ML21005A394

NRC Materials Licenses: Standard License Conditions (January 2021)

ML21005A394
Person / Time
Issue date:	12/15/2020
From:	Ann Sheetz Office of Nuclear Material Safety and Safeguards
To:
Tony McMurtray, NRC/NMSS
References
Download: ML21005A394 (33)

Text

Updated12/15/2020 ConditionName ConditionDesc CategoryCodes Animals/AnimalProductsNotforHumanor AnimalConsumption Experimentalanimals,ortheproductsfromexperimentalanimals, thathavebeenadministeredlicensedmaterialshallnotbeusedfor humanoranimalconsumption.

01100,01110,01120,02110,02400,03610,03611,03612, 03613,03620,04410,04411,04616,04617,04618,04619, 04620,04621,04622,04623,04710,04711 ARSO TheAssociateRadiationSafetyOfficer(ARSO)forthislicenseis

<<!ARSONames!>>.

02110,02120,02121,02200,02201,02210,02220,02230, 02231,02240 AuthorizedtoDistribute,SpecificProducts Thelicenseeisauthorizedtodistributethefollowingseriesofself luminous[specifyproducts,(e.g.compassesandknivesmodels, gunsights)]devicesprovidedtheamountof[hydrogen3]doesnot exceedtheamountspecifiedinthefollowingtable:DeviceModel, MaximumActivity 03254 Cleaning,Maintenance,RepairofGauges Anycleaning,maintenance,orrepairofthegauge(s)thatrequires detachingthesourceorsourcerodfromthegaugeshallbe performedonlybythemanufacturerorbyotherpersonsspecifically licensedbytheU.S.NuclearRegulatoryCommissionoranAgreement Statetoperformsuchservices.

03121,04416,04417 ContaminatedEquipment Exceptforcalibrationsources,referencestandards,andradioactively contaminatedequipmentownedbythelicensee,receipt,storage, anduseincidentaltoanyactivityinvolvinglicensedmaterialata temporaryjobsiteshallbelimitedtomaterialoriginatingfromthat site.Thismaterialmusteitherbetransferredtoanauthorized recipientorremainatthesiteafterlicenseeactivitiesarecompleted.

03219,03234 DecayInStorage(Header)

Thelicenseeisauthorizedtoholdradioactivematerialwithaphysical halflifeoflessthanorequalto120daysfordecayinstoragebefore disposalinordinarytrashprovided:

01100,01110,01120,02110,02400,02410,02500,02511, 02513,02600,03112,03210,03211,03212,03213,03214, 03220,03232,03240,03241,03242,03243,03244,03610, 03611,03612,03613,03620,03800,03810,04010,04011, 04012,04013,04014,04015,04110,04111,04210,04211, 04212,04213,04214,04215,04410,04411,04412,04413, 04424,04425,04430,04431,04432,04433,04610,04611, 04612,04613,04614,04615,04616,04617,04618,04619, 04620,04621,04622,04623,04710,04711 DecayInStorage(A)

Beforedisposalasordinarytrash,thewasteshallbesurveyedatthe containersurfacewiththeappropriatesurveyinstrumentsetonits mostsensitivescaleandwithnointerposedshieldingtodetermine thatitsradioactivitycannotbedistinguishedfrombackground.All radiationlabelsshallberemovedorobliterated,exceptforradiation labelsonmaterialsthatarewithincontainersandthatwillbe managedasbiomedicalwasteaftertheyhavebeenreleasedfrom thelicensee.

01100,01110,01120,02110,02400,02410,02500,02511, 02513,02600,03112,03210,03211,03212,03213,03214, 03220,03232,03240,03241,03242,03243,03244,03610, 03611,03612,03613,03620,03800,03810,04010,04011, 04012,04013,04014,04015,04110,04111,04210,04211, 04212,04213,04214,04215,04410,04411,04412,04413, 04424,04425,04430,04431,04432,04433,04610,04611, 04612,04613,04614,04615,04616,04617,04618,04619, 04620,04621,04622,04623,04710,04711

Updated12/15/2020 DecayInStorage(B)

Arecordofeachsuchdisposalpermittedunderthislicensecondition shallberetainedfor3years.Therecordmustincludethedateof disposal,thedateonwhichthebyproductmaterialwasplacedin storage,theradionuclidesdisposed,thesurveyinstrumentused,the backgrounddoserate,thedoseratemeasuredatthesurfaceofeach wastecontainer,andthenameoftheindividualwhoperformedthe disposal.

01100,01110,01120,02110,02400,02410,02500,02511, 02513,02600,03112,03210,03211,03212,03213,03214, 03220,03232,03240,03241,03242,03243,03244,03610, 03611,03612,03613,03620,03800,03810,04010,04011, 04012,04013,04014,04015,04110,04111,04210,04211, 04212,04213,04214,04215,04410,04411,04412,04413, 04424,04425,04430,04431,04432,04433,04610,04611, 04612,04613,04614,04615,04616,04617,04618,04619, 04620,04621,04622,04623,04710,04711 DestructiveTests Thelicenseeshallnotconductdestructivetestsinvolvingsource materialsuchthatairborneradioactivitywouldbereleasedtothe unrestrictedareas.

11221 DeviceComponentsNotRelatedtoRadiological Safety(A)

Thelicenseemaymaintain,repair,orreplacedevicecomponents thatarenotrelatedtotheradiologicalsafetyofthedevice containinglicensedmaterialandthatdonotresultinthepotential foranyportionofthebodytocomeintocontactwiththeprimary beamorresultinincreasedradiationlevelsinaccessibleareas.

03120,03130,03214,04110,04111,04414,04415,04436, 04437 DeviceComponentsNotRelatedtoRadiological Safety(B)

Thelicenseemaynotmaintain,repair,orreplaceanyofthefollowing devicecomponents:(i)thesealedsource,(ii)thesourceholder,(iii) sourcedrivemechanism,(iv)onoffmechanism(shutter),(v)shutter control,(vi)shielding,or(vii)anyothercomponentrelatedtothe radiologicalsafetyofthedevice,exceptasprovidedotherwiseby specificconditionofthislicense.

03120,03130,03214,04110,04111,04414,04415,04436, 04437 DistributionofProductsunder10CFR32.14 Eachlotoftimepieces,handsanddialsreceived,containingtritium fordistributionpursuanttoa10CFR32.14exemptdistribution license,mustbeaccompaniedbyacertificate,providedbythe manufacturer,whichatteststothefollowing:

Thetimepieces,hands,anddialshavebeenmanufacturedin accordancewiththeInternationalStandardsOrganization,American NationalStandardsInstitute,orequivalentindustrystandardandthe amountoftritiumonthetimepieces,hands,anddialsisnotinexcess ofthemaximumpermissibleamountauthorizedin10CFR30.15(a).

03251 DistributionofProductsunder10CFR32.18 Specialcondition(forlicenseestodistributesourcesalongwitha device):

Thechecksourcesdistributedunder10CFR32.18maybeattached totheoutsideofradiationdetectioninstrumentsfortheconvenience oftheuser.

03253

Updated12/15/2020 DistributionofProductsunder10CFR32.22 Thefollowingdevicecontainingbyproductmaterialdesignedand manufacturedinaccordancewithNRCregistrationcertificateNo.

[NRxxxxD101E],maybedistributedaccordingtothislicense providedtheamountof[e.g.,americium241]containedinthe devicedoesnotexceedtheamountspecifiedinthefollowingtable:

DeviceModelMaximumQuantityPerDevice WatchTritiumM160microcuries(5.92MBq) 03254 DistributionofProductsunder10CFR32.26 Thefollowingdevicecontainingbyproductmaterialdesignedand manufacturedinaccordancewithNRCregistrationcertificateNo.

[NRxxxxD101E],maybedistributedaccordingtothislicense providedtheamountof[e.g.,americium241]containedinthe devicedoesnotexceedtheamountspecifiedinthefollowingtable:

DeviceModelMaximumQuantityPerDevice ChemPro100V2160microcuries(5.92MBq) 03255 DistributionofProductsunder10CFR32.30 Thefollowingindustrialdevicecontainingbyproductmaterial designedandmanufacturedinaccordancewithNRCregistration certificateNo.[NRxxxxD101E],forthepurposeof[e.g.,measuring qualitativeorquantitativechemicalcomposition],maybedistributed accordingtothislicenseprovidedtheamountof[i.e.Nickel63]

containedinthedevicedoesnotexceedtheamountspecifiedinthe followingtable:

GasChromatographModelECDModel SCION436GCand456GC020019720215millicuries(555MBq) 03257 DistributionDeviceInfo Eachdevicedistributedpursuanttotheconditionsofthislicense shallbeinaccordancewiththefollowingtable:DeviceModel NumberIsotopeSourceModelNumberMaximumActivityPer Source 02513,03240,03241,03242,03243,03244,04214,04215 DistributionDeviceInfo,NotExceeding AmountsSpecified Thefollowingproducts[ifneeded:manufacturedinaccordancewith NRCSealedSourceandDeviceRegistrationNo.(insertnumber)],

maybedistributed,providedtheamountof[insertisotope]

containedinthedevicedoesnotexceedtheamountsspecifiedinthe followingtable:Device/SeriesModelMaximumActivityperDevice 03250,03251,03254,03255

Updated12/15/2020 DistributionLocationofUse Thelicenseemaydistributelicensedmaterialfromitsfacilities locatedat<<!LicenseLocations!>>

02511,02513,03211,03214,03221,03240,03241,03242, 03243,03244,03250,03251,03252,03253,03254,03255, 03256,03257,04010,04011,04110,04111,04212,04213, 04214,04215,04426,04427,11240 DistributionProductInfo Eachproductdistributedunderthislicenseshallnotcontain,asof theassaydate,morethanthequantityofbyproductmateriallisted inthefollowingtable:Byproduct MaterialProductNameMaximumActivity 02511,03240,03241,03242,03243,03244,04212,04213 DistributionSourceInfo Eachsealedsourcedistributedunderthislicenseshallnotcontain,as oftheassaydate,morethanthequantityofbyproductmaterial listedinthefollowingtable:Byproduct MaterialModelNumberChemicaland/orPhysicalFormMaximum Activity 02513,04214,04215 DutiesoftheTeletherapyPhysicist Notwithstandingtherequirementsof10CFR35.1690,[insertname]

mayperformthedutiesoftheteletherapyphysicistforthosefull calibrationmeasurmentsandperiodicspotchecksspecifiedin10 CFRPart35.

02300,02310,04510,04511,04512,04513 EmergencyActiontoProtectPublicHealthand Safety IfapprovedbyaRadiationSafetyOfficerspecificallyidentifiedinthis license,thelicenseemaytakereasonableactioninanemergency thatdepartsfromconditionsinthislicensewhentheactionis immediatelyneededtoprotectpublichealthandsafetyandno actionconsistentwithalllicenseconditionsthatcanprovide adequateorequivalentprotectionisimmediatelyapparent.The licenseeshallnotifytheU.S.NuclearRegulatoryCommission HeadquartersOperationsCenterat3018165100andtheU.S.

NuclearRegulatoryCommissionRegionalcontactbefore,if practicable,andinanycaseimmediatelyaftertakingsuchemergency actionusingthecontactinformationspecifiedinAppendixDof10 CFRPart20.

03219,03234 EmergencyPlan(Header)

Thelicenseeisnotrequiredtoestablishanemergencyplan.Before takingpossessionoflicensedmaterialatatemporaryjobsitein quantitiesrequiringanemergencyplan,thelicenseeshalleither:

03219,03234 EmergencyPlan(A)

ObtainU.S.NuclearRegulatoryCommissionapprovalofan evaluationdemonstratingthatanemergencyplanisnotrequired pursuantto10CFR[30.32(i),40.31(j),and70.22(i)],or 03219,03234 EmergencyPlan(B)

SubmitwrittenconfirmationtotheU.S.NuclearRegulatory Commission,usingcontactinformationinAppendixDof10CFRPart 20,thatlicenseepersonnelhavebeentrainedandwillfollowthe provisionsofanexistingemergencyplanapprovedbytheU.S.

