ML20249C413
| ML20249C413 | |
| Person / Time | |
|---|---|
| Issue date: | 06/26/1998 |
| From: | Kime T NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| To: | Shane J AFFILIATION NOT ASSIGNED |
| References | |
| SSD, NUDOCS 9806290260 | |
| Download: ML20249C413 (2) | |
Text
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June 26,1998 Center for Womens Well Being ATTN: Dr. John M. Shane 1705 East 19th Street, Suite 703 Tulsa, Oklahoma 71104
Dear Dr. Shane:
This letter verifies the receipt of the completed NRC Form 483 dated June 19,1998. 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 8554. 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, N
Traci Kime, Acting Registration Specialist Materials Safety Branch Division of industrial and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards DISTRiflUTION SBaggett IMNS r/f NEO3 M l
DOCUMENT NAME: a:\\ women's.483 Ts receive e copy of this document. IntNcete in the hos! 'C' = Copy without ottachment/ enclosure "E* = Copy w,th attachment / enclosure
'N' = No copy OFFICE.
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DATE 6/26/98 OFFICIAL RECORD COPY
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NRC FORM 483 U. S. NVCLEAR RE;ULATORY COMMISSION APPROVED BY OMB: NO. 31540038 EXPIRES. 6-30-99 r9 sei Esnmated tiuroen per response to comply wm ths mandatory mtormation
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REGISTRATION CERTIFICATE --In vitro TESTING
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c' WITH BYPRODUCT MATERIAL UNDER Paperwork Reduchon Pro,ect (31504038). Office of Management and GENE L LIC qE Budget, Wia.hington oC 20503 NRC ma, not conduct or spon.or, and a w
p..on a nd mouired to respond m. e conection at m#ormation un n
depiays a currenOy vahd oMB control number Section 3111 of 10 CFR 31 estabhshes a general heense authortz1ng physicians, chnical laboratones, hospitals, and vetennanans b the practce of veterinary medcene to possesa certain small quantities of byproduct matertal for in vftro chnical or laboratory tests not invoMng the intemal or extemal adrninistration of the byproduct matenal or the radiation therefrom to human beings or animals. Possession of bypmouct matenal under 10 CFR 31.11 is not authonzed until the physcian, chnical laboratory, hospital, or vetenanan in the practice of veterinary medmine, has filed NRC Form 483 and receNed from the Commission a validated copy of NRC Form 483 with a registration number.
- 1. NAME AND ADDRESS OF APPLICANT (See instruccon 3 B. below)
- 2. APPLICATION (Check one box only)
CUD Ur for Mouens Uell being I herebyf spply for a registration number pursuant to 10 CFR 31, Section st11 fx use d bypmouct materiais fx:
Dr. John Shane 17US Lr15t 19th StreeL, Suite 703 A. Myself, a duty Icensed physician authonzed to disperse drugs in
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'M sa, 501ahona 74104 v
B The above-named chncallaboratory.
ElNONE NUMBLA (include Aree Code) f,
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C. The above named hospital.
910-748-7565 1
o vetennanan in the practice of vetennary medicine
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- 3. ' INSTRUCTIONS:
- 4. REGISTRATION A Submit this form in duphcate to-REGISTRATION NUMBER:
Medcol. Academe and Commercial Use
/g" "849'o Safety Brench (T-8 FS)
Otvision of industnal and Medical Nuclear Safety Offee of Nuclear Matenal Safety and Safeguards n U.S. f.'UC11AR REGULATORY f
U S. Nuclear Regulatory Commisson 3
E COWISSION Washington, DC 20555-0001 g
(At NRC, a registration number will be assigned and a validated copy
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of NRC Form 483 will be retumed )
StevenL.Badett 6/ 6 /98 B in the box above, pnnt or type the name, address (including ZIP Code), and telephone number of the registrant physcian, chnc&l (if this an h/0alregistrabon. Jeeve this space blank - number to be laboratory, hospital, or vetennanan in the practce of vetennary assigned by AIRC. // this is a change ofinforma0'on from a previously medctne for whom or for wtuch thus registration form is fibed.
repstered generalIcense, snclude your registra00n number) 6 4f pjace of use is different from address listed above, grve complete address:
7 f
- 6. CERTIFICATION I hereby certify that:
A All information in this registration certificate is true and complete.
B The registrant has appropnate radiation measunng instruments to carry out the tests for which byproduct matenal will be used under the general heense of 10 CFR 3111. The tests will be performed onty by personnel competent in the use of the instruments and in the handhng of the byproduct materials.
C.
I t,,nderstand that Commission regulations require that any change in the information fumished by a registrant on this registration certifcate be reported to the Director of Nuclear Material Safety and Safeguards wtthin 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 (repnnted on the reverse side of this form), and I understand that the regtotrant is required to comply wtth those provisions as to all byproduct material whch he receives, acquires, possesses, uses, or transfers under the general heense for which this Registration Certmcate is filedy the U;S.gr Regulgory Commission.
PRINTED OR TYPED NAME AND TITLE OF APPLICANT SIG AP T
/ /
DATE I
br. John M. hme WARNING:
FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO CML AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS.18 U.S.C. SECTION 100'1 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.
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