ML23033A108

NRC Materials Licenses: Standard License Conditions (January 2023)

ML23033A108
Person / Time
Issue date:	01/31/2023
From:	Booma Venkataraman NRC/NMSS/DMSST/FSTB
To:
References
Download: ML23033A108 (1)

Text

ConditionName ConditionDesc ProgramCodes Animals/Animal Products Not for Human or Experimental animals, or the products from experimental animals, 01100, 01110, 01120, 02110, 02400, 03610, 03611, 03612, Animal Consumption that have been administered licensed material shall not be used for 03613, 03620, 04410, 04411, 04616, 04617, 04618, 04619, human or animal consumption. 04620, 04621, 04622, 04623, 04710, 04711 ARSO The Associate Radiation Safety Officer (ARSO) for this license is 02110, 02120, 02121, 02200, 02201, 02210, 02220, 02230,

<<!ARSONames!>>. 02231, 02240 Authorized to Distribute, Specific Products The licensee is authorized to distribute the following series of self-03254 luminous [specify products, (e.g. compasses and knives models, gunsights)] devices provided the amount of [hydrogen-3] does not exceed the amount specified in the following table: Device Model, Maximum Activity Certain Non-Routine Maintenance Allowed [Insert the services authorized in this license, delete remaining: (i) 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, Installation, (ii) initial radiation surveys, (iii) relocation, (iv) removal 04436, 04437 from service, (v) dismantling, (vi) alignment, (vii) replacement, (viii) disposal of the sealed source, and (ix) non-routine maintenance or repair of components related to the radiological safety of the gauge]

shall be performed only by [insert name(s)], or other individuals who have completed the training specified in [insert application/letter]

dated [insert date], or by persons specifically licensed by the U.S.

Nuclear Regulatory Commission or an Agreement State to perform such services.

Cleaning, Maintenance, Repair of Gauges Any cleaning, maintenance, or repair of the gauge(s) that requires 03121, 04416, 04417 detaching the source or source rod from the gauge shall be performed only by the manufacturer or by other persons specifically licensed by the U.S. Nuclear Regulatory Commission or an Agreement State to perform such services.

Contaminated Equipment Except for calibration sources, reference standards, and radioactively 03219, 03234 contaminated equipment owned by the licensee, receipt, storage, and use incidental to any activity involving licensed material at a temporary job site shall be limited to material originating from that site. This material must either be transferred to an authorized recipient or remain at the site after licensee activities are completed.

Decay In-Storage (A) Before disposal as ordinary trash, the waste shall be surveyed at the 01100, 01110, 01120, 02110, 02400, 02410, 02500, 02511, container surface with the appropriate survey instrument set on its 02513, 02600, 03112, 03210, 03211, 03212, 03213, 03214, most sensitive scale and with no interposed shielding to determine 03220, 03232, 03240, 03241, 03242, 03243, 03244, 03610, that its radioactivity cannot be distinguished from background. All 03611, 03612, 03613, 03620, 03800, 03810, 04010, 04011, radiation labels shall be removed or obliterated, except for radiation 04012, 04013, 04014, 04015, 04110, 04111, 04210, 04211, labels on materials that are within containers and that will be 04212, 04213, 04214, 04215, 04410, 04411, 04412, 04413, managed as biomedical waste after they have been released from 04424, 04425, 04430, 04431, 04432, 04433, 04610, 04611, the licensee. 04612, 04613, 04614, 04615, 04616, 04617, 04618, 04619, 04620, 04621, 04622, 04623, 04710, 04711 Decay In-Storage (B) A record of each such disposal permitted under this license condition 01100, 01110, 01120, 02110, 02400, 02410, 02500, 02511, shall be retained for 3 years. The record must include the date of 02513, 02600, 03112, 03210, 03211, 03212, 03213, 03214, disposal, the date on which the byproduct material was placed in 03220, 03232, 03240, 03241, 03242, 03243, 03244, 03610, storage, the radionuclides disposed, the survey instrument used, the 03611, 03612, 03613, 03620, 03800, 03810, 04010, 04011, background dose rate, the dose rate measured at the surface of each 04012, 04013, 04014, 04015, 04110, 04111, 04210, 04211, waste container, and the name of the individual who performed the 04212, 04213, 04214, 04215, 04410, 04411, 04412, 04413, disposal. 04424, 04425, 04430, 04431, 04432, 04433, 04610, 04611, 04612, 04613, 04614, 04615, 04616, 04617, 04618, 04619, 04620, 04621, 04622, 04623, 04710, 04711 Decay In-Storage (Header) The licensee is authorized to hold radioactive material with a physical 01100, 01110, 01120, 02110, 02400, 02410, 02500, 02511, half-life of less than or equal to 120 days for decay-in-storage before 02513, 02600, 03112, 03210, 03211, 03212, 03213, 03214, disposal in ordinary trash provided: 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 Destructive Tests The licensee shall not conduct destructive tests involving source 11221 material such that airborne radioactivity would be released to the unrestricted areas.

