ML21078A044

Us Dept. of Commerce, National Institute of Standards & Technology, License Amendment Application

ML21078A044
Person / Time
Site:	07000398
Issue date:	03/12/2021
From:	Mackey E US Dept of Commerce, National Institute of Standards & Technology (NIST)
To:	NRC Region 4
Naquin T
Shared Package
ML21078A044	List: ML21078A044
References
Download: ML21078A044 (1)

Text

NRC FORM 313 U.S. NUCLEAR REGULATORY COMMISSION APPROVEDBYOMB: NO.3150{120 EXPIRES: 0113112023 (01-2020J Estimated burden per sponse to mply with this mandatory mllecton Equest: 4.3 hou6. Submittal of the 10 cFR 30, 32, 33, 34, 35, 36, applimtion is neessry lo detemine that he applicant is qualifed and that adequate pocedures exist to protect the 37, 39, and 40 -r'}{ - ,e .i APPLICATION FOR public health aM sfety. Send @mrents regarding burden estimte to he lnformhon Seruics Banch [{

U.S. Nucltrr Regulatory Commission, Washington, DC 2055+0001, or by e-mail to lnfomilsb.Resource@nrc.gov, A10M),

i*try#; MATERIALS LICENSE and to the Desk Offrer, Offie ol lnforrolion and Regulatory Affairs, NE0B-10202, (315G0120), Offlce of Managemenl aM Budget, Washinglon, DC 20503. tl a means used lo impose an inforrotion collection d@s rct display a curenty valid OMB @nlrol number, t re NRC may not @nduct or spoMr, and a peMn ls not requtred to respond to, the informtjm Elltrton.

INSTRUCTIONS: SEETHECURRENTVOLUTESOFTHENUREG-I556TECHNICALREPORTSERlES('CONSOLIDATEDGUIDANCEABOUTTATERIALSLICENSES")FORDETAILED OFFICE SPECIFIEO BELOW.

APPUCATION FOR DISTRIBUTION OF EXETTPT PRODUCTS FILE APPUCATIONS WITH: IF YOU ARE LOCATED IN:

MATERIALS SAFEry LICENSING BRANCH tLLlt{olS, lt{IxANA, lor{A, HtcHlGAN, stNt{EsoTA, tt3aouRt, oHto, oR wl3coHstil, sEl{D DIVISION OF MATERIAL SAFETY, STATE, TRIBAL AND RULEMAKING PROGRAMS APPLIGATIONS TO:

OFFICE OF NUCLEAR MATERIALS SAFETY AND SAFEGUARDS U.S. NUCLEAR REGULATORY COMMISSION MATERIALS LICENSING BRANCH WASHINGTON, DC 20555.0001 U.S. NUCLEAR REGULATORY COMMISSION, REGION III 2443 WARRENWLLE ROAD, SUIIE 210 ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS: LlsLE, tL 60532-4352 IF YOU ARE LOCATED IN: IF YOU ARE LOCATED IN:

ALABAIIA, CONNECTICUT, DELAWARE, DISTRICT OF COLUI'BIA, FLORIOA, ALASXA, ARIZONA, ARKAN9AS, CALIFORNIA, COLORADO, HAWAII, IOAHO, KANSAS, GEORGIA, KEMTUCKY, TAINE, MARYLAND, MASSACHUSETIS, NEW HAXIPSHIRE, LOUISIANA, HISSISSIPPI, MONTANA, NEBRASKA, NEVADA NEW MEXICO, NORTH NEW JERSEY, NEW YORK, NORTH CAROLINA PENNSYLVANIA, PUERTO RICO, DAKOTA, OKLAHOI'A, OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, TEXAS, RHODE ISLANO, SOUTH CAROLINA, TENNESSEE, VERMONT, VIRGINIA, VIRGIN UTAH, WASHINGTON, OR WYOMING, ISLANDS, OR WEST VIRGINIA, SEHD APPLICATIONS TO: SEND APPLICATOilS TO:

