ML20248F368
| ML20248F368 | |
| Person / Time | |
|---|---|
| Issue date: | 06/02/1998 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Cooney T AFFILIATION NOT ASSIGNED |
| References | |
| SSD, NUDOCS 9806040216 | |
| Download: ML20248F368 (2) | |
Text
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June 2,1998 l
1 l
l The Hamot Research Center.
i Hamot Professional Building l
ATTN: Mr. Timothy Cooney 104 E. 2nd Street Erie, PA-16507
Dear Mr. Cooney:
This letter verif;es the receipt of the. completed NRC Form 483 dated May 28,1998. This form i
' 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 9142. 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.
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Sincerely, hl
\\
Traci Kime, Acting Registration Specialist i
Materials Safety Branch i
Division of Industrial and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards NNO3 d l
S ag tt IMNS r/f i
DOCUMENT NAME:
To receive e copy of this document, indicate in the box: 'C" = Copy without ottachment/ enclosure
- E" = Copy with ettachment/ enclosure
- N" = No copy OFFICE MSB l
l l
l NAME TKime sfd.
L DATE.
6/ 4/98 OFFICIAL RECORD COPY
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9806040216 900602 i
L___________-.
PIRC FORM 483 U. S. NUCLEAR REGULATORY COMMISSION APPRoYED EY OMR No.31So4038 g
EXPIRES 3 31.e6 ESTIMATED BURDEN PER RESPONSE TO CO THIS 7 MINUTE.MPLY WITH INFORMATION COLLECTION REQUEST.
THE VAUDATED REGISTRATION CERTIFICATE --In vitro TESTING
"'Cs" 0, b"R 8^JT MATi St TS*n'E ES'TET,
^"
"* ^" *'
d s;
WITH BYPRODUCT MATERIAL UNDER
'""STs REM"E'o *u"Rc J"EEETs"*"ENJ " MAT cOu 0 Ti GENERAL LICENSE AND RECORDS MANAGEMENT BRANCH (MNBB 7714), u S. NUCLEAR l
REoutATORv couMissiON. wAsHiNoTON. DC 20sss.o0os. AND TO THE PAPERWORK REDUCTION PROJECT (31So4020). OFFICE OF MANAGEMENT AND BUDGET. W ASHINGTON. DC 20s03 Section 31.11 of 10 CFR 31 establishes a general license authorizing physicians, clinical laboratories, hospitals, and veterinarians in the practice of veterinary medicine to possess certain smaH quantities of byproduct material for in vitro clinical or laboratory tests not invoMng the intamal or extemal administration of the byproduct material or the radiation therefrom to human beings or arumals. Possession of byproduct material under 10 CFR 31.11 is not authorized until the physician, clinicallaboratory, hospital, or veterinarian in the practice of veterinary medicine, has filed NRC Form 483 and received from the Commission a val 6 dated copy of NRC Form 483 with a registration number.
- 1. NAME AND ADDRESS OF APPLICANT (Seeinstruccon 3.B. below)
- 2. APPLICATION (Check one box only)
The Hamot Research Centar I hereby apply for a registration number pursuant to 10 CFR 31, Section 31.11, for use of byproduct materials for:
Ha:not Professional Bldg.
104 E.
2nd Street tu practice of medicine.
X B. The above-named slinicallaboratory. ( ren e a rch 1 TELEPHONE NUMBER (Mc4* Ame Corse C. The above named hospital.
814-877-6026 D. Veterinarian in the practice of veterinary medicine 3.
INSTRUCTIONS:
- 4. REGISTRATION A.
Submit this form in duplicate to:
REGISTRATION NUMBER:
Medical, Academic and Commercial Use 9142 y(g""4 9[o U.S. NuC1 car Regulator 0
Safety Branch (T-8 F5)
Division of Industrial and Medical Nuclear Safety g
Office of Nuclear Material Safety and Safeguards o
Com15Sion U.S. Nuclear Regulatory Cwin...A
- r j
Washington, DC 20555-0001 r
(At NRC, a registration number will be assigned and a validated copy
+*
j k
f of NRC Form 463 wiu be retumed.)
B. In the box above, print or type the name, address (including ZIP Steven L'.' %Wett 6/
/%
Code), and telephone number of the registrant physician, clinical (if mis an inibalregrstrabon, leave this space blank - number to be i
laboratory, hospital, or vetennarian in the practice of veterinary assigned by NRC. If this is a change ofinfbima6on from a previously l
medicine for whom or for which this registration form is filed.
I'9'stered gwneralicense, include your regisfra6on number.)
- 5. If place of use is different from address listed above, give complete address:
- 8. CERTIFICATION I hereby certify that:
A.
AD Information in this registration certificate is true and complete.
i B.
The reg 6strant has appropriate radiation measuring instruments to carry out the tests for which byproduct material will b9 used under the general license of 10 CFR 31.11. The tests win be performed onty 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 fumished by a registrant on this registration certificate be l
reported to the Director of Nuclear Material Safety and Safeguards within 30 cays from the effective date of such change.
D 1 have read and understand the provisions of Section 31.11 of NRC regulations 10 CFR 31 (reprinted on the reverse side of inis form); and I understand that the registrant is required to comply with those provisions as to an byproduct mate ial which he receives, acquires, possesses, uses, or transfers under the general license for which this Registration Certificate is filed with the U.S. Nuclear Regulatory Commission.
PRINTED OR TYPED NAME AND TITLE OF APPLICANT SIGNATURE OF APPLICANT DATE 9Mh-
/Mg 5/28/98 Phyllis J.
Kuhn, Ph.D.
t
/
WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CIVIL AND/OR CRIMINAL FENALTIES.
NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C. SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION.
NRC FORM 483 (tes)
L f?SP^"S c IY- - - - - - - - - - - - -
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