Device Components Not Related to Radiological The licensee may maintain, repair, or replace device components 03120, 03130, 03214, 04110, 04111, 04414, 04415, 04436, Safety (A) that are not related to the radiological safety of the device 04437 containing licensed material and that do not result in the potential for any portion of the body to come into contact with the primary beam or result in increased radiation levels in accessible areas.

Device Components Not Related to Radiological The licensee may not maintain, repair, or replace any of the following 03120, 03130, 03214, 04110, 04111, 04414, 04415, 04436, Safety (B) device components: (i) the sealed source, (ii) the source holder, (iii) 04437 source drive mechanism, (iv) on-off mechanism (shutter), (v) shutter control, (vi) shielding, or (vii) any other component related to the radiological safety of the device, except as provided otherwise by specific condition of this license.

Distribution Device Info Each device distributed pursuant to the conditions of this license 02513, 03240, 03241, 03242, 03243, 03244, 04214, 04215 shall be in accordance with the following table: Device Model Number Isotope Source Model Number Maximum Activity Per Source Distribution Device Info, Not Exceeding The following products [if needed: manufactured in accordance with 03250, 03251, 03254, 03255 Amounts Specified NRC Sealed Source and Device Registration No. (insert number)], may be distributed, provided the amount of [insert isotope] contained in the device does not exceed the amounts specified in the following table: Device/Series Model Maximum Activity per Device

Distribution Location of Use The licensee may distribute licensed material from its facilities 02511, 02513, 03211, 03214, 03221, 03240, 03241, 03242, located at <<!LicenseLocations!>> 03243, 03244, 03250, 03251, 03252, 03253, 03254, 03255, 03256, 03257, 04010, 04011, 04110, 04111, 04212, 04213, 04214, 04215, 04426, 04427, 11240 Distribution of Products under 10 CFR 32.14 Each lot of timepieces, hands and dials received, containing tritium 03251 for distribution pursuant to a 10 CFR 32.14 exempt distribution license, must be accompanied by a certificate, provided by the manufacturer, which attests to the following: The timepieces, hands, and dials have been manufactured in accordance with the International Standards Organization, American National Standards Institute, or equivalent industry standard and the amount of tritium on the timepieces, hands, and dials is not in excess of the maximum permissible amount authorized in 10 CFR 30.15(a).

Distribution of Products under 10 CFR 32.18 Special condition (for licensees to distribute sources along with a 03253 device): The check sources distributed under 10 CFR 32.18 may be attached to the outside of radiation detection instruments for the convenience of the user.

Distribution of Products under 10 CFR 32.22 The following device containing byproduct material designed and 03254 manufactured in accordance with NRC registration certificate No.

[NR-xxxx-D-101-E], may be distributed according to this license provided the amount of [e.g., americium-241] contained in the device does not exceed the amount specified in the following table:

Device Model Maximum Quantity Per Device Watch Tritium M 160 microcuries (5.92 MBq)

Distribution of Products under 10 CFR 32.26 The following device containing byproduct material designed and 03255 manufactured in accordance with NRC registration certificate No.

