g
ing zip code) of the registrant physician, clinical
-- M NQ4 b eU E
laboratory, or hospital for whom of for which a,,3r-j this registration ft,rm is filed. Posstion the first Steven L. Ba tt
/6 nk - nu/
lettet of the address below the left dot and do lif this as en unitsalregn verson. Itave this space m
to be not extend the address beyond the tight dot. ( At surgned by NRC If thus as a change of information from a previously NRC, a registration number will be assigned and regnstered generallicensee. include your rettstrarson number.)
a vandated copy of NRC Form 483 will be re-turned.)
S. If place of use is different from address in item 1. please give comp 6ete address:
- 6. Certification:
I hereby certify that:
- a. Allinformation in this registration certificate is true and complete.
- b. The registrant has appropriate radiation measuring inst uments 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.
- c. I understand that Commisuon 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 withm 30 days from the effective date of such change.
- d. I have read and understand the provisions of Section 31.11 of NRC regulations 10 CFR 31 (reprinted 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. acquires.
possesses.uses,or transfers under the generallicense for a hich this Registration Certificate is filed with the Nuclear Regulatory Commission.
Dat.:
2/10/98 I
I b
By Mert k'M%
h o.
Prmted name and title or position of person fihng form WARNINC 28 U.S.C..Section 1001; Act of June 25.1948; 62 Stat. 749; makes it a enmmal offense to make a willf ully f ame statement or i
representation to any department or agency of the United States as to any rnetter withm its jurisdiction.