NuclearRegulatoryCommissionoranAgreementStateforthe temporaryjobsite.

03219,03234

Updated12/15/2020 EnergyCompensationSource Theopening,repair,ormodificationofanyEnergyCompensation Sourcemustbeperformedbypersonsspecificallylicensedbythe U.S.NuclearRegulatoryCommissionoranAgreementStateto performsuchservices.

03111 ExemptfromIndependentBackupAccess Control Notwithstandingtherequirementsof10CFR36.23(b),thelicenseeis exemptfromtherequirementtohaveanindependentbackupaccess controltodetectpersonnelentrywhilesourcesareexposedbased onthecommitmentsdescribedinthe[letter/application]dated

[insertdate].

03511,03521 ExemptfromMonitorIntegratedwith PersonnelAccessDoorLocks Notwithstandingtherequirementsof10CFR36.23(c),thelicenseeis exemptfromtherequirementtointegratetheradiationmonitor withpersonnelaccessdoorlockstopreventroomaccesswhen radiationlevelsarehighbasedonthecommitmentsdescribedinthe

[letter/application]dated[insertdate].

03511,03521 ExemptfromSourceMovementControlPart 36 Notwithstandingtherequirementsof10CFR36.23(f),thelicenseeis exemptfromtherequirementtohaveacontrolthatpreventsthe sourcesfrommovingfromtheshieldedpositionunlessthecontrol hasbeenactivatedandthedoororbarriertotheradiationroomhas beenclosedwithinapresettimebasedonthecommitments describedinthe[letter/application]dated[insertdate].

03511,03521 ExemptfromVisibleandAudibleAlarmPart 36 Notwithstandingtherequirementsof10CFR36.23(d),thelicenseeis exemptfromhavingavisibleandaudiblealarmwithintheradiation room,basedonthecommitmentsdescribedinthe

[letter/application]dated[insertdate].

03511,03521 ExemptionfromConsoleKeyAttachedto SurveyMeterPart36 Notwithstandingtherequirementsof10CFR36.31(a),thelicenseeis exemptfromtherequirementtohaveaconsolekeyattachedtoa portablesurveymeterbyachainorcableandthedoortothe radiationroomtohavethesamekey,basedonthecommitments describedinthe[letter/application]dated[insertdate].The radiationroomdoorkeyshallbeattachedtotheportablesurvey meter.

03511,03521 ExemptionfromPositionIndicator RequirementforSourceinTransitPart36 Notwithstandingtherequirementsof10CFR36.31(b),thelicenseeis exemptfromtherequirementtohaveasourcepositionindicatorto indicatewhenthesourceisintransit,inaccordancewiththe

[letter/application]dated[insertdate].

03511

Updated12/15/2020 ExemptionfromRadiationRoomControl RequirementPart36 Notwithstandingtherequirementsof10CFR36.67(b)(2),thelicensee isexemptfromtherequirementtohaveacontrolintheradiation roomthatmustbeactivatedpriortoirradiationandthatwouldnot allowthesourcetobemovedfromtheshieldedpositionunlessthe doortotheradiationroomislockedwithinapresettime,basedon thecommitmentsdescribedinthe[letter/application]dated[insert date].

03511,03521 Exemptionsfrom10CFR36.27Part36 Notwithstandingtherequirementsof10CFR36.27,thelicenseeis exemptfrom[insertwhatisexempted],basedonthecommitments describedinthe[letter/application]dated[insertdate].

03511,03521 ExtendedTimeforInspection/Servicing Teletherapy/GammaStereotacticUnit Notwithstandingtherequirementsof10CFR35.655,thelicenseeis notrequiredtofullyinspectandservice[insertteletherapyunitor gammastereotacticunit]every[insert5or7years].Thelicensee shallinspectthe[insertteletherapyunitorgammastereotactic unit]every[insertnumberofyears].

02300,02310,04510,04511,04512,04513 FieldStation,RadiographicInstallation, TemporaryJobSites(A)

Licensedmaterialmaybeonlyatthelicensee'sfacilitieslocatedat

<<!LicenseLocations!>><<!FieldStations!>>

<<!RadiographicInstallations!>>

03111,03112,03310,03320,03800,03810,04430,04431, 04432,04433 FieldStation,RadiographicInstallation, TemporaryJobSites(B)

Licensedmaterialmaybestoredorusedatthefollowing:(i)Field Station(s):<<!FieldStations!>>(ii)Permanentradiographic installation(s):<<!RadiographicInstallations!>>(iii)Temporaryjob site(s):AnywhereintheUnitedStateswheretheU.S.Nuclear RegulatoryCommissionmaintainsjurisdictionforregulatingtheuse oflicensedmaterial,includingareasofexclusiveFederaljurisdiction withinAgreementStates.IfthejurisdictionstatusofaFederal facilitywithinanAgreementStateisunknown,thelicenseeshould contacttheFederalagencycontrollingthejobsiteinquestionto determinewhethertheproposedjobsiteisanareaofexclusive Federaljurisdiction.Authorizationforuseofradioactivematerialsat jobsitesinAgreementStatesnotunderexclusivefederaljurisdiction shouldbeobtainedfromtheappropriatestateregulatoryagency.

03111,03112,03310,03320,03800,03810,04430,04431, 04432,04433 FinancialAssuranceExemptforSealedSource Exchanges Thislicenseeisexemptfromdecommissioningfinancialassurance requirementsforpossessionoflicensedmaterialinsealedsourcesin quantitiesgreaterthanthelimitsin10CFR30.35(d)forthepurpose ofsourcechangesonly.Thisexemptionisgrantedfornomorethan 30daysforanyonesourcechange.

02300,02310,04510,04511,04512,04513

Updated12/15/2020 FinancialAssuranceExemptionfor DecontaminationServices Pursuantto10CFR30.11,40.14,70.14,andCondition10ofthis license,thelicenseeisexemptedfromrequirementsof10CFR30.35, 40.36,and70.25toprovidedecommissioningfinancialassurance.

03219 FinancialAssurancenotrequired

[Ifneeded]InadditiontothepossessionlimitsinItem8,thelicensee shallfurtherrestrictthepossessionoflicensedmaterialtoquantities belowtheminimumlimitin10CFR[30.35(d)or40.36(b)or70.25(d)]

forwhichdecommissioningfinancialassuranceisrequired.

01100,01110,01120,02110,02120,02200,02201,02230, 03610,03611,03612,03613,04610,04611,04612,04613, 04614,04615,04616,04617,04618,04619,04620,04621, 04622,04623,04710,04711 FinancialAssuranceRequired InadditiontothepossessionlimitsinItem8,asspecifiedin10CFR

[30.35(d)or40.36(b)or70.25(d)],thelicenseeshallfurtherrestrict thepossessionof:(i)unsealedbyproductmaterialorunsealed specialnuclearmaterialtoquantitieslessthanorequalto[10^4or 10^5]timestheapplicablelimitsinAppendixBof10CFRPart30,or (ii)readilydispersiblesourcematerialtoquantitieslessthanorequal to100microcuries,or(iii)sealedbyproductmaterialtoquantities lessthanorequalto10^12timestheapplicablelimitsinAppendixB of10CFRPart30.

01100,01110,01120,02110,03610,03611,03612,03613, 04610,04611,04612,04613,04614,04615,04616,04617, 04618,04619,04620,04621,04622,04623,04710,04711 GaugeMountingRequirements(Header)

Thelicenseemayinitiallymountagauge,ifpermittedbythe certificateofregistrationissuedbytheU.S.NuclearRegulatory CommissionoranAgreementState,andunderthefollowing conditions:

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437 GaugeMountingRequirements(A)

Thegaugemustbemountedinaccordancewithwritteninstructions providedbythemanufacturer.

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437 GaugeMountingRequirements(B)

Thegaugemustbemountedinalocationcompatiblewiththe ConditionsofNormalUseandLimitationsand/orOther ConsiderationsofUseinthecertificateofregistrationissuedbythe U.S.NuclearRegulatoryCommissionoranAgreementState.

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437 GaugeMountingRequirements(C)

Theonoffmechanism(shutter)mustbelockedintheoffposition,if applicable,orthesourcemustbeotherwisefullyshielded.

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437 GaugeMountingRequirements(D)

Thegaugemustbereceivedingoodconditions(e.g.,thepackagewas notdamaged).

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437 GaugeMountingRequirements(E)

Thegaugemustnotrequireanymodificationtofitintheproposed location.

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437 GaugeMountingRequirements(Footer)

Mountingdoesnotincludeelectricalconnection,activation,or operationofthegauge.Thesourcemustremainfullyshielded,and thegaugemaynotbeuseduntilitisinstalledandmadeoperational byapersonspecificallylicensedbytheU.S.NuclearRegulatory CommissionoranAgreementStatetoperformsuchoperations.

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437

Updated12/15/2020 GaugeShutterTesting(A)

Eachgaugeshallbetestedfortheproperoperationoftheonoff mechanism(shutter)andindicator,ifany,atintervalsnottoexceed 6monthsoratsuchlongerintervalsasspecifiedinthecertificateof registrationissuedbytheU.S.NuclearRegulatoryCommission pursuantto10CFR32.210ortheequivalentregulationsofan AgreementState.

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437 GaugeShutterTesting(B)

Theperiodiconoffmechanism(shutter)andindicatortest requirementdoesnotapplytogaugesthatarestored,notbeing used,andhavetheshutterlockmechanisminalockedposition.The gaugesexemptedfromthisperiodictestshallbetestedbeforeuse.

Recordsoftestresultsshallbemaintainedfor3yearsfromthedate ofeachtest.

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437 Productsunder10CFR32.11Gemstones(A) Notwithstandingtherequirementsof10CFR32.11(c),thelicensee maydistributeprocessedgemstonesasdescribedintheapplication dated[insertdate],forthepurposeofbeingwornbyhumanbeings.

Thesemaycontainradionuclidesthatdonotappearin10CFR30.70 atconcentrationsuptothosespecifiedintheapplication,applying NOTE2of10CFR30.70;and 03250 Productsunder10CFR32.11Gemstones(B) Thelicenseeshallevaluateanygemstonesthatthelicenseehas determinedarebelowtheexemptconcentrations,andhave subsequentlybeenirradiatedwithanaccelerator,usingappropriate instrumentationandfollowingappropriateprocedurestoensurethat anyinducedradionuclidesdonotexceedtheconcentrationlimits specifiedin10CFR30.70,ScheduleA,andtheapprovedderived concentrationlimitsforradionuclidesnotappearingin10CFR30.70; or 03250 Productsunder10CFR32.11Gemstones(C) Thelicenseeshallnotacceptanymaterialunlessitisaccompaniedby documentationindicatingthatthematerialhasbeenanalyzedand foundtocontainlessthanexemptconcentrationsasspecifiedin10 CFR30.14and30.70,andinaccordancewithNOTE2to10CFR30.70.

Thelicenseeshallensurethatthemeasurementprocesswas adequatetomeasureradioactivitybelowtheexemptconcentrations.

Thelicenseeshallperformperiodicconfirmatorymeasurements,as approved,ofthematerialreceivedtoensuretheregulatory requirementsaremet.

03250 IncinerationDisposal Pursuantto10CFR20.2002,thelicenseeisauthorizedtodisposeof licensedmaterialbyincineration[NOTE:addreference(i.e,as describedinAttachment111toapplicationdatedMonth,DD, YYYY)],providedthegaseouseffluentfromincinerationdoesnot exceedthelimitsspecifiedforairinAppendixBto10CFRPart20, Table2.