[NR-xxxx-D-101-E], may be distributed according to this license provided the amount of [e.g., americium-241] contained in the device does not exceed the amount specified in the following table:

Device Model Maximum Quantity Per Device ChemPro 100 V2 160 microcuries (5.92 MBq)

Distribution of Products under 10 CFR 32.30 The following industrial device containing byproduct material 03257 designed and manufactured in accordance with NRC registration certificate No. [NR-xxxx-D-101-E], for the purpose of [e.g., measuring qualitative or quantitative chemical composition], may be distributed according to this license provided the amount of [i.e. Nickel-63]

contained in the device does not exceed the amount specified in the following table: Gas Chromatograph Model ECD Model SCION 436GC and 456GC 02-001972-02 15 millicuries (555 MBq)

Distribution Product Info Each product distributed under this license shall not contain, as of 02511, 03240, 03241, 03242, 03243, 03244, 04212, 04213 the assay date, more than the quantity of byproduct material listed in the following table: Byproduct Material Product Name Maximum Activity Distribution Source Info Each sealed source distributed under this license shall not contain, as 02513, 04214, 04215 of the assay date, more than the quantity of byproduct material listed in the following table: Byproduct Material Model Number Chemical and/or Physical Form Maximum Activity Duties of the Teletherapy Physicist Notwithstanding the requirements of 10 CFR 35.1690, [insert name] 02300, 02310, 04510, 04511, 04512, 04513 may perform the duties of the teletherapy physicist for those full-calibration measurments and periodic spot-checks specified in 10 CFR Part 35.

Emergency Action to Protect Public Health and If approved by a Radiation Safety Officer specifically identified in this 03219, 03234 Safety license, the licensee may take reasonable action in an emergency that departs from conditions in this license when the action is immediately needed to protect public health and safety and no action consistent with all license conditions that can provide adequate or equivalent protection is immediately apparent. The licensee shall notify the U.S. Nuclear Regulatory Commission Headquarters Operations Center at 301-816-5100 and the U.S.

Nuclear Regulatory Commission Regional contact before, if practicable, and in any case immediately after taking such emergency action using the contact information specified in Appendix D of 10 CFR Part 20.

Emergency Plan (A) Obtain U.S. Nuclear Regulatory Commission approval of an 03219, 03234 evaluation demonstrating that an emergency plan is not required pursuant to 10 CFR [30.32(i), 40.31(j), and 70.22(i)], or Emergency Plan (B) Submit written confirmation to the U.S. Nuclear Regulatory 03219, 03234 Commission, using contact information in Appendix D of 10 CFR Part 20, that licensee personnel have been trained and will follow the provisions of an existing emergency plan approved by the U.S.

Nuclear Regulatory Commission or an Agreement State for the temporary job site.

Emergency Plan (Header) The licensee is not required to establish an emergency plan. Before 03219, 03234 taking possession of licensed material at a temporary job site in quantities requiring an emergency plan, the licensee shall either:

Energy Compensation Source The opening, repair, or modification of any Energy Compensation 03111 Source must be performed by persons specifically licensed by the U.S. Nuclear Regulatory Commission or an Agreement State to perform such services.

Exempt Distribution Not Authorized This license does not authorize distribution to persons exempt from 02500, 04210, 04211 licensing.

Exempt from Independent Backup Access Notwithstanding the requirements of 10 CFR 36.23(b), the licensee is 03511, 03521 Control exempt from the requirement to have an independent backup access control to detect personnel entry while sources are exposed based on the commitments described in the [letter/application] dated

[insert date].

Exempt from Monitor Integrated with Notwithstanding the requirements of 10 CFR 36.23(c), the licensee is 03511, 03521 Personnel Access Door Locks exempt from the requirement to integrate the radiation monitor with personnel access door locks to prevent room access when radiation levels are high based on the commitments described in the

[letter/application] dated [insert date].

Exempt from Source Movement Control Part Notwithstanding the requirements of 10 CFR 36.23(f), the licensee is 03511, 03521 36 exempt from the requirement to have a control that prevents the sources from moving from the shielded position unless the control has been activated and the door or barrier to the radiation room has been closed within a preset time based on the commitments described in the [letter/application] dated [insert date].

Exempt from Visible and Audible Alarm Part Notwithstanding the requirements of 10 CFR 36.23(d), the licensee is 03511, 03521 36 exempt from having a visible and audible alarm within the radiation room, based on the commitments described in the

[letter/application] dated [insert date].

