ML20247H560
| ML20247H560 | |
| Person / Time | |
|---|---|
| Site: | 07000466 |
| Issue date: | 10/15/1987 |
| From: | Cukierski M MAINE MARITIME ACADEMY, CASTINE, ME |
| To: | |
| Shared Package | |
| ML20247H509 | List: |
| References | |
| 108117, NUDOCS 8904040480 | |
| Download: ML20247H560 (5) | |
Text
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U.S. NUCLE AM RE2VLATOdY COMMISSION NRC FOflM 313.. *, -
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INSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUlOE FOR DETAILEO INSTRUCTIONS FOR COMPLETING APPLICATION, SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW, PEOGEL AGENCIES FILE APPL: CATIONS $WITH:
IF YOU ARE LOCATED IN:
lLLINOlt, INDI ANA, IOWA, MICHIGAN, MiteNESOT A, MISSOURI, OHIO, OR U.S. NUCLE AM REGULATORY COMMISSION -
WISCONSIN, SENO APPLICATIONS TO:
DIVISION OF FUEL CYCLE AND MATERIAL SAFETY,NMSS
' WASHINGTON.DC 20856 '
U.S. NUCLE AR REGULATORY COMMIS$lON, REGION ill ALL OTHER PERSONS FILE APPLICATIO816 AS FOLLOWS,IF YOU ARE.
MATERI ALS LICENSING SECTION LOCATED IN: ;
798 ROOSEVELT ROAD GLEN ELLYN. IL 80137 CONelECTICUT. OELAWARE DISTRICT OF COLUMSIA. MAINE, MARYLANO, MASSACHUSETTS. NEW HAMPSHIRE. NEW JERSEY, NEW YORK, PENNSYLVANIA, ARKA88SAS, COLORADO, IDAHO, KANSAS, LOUISIANA. AGONTANA, NESRASK A,-
RHODE ISLAND, OR VERMONT, SENO APPLICATIONS TO: -
NEW MEXICO, NORTH DAKOTA, OKLAHOM A, SOUTH DAKOTA, TEXAS, UTAH, OR WYOMING SENO APPLICATIONS TO:
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- U.S. NUCLEAR REGULATORY COMMISSION, REGION 1 -
NUCLEAR MATERIAL SECTION 5
. U.S. NUCLE AR REGULATORY COMMIS$10N. REGION IV 4*
$31 PARK AVENUE MATERIAL RADtATION PROTECTION SECTION
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KING OF PRUS$1 A, PA 19408 S11 RYAN PLAZA DRIVE,SulTE 1000 ARLINGTON, TX 78011 (3 Anana, FLORIOA, GEOnelA, KENTLMMY, MISSISSIPPI, NORTH CAROLINA,'
i PUERTO RICO, SOUTH CAROLINA, TENNESSE E, VIRGINIA, VIRGIN ISLANDS, OR ALASKA, AR120NA, CALIFORNI A, MAWAll, NEVADA, OR EGON, WASHINGTON, WEST VIRGINIA,SENO APPLICATIONS TO:
ANO U.S. TERRITORIES AND POSSENIOf85 BN THE PACIFIC,SEtso APPLICATIONS 10:
t U.S. NUCLEAR REGULATORY COMMISSION. REGION 11 -
< MATERIAL RADIATION PROTECTION SECTION '
U.S. NLICLE AR REGULATORY COMul8SION, REGION.
v 111 MARIETTA STREET,SulTE 2900 MATERI AL RADI ATION PROTECTION SECTION ATLANTA, GA 30323 1450 MARIA LANE. SUITE 210 WALNUT CREEK,CA $4888 e
i PERSONS LOCA700 IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR REOULATORY COMRelSSION ONLY OF THEY WlSH TO POSSESS AND USE LICENSED MATERIAL l
1 IN STATES SUOJECT TO U.S. NUCLEAR REOULATORY COMeeBSSION JURISDICTION.
- t. THIS IS AN APPLICATION FOR (Check approprasse sasm) 2.NAME AND, MAILING ADDRESS OF APPLICANT (ine/ualelip Coslet -
A NEW LICENSE -
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- 4. NAME OF PERSON TO SE CONT ACTED ABOUT THl3 APPLICATION TELEPHONE NUMSER Pn'o f ^
Me w. COM/6Mni il0 7-52 6 A3H SUSMIT ITEMS S THROUGH 11 ON 8% a 11** PAPER, THE TYPE ANO SCOPE OF INFORMATION TO SE PROVIDED 13 DESCRISED IN THE LICENSE APPLICATION GUIDE.
S. RADIOACTIVE MATERIAL 8, PURPOSE (S) FOR WHICH LICENSED MATERIAL WILL SE USED,
- s. Element and mass number, ts. chemical and/or physecal 10rm, and c. maairnum amount
- wmch will be possessed at any one time.