03235

Updated12/15/2020 IncineratorAsh/Disposal Pursuantto10CFR20.2002,[NOTE:addreference(i.e,asdescribed inAttachment111toapplicationdatedMonth,DD,YYYY)],the licenseemaydisposeofincineratorashcontainingradioactive materialswithAtomicNos.1through83,exceptasidentifiedbelow, asordinarywastein[specifythelandfill(s)],providedthatthe concentrationofradionuclides(inmicrocuriespergramofash)atthe timeofdisposalarenogreaterthanthevaluesinAppendixBof10 CFRPart20,Table2,Column2.Forhydrogen3,carbon14, aluminum26,chlorine36,silver108m,niobium94,iodine129, technetium99,andthallium204,theconcentrationcanbeno greaterthanonetenthofthevalueinAppendixBof10CFRPart20, Table2,Column2.Ifmorethanoneradionuclideispresentinthe ash,thesumoffractionsruleapplies.

03235 Inspecting/ServicingIntravascular BrachytherapyAfterloaderDevice Theintravascularbrachytherapyafterloaderdeviceshallbe inspectedandservicedatintervalsrecommendedbythe manufacturer,andmaintenanceandrepairshallbeperformedbythe manufacturerorpersonsspecificallylicensedbytheU.S.Nuclear RegulatoryCommissionoranAgreementStatetoperformsuch services.

02110,02240,04710,04711,04826,04827 IrradiatorInstallationSurvey Afterinstallationoftheirradiatorand/orCobalt60orCesium137 source(s)andpriortoinitiationoftheirradiationprogram,a radiationsurveyshallbeconductedtodeterminethemaximum radiationlevelsineachareaadjoiningtheirradiationroom.

03511,03521 IrradiatorProcedures Theprocedurescontainedinthemanufacturer'sinstructionmanual fortheirradiatorauthorizedbythislicenseshallbefollowed,anda copyoftheproceduresshallbemadeavailabletoeachpersonusing orhavingresponsibilityfortheuseofthedevice.

03510,03511,03520,03521 IrradiatorRequirementsJ.L.ShepherdMark I/8122(Header)

ForeachJ.L.ShepherdandAssociates,MarkIorModel8122, Cesium137irradiatorinstalledandused,thelicenseeshall:

03510,03520 IrradiatorRequirementsJ.L.ShepherdMark I/8122(A)

Permittheuseoftheirradiatoronlywhenacalibratedandoperable radiationsurveymeterorroommonitorisavailable;and 03510,03520 IrradiatorRequirementsJ.L.ShepherdMark I/8122(B)

Permittheirradiatordoortobeopenedonlyaftertheoperatorhas checkedvisualindicatorstoverifythatthesourcehasreturnedtoits safestorageposition;and 03510,03520 IrradiatorRequirementsJ.L.ShepherdMark I/8122(C)

Haveroommonitorsinstalledthatwill:(i)Operateatalltimeswhen theirradiatorisinuse;and(ii)Activateavisibleandaudiblealarm whenradiationexceeds2milliremsperhour;and(iii)Detectany radiationleakingfromtheirradiatordoor;and(iv)Bevisibletothe irradiatoruserwhenheisnexttotheirradiator;or 03510,03520

Updated12/15/2020 IrradiatorRequirementsJ.L.ShepherdMark I/8122(D)

Ifaroommonitorisnotinstalled,haveavailableacalibratedand operablesurveymeterthatwillbeusedto:(i)Determinethe radiationlevelattheirradiatordoorwhenthedoorisclosed;and (ii)Checkforanyincreaseinradiationlevelseachtimetheirradiator doorisopened.

03510,03520 IrradiatorRequirementsJ.L.ShepherdMark I/8122(E)

Ifabnormalradiationlevelsoranymalfunctionsoftheirradiatorare detectedatanytime,ceaseusingtheirradiator,restrictaccesstothe areahousingtheirradiator,immediatelynotifytheRadiationSafety Officer,andsubmitallreportsrequiredunder10CFRPart20,Part21 orPart30.

03510,03520 IrradiatorRequirementsJ.L.ShepherdMark I/8122(F)

Notrepairorauthorizerepairsoftheirradiatorexceptbythe manufacturerorotherpersonsspecificallyauthorizedbytheU.S.

NuclearRegulatoryCommissionoranAgreementStatetoperform suchservices.

03510,03520 InstallationSurvey-MaximumRadiationLevels Determined Afterinstallationofthe[irradiator/calibrator/HDR/etc.]andpriorto theinitiationofthe[irradiator/calibration/medicalprogram],a radiationsurveyshallbeconductedtodeterminethemaximum radiationlevelsineachareaadjoiningthe

[irradiaton/calibraton/HDR/etc.]room.

02110,02120,02230,02240,03221,03222,03225,03226, 04426,04427,04428,04429,04710,04711,04810,04811, 04822,04823,04826,04827 Labeling Exceptformaintaininglabelingasrequiredby10CFRPart20,orPart 71,thelicenseeshallobtainauthorizationfromtheU.S.Nuclear RegulatoryCommissionbeforemakinganychangesinthesealed source,device,orsourcedevicecombinationthatwouldalterthe descriptionorspecificationsasindicatedintherespectivecertificate ofregistrationissuedeitherbytheU.S.NuclearRegulatory Commissionpursuantto10CFR32.210orbyanAgreementState.

02500,03120,03121,03122,03124,03210,03510,03520, 04210,04211,04414,04415,04416,04417,04418,04419, 04422,04423 LabelingRequirementsTags(A)

Eachsealedsourcecontaininglicensedmaterialtobeusedoutsideof ashieldedexposuredeviceshallhaveadurable,legible,andvisible tagpermanentlyattachedbyadurablering.Thetagshallbeatleast 1inchsquare,shallbearaconventionalradiationsymbolprescribed in10CFR20.1901(a),andaminimumofthefollowinginstructions:

"DANGERRADIOACTIVEMATERIAL,""DONOTHANDLE"and "NOTIFYCIVILAUTHORITIESIFFOUND."

03710 LabelingRequirementsTags(B)

Replacementofdurableringsshallbecarriedoutbythelicenseeor inaccordancewith[describeinstructionsorprocedure].

03710

Updated12/15/2020 LabelingSourceHolder/Tool Thelicenseeshallensurethateachsourceholderortoolcontaining radioactivematerialbearsadurableandclearlyvisiblelabelbearing theradiationsymbolandthewords"Caution,RadioactiveMaterial."

Thelabelmustbeonthesmallestcomponentthatcontainsthe licensedmaterialandistransportedasaseparatepieceof equipment.

03110,03111 LeakTestExemption(A)

Notwithstandingtheperiodicleaktestrequiredby10CFR34.27(c)(1) and(e),therequirementdoesnotapplytoradiographysourcesthat arestoredandnotbeingused.Theseradiographysourcesmustbe leaktestedbeforetheyareusedortransferredtoanotherperson.

Nosealedsourcemaybestoredforaperiodofmorethan10years withoutbeingtestedinaccordancewith10CFR34.27(c)(1)and(e).

03310,03320 LeakTestExemption(B)

Sealedsourcesauthorizedforusesotherthanradiographyshallbe testedforleakageandshallbeinventoriedinaccordancewith10CFR 34.27and10CFR34.29,respectively.

03310,03320 LeakTestExemption(C)

Thislicenseeisauthorizedtoanalyzeleaktestsamplesinaccordance withthe[application/letter]dated[insertdate].

03310,03320 LicenseeShallNotOpen/RemoveSources

[Insert:Sealedsources,Sourcerods,Foilsources,orDetectorcells]

containinglicensedmaterialshallnotbeopened[Insert:orsources removedfromsourceholdersordetachedfromsourcerods,orfoil sourcesremovedfromdetectorcells]bythelicensee,exceptas specificallyauthorized.

01100,01110,01120,02110,02120,02230,02231,02240, 02400,02500,03120,03121,03122,03124,03130,03210, 03211,03219,03220,03221,03222,03225,03234,03310, 03320,03510,03511,03520,03521,03610,03611,03612, 03613,03710,04010,04011,04210,04211,04410,04411, 04414,04415,04416,04417,04418,04419,04422,04423, 04424,04425,04426,04427,04428,04429,04436,04437, 04610,04611,04612,04613,04614,04615,04616,04617, 04618,04619,04620,04621,04622,04623,04710,04711, 04810,04811,04822,04823,04824,04825,04826,04827 LocationofStorage Licensedmaterialshallbestoredatthelicenseesfacilitieslocatedat:03111,03112,03310,03320,03800,03810,04430,04431, 04432,04433

Updated12/15/2020 LocationofUse Licensedmaterialshallbeusedorstoredatthelicensee'sfacilities locatedat:<<!LicenseLocations!>>

01100,01110,01120,02120,02121,02200,02201,02210, 02220,02230,02231,02240,02300,02310,02400,02410, 02500,02511,02513,02600,02700,02710,03120,03121, 03122,03123,03124,03130,03210,03211,03212,03213, 03214,03215,03220,03221,03222,03225,03226,03310, 03510,03511,03520,03521,03610,03611,03612,03620, 03710,03800,03810,04010,04011,04012,04013,04014, 04015,04110,04111,04112,04113,04210,04211,04212, 04213,04214,04215,04410,04411,04412,04413,04414, 04415,04416,04417,04418,04419,04420,04421,04422, 04423,04424,04425,04426,04427,04428,04429,04430, 04431,04432,04433,04436,04437,04510,04511,04512, 04513,04610,04611,04612,04613,04614,04615,04618, 04619,04620,04621,04622,04623,04810,04811,04812, 04813,04814,04815,04816,04817,04818,04819,04820, 04821,04822,04823,04824,04825,04826,04827,04828, 04829,11200,11210,11220,11221,11230,11300,11800, 11810,11900,22110,22111,22120,22140,22150,22151, 22160,22170,22200,23300,23310 LocationofUseandTemporaryJobSites Licensedmaterialshallbeusedorstoredatthelicensee'sfacilities locatedat<<!LicenseLocations!>>andmaybeusedattemporaryjob sitesofthelicenseeanywhereintheUnitedStateswheretheU.S.

NuclearRegulatoryCommissionmaintainsjurisdictionforregulating theuseoflicensedmaterial,includingareasofexclusiveFederal jurisdictionwithinAgreementStates.Ifthejurisdictionstatusofa FederalfacilitywithinanAgreementStateisunknown,thelicensee shouldcontacttheFederalagencycontrollingthejobsiteinquestion todeterminewhethertheproposedjobsiteisanareaofexclusive Federaljurisdiction.Authorizationforuseofradioactivematerialsat jobsitesinAgreementStatesnotunderexclusiveFederaljurisdiction shouldbeobtainedfromtheappropriatestateregulatoryagency.

03111,03112,03120,03122,03124,03210,03211,03219, 03225,03226,03234,03310,03320,03800,03810,04010, 04011,04414,04415,04418,04419,04422,04423,04430, 04431,04432,04433,11200,11210,11220,11221,11230, 11300,11800,11810,11900

Updated12/15/2020 LocationofUseandUsers Licensedmaterialshallbeusedat[insertMML:(e.g.,UnitedStates AirForce)]facilitiesby:(1)[UnitedStatesAirForce]personnelas authorizedbypermitsissuedbythe[insertnameofRadiationSafety Committee,(e.g.,NationalRadiationSafetyCommittee)];and(2) userswhoarenot[insertMML:(e.g.,UnitedStatesAirForce)]

personnelwhensuchuseisauthorizedbythe[insertnameof RadiationSafetyCommittee,(e.g.,NationalRadiationSafety Committee)]andisconductedinworkspacesunderthecontrolof the[insertMML:(e.g.,UnitedStatesAirForce)].

03614 LocationofUseOffShore LicensedMaterialshallbeusedatthelicensee'sfacilitieslocatedat:

[specifytheProducer,OfficialProtractionDiagramOilFieldName, BlockNumber,GulfofMexico(orPacificOcean),PlatformOSC assignednumberorlatitude/longitudeiftheplatformnumberhas notbeenassignedorifthedeviceisplacedsubsea.]