Exemption from Console Key Attached to Notwithstanding the requirements of 10 CFR 36.31(a), the licensee is 03511, 03521 Survey Meter Part 36 exempt from the requirement to have a console key attached to a portable survey meter by a chain or cable and the door to the radiation room to have the same key, based on the commitments described in the [letter/application] dated [insert date]. The radiation room door key shall be attached to the portable survey meter.

Exemption from Position Indicator Notwithstanding the requirements of 10 CFR 36.31(b), the licensee is 03511 Requirement for Source in Transit Part 36 exempt from the requirement to have a source position indicator to indicate when the source is in transit, in accordance with the

[letter/application] dated [insert date].

Exemption from Radiation Room Control Notwithstanding the requirements of 10 CFR 36.67(b)(2), the licensee 03511, 03521 Requirement Part 36 is exempt from the requirement to have a control in the radiation room that must be activated prior to irradiation and that would not allow the source to be moved from the shielded position unless the door to the radiation room is locked within a preset time, based on the commitments described in the [letter/application] dated [insert date].

Exemptions from 10 CFR 36.27 Part 36 Notwithstanding the requirements of 10 CFR 36.27, the licensee is 03511, 03521 exempt from [insert what is exempted], based on the commitments described in the [letter/application] dated [insert date].

Extended Time for Inspection/Servicing Notwithstanding the requirements of 10 CFR 35.655, the licensee is 02300, 02310, 04510, 04511, 04512, 04513 Teletherapy/Gamma Stereotactic Unit not required to fully inspect and service [insert teletherapy unit or gamma stereotactic unit] every [insert 5 or 7 years]. The licensee shall inspect the [insert teletherapy unit or gamma stereotactic unit]

every [insert number of years].

Field Station, Radiographic Installation, Licensed material may be only at the licensee's facilities located at 03111, 03112, 03310, 03320, 03800, 03810, 04430, 04431, Temporary Job Sites (A) <<!LicenseLocations!>> <<!FieldStations!>> 04432, 04433

<<!RadiographicInstallations!>>

Field Station, Radiographic Installation, Licensed material may be stored or used at the following: (i) Field 03111, 03112, 03310, 03320, 03800, 03810, 04430, 04431, Temporary Job Sites (B) Station(s): <<!FieldStations!>> (ii) Permanent radiographic 04432, 04433 installation(s): <<!RadiographicInstallations!>> (iii) Temporary job site(s): Anywhere in the United States where the U.S. Nuclear Regulatory Commission maintains jurisdiction for regulating the use of licensed material, including areas of exclusive Federal jurisdiction within Agreement States. If the jurisdiction status of a Federal facility within an Agreement State is unknown, the licensee should contact the Federal agency controlling the job site in question to determine whether the proposed job site is an area of exclusive Federal jurisdiction. Authorization for use of radioactive materials at job sites in Agreement States not under exclusive federal jurisdiction should be obtained from the appropriate state regulatory agency.

Financial Assurance Exempt for Sealed Source This licensee is exempt from decommissioning financial assurance 02300, 02310, 04510, 04511, 04512, 04513 Exchanges requirements for possession of licensed material in sealed sources in quantities greater than the limits in 10 CFR 30.35(d) for the purpose of source changes only. This exemption is granted for no more than 30 days for any one source change.

Financial Assurance Exemption for Pursuant to 10 CFR 30.11, 40.14, 70.14, and Condition 10 of this 03219 Decontamination Services license, the licensee is exempted from requirements of 10 CFR 30.35, 40.36, and 70.25 to provide decommissioning financial assurance.

