ML20247H349
| ML20247H349 | |
| Person / Time | |
|---|---|
| Issue date: | 05/17/1998 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Kay D AFFILIATION NOT ASSIGNED |
| References | |
| SSD, NUDOCS 9805210142 | |
| Download: ML20247H349 (2) | |
Text
_ __ ___ ___ __-
!L May 17,1998 Deborah A. Kay, D.O.
24748 W Warren
Dearbom,
MI 48127 Dear Dr. Kay; This letter verifies the receipt of the completed NRC Form 483 dated January 13,1998. 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 9135. 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, 3
Traci Kime, Acting Registration Specialist Materials Safety Branch Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards DISTRIBUTION:
Ah SBaggett IMNS r/f NEO3Q/"
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DOCUMENT NAME: PAKAY.483 Ta receive a copo of this document, indicate in the boa: "C" = Copy without attachment / enclosure
-E" - Copy with attachment / enclosure "N" = No copy OFFICE MSB l
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NAME TKime DATE 5//9/98 OFFICIAL RECORD COPY i
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!Y L
l 9905210142 990517 i
PDR RC l
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l NEC Ferm esa U.S. NUCtiAR RECtJLATORY COMMISSION A3 proved by GAO 38'"8188 REGISTRATION CERTIFICATE-IN VITRO TESTING to Fuat WITH BYPRODUCT MATERIAL UNDER GENERAL LICENSE l
i Section 31.11 of 10 CFR 31 establishes a general ilcense authorizing physicians, clinicallaboratories, and hospitals to l
possess certain small quantities of byproduct material for in vitro clinical or laboratory tests not involving theinternalor l
external administration of the byproduct material or the radiation therefrom to human beings or animals. Possession of j
byproduct material under 10 CFR 31.11 is not authorized untti tha physician, clinscallaboratory.or hospitallias filed NRC Form 483 and received from the Commission a validated cecy of NRC Form 483 with registration number.
e s.
DEBORAH A.
KAY, D.O.
l
.c l
" 's 24748"W~ WARREN
' 3. I inreby apply for a registration number pursuant to DEARBORN HGTS MI 46127 Ml! M N M f" " *I 5""'d"" **"d*!' f '
pleen check one block only)
U (a. Myself,a duty licensed physician authorized to dispense drugs in the practice of medicine.
O b. The above. named clinicallaboratory.
O c. The above. named hospital.
- 4. To be completed by the Nuclear Regulatory Commission.
4 l
INSTRUCTIONS Registration number:
- l. Submit this form in triplicate to:
9135
[
Office of Naicar Materhl Safety and Safeguards pnmaag*
A1TN: Radioisotopes Licensing Branch g
II.S. Nuclear Regula ory Commission iS Nuc1rtr Regyti ss ton Washington D.C. 20555 a
E 1 Please print or type the name and address (includ.
J l
Ing tip code) of the registrant physician, clinica!
),
laboratory, or hospital for whom or for which this registration form is fUed. Position the first StcVen' L. Bagget't' - *
- 5/N /98 lettet of the address below the left dot and do fif thh is en imtsal reststronon. leave this spaer blank - number to be l
not extend the address beyond the txght dot. (At migned by NRC ff this is a change ofinformation from a previously NRC. a registration number will be assigned and reskrered generet Ikensee. include your registranors numberJ i
a validated copy of NRC Form 483 will be re-turned.)
- 3. If place of use is different from address in item 1.please give comphte address:
- 6. Certincauoo:
1 1
l 1 hereby certify that:
l
- a. Allinformation in this registration certifieste is true and complete.
i
- b. The registrant has appropriate radiation measurW 'a"m~~ts to carrmut 'he tests for which byproduct material win be used under the I
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 hand!!ng of the byproduct materials.
- c. I understand that Commission regulations require that any change in the information furnished by a registrant on this registration l
ourtificate be reported to the Director of Nuclear MaterialSafety and Safeguards within 30 days from the effective date of such change.
L I have read and understand the provisions of Section 31.!! 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.
oossesses.use or transfers under the generallicense for which this Registration Certificate is filed with the Nuclear Regulatory Commission.
k gy X e
DataX
~
Signature of person filird fo'rm /~
DEBORAH A.
KAY.
D.O.
Frusted anme and title or position of person filing forra WAftNING-18 U.S.C Section 1001: Act of June 25,1948: 62 Stat. 749:mebes it a criminal offense to make a willfuny fahe statement or 1
representation to any deperonent or agency of the United States es to any matter within its jurisdiction, f
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