03110,03111 LocationofUse/SpecificAddressforMaterial LicensedmateriallistedinSubitemNos.[insertsubitem]through

[insertsubitem]shallbeusedatthelicensee'sfacilitieslocatedat

<<!LicenseLocations!>>.

01100,01110,01120,02110,02120,02121,02200,02201, 02210,02220,02230,02231,02240,02300,02310,02400, 02410,02500,02511,02513,02600,02700,02710,03110, 03111,03112,03113,03120,03121,03122,03124,03130, 03210,03211,03212,03213,03710,04010,04011,04012, 04013,04014,04015,04210,04211,04212,04213,04214, 04215,04410,04411,04412,04413,04414,04415,04416, 04417,04418,04419,04422,04423,04436,04437,04510, 04511,04512,04513,04618,04619,04620,04621,04622, 04623,04710,04711,04810,04811,04812,04813,04814, 04815,04816,04817,04818,04819,04820,04821,04822, 04823,04824,04825,04826,04827,11200,11210,11220, 11221,11230,11300,11800,11810,11900 LossofContactwithNuclearPowered PacemakerPatient ThelicenseeshallreporttotheU.S.NuclearRegulatoryCommission usingthecontactinformationinAppendixDof10CFRPart20,within 10daysafterdiscoveryoflossofcontactwithanuclearpowered pacemakerpatient.

22160,04828,04829 Maintenance,Repair,Cleaning,Replacement, andDisposal...

Maintenance,repair,cleaning,replacement,anddisposaloffoils containedindetectorcellsshallbeperformedonlybythedevice manufacturerorotherpersonsspecificallyauthorizedbytheU.S.

NuclearRegulatoryCommissionoranAgreementStatetoperform suchservices.

01120,02110,03123,03124,03211,03610,03611,03612, 03620,04010,04011,04420,04421,04422,04423,04610, 04611,04612,04613,04614,04615,04622,04623,04710, 04711 MaterialNotforUseinFieldApplications Thelicenseeshallnotuselicensedmaterialinfieldapplications whereactivityisreleasedexceptasprovidedotherwisebyspecific conditionofthislicense.

01100,01110,01120,02110,03610,03611,03612,03613, 03620,04610,04611,04612,04613,04614,04615,04616, 04617,04618,04619,04620,04621,04622,04623,04710, 04711

Updated12/15/2020 MaterialNotforUseIn/OnHumans Thelicenseeshallnotusethelicensedmaterialinoronhumans.

[NOTE:ifneededaddthefollowing:exceptasprovidedotherwise byspecificconditionofthislicense].

01100,01110,01120,02400,03240,03241,03242,03243, 03244,03610,03611,03612,03613,03620,04410,04411, 04610,04611,04612,04613,04614,04615,04616,04617, 04618,04619,04620,04621,04622,04623 MobileNuclearMedicineActivities Licensedmaterialincidenttomobilenuclearmedicineactivitiesmay bedeliveredtothelicensee'smobilevanlocatedattemporaryjob siteswhentrainedlicenseepersonnelarepresenttoreceivethe licensedmaterial.

02220,02231,04820,04821,04824,04825 ModificationstotheSourceRack Thelicenseeisauthorizedtomakemodificationstothesourcerack asrequestedin[application/letter]dated[insertdate].Thelicensee shalltestthemovementofthesourcerackforproperoperationin accordancewith10CFR36.41(f)and(i)priortosourceloading.

03521 ExemptDistributionNotAuthorized Thislicensedoesnotauthorizedistributiontopersonsexemptfrom licensing.

02500,04210,04211 NoIrradiatorRepairs Thelicenseeshallnotperformrepairsoralterationsoftheirradiator involvingremovalofshieldingoraccesstothelicensedmaterial.

Removal,replacement,anddisposalofsealedsourcesinthe irradiatorshallbeperformedbypersonsspecificallylicensedbythe U.S.NuclearRegulatoryCommissionoranAgreementStateto performsuchservices.

03510,03511,03520,03521 NoPossessionorUse Thislicensedoesnotauthorizepossessionoruseoflicensed materials.

02511,02513,03240,03241,03242,03243,03244,03250, 03251,03252,03253,03254,03255,03256,03257,04212, 04213,04214,04215,11240 NoPossessionatCustomerFacility Thelicenseemaynottakepossessionoftheradioactivematerials and/orsealedsourceswhileatthecustomer'sfacility[insertas neededforexample"exceptforanalyticalsamples"].

03219,03226,03234 NoTemporaryJobSitesAuthorized IfacustomeralsoholdsalicenseissuedbytheU.S.Nuclear RegulatoryCommissionoranAgreementState,thelicenseeshall establishawrittenagreementbetweenthelicenseeandthe customerspecifyingwhichlicenseeactivitiesshallbeperformed pursuanttothecustomer'slicenseandsupervision,andwhich licenseeactivitiesshallbeperformedunderthelicensee'ssupervision pursuanttothislicense.Acopyofthisagreementshallbeincluded inthenotificationrequiredbylicensecondition[insertnumber].

03219,03234 NonCommercialDistribution Thislicensedoesnotauthorizecommercialdistributionoflicensed material.

03214,03220,03232,03610,03611,04110,04111,04424, 04425,04610,04611,04612,04613 NonCommercialDistribution10CFR30 Thislicensedoesnotauthorizecommercialdistributiontopersons exemptfromlicensingpursuantto[insertapplicableregulation, suchas10CFR30.19or10CFR30.14through30.21,inclusive].

03214,04110,04111

Updated12/15/2020 NonCommercialDistribution10CFR31 Thislicensedoesnotauthorizecommercialdistributionoflicensed materialtopersonsgenerallylicensedpursuantto10CFRPart31or topersonsexemptfromlicensingpursuantto[insertapplicable regulation,suchas10CFR30.18].

03214,04110,04111 NonCommercialDistributionPursuantto10 CFR31and/or32 Thislicensedoesnotauthorizecommercialdistributionoflicensed materialpursuantto10CFR32.72or10CFR32.74topersons generallylicensedpursuantto10CFRPart31orequivalent regulationsofanyAgreementState;ortopersonsexemptfrom licensingpursuantto10CFR30.14through10CFR30.21inclusive,or equivalentregulationsofanyAgreementState.

03210,03214,04110,04111 NonRoutineMaintenanceNotAllowed Thefollowingservicesshallnotbeperformedbythelicensee:[Insert whichservicesareNOTauthorizedinthislicense,delete remaining:](i)installation,(ii)initialradiationsurveys,(iii)relocation, (iv)removalfromservice,(v)dismantling,(vi)alignment, (vii)replacement,(viii)disposalofthesealedsource,and(ix)non routinemaintenanceorrepairofcomponentsrelatedtothe radiologicalsafetyofthegauge(i.e.,thesealedsource,thesource holder,sourcedrivemechanism,onoffmechanism(shutter),shutter control,shielding).Theseservicesshallbeperformedonlybypersons specificallylicensedbytheU.S.NuclearRegulatoryCommissionoran AgreementStatetoperformsuchservices.

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437 CertainNonRoutineMaintenanceAllowed

[Inserttheservicesauthorizedinthislicense,deleteremaining:(i)

Installation,(ii)initialradiationsurveys,(iii)relocation,(iv)removal fromservice,(v)dismantling,(vi)alignment,(vii)replacement,(viii) disposalofthesealedsource,and(ix)nonroutinemaintenanceor repairofcomponentsrelatedtotheradiologicalsafetyofthe gauge]shallbeperformedonlyby[insertname(s)],orother individualswhohavecompletedthetrainingspecifiedin[insert application/letter]dated[insertdate],orbypersonsspecifically licensedbytheU.S.NuclearRegulatoryCommissionoranAgreement Statetoperformsuchservices.

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437 NonroutineMaintenanceofGauges Thelicenseemaydetachthesourcerodfromthegauge(s)forthe purposeofcleaning,maintenance,orrepairofthegauge(s)in accordancewithproceduresoutlineinthe[application/letter]dated

[insertdate].

03121,04416,04417 NotAuthorizedtoPerformSourceChanges Thelicenseeisnotauthorizedtoperformsourcechangesin radiographicexposuredevices.Theseservicesshallbeperformedby personsspecificallylicensedbytheU.S.NuclearRegulatory CommissionoranAgreementStatetoperformsuchactivities.

03310,03320

Updated12/15/2020 NotificationofTransferringorDisposingof DepletedUraniumShielding ThelicenseeshallinformtheU.S.NuclearRegulatoryCommission,

[insertnameofRegionalOffice],priortotransferringordisposingof depleteduraniumshielding.

11200,11210,11220,11221,11230,11300,11800,11810, 11900 NotificationtoNRC(A)

ThelicenseeshallnotifytheU.S.NuclearRegulatoryCommission, usingcontactinformationinAppendixDof10CFRPart20,inwriting, atleast14daysbeforeinitiatingactivitiesunderthislicenseata temporaryjobsite,excludingroutinepackagingorrepackagingfor purposesoftransportingandnotrequiringajoborsitespecificwork package,andcharacterizationand/orfinalsurveyswhereneither radioactivematerialsnorradiationarelikelytobedetected.This notificationshallinclude:(1)Theestimatedtype,quantity,and physical/chemicalformsoflicensedmaterialtobeused,(2)The specificsitelocation,(3)Adescriptionofplannedactivitiesincluding wastemanagementanddisposition,(4)Theestimatedstartdateand completiondateforthejob,(5)Thenameandtitleofapointof contactforthejob,includinginformationonhowtocontactthis individual,and(6)Copyofthewrittenagreementbetweenthe licenseeandthecustomerasdescribedbylicensecondition[insert numberforlicenseconditionNoTemporaryJobSitesAuthorized].

03219,03234 NotificationtoNRC(B)

Within30daysofcompletingactivitiesateachjobsitelocation,the licenseeshallnotifytheU.S.NuclearRegulatoryCommission,using contactinformationinAppendixDof10CFRPart20,inwriting,of thetemporaryjobsitestatusandthedispositionofanylicensed materialused.

03219,03234 NuclearPoweredPacemakers Thephysician(s)responsibleforfollowup,explantationandreturnof nuclearpoweredpacemakerstothemanufacturerforproper disposalis[insertname(s)].

22160,04828,04829 OperatingRequirements Thelicenseeshalloperateeachdevicecontaininglicensedmaterial withinthemanufacturer'sspecifiedtemperatureandenvironmental limitssuchthattheshieldingandshuttermechanismofthesource holderarenotcompromised.

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437 GasChromatographOperatingTemperature ControlMechanism(A)

Detectorcellscontainingatitaniumtritidefoilorscandiumtritidefoil shallonlybeusedinconjunctionwithaproperlyoperating temperaturecontrolmechanismthatpreventsthefoiltemperature fromexceedingthatspecifiedinthecertificateofregistrationissued bytheU.S.NuclearRegulatoryCommissionpursuantto10CFR 32.210orequivalentregulationsfromanAgreementState.

03123,03610,04420,04421 GasChromatographOperatingTemperature ControlMechanism(B)

Wheninuse,detectorcellscontainingatitaniumtritidefoilor scandiumtritidefoilshallbeventedtotheoutside.

03123,03610,04420,04421

Updated12/15/2020 OutdoorTargetArea Thetotalamountofdepleteduraniumcontainedinspentmunitions whichmayremainintheOutdoorTargetAreaunderthe authorizationofthislicenseshallnotexceed[insertamount]

kilograms.Recordsofinventoryofmaterialfiredintoandretrieved fromtheOutdoorTargetAreashallbemaintained.

11221 Ownership/PossessionWrittenApproval Thelicenseemaynottakeownershiporpossessionofradioactive material(s)orsource(s)originatingfromaclient'ssite,withoutprior notificationandwrittenapprovalfromtheU.S.NuclearRegulatory Commission.