Financial Assurance not required [If needed] In addition to the possession limits in Item 8, the licensee 01100, 01110, 01120, 02110, 02120, 02200, 02201, 02230, shall further restrict the possession of licensed material to quantities 03610, 03611, 03612, 03613, 04610, 04611, 04612, 04613, below the minimum limit in 10 CFR [30.35(d) or 40.36(b) or 70.25(d)] 04614, 04615, 04616, 04617, 04618, 04619, 04620, 04621, for which decommissioning financial assurance is required. 04622, 04623, 04710, 04711

Financial Assurance Required In addition to the possession limits in Item 8, as specified in 10 CFR 01100, 01110, 01120, 02110, 03610, 03611, 03612, 03613,

[insert: 30.35(d) or 40.36(b) or 70.25(d)], the licensee shall further 04610, 04611, 04612, 04613, 04614, 04615, 04616, 04617, restrict the possession of: (i) unsealed byproduct material or 04618, 04619, 04620, 04621, 04622, 04623, 04710, 04711 unsealed special nuclear material to quantities less than or equal to

[insert: 10^4 or 10^5] times the applicable limits in Appendix B of 10 CFR Part 30, or (ii) readily dispersible source material to quantities less than or equal to [insert: 10 or 100 millicuries], or (iii) sealed byproduct material to quantities less than or equal to [insert: 10^10 or 10^12] times the applicable limits in Appendix B of 10 CFR Part 30.

Gas Chromatograph Operating Temperature Detector cells containing a titanium tritide foil or scandium tritide 03123, 03610, 04420, 04421 Control Mechanism (A) foil shall only be used in conjunction with a properly operating temperature control mechanism that prevents the foil temperature from exceeding that specified in the certificate of registration issued by the U.S. Nuclear Regulatory Commission pursuant to 10 CFR 32.210 or equivalent regulations from an Agreement State.

Gas Chromatograph Operating Temperature When in use, detector cells containing a titanium tritide foil or 03123, 03610, 04420, 04421 Control Mechanism (B) scandium tritide foil shall be vented to the outside.

Gauge Mounting Requirements (A) The gauge must be mounted in accordance with written instructions 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, provided by the manufacturer. 04436, 04437 Gauge Mounting Requirements (B) The gauge must be mounted in a location compatible with the 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, Conditions of Normal Use and Limitations and/or Other 04436, 04437 Considerations of Use in the certificate of registration issued by the U.S. Nuclear Regulatory Commission or an Agreement State.

Gauge Mounting Requirements (C) The on-off mechanism (shutter) must be locked in the off position, if 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, applicable, or the source must be otherwise fully shielded. 04436, 04437

Gauge Mounting Requirements (D) The gauge must be received in good conditions (e.g., the package 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, was not damaged). 04436, 04437 Gauge Mounting Requirements (E) The gauge must not require any modification to fit in the proposed 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, location. 04436, 04437 Gauge Mounting Requirements (Footer) Mounting does not include electrical connection, activation, or 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, operation of the gauge. The source must remain fully shielded, and 04436, 04437 the gauge may not be used until it is installed and made operational by a person specifically licensed by the U.S. Nuclear Regulatory Commission or an Agreement State to perform such operations.

Gauge Mounting Requirements (Header) The licensee may initially mount a gauge, if permitted by the 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, certificate of registration issued by the U.S. Nuclear Regulatory 04436, 04437 Commission or an Agreement State, and under the following conditions:

Gauge Shutter Testing (A) Each gauge shall be tested for the proper operation of the on-off 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, mechanism (shutter) and indicator, if any, at intervals not to exceed 04436, 04437 6 months or at such longer intervals as specified in the certificate of registration issued by the U.S. Nuclear Regulatory Commission pursuant to 10 CFR 32.210 or the equivalent regulations of an Agreement State.

Gauge Shutter Testing (B) The periodic on-off mechanism (shutter) and indicator test 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, requirement does not apply to gauges that are stored, not being 04436, 04437 used, and have the shutter lock mechanism in a locked position. The gauges exempted from this periodic test shall be tested before use.

Records of test results shall be maintained for 3 years from the date of each test.

Incineration Disposal Pursuant to 10 CFR 20.2002, the licensee is authorized to dispose of 03235 licensed material by incineration [NOTE: add reference (i.e, as described in Attachment 11-1 to application dated Month, DD, YYYY)], provided the gaseous effluent from incineration does not exceed the limits specified for air in Appendix B to 10 CFR Part 20, Table 2.