LICENSING ASSISTANCE TEAM NUCLEAR MATERIALS LICENSING BRANCH DIVISION OF NUCLEAR MATERIALS SAFETY U.S. NUCLEAR REGUI-ATORY COMMISSION, REGION IV U-S. NUCLEAR REGULATORY COMMISSION. REGION I 1600 E- LAMAR BOULEVARD 21OO RENAISSANCE BOULEVARD, SUITE 1OO ARLINGTON, TX 76011-4511 KING OF PRUSSIA. PA 19406-2713 PERSOXS LOCATED IN AGREET'ENT STATES SEilD APPLICAIIOilS TO THE U.S. NUCLEAR REGULATORY COITMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED iTATERIAL IIiI STATES SUAJECT TO U.S. IIUCLEAR REGULATORY COTTIISSION JURISDICTIONS.

1. THIS lS AN APPLICATION FOR fcheck awrcpiate item) 2. NAME AND MAILING ADDRESS OF APPLICANT (lnclude zip cuie) l-l r. rrw r-rcrrusE National lnstitute of Standards and Technology Attn: Radiation Safety Officer B. AMENDMENT TO LICENSE NUMBER SNM-362 100 Bureau Drive, Mail Stop 1731 l-l c. nENEwlr- oF LrcENsE NUMBER Gaithersburg, MD 20899 3, ADDRESS WHERE LICENSED MATERIALS WILL BE USED OR POSSESSED 4. NAME OF PERSON TO BE CONTACTED ABOUI THIS APPLICATION Manny Mejias BUSINESS IELEPHONE NUMBER BUSINESS CELLUTAR TELEPHONE NUMBER See ltem 2. (301 ) 975-5800 (202)253-3890 BUSINESS E-MAIL ADDRESS manny.mejias@nist.gov SUBMIT ITEMS 5 THROUGH 11 ON &1/2 X 11' PAPER. THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED IN THE LICENSE APPLICATION GUIDE, 5 RADIOACTIVE MATERIAL 6. PURPOSE(S) FOR WHICH LICENSED MATERIAL WILL BE USED-

a. Element and mass numbefi b- chemil andlor physil lorm; and c- maximum amount 7. INDIVIDUAL(S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND IHEIR IRAINING AND which will be possessed at any one tima. EXPERIENCE,

8. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS. 9- FACILITIES AND EOUIPMENT

10. RADIATION SAFETY PROGRAM. 11. WASTEMANAGEMENT

12. LICENSE FEES (F@s required or{y fq rew applications, with lew exeptions')

(See 10 CFR 170 and Soclion 17o.at AMOUNT FEE CAEGoRY ENCLOSED $

'Amendments/Renflals that incrqse the scope of lhe axisting license to a new or highor fee tegory *ill ,"qrir" f*.

PERTHEDEBTCOLLECTIONIMPROVEI!ENTACTOF1996(PUBLlCLAWl04.13il),YOUAREREQUIREDTOPROVIDEYOURTAXPAYERIDENTIFICATIONNUTTBER. PROVIDETHIS

13. CERTIFICATION. (Mustbecompletqdbyappticant) THEAPPLTCANTUNDERSIANOSIHATALLSIAIEME^/TSANDREPRESENTATTONSMADETNTHTSAPPLICATTONAREBTNDIN5UPON THE APPLICANT.

THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEHALF OF THE APPLICANT, NAMED IN ITEM 2, CERTIFY THAT THIS APPLICATION IS PREPARED IN CONFORMITY WITH TITLE 10, CODE OF FEDERAL REGULATIONS, PARTS 30, 32, 33, 34, 35, 36, 37, 39, AND 40, AND THAT ALL INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF.

WARNING: ISU.S.C.SECTIONI00IACTOFJUNE25.I94862STAT.T49MAKESITACRlMlNALOFFENSETOMAKEAWlLLFULLYFALSESTATEMENTORREPRESENTATlONTO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION, CERTIFYING OFFICER _ TYPED/PRINTED NAME AND TITLE Elizabeth A. Mackey, NIST Chief Safety Officer slrz/zt FOR NRC USE ONLY TYPE OF FEE FEE LOG FEE CATEGORY AMOUNT RECEIVED CHECK NUMBER COMMENTS APPROVED BY DATE NRC FORM 313 (01-2020)