03219,03234 PatientFollowUpNuclearPowered Pacemakers Thelicenseeshallcontinuepatientfollowupandreplacement proceduresforthenuclearpoweredpacemakerduringthelifeofthe patient.Proceduresforrecoveryandauthorizeddisposalofthe nuclearpoweredpacemakerbyreturntothemanufacturershallbe followeduponthedeathofthepatient.Ifreturnoftheexplanted pacemakerbyreturntothemanufacturerisnotpossible,explanted pacemakersmaybedisposedofinaccordancewiththe commitments,representationsandproceduresinthe

[letter/application]dated[insertdate].

22160,04828,04829 RadiationSafetyCriteria-AuthorizedNuclear Pharmacists Pharmacists,asdefinedin10CFR35.2,designatedinwritingtowork asauthorizednuclearpharmacistsbythelicensee'sRadiationSafety Committee,shallmeettherequirementsinaccordancewithletter(s) dated[insertdate].Thelicenseeshallmaintainrecordsofindividuals designatedasauthorizednuclearpharmacistsfor3yearsfollowing thelastuseoflicensedmaterialbytheindividual.

02500,04210,04211 PhysicalInventory Thelicenseeshallconductaphysicalinventoryevery6months,orat otherintervalsapprovedbytheU.S.NuclearRegulatoryCommission, toaccountforallsealedsourcesand/ordevicesreceivedand possessedunderthelicense.Recordsofinventoriesshallbe maintainedfor3yearsfromthedateofeachinventory,andshall includetheradionuclides,quantities,manufacturer'snameand modelnumbers,andthedateoftheinventory.

01100,01110,01120,02110,02400,02500,02513,03120, 03121,03122,03123,03124,03130,03210,03211,03214, 03219,03220,03221,03222,03225,03226,03240,03241, 03242,03243,03244,03510,03511,03520,03521,03610, 03611,03612,03613,03710,04010,04011,04110,04111, 04210,04211,04214,04215,04410,04411,04414,04415, 04416,04417,04418,04419,04420,04421,04422,04423, 04424,04425,04426,04427,04428,04429,04436,04437, 04610,04611,04612,04613,04614,04615,04616,04617, 04618,04619,04620,04621,04622,04623,04710,04711, 11200,11210,11220,11221,11230,11300,11800,11810, 11900 PhysicalInventoryMML(A)

Thelicenseeshallrequirepermitteestoconductaphysicalinventory every6monthstoaccountforallsourcesand/ordevicesreceived andpossessedundertheirrespectivepermits.

03614

Updated12/15/2020 PhysicalInventoryMML(B)

Thelicenseeshallrequirethatpermitteesmaintainrecordsof physicalinventoriesfor3yearsfromthedateofeachinventory.

Recordsshallincludethequantitiesandkindsoflicensedmaterial, manufacturer'snameandmodelnumbers,locationofthesources and/ordevices,andthedateoftheinventory.

03614 PortableGaugeBarriers Eachportablenucleargaugeshallhavealockorouterlocked containerdesignedtopreventunauthorizedoraccidentalremovalof thesealedsourcefromitsshieldedposition.Thegaugeorits containermustbelockedwhenintransportorstorage,orwhennot underthedirectsurveillanceofanauthorizeduser.

03121,04416,04417 PossessionforBroadTypeB Ifonlyoneradionuclideispossessed,thepossessionlimitisthe quantityspecifiedforthatradionuclidein10CFR33.100,ScheduleA, ColumnI.Iftwoormoreradionuclidesarepossessed,thenthe possessionlimitisdeterminedasfollows:Foreachradionuclide, determinetheratioofthequantitypossessedtotheapplicable quantityspecifiedin10CFR33.100,ScheduleA,ColumnI,forthat radionuclide.Thesumoftheratiosforallradionuclidespossessed underthelicenseshallnotexceedunity.

01110,03611,04612,04613,04620,04621 PossessionforBroadTypeC Ifonlyoneradionuclideispossessed,thepossessionlimitisthe quantityspecifiedforthatradionuclidein10CFR33.100,ScheduleA, ColumnII.Iftwoormoreradionuclidesarepossessed,thenthe possessionlimitisdeterminedasfollows:Foreachradionuclide, determinetheratioofthequantitypossessedtotheapplicable quantityspecifiedin10CFR33.100,ScheduleA,ColumnII,forthat radionuclide.Thesumoftheratiosforallradionuclidespossessed underthelicenseshallnotexceedunity.

01120,03612,04614,04615,04622,04623 PossessionLimitforNuclearPowered Pacemakers Thespecifiedpossessionlimitfornuclearpoweredpacemakers includesalllicensedmaterialpossessedbythelicenseeunderthis licensewhetherinstorage,implantedinpatients,orotherwisein use.

22160,04828,04829 ProgramChangestoProcedures(Header)

NotwithstandingtherequirementsofLicenseCondition[InsertTie DownConditionNumber],thelicenseeisauthorizedtomake programchangesandchangestoproceduresspecificallyidentifiedin the[application/letter]dated[insertdate],whichwerepreviously approvedbytheU.S.NuclearRegulatoryCommissionand incorporatedintothelicensewithoutpriorCommissionapprovalas longas:

01100,02110,03211,03610,04010,04011,04610,04611, 04618,04619,04710,04711 ProgramChangestoProcedures(A)

Theproposedrevisionisdocumented,reviewed,andapprovedby thelicensee'sRadiationSafetyCommitteeinaccordancewith establishedprocedurespriortoimplementation; 01100,02110,03211,03610,04010,04011,04610,04611, 04618,04619,04710,04711

Updated12/15/2020 ProgramChangestoProcedures(B)

Therevisedprogramisinaccordancewithregulatoryrequirements, willnotchangethelicenseconditions,andwillnotdecreasethe effectivenessoftheRadiationSafetyProgram; 01100,02110,03211,03610,04010,04011,04610,04611, 04618,04619,04710,04711 ProgramChangestoProcedures(C)

Thelicensee'sstaffistrainedintherevisedprocedurespriorto implementation;and 01100,02110,03211,03610,04010,04011,04610,04611, 04618,04619,04710,04711 ProgramChangestoProcedures(D)

Thelicensee'sauditprogramevaluatestheeffectivenessofthe changeanditsimplementation.

01100,02110,03211,03610,04010,04011,04610,04611, 04618,04619,04710,04711 ProposedChangesinPackaging,Labeling, Shielding,Instructions Anyproposedchangesinpackaging,labeling,shielding,or instructionsforuseandstorageshallbesubmittedforreviewtothe U.S.NuclearRegulatoryCommissioninaccordancewithAppendixD of10CFRPart20.Theapprovalofthechangesshallbereceivedby thelicenseepriortoimplementinganyofthechanges.

02511,02513,03240,03241,03242,03243,03244,04212, 04213,04214,04215 PulsedNeutronGeneratorToolNotEnergized Thepulsedneutrongeneratortoolshouldnotbeenergizedbefore goingdownholetoadepthofatleast200feetorintoacalibration tank.

03110,03111 PulsedNeutronGeneratorToolNotRetracted Thepulsedneutrongeneratortoolshouldnotberetractedtothe surfaceorfromthecalibrationtankuntilsufficienttimehasallowed foractivationproductsinthetooltodecayinaccordancewith

[application/letter]dated[insertdate].

03110,03111 RadiationSafetyCommittee Licensedmaterialshallonlybeusedby,orunderthesupervisionof, individualsdesignated,inwriting,bythe[Note:enterlicensee's RadiationSafetyCommitteename].Thelicenseeshallmaintain recordsofindividualsdesignatedasusersfor3yearsafterthe individual'slastuseoflicensedmaterial.

01100,03211,03610,03613,04010,04011,04610,04611, 04616,04617,04618,04619 RadiationSafetyCommitteeRequests

[InsertnameofRadiationSafetyCommittee,e.g.,National RadiationSafetyCommittee]shallsubmitrequestsforapprovalto theU.S.NuclearRegulatoryCommissionforexemptionsfromthe Commission'sregulations.

03614 RecordsforDecommissioning Thelicenseeshallmaintainrecordsofinformationimportantto decommissioningforeachtemporaryjobsitepursuantto10CFR

[30.35(g),40.36(f),and70.25(g)].Therecordsshallbemadeavailable tothecustomeruponrequest.Atthecompletionofactivitiesata temporaryjobsite,thelicenseeshalltransfertheserecordstothe customerforretention.

03219,03234 RedistributionofAlpha,Beta,orPhoton EmittingRadioactiveDrugs Notwithstandingtherequirementsof10CFR32.72(c),thelicensee mayredistributealpha,beta,orphotonemittingradioactivedrugs, whichhavebeeninitiallydistributedbyanotherradiopharmaceutical supplierlicensedpursuantto10CFR32.72,withoutverifyingthe radioactivityofthedosage.Thelicenseemustnotmanipulatethe dosage,includingthepackagingandlabel.

02511,04212,04213

Updated12/15/2020 RegistrationCertificateReference Thefollowingdevicecontainingbyproductmaterialdesignedand manufacturedinaccordancewithNRCregistrationcertificateNos.

[NRxxxxD101EandNRxxxxD101E],maybedistributed accordingtothislicenseprovidedtheamountof[e.g.,americium 241]containedinthedevicedoesnotexceedtheamountspecifiedin thefollowingtable:DeviceModel,MaximumQuantityPerDevice 03255 RegistrationCertificateReferenceIndustrial Device Thefollowingindustrialdevicecontainingbyproductmaterial designedandmanufacturedinaccordancewithNRCregistration certificateNo.[NRxxxxD101E],forthepurposeof[e.g.,

measuringqualitativeorquantitativechemicalcomposition],may bedistributedaccordingtothislicenseprovidedtheamountof[e.g.,

Nickel63]containedinthedevicedoesnotexceedtheamount specifiedinthefollowingtable:GasChromatographModel,Device Model,MaximumQuantityPerDevice 03257 Registrationunder10CFR32.210 Thelicenseeshallnotacquirelicensedmaterialinasealedsourceor deviceunlessthesourceordevicehasbeenregisteredwiththeU.S.

NuclearRegulatoryCommissionpursuantto10CFR32.210or equivalentregulationsofanAgreementState.

02110,03211,03610,03611,03612,03620,04010,04011, 04610,04611,04612,04613,04614,04615,04710,04711 ReportofNuclearPoweredPacemakerDeath orIssue ThelicenseeshallreporttotheU.S.NuclearRegulatoryCommission inaccordancewithAppendixDof10CFRPart20,within24hoursof occurrence,discoveryofthedeathofanynuclearpowered pacemakerpatient,andanyadversereactionand/ormalfunction involvingapacemakersystem,includingtheleads.Awrittenreport givingdetailsoftheadversereactionand/ormalfunctionshallbe submittedwithin30days.

22160,04828,04829 Requirementsin10CFR35.14forMML (notifications)

Notwithstandingtherequirementsin10CFR35.14tonotifytheU.S.

NuclearRegulatoryCommission,the[insertMMLname:e.g.,

DepartmentofVeteransAffairs]medicalusepermitteesare authorizedtomakethenotificationrequiredin10CFR35.14tothe

[insertMMLentitye.g.,DepartmentofVeteransAffairsNational HealthPhysicsProgramDirector]providedtheappropriate requirementsin10CFR35.13(b)and35.14aremet.

03614 Requirementsin10CFR35.6forMML(human researchsubjects)

[InsertnameofRadiationSafetyCommittee,e.g.,National RadiationSafetyCommittee]shallassurethatallusesofbyproduct materialonhumanresearchsubjectsareauthorizedandperformed inaccordancewiththerequirementsin10CFR35.6.

03614

Updated12/15/2020 RestrictedPossessionfor10CFR30.72for EmergencyPlan InadditiontothepossessionlimitsinItem8,thelicenseeshall furtherrestrictthepossessionoflicensedmaterialtoquantities belowthelimitsspecifiedin10CFR30.72whichrequire considerationoftheneedforanemergencyplanforrespondingtoa releaseoflicensedmaterial.