Incinerator Ash/Disposal Pursuant to 10 CFR 20.2002, [NOTE: add reference (i.e, as described 03235 in Attachment 11-1 to application dated Month, DD, YYYY)], the licensee may dispose of incinerator ash containing radioactive materials with Atomic Nos. 1 through 83, except as identified below, as ordinary waste in [specify the landfill(s)], provided that the concentration of radionuclides (in microcuries per gram of ash) at the time of disposal are no greater than the values in Appendix B of 10 CFR Part 20, Table 2, Column 2. For hydrogen-3, carbon-14, aluminum-26, chlorine-36, silver-108m, niobium-94, iodine-129, technetium-99, and thallium-204, the concentration can be no greater than one-tenth of the value in Appendix B of 10 CFR Part 20, Table 2, Column 2. If more than one radionuclide is present in the ash, the sum of fractions rule applies.

Inspecting/Servicing Intravascular The intravascular brachytherapy afterloader device shall be 02110, 02240, 04710, 04711, 04826, 04827 Brachytherapy Afterloader Device inspected and serviced at intervals recommended by the manufacturer, and maintenance and repair shall be performed by the manufacturer or persons specifically licensed by the U.S. Nuclear Regulatory Commission or an Agreement State to perform such services.

Installation Survey - Maximum Radiation Levels After installation of the [irradiator/calibrator/HDR/etc.] and prior to 02110, 02120, 02230, 02240, 03221, 03222, 03225, 03226, Determined the initiation of the [irradiator/calibration/medical program], a 04426, 04427, 04428, 04429, 04710, 04711, 04810, 04811, radiation survey shall be conducted to determine the maximum 04822, 04823, 04826, 04827 radiation levels in each area adjoining the

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

Installation Survey - Open Shutter Required Prior to initial use and after installation, relocation, dismantling, 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, alignment, or any other activity involving the source or removal of 04436, 04437 the shielding, the licensee shall assure that a radiological survey is performed to determine radiation levels in accessible areas around, above, and below the gauge with the shutter open. This survey shall be performed only by persons authorized to perform such services by the U.S. Nuclear Regulatory Commission or an Agreement State.

Irradiator Installation Survey After installation of the irradiator and/or Cobalt-60 or Cesium-137 03511, 03521 source(s) and prior to initiation of the irradiation program, a radiation survey shall be conducted to determine the maximum radiation levels in each area adjoining the irradiation room.

Irradiator Procedures The procedures contained in the manufacturer's instruction manual 03510, 03511, 03520, 03521 for the irradiator authorized by this license shall be followed, and a copy of the procedures shall be made available to each person using or having responsibility for the use of the device.

Irradiator Requirements J.L. Shepherd Mark Permit the use of the irradiator only when a calibrated and operable 03510, 03520 I/81-22 (A) radiation survey meter or room monitor is available; and

Irradiator Requirements J.L. Shepherd Mark Permit the irradiator door to be opened only after the operator has 03510, 03520 I/81-22 (B) checked visual indicators to verify that the source has returned to its safe storage position; and Irradiator Requirements J.L. Shepherd Mark Have room monitors installed that will: (i) Operate at all times when 03510, 03520 I/81-22 (C) the irradiator is in use; and (ii) Activate a visible and audible alarm when radiation exceeds 2 millirems per hour; and (iii) Detect any radiation leaking from the irradiator door; and (iv) Be visible to the irradiator user when he is next to the irradiator; or

Irradiator Requirements J.L. Shepherd Mark If a room monitor is not installed, have available a calibrated and 03510, 03520 I/81-22 (D) operable survey meter that will be used to: (i) Determine the radiation level at the irradiator door when the door is closed; and (ii) Check for any increase in radiation levels each time the irradiator door is opened.

Irradiator Requirements J.L. Shepherd Mark If abnormal radiation levels or any malfunctions of the irradiator are 03510, 03520 I/81-22 (E) detected at any time, cease using the irradiator, restrict access to the area housing the irradiator, immediately notify the Radiation Safety Officer, and submit all reports required under 10 CFR Part 20, Part 21 or Part 30.

Irradiator Requirements J.L. Shepherd Mark Not repair or authorize repairs of the irradiator except by the 03510, 03520 I/81-22 (F) manufacturer or other persons specifically authorized by the U.S.