IDuA $
S SL FOR RADIATION SAFETY PROGRAM AND THEIR S. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTEO AREAS.
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9[PACILITIES AND' EQUIPMENT.
- 10. RADIATIO $iSAFETY PROGRAM.
11 WASTE MANAGEMENT,.
- 12. LICENSEE F EES (See 10 CF$\\ Iff end Sectoon i?O.3th FEE CATEGORY.
NCLOSED $
- 13. CERTIFICATION. (Arust be tornederedby appseent) THE APPLICANT UN JERSTANDS THAT ALL STATEMENTS AND REPRESENTATIONS MADE IN THl3 APPLICATION ARE
' SINDING UPON THE APPLICANT, THE APPLICANT ANO ANY OFFICIAL EXECUTING THl3 CERTIFICATE.N ON SEMALF OF THE APPLICANT, NAMED IN ITEM 2. CERTIFY THAT THIS APPLICATION 13 j
P/.EPARED IN CONFORMITY WITH TITLE 10. COOE OF FEDERAL REGU. ATIONS. PARTS 30.32,33,34,35, AND 40 AND THAT ALL INFORMATION CONTAINED HEREIN, 18 TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND SEL107
'ffARNING; 18 U S.C. SECTION 1001 ACT OF JUNE 25.1948, $2 STAT. 749 b AKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY F ALSE STATEMENT OR REPRESENTATION I
- TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY IMTTER WITHIN ITS JURISDICTION.
SIGNATURE-CERTI YING OF F?C TYPED / PRINTED NAME TITLE DATE fffg) ).
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- c. NUMSER OF EMPLOvEES ITeres for d WOULD YOU SE WILLING TO FURNISH COST INFORMATION (;10/ser end/orstaff Acurst
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ON THE ECONOMIC IMPACT OF CURRENT NRC REGULATIONS OR ANY FUTURE
<$250K '
SIM-3 SM PROPOSED NRC REGULATIONS THAT MAY AFFECT YOU7 (NRC rofu/enons permit
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> $10M FOR NRC USE ONLY TYF'E OF FEE FEE LOG FEECATEGORY COMMENTS APPROVED S Y b
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PRIVACY ACT STATEMENT Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by section 3 of the Privacy Act of 1974 (Public Law 93 579), the follow-ing statement is furnished to individuals who supply information to the Nuclear Regulatory Commission on NRC Form 313. This information is maintained in a system of records designated as NRC 3 and described at 40 Federal Register 45334 (October 1,1975).
- 1. AUTHORITY: Sections 81 and 161(b) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2111 and 2201(b)).
- 3. 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
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'3. ROUTINE USES: The information may be (a) provided to State health departments for their information and use;
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' and.(b) provided to Federal, State, and loc'al health officials and 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-l
! closed to appropriate Federal, State, and local agencies in the event that the information indicates a violation or potential
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. violation of law and in the course of an administrative or judicial proceeding, in addition, this information may be trans-l ferred to an appropriate Federal, State, or local agency to the extent relevant and necessary for an NRC decision or to
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an appropriate Federal agency to the extent relevant and necessary for that agency's decision about you.
NHETHER DISCLOSURE IS MANDATOR OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVID.
NG INFORMATION: Disclosure of the requested information is voluntary. If the requested information is not furn.
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- .aed, 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-l ing from public inspection shall not affect the right, if any, of persons properly and directly concerned need to inspect l
the document.
' 5. SYSTEM MANAGER (S) AND ADDRESS: U.S. Nuclear Regulatory Commission Director, Division of Fuel Cycle and Material Safety Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555 l
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- 6. Student training-( nuclear physics lab. class ).-
- 7.- Prof. M.W. Cukterski
. BS Nuclear Science SUNY Maritime College -
M. Eng. (Nuclear)
Cornell University Seven years start up & testing experience (Nuclear Power Plants)~
Ten years College, teaching L 8. ~ Prof. M..W. Cukterski is the only person working in this area.
9.~ Andrews Lab-Subtritical nuclear assembly with 2494.8 kg of natural uranium.
- 10. Prof. M. W. Cuklerski is in charge of Radiation Safety all acess is
- strickly controlled. Lab. is not in active use at the present time.
11.L No waste is generated or is expected to be generated.
12.None
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Dear Sir.
%.1 Enclosed is a copy _.of our application renewal. The original was sent.'to
-1 Washington on oct. 1 5 1 9 8 7.'
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Very truly 'yours x
M.W.C erski:
Prof Engr.
Maine Maritime Academy t
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'INFORMATION1FROM LMS:
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ST ATUS CODC:' 2 i
1 N' REGIONAL l LICENSING ~ SECTIONS
- . FEE: CATEGORY: EX 1K
- ' EXP..DATE: 19871130
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- 108117,
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AMOUNT:.
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APPLICATION MAY BE PROCESSED F.OR:. /fd,f[f/h AMENOMENT=
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