01100,02110,03211,03212,03213,03214,03219,03232, 03234,03610,03611,03613,04010,04011,04012,04013, 04014,04015,04110,04111,04610,04611,04612,04613, 04616,04617,04710,04711 RestrictionofIrradiatorMaintenance Thelicenseeshallnotrepair,remove,replace,oralteranyofthe following:electricalandmechanicalsystemsthatcontrolsourceor shieldingmovement,theirradiator'sshieldingorsealedsource, safetyinterlocks,oranycomponentthatmayaffectsafeoperationof theirradiator.Theseactivitiesshallbeperformedbyaperson specificallylicensedbytheU.S.NuclearRegulatoryCommissionoran AgreementStatetoperformsuchservices.

03510,03511,03520,03521 RestrictionofIrradiatorMaintenanceException Exceptfortherepairormaintenanceoperationsdescribedin

[letter/application]dated[insertdate],thelicenseeshallnotrepair, remove,replace,oralteranyofthefollowing:electricaland mechanicalsystemsthatcontrolsourceorshieldingmovement,the irradiator'sshieldingorsealedsource,safetyinterlocks,orany componentthatmayaffectsafeoperationoftheirradiator.These activitiesshallbeperformedbyapersonspecificallylicensedbythe U.S.NuclearRegulatoryCommissionoranAgreementStateto performsuchservices.

03510,03511,03520,03521 Retrieve,ReceiveandDisposeofRadioactive Waste Thelicenseeisauthorizedtoretrieve,receiveanddisposeof radioactivewastefromitscustomers,limitedtoradiopharmacy suppliedsyringesandvialsandtheircontents.

02500,04210,04211

Updated12/15/2020 RSO TheRadiationSafetyOfficer(RSO)forthislicenseis<<!RSOName!>>. 01100,01110,01120,02110,02120,02121,02200,02201, 02210,02220,02230,02231,02240,02300,02310,02400, 02410,02500,02511,02513,02600,03110,03111,03120, 03121,03122,03123,03124,03130,03210,03211,03212, 03213,03214,03215,03219,03220,03221,03222,03225, 03226,03232,03235,03236,03240,03241,03242,03243, 03244,03310,03320,03510,03511,03520,03521,03610, 03611,03612,03613,03620,03710,03800,03810,03900, 04010,04011,04012,04013,04014,04015,04110,04111, 04112,04113,04210,04211,04212,04213,04214,04215, 04410,04411,04412,04413,04414,04415,04416,04417, 04418,04419,04420,04421,04422,04423,04424,04425, 04426,04427,04428,04429,04430,04431,04432,04433, 04436,04437,04510,04511,04512,04513,04610,04611, 04612,04613,04614,04615,04616,04617,04618,04619, 04620,04621,04622,04623,04710,04711,04810,04811, 04812,04813,04814,04815,04816,04817,04818,04819, 04820,04821,04822,04823,04824,04825,04826,04827, 04828,04829,11200,11210,11220,11221,11230,11300, 11800,11810,11900,22110,22111,22120,22140,22150, 22151,22160,22170,22200,23300,23310 LeakTest(A)

Sealedsourcesanddetectorcellsshallbetestedforleakageand/or contaminationatintervalsnottoexceedtheintervalsspecifiedinthe certificateofregistrationissuedbytheU.S.NuclearRegulatory Commissionunder10CFR32.210orbyanAgreementState.Inthe absenceofaregistrationcertificate,sealedsourcesshallbetested forleakageand/orcontaminationatintervalsnottoexceed6 months,oratsuchotherintervalsasspecified.

01100,01110,01120,02231,02400,02500,02513,03111, 03120,03121,03122,03123,03124,03130,03210,03211, 03214,03219,03220,03221,03222,03225,03226,03234, 03510,03511,03520,03521,03610,03611,03612,03613, 03620,03710,04010,04011,04110,04111,04210,04211, 04214,04215,04410,04411,04414,04415,04416,04417, 04418,04419,04420,04421,04422,04423,04424,04425, 04426,04427,04428,04429,04436,04437,04610,04611, 04612,04613,04614,04615,04616,04617,04618,04619, 04620,04621,04622,04623,04824,04825 LeakTest(B)

NotwithstandingParagraphAofthisCondition,sealedsources designedtoprimarilyemitalphaparticlesshallbetestedforleakage and/orcontaminationatintervalsnottoexceed3months.

01100,01110,01120,02231,02400,02500,02513,03111, 03120,03121,03122,03123,03124,03130,03210,03211, 03214,03219,03220,03221,03222,03225,03226,03234, 03510,03511,03520,03521,03610,03611,03612,03613, 03620,03710,04010,04011,04110,04111,04210,04211, 04214,04215,04410,04411,04414,04415,04416,04417, 04418,04419,04420,04421,04422,04423,04424,04425, 04426,04427,04428,04429,04436,04437,04610,04611, 04612,04613,04614,04615,04616,04617,04618,04619, 04620,04621,04622,04623,04824,04825

Updated12/15/2020 LeakTest(C)

Eachsealedsourcefabricatedbythelicenseeshallbeinspectedand testedforconstructiondefects,leakage,andcontaminationpriorto anyuseortransferasasealedsource.

01100,01110,01120,02231,02400,02500,02513,03111, 03120,03121,03122,03123,03124,03130,03210,03211, 03214,03219,03220,03221,03222,03225,03226,03234, 03510,03511,03520,03521,03610,03611,03612,03613, 03614,03620,03710,04010,04011,04110,04111,04210, 04211,04214,04215,04410,04411,04414,04415,04416, 04417,04418,04419,04420,04421,04422,04423,04424, 04425,04426,04427,04428,04429,04436,04437,04610, 04611,04612,04613,04614,04615,04616,04617,04618, 04619,04620,04621,04622,04623,04824,04825 LeakTest(D)

Intheabsenceofacertificatefromatransferorindicatingthataleak testhasbeenmadewithintheintervalsspecifiedinthecertificateof registrationissuedbytheU.S.NuclearRegulatoryCommissionunder 10CFR32.210orbyanAgreementState,priortothetransfer,a sealedsourcereceivedfromanotherpersonshallnotbeputintouse untiltestedandthetestresultsreceived.

01100,01110,01120,02231,02400,02500,02513,03111, 03120,03121,03122,03123,03124,03130,03210,03211, 03214,03219,03220,03221,03222,03225,03226,03234, 03510,03511,03520,03521,03610,03611,03612,03613, 03614,03620,03710,04010,04011,04110,04111,04210, 04211,04214,04215,04410,04411,04414,04415,04416, 04417,04418,04419,04420,04421,04422,04423,04424, 04425,04426,04427,04428,04429,04436,04437,04610, 04611,04612,04613,04614,04615,04616,04617,04618, 04619,04620,04621,04622,04623,04824,04825 LeakTest(E)

Sealedsourcesneednotbetestediftheycontainonlyhydrogen3;or theycontainonlyaradioactivegas;orthehalflifeoftheisotopeis 30daysorless;ortheycontainnotmorethan100microcuriesof betaand/orgammaemittingmaterialornotmorethan10 microcuriesofalphaemittingmaterial.

01100,01110,01120,02231,02400,02500,02513,03111, 03120,03121,03122,03123,03124,03130,03210,03211, 03214,03219,03220,03221,03222,03225,03226,03234, 03510,03511,03520,03521,03610,03611,03612,03613, 03614,03620,03710,04010,04011,04110,04111,04210, 04211,04214,04215,04410,04411,04414,04415,04416, 04417,04418,04419,04420,04421,04422,04423,04424, 04425,04426,04427,04428,04429,04436,04437,04610, 04611,04612,04613,04614,04615,04616,04617,04618, 04619,04620,04621,04622,04623,04824,04825 LeakTest(F)

Sealedsourcesneednotbetestediftheyareinstorageandarenot beingused.However,whentheyareremovedfromstorageforuse ortransferredtoanotherperson,andhavenotbeentestedwithin therequiredleaktestinterval,theyshallbetestedbeforeuseor transfer.Nosealedsourceshallbestoredforaperiodofmorethan 10yearswithoutbeingtestedforleakageand/orcontamination.

01100,01110,01120,02231,02400,02500,02513,03111, 03120,03121,03122,03123,03124,03130,03210,03211, 03214,03219,03220,03221,03222,03225,03226,03234, 03510,03511,03520,03521,03610,03611,03612,03613, 03614,03620,03710,04010,04011,04110,04111,04210, 04211,04214,04215,04410,04411,04414,04415,04416, 04417,04418,04419,04420,04421,04422,04423,04424, 04425,04426,04427,04428,04429,04436,04437,04610, 04611,04612,04613,04614,04615,04616,04617,04618, 04619,04620,04621,04622,04623,04824,04825

Updated12/15/2020 LeakTest(G)

Theleaktestshallbecapableofdetectingthepresenceof185 becquerels(0.005microcuries)ofradioactivematerialonthetest sample.Ifthetestrevealsthepresenceof185becquerels(0.005 microcuries)ormoreofremovablecontamination,areportshallbe filedwiththeU.S.NuclearRegulatoryCommissioninaccordance with10CFR30.50(c)(2),andthesourceshallberemoved immediatelyfromserviceanddecontaminated,repaired,ordisposed ofinaccordancewithCommissionregulations.

01100,01110,01120,02231,02400,02500,02513,03111, 03120,03121,03122,03123,03124,03130,03210,03211, 03214,03219,03220,03221,03222,03225,03226,03234, 03510,03511,03520,03521,03610,03611,03612,03613, 03614,03620,03710,04010,04011,04110,04111,04210, 04211,04214,04215,04410,04411,04414,04415,04416, 04417,04418,04419,04420,04421,04422,04423,04424, 04425,04426,04427,04428,04429,04436,04437,04610, 04611,04612,04613,04614,04615,04616,04617,04618, 04619,04620,04621,04622,04623,04824,04825 LeakTest(H)AuthorizedforCollectionand Analysis

[THELICENSECONDITIONISUSEDIFTHELICENSEEISAUTHORIZED TOCOLLECTANDANALYZELEAKTESTSAMPLES.]Testsforleakage and/orcontamination,includingleaktestsamplecollectionand analysis,shallbeperformedbythelicenseeorotherpersons specificallylicensedbytheU.S.NuclearRegulatoryCommissionoran AgreementStatetoperformsuchservices.

01100,01110,01120,02231,02400,02500,02513,03111, 03120,03121,03122,03123,03124,03130,03210,03211, 03214,03219,03220,03221,03222,03225,03226,03234, 03510,03511,03520,03521,03610,03611,03612,03613, 03614,03620,03710,04010,04011,04110,04111,04210, 04211,04214,04215,04410,04411,04414,04415,04416, 04417,04418,04419,04420,04421,04422,04423,04424, 04425,04426,04427,04428,04429,04436,04437,04610, 04611,04612,04613,04614,04615,04616,04617,04618, 04619,04620,04621,04622,04623,04824,04825 LeakTest(H)NotAuthorizedforAnalysis

[THISLICENSECONDITIONISUSEDIFTHELICENSEEISNOT AUTHORIZEDTOPERFORMLEAKTESTANALYSIS.]Analysisofleak testsamplesand/orcontaminationshallbeperformedbypersons specificallylicensedbytheU.S.NuclearRegulatoryCommissionoran AgreementStatetoperformsuchservices.Thelicenseeisauthorized tocollectleaktestsamplesbutnotperformtheanalysis.