Nuclear Regulatory Commission or an Agreement State to perform such services.

Irradiator Requirements J.L. Shepherd Mark For each J.L. Shepherd and Associates, Mark I or Model 81-22, 03510, 03520 I/81-22 (Header) Cesium-137 irradiator installed and used, the licensee shall:

Labeling Except for maintaining labeling as required by 10 CFR Part 20, or Part 02500, 03120, 03121, 03122, 03124, 03210, 03510, 03520, 71, the licensee shall obtain authorization from the U.S. Nuclear 04210, 04211, 04414, 04415, 04416, 04417, 04418, 04419, Regulatory Commission before making any changes in the sealed 04422, 04423 source, device, or source-device combination that would alter the description or specifications as indicated in the respective certificate of registration issued either by the U.S. Nuclear Regulatory Commission pursuant to 10 CFR 32.210 or by an Agreement State.

Labeling Requirements The licensee shall mark the following statements, [name of 03251, 11240 manufacturer or initial transferor] or Distributed under US NRC License No. [License Number] and Contains Radioactive Material Kr-85 and/or thorium on each immediate container, as described in the labeling guidance in Consolidated Guidance About Materials Licenses: Program-Specific Guidance About Exempt Distribution Licenses (NUREG-1556 Volume 8 Revision 1, Pages 9-11).

Labeling Requirements Tags (A) Each sealed source containing licensed material to be used outside of 03710 a shielded exposure device shall have a durable, legible, and visible tag permanently attached by a durable ring. The tag shall be at least 1 inch square, shall bear a conventional radiation symbol prescribed in 10 CFR 20.1901(a), and a minimum of the following instructions:

"DANGER - RADIOACTIVE MATERIAL," "DO NOT HANDLE" and "NOTIFY CIVIL AUTHORITIES IF FOUND."

Labeling Requirements Tags (B) Replacement of durable rings shall be carried out by the licensee or 03710 in accordance with [describe instructions or procedure].

Labeling Source Holder/Tool The licensee shall ensure that each source holder or tool containing 03110, 03111 radioactive material bears a durable and clearly visible label bearing the radiation symbol and the words "Caution, Radioactive Material."

The label must be on the smallest component that contains the licensed material and is transported as a separate piece of equipment.

Leak Test (A) Sealed sources and detector cells shall be tested for leakage and/or 01100, 01110, 01120, 02231, 02400, 02500, 02513, 03111, contamination at intervals not to exceed the intervals specified in the 03120, 03121, 03122, 03123, 03124, 03130, 03210, 03211, certificate of registration issued by the U.S. Nuclear Regulatory 03214, 03219, 03220, 03221, 03222, 03225, 03226, 03234, Commission under 10 CFR 32.210 or by an Agreement State. In the 03510, 03511, 03520, 03521, 03610, 03611, 03612, 03613, absence of a registration certificate, sealed sources shall be tested 03620, 03710, 04010, 04011, 04110, 04111, 04210, 04211, for leakage and/or contamination at intervals not to exceed 6 04214, 04215, 04410, 04411, 04414, 04415, 04416, 04417, months, or at such other intervals as specified. 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 Leak Test (B) Notwithstanding Paragraph A of this Condition, sealed sources 01100, 01110, 01120, 02231, 02400, 02500, 02513, 03111, designed to primarily emit alpha particles shall be tested for leakage 03120, 03121, 03122, 03123, 03124, 03130, 03210, 03211, and/or contamination at intervals not to exceed 3 months. 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 Leak Test (C) Each sealed source fabricated by the licensee shall be inspected and 01100, 01110, 01120, 02231, 02400, 02500, 02513, 03111, tested for construction defects, leakage, and contamination prior to 03120, 03121, 03122, 03123, 03124, 03130, 03210, 03211, any use or transfer as a sealed source. 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 Leak Test (D) In the absence of a certificate from a transferor indicating that a leak 01100, 01110, 01120, 02231, 02400, 02500, 02513, 03111, test has been made within the intervals specified in the certificate of 03120, 03121, 03122, 03123, 03124, 03130, 03210, 03211, registration issued by the U.S. Nuclear Regulatory Commission under 03214, 03219, 03220, 03221, 03222, 03225, 03226, 03234, 10 CFR 32.210 or by an Agreement State, prior to the transfer, a 03510, 03511, 03520, 03521, 03610, 03611, 03612, 03613, sealed source received from another person shall not be put into use 03614, 03620, 03710, 04010, 04011, 04110, 04111, 04210, until tested and the test results received. 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 Leak Test (E) Sealed sources need not be tested if they contain only hydrogen-3; or 01100, 01110, 01120, 02231, 02400, 02500, 02513, 03111, they contain only a radioactive gas; or the half-life of the isotope is 03120, 03121, 03122, 03123, 03124, 03130, 03210, 03211, 30 days or less; or they contain not more than 100 microcuries of 03214, 03219, 03220, 03221, 03222, 03225, 03226, 03234, beta-and/or gamma-emitting material or not more than 10 03510, 03511, 03520, 03521, 03610, 03611, 03612, 03613, microcuries of alpha-emitting material. 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 Leak Test (F) Sealed sources need not be tested if they are in storage and are not 01100, 01110, 01120, 02231, 02400, 02500, 02513, 03111, being used. However, when they are removed from storage for use 03120, 03121, 03122, 03123, 03124, 03130, 03210, 03211, or transferred to another person, and have not been tested within 03214, 03219, 03220, 03221, 03222, 03225, 03226, 03234, the required leak test interval, they shall be tested before use or 03510, 03511, 03520, 03521, 03610, 03611, 03612, 03613, transfer. No sealed source shall be stored for a period of more than 03614, 03620, 03710, 04010, 04011, 04110, 04111, 04210, 10 years without being tested for leakage and/or contamination. 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 Leak Test (G) The leak test shall be capable of detecting the presence of 185 01100, 01110, 01120, 02231, 02400, 02500, 02513, 03111, becquerels (0.005 microcuries) of radioactive material on the test 03120, 03121, 03122, 03123, 03124, 03130, 03210, 03211, sample. If the test reveals the presence of 185 becquerels (0.005 03214, 03219, 03220, 03221, 03222, 03225, 03226, 03234, microcuries) or more of removable contamination, a report shall be 03510, 03511, 03520, 03521, 03610, 03611, 03612, 03613, filed with the U.S. Nuclear Regulatory Commission in accordance 03614, 03620, 03710, 04010, 04011, 04110, 04111, 04210, with 10 CFR 30.50(c)(2), and the source shall be removed 04211, 04214, 04215, 04410, 04411, 04414, 04415, 04416, immediately from service and decontaminated, repaired, or disposed 04417, 04418, 04419, 04420, 04421, 04422, 04423, 04424, of in accordance with Commission regulations. 04425, 04426, 04427, 04428, 04429, 04436, 04437, 04610, 04611, 04612, 04613, 04614, 04615, 04616, 04617, 04618, 04619, 04620, 04621, 04622, 04623, 04824, 04825 Leak Test (H) Authorized for Collection and [THE LICENSE CONDITION IS USED IF THE LICENSEE IS AUTHORIZED 01100, 01110, 01120, 02231, 02400, 02500, 02513, 03111, Analysis TO COLLECT AND ANALYZE LEAK TEST SAMPLES.] Tests for leakage 03120, 03121, 03122, 03123, 03124, 03130, 03210, 03211, and/or contamination, including leak test sample collection and 03214, 03219, 03220, 03221, 03222, 03225, 03226, 03234, analysis, shall be performed by the licensee or other persons 03510, 03511, 03520, 03521, 03610, 03611, 03612, 03613, specifically licensed by the U.S. Nuclear Regulatory Commission or an 03614, 03620, 03710, 04010, 04011, 04110, 04111, 04210, Agreement State to perform such services. 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 Leak Test (H) Not Authorized for Analysis [THIS LICENSE CONDITION IS USED IF THE LICENSEE IS NOT 01100, 01110, 01120, 02231, 02400, 02500, 02513, 03111, AUTHORIZED TO PERFORM LEAK TEST ANALYSIS.] Analysis of leak 