01100,01110,01120,02231,02400,02500,02513,03111, 03120,03121,03122,03123,03124,03130,03210,03211, 03214,03219,03220,03221,03222,03225,03226,03234, 03510,03511,03520,03521,03610,03611,03612,03613, 03614,03620,03710,04010,04011,04110,04111,04210, 04211,04214,04215,04410,04411,04414,04415,04416, 04417,04418,04419,04420,04421,04422,04423,04424, 04425,04426,04427,04428,04429,04436,04437,04610, 04611,04612,04613,04614,04615,04616,04617,04618, 04619,04620,04621,04622,04623,04824,04825 LeakTest(I)

Recordsofleaktestresultsshallbekeptinunitsofbecquerels (microcuries)andshallbemaintainedfor3years.

01100,01110,01120,02231,02400,02500,02513,03111, 03120,03121,03122,03123,03124,03130,03210,03211, 03214,03219,03220,03221,03222,03225,03226,03234, 03510,03511,03520,03521,03610,03611,03612,03613, 03614,03620,03710,04010,04011,04110,04111,04210, 04211,04214,04215,04410,04411,04414,04415,04416, 04417,04418,04419,04420,04421,04422,04423,04424, 04425,04426,04427,04428,04429,04436,04437,04610, 04611,04612,04613,04614,04615,04616,04617,04618, 04619,04620,04621,04622,04623,04824,04825

Updated12/15/2020 SealedSourcesInspection/TestPriorto Transfer Eachsealedsourcefabricatedbythelicenseeshallbeinspectedand testedforconstructiondefects,leakage,andcontaminationpriorto anyuseortransferasasealedsource.Recordsofleaktestresults shallbekeptinunitsofmicrocuriesandshallbemaintainedfor3 years.

01100,01110,01120,03210,03212,03213,03214,03610, 03611,03612,03613,03620,04012,04013,04014,04015, 04110,04111,04610,04611,04612,04613,04614,04615, 04616,04617,04618,04619,04620,04621,04622,04623 LeakTestforMML(A)

Thelicenseeshallrequirepermitteestoconductleaktestsofsealed sourcesanddetectorcells.Sealedsourcesanddetectorcellsshallbe testedforleakageand/orcontaminationatintervalsnottoexceed theintervalsspecifiedinthecertificateofregistrationissuedbythe U.S.NuclearRegulatoryCommissionunder10CFR32.210orbyan AgreementState.Intheabsenceofaregistrationcertificate,sealed sourcesshallbetestedforleakageand/orcontaminationatintervals nottoexceed6months,oratsuchotherintervalsasspecified.

03614 LeakTestforMML(B)

NotwithstandingParagraphAofthisCondition,sealedsources designatedtoprimarilyemitalphaparticlesshallbetestedfor leakageand/orcontaminationatintervalsnottoexceed3months.

03614 SeparateKeysforPersonnelLockandBarrier Entrance Notwithstandingtherequirementsof10CFR36.23(a),thelicensee mayuseseparatekeystooperatethelockonthepersonnelentrance doororbarrierandtomovethesourcesinaccordancewith proceduresdescribedinthe[letter/application]dated[insertdate].

03511,03521 ShipmentofPlutonium Exceptforplutoniumcontainedinamedicaldevicedesignedfor individualhumanapplication,noplutonium,regardlessofform,shall bedeliveredtoacarrierforshipmentbyairtransportortransported inanaircraftbythelicenseeexceptinpackagesthedesignofwhich U.S.NuclearRegulatoryCommissionhasspecificallyapprovedfor transportofplutoniumbyair.

22110,22111,22120,22140,22150,22151,22160,22170, 22200,23300,23310,04828,04829 ShutterLocked Thelicenseeshallassurethattheshuttermechanismofeachdevice containinglicensedmaterialislockedintheclosedpositionduring periodswhenaportionofanindividual'sbodymaybesubjecttothe directradiationbeam.Thelicenseeshallreviewandmodify,as appropriate,its"lockout"procedureswheneveranewdeviceis obtainedtoincorporatethedevicemanufacturer's recommendations.

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437

Updated12/15/2020 SiteRemediationSpecialLCtoEliminateNeed forEA/NEPAReview(A)

ExceptasprovidedforinparagraphBofthislicensecondition,any activityperformedbythelicenseeatatemporaryjobsiterelatedto sitecharacterizationorthedecontaminationanddecommissioning offacilities,equipment,andcontainers,includinganywaste packagingincidentaltotheseactivities,mustbeperformedin accordancewiththecustomerlicenseesNRCapproved decommissioningplanthatpertainstothattemporaryjobsite.

03219,03234 SiteRemediationSpecialLCtoEliminateNeed forEA/NEPAReview(B)

Ifthecustomerlicenseeisnotrequiredtosubmitadecommissioning plantotheNRCandifthecustomerlicenseesoperationsata temporaryjobsitehavebeenlimitedtotheuseof:(1)small quantitiesofshortlivedradioactivematerials,or(2)radioactive materialsinsealedsourcesprovidedthereisnoevidenceofleakage ofradioactivematerialfromthesesealedsources,thenanyactivity performedbythelicenseeatthattemporaryjobsiterelatedtosite characterizationorthedecontaminationanddecommissioningof facilities,equipment,andcontainers,includinganywastepackaging incidentaltotheseactivities,mustbeperformedinaccordancewith thelicenseesdecommissioningproceduresapprovedbytheNRC underthislicense.

03219,03234 SiteRemediationSpecialLCtoEliminateNeed forEA/NEPAReview(C)

Anyactivityproposedtobeperformedbythelicenseeata temporaryjobsitethatisnotcoveredbyeitherparagraphAorBof thislicenseconditionmustbeapprovedbytheNRCthroughasite specificlicenseamendmentorexemptionrequest.

03219,03234 SourceRetrieval Thelicenseeisauthorizedtoconductsourceretrievalactivitiesin accordancewith[application/letter]dated[insertdate].

03310,03320 StorageofWaste Radioactivewastepossessedunderthislicenseshallbestoredin accordancewiththestatements,representations,andprocedures includedwiththelicensee'swastestorageplandescribedinthe licensee's[application/letter]dated[insertdate].

01100,01110,02110,03211,03225,03226,03610,03611, 03620,04010,04011,04610,04611,04612,04613,04618, 04619,04620,04621,04710,04711 SupervisionandPhysicalPresenceof IndividualsDesignatedbyRSO Licensedmaterialshallonlybeusedby,orunderthesupervisionand inthephysicalpresenceof,individualswhohavebeendesignatedin writingbytheRadiationSafetyOfficerandhavebeentrained:(A)As specifiedinthe[application/letter]dated[insertdate];and(B)In accordancewiththeprovisionsof10CFR34.43 03310,03320 SupervisionandPhysicalPresenceofName Listed Licensedmaterialshallonlybeusedby,orunderthesupervisionand inthephysicalpresenceof,[insertname(s)].

03221,03222,03232,03900,04426,04427,04428,04429, 22120

Updated12/15/2020 SupervisionandPhysicalPresenceofTrained Individuals Licensedmaterialshallonlybeusedby,orunderthesupervisionand inthephysicalpresenceof,individualswhohavereceivedthe trainingdescribedinthe[application/letter]dated[insertdate].The licenseeshallmaintainrecordsofindividualsdesignatedasusersfor 3yearsfollowingthelastuseoflicensedmaterialbytheindividual.

03121,04416,04417,22140 InstallationSurvey-OpenShutterRequired Priortoinitialuseandafterinstallation,relocation,dismantling, alignment,oranyotheractivityinvolvingthesourceorremovalof theshielding,thelicenseeshallassurethataradiologicalsurveyis performedtodetermineradiationlevelsinaccessibleareasaround, above,andbelowthegaugewiththeshutteropen.Thissurveyshall beperformedonlybypersonsauthorizedtoperformsuchservicesby theU.S.NuclearRegulatoryCommissionoranAgreementState.

03120,03124,03130,03310,04414,04415,04422,04423, 04436,04437 LocationofUse-TemporaryJobSites Licensedmaterialmaybe[usedorstored]onlyattemporaryjob sitesofthelicenseeanywhereintheUnitedStateswheretheU.S.

NuclearRegulatoryCommissionmaintainsjurisdictionforregulating theuseoflicensedmaterial,includingareasofexclusiveFederal jurisdictionwithinAgreementStates.Ifthejurisdictionstatusofa FederalfacilitywithinanAgreementStateisunknown,thelicensee shouldcontacttheFederalagencycontrollingthejobsiteinquestion todeterminewhethertheproposedjobsiteisanareaofexclusive Federaljurisdiction.Authorizationforuseofradioactivematerialsat jobsitesinAgreementStatesnotunderexclusiveFederaljurisdiction shouldbeobtainedfromtheappropriatestateregulatoryagency.

02220,03120,03121,03123,03124,03211,03219,03225, 03226,03234,04010,04011,04414,04415,04416,04417, 04420,04421,04422,04423,04820,04821,11200,11210, 11220,11221,11230,11300,11800,11810,11900

Updated12/15/2020 Tiedown Exceptasspecificallyprovidedotherwiseinthislicense,thelicensee shallconductitsprograminaccordancewiththestatements, representations,andprocedurescontainedinthedocuments, includinganyenclosures,listedbelow.Thislicenseconditionapplies onlytothosestatements,representations,andproceduresthatare requiredtobesubmittedinaccordancewiththeregulations.The U.S.NuclearRegulatoryCommission'sregulationsshallgovernunless thestatements,representations,andproceduresinthelicensee's applicationandcorrespondenceimposeonthelicensee requirementsthataremorerestrictivethanorinadditiontothe regulations.

01100,01110,01120,02400,02410,02500,02511,02513, 02600,02700,02710,03110,03111,03112,03113,03120, 03121,03122,03123,03124,03130,03210,03211,03212, 03213,03214,03215,03219,03220,03221,03222,03225, 03226,03232,03234,03235,03236,03240,03241,03242, 03243,03244,03250,03251,03252,03253,03254,03255, 03256,03257,03310,03320,03510,03511,03520,03521, 03610,03611,03612,03613,03620,03710,03800,03810, 03900,04010,04011,04012,04013,04014,04015,04110, 04111,04112,04113,04210,04211,04212,04213,04214, 04215,04410,04411,04412,04413,04414,04415,04416, 04417,04418,04419,04420,04421,04422,04423,04424, 04425,04426,04427,04428,04429,04430,04431,04432, 04433,04436,04437,04610,04611,04612,04613,04614, 04615,04616,04617,04618,04619,04620,04621,04622, 04623,04828,04829,11200,11210,11220,11221,11230, 11240,11300,11800,11810,11900,22110,22111,22120, 22140,22150,22151,22160,22170,22200,23300,23310 Tiedown-Medical Exceptasspecificallyprovidedotherwiseinthislicense,thelicensee shallconductitsprograminaccordancewiththestatements, representations,andprocedurescontainedinthedocuments, includinganyenclosures,listedbelow.Thislicenseconditionapplies onlytothosestatements,representations,andproceduresthatare requiredtobesubmittedinaccordancewiththeregulations.

Additionally,thislicenseconditiondoesnotlimitthelicensee'sability tomakechangestotheradiationprotectionprogramasprovidedfor in10CFR35.26.TheU.S.NuclearRegulatoryCommission's regulationsshallgovernunlessthestatements,representations,and proceduresinthelicensee'sapplicationandcorrespondenceimpose onthelicenseerequirementsthataremorerestrictivethanorin additiontotheregulations.

02110,02120,02121,02200,02201,02210,02220,02230, 02231,02240,02300,02310,04510,04511,04512,04513, 04710,04711,04810,04811,04812,04813,04814,04815, 04816,04817,04818,04819,04820,04821,04822,04823, 04824,04825,04826,04827

Updated12/15/2020 Tiedown-MML Exceptasspecificallyprovidedotherwiseinthislicense,thelicensee shallconductitsprograminaccordancewiththestatements, representations,andprocedurescontainedinthedocuments, includinganyenclosures,listedbelow([insertanydisclaimers,if necessary,e.g.,excludingVHADirective1105.1,VHAHandbook 1105.1,andtheinternalprocedureslistedinNHPPInternal ProcedureNo.1,etc.]).Thislicenseconditionappliesonlytothose statements,representations,andproceduresthatarerequiredtobe submittedinaccordancewiththeregulations.TheU.S.Nuclear RegulatoryCommissionsregulationsshallgovernunlessthe statements,representations,andproceduresinthelicensees applicationandcorrespondenceimposeonthelicensee requirementsthataremorerestrictivethanorinadditiontothe regulations.

03614 Tiedownfor35.1000Uses

[USETHISTIEDOWNLICENSECONDITIONIFTHELICENSEEIS APPROVEDTOCHANGE/REVISELICENSECOMMITMENTSFOR 35.1000USE(IFNRCGUIDANCEISUPDATEDATLATERDATE)]

Exceptasspecificallyprovidedotherwiseinthislicense,thelicensee shallconductitsprograminaccordancewiththestatements, representations,andprocedurescontainedinthedocuments, includinganyenclosures,listedbelow.Thislicenseconditionapplies onlytothosestatements,representations,andproceduresthatare requiredtobesubmittedinaccordancewiththeregulations.

Additionally,thislicenseconditiondoesnotlimitthelicenseesability tomakechangestotheradiationprotectionprogramasprovidedfor in10CFR35.26andapplicableguidanceupdatesfor10CFR35.1000 uses.TheU.S.NuclearRegulatoryCommissionsregulationsshall governunlessthestatements,representations,andproceduresinthe licenseesapplicationandcorrespondenceimposeonthelicensee requirementsthataremorerestrictivethanorinadditiontothe regulations.

02240,04826,04827 TransportationPublicRoads Exceptforvehiclemaintenance,thelicenseeshallnotmovemobile nonintrusiveinspectionsystemsonpublicroadsunlessspecific authorizationisobtainedfromtheU.S.NuclearRegulatory Commission.

03130,04436,04437

Updated12/15/2020 SupervisionbyNameListed Licensedmaterialshallonlybeusedby,orunderthesupervisionof:

<<!AuthorizedUsers!>>.

02400,02410,02513,03122,03123,03124,03210,03214, 03215,03219,03220,03221,03222,03225,03226,03235, 03236,03240,03241,03242,03243,03244,03612,03613, 03620,03710,03800,03810,03900,04110,04111,04112, 04113,04214,04215,04410,04411,04412,04413,04418, 04419,04420,04421,04422,04423,04424,04425,04426, 04427,04428,04429,04430,04431,04432,04433,04614, 04615,04616,04617,04828,04829,11200,11210,11220, 11221,11230,11300,11800,11810,11900,22110,22111, 22120,22140,22150,22151,22160,22170,22200,23300, 23310 SupervisionbyIndividualsDesignatedbythe RSCMML Licensedmaterialshallonlybeusedby,orunderthesupervisionof individualsdesignatedby[insertnameofRadiationSafety Committee,e.g.,NationalRadiationSafetyCommittee].

03614 SupervisionbyTrainedIndividualsDesignated bytheRSO Licensedmaterialshallonlybeusedby,orunderthesupervisionof, individualswhohavereceivedthetrainingdescribedinthe

[application/letter]dated[insertdate],andhavebeendesignatedin writingbytheRadiationSafetyOfficer.Thelicenseeshallmaintain recordsofindividualsdesignatedasusersfor3yearsfollowingthe lastuseoflicensedmaterialbytheindividual.

03120,03122,03130,03220,03225,03226,03234,03710, 04414,04415,04418,04419,04424,04425,04436,04437 SupervisionandPhysicalPresencebyTrained IndividualsDesignatedbytheRSO Licensedmaterialshallonlybeusedby,orunderthesupervisionand inthephysicalpresenceof,individualswhohavereceivedthe trainingdescribedinthe[application/letter]dated[insertdate],and havebeendesignatedinwritingbytheRadiationSafetyOfficer.The licenseeshallmaintainrecordsofindividualsdesignatedasusersfor 3yearsfollowingthelastuseoflicensedmaterialbytheindividual.

03510,03511,03520,03521 UseofLicensedMaterial

[InsertMMLname:e.g.,UnitedStatesAirForce]requirements, policies,anddirectivesgoverningtheuseoflicensedmaterialmust beconsistentwiththeNuclearRegulatoryCommission'sregulations.

03614 UseofMaterial Licensedmaterialshallonlybeusedby,orunderthesupervisionand inthephysicalpresenceof,individualswhohavereceivedthe trainingdescribedinthe[application/letter]dated[insertdate].The licenseeshallmaintainrecordsofindividualsdesignatedasusersfor 3yearsfollowingthelastuseoflicensedmaterialbytheindividual.

03121,04416,04417

Updated12/15/2020 UseofRadioactiveMarkersforSubsurface Monitoring Notwithstandingtherequirementof10CFR39.47,pursuantto10 CFR39.91,andinaccordancewithstatements,representations,and procedurescontainedin[insertreference:e.g.,thelettersdated Month,DD,YYYY,Month,DD,YYYY,andMonth,DD,YYYY],the licenseemayuseradioactivemarkerswithactivitiesof100 microcuriesorlessofcobalt60and50microcuriesorlessofcesium 137forsubsurfacemonitoringinsurfacecasedoiland/orgaswells, providedthatamemberofthepublicwouldnotreceivemorethan 100milliremsannually,intheeventthesourcesruptured.

03110,03111 Supervision10CFR32.72(Header)

Licensedmaterialshallonlybeusedby,orunderthesupervisionof:

02500,04210,04211 Supervision10CFR32.72(A)

Apharmacistworkingordesignatedasanauthorizednuclear pharmacistinaccordancewith10CFR32.72(b)(2)(i)or(4).

02500,04210,04211 Supervision10CFR32.72(B)

AuthorizedNuclearPharmacists:<<!NuclearPharmacists!>>

02500,04210,04211 Supervision10CFR32.72(C)

AuthorizedUsersforNonMedicalUse:<<!NonMedicalUsers!>>

02500,04210,04211 SupervisionbyIndividualsDesignatedbythe RSO Licensedmaterialshallonlybeusedby,orunderthesupervisionof, individualsdesignated,inwriting,bytheRadiationSafetyOfficer.The licenseeshallmaintainrecordsofindividualsdesignatedasusersfor 3yearsaftertheindividual'slastuseoflicensedmaterial.

01110,03212,03611,04012,04013,04612,04613,04620, 04621 SupervisionoftheRSOorTrainedIndividuals WellLogging Licensedmaterialshallonlybeusedby,orunderthesupervisionand inthephysicalpresenceoftheRadiationSafetyOfficer,orindividuals whohavebeentrainedinaccordancewiththe[application/letter]

dated[insertdate].Thelicenseeshallmaintainrecordsofindividuals designatedasloggingsupervisor(s)andloggingassistant(s).

03110,03111,03112 Supervision10CFR33.15(b)

Licensedmaterialshallonlybeusedbyorunderthesupervisionof individualsmeetingtherequirementsstatedin10CFR33.15(b)for thematerialsandusesasindicated:<<!AuthorizedUsers!>>

01120,03213,03612,04014,04015,04614,04622,04623 Supervision10CFR35.13and35.14(A)

Individualspermittedtoworkas[inserteitherauthorizedusers, authorizednuclearpharmacists,and/orauthorizedmedical physicists,asappropriate]inaccordancewith10CFR35.13and10 CFR35.14.

02120,02121,02200,02201,02210,02220,02230,02231, 02240,02300,02310,04510,04511,04512,04513,04810, 04811,04812,04813,04814,04815,04816,04817,04818, 04819,04820,04821,04822,04823,04824,04825,04826, 04827 Supervision10CFR35.13and35.14(B)

Thefollowingindividualsareauthorizedusersforthematerialand medicalusesasindicated:<<!AuthorizedUsers!>>

<<!AuthorizedUsersMDMO!>>

02120,02121,02200,02201,02210,02220,02230,02231, 02240,02300,02310,04510,04511,04512,04513,04810, 04811,04812,04813,04814,04815,04816,04817,04818, 04819,04820,04821,04822,04823,04824,04825,04826, 04827

Updated12/15/2020 Supervision10CFR35.13and35.14(C)

Thefollowingindividualsareauthorizedusersfornonmedicalusesas indicated:<<!AuthorizedUsers!>><<!NonMedicalUsers!>>

02120,02121,02200,02201,02210,02220,02230,02231, 02240,02300,02310,04510,04511,04512,04513,04810, 04811,04812,04813,04814,04815,04816,04817,04818, 04819,04820,04821,04822,04823,04824,04825,04826, 04827 Supervision10CFR35.13and35.14(D)

Thefollowingindividualsareauthorizedmedicalphysicists[or ophthalmicphysicists]forthematerialsandusesasindicated:

<<!AuthorizedUsers!>><<!MedicalPhysicists!>>

02120,02121,02200,02210,02220,02230,02231,02240, 02300,02310,04510,04511,04512,04513,04810,04811, 04812,04813,04814,04815,04818,04819,04820,04821, 04822,04823,04824,04825,04826,04827 SupervisionMedicalwithRSC(A)

Medicaluseshallbebyanauthorizeduserasdefinedin10CFR35.2. 02110,04710,04711 SupervisionMedicalwithRSC(B)

Individualsdesignatedtoworkas[inserteitherauthorizedusers, authorizednuclearpharmacists,orauthorizedmedicalphysicists,as applicable]asdefinedin10CFR35.2,shallmeetthetraining, experienceandrecentnessoftrainingcriteriaestablishedin10CFR Part35andshallbedesignatedinwritingbythelicensee'sRadiation SafetyCommittee.

02110,04710,04711 SupervisionMedicalwithRSC(C)

Licensedmaterialforotherthanhumanuseshallbeusedby,or underthesupervisionof,individualsdesignatedbytheRadiation SafetyCommittee.

02110,04710,04711 SupervisionMedicalwithRSC(D)

[ASNEEDED]Licensedmaterial[initem#]shallonlybeusedby,or underthesupervisionof,individualswhohavereceivedthetraining describedinthe[application/letter]dated[insertdate],andhave beendesignatedinwritingbytheRadiationSafetyOfficer.The licenseeshallmaintainrecordsofindividualsdesignatedasusersfor 3yearsfollowingthelastuseoflicensedmaterialbytheindividual.

02110,04710,04711 UtilizationFacilityonHumanSubjects ThislicensedoesnotauthorizetheuseofradiationfromanNRC licensedutilizationfacilityonhumansubjects.

03614 Watchesunder30.15(Header)

Eachlotoftimepieces,handsanddialsreceived,containingtritium fordistributionforuseunder10CFR30.15,mustbeaccompaniedby acertificatewhichatteststothefollowing:

03250 Watchesunder30.15 Thetimepieces,hands,anddialshavebeenmanufacturedin accordancewiththeInternationalAtomicEnergyAgency, InternationalStandardsOrganization,OECDNuclearEnergyAgency, AmericanNationalStandardsInstituteorequivalentindustry standard;andtheamountoftritiumonthetimepieces,hands,and dialsisnotinexcessofthemaximumpermissibleamounts authorizedin10CFR30.15(a)(1).

03250

Updated12/15/2020 LeakTestWellLogging(A)

Notwithstandingtheperiodicleaktestrequiredby10CFR39.35,the requirementdoesnotapplytosources,exceptsourcescontaining plutonium,thatarestoredandnotbeingused.Thesources exemptedfromthisperiodictestshallbetestedforleakagebefore useortransfertoanotherperson.

03110,03111,03112,03113 LeakTestWellLogging(B)

Sealedsourcesauthorizedforuseotherthanwellloggingshallbe testedforleakageandshallbeinventoriedinaccordancewith10CFR 39.35and10CFR39.37.

03110,03111,03112,03113 LeakTestWellLogging(C)

Nosealedsourceshallbestoredforaperiodofmorethan10years withoutbeingtestedforleakageand/orcontamination.

03110,03111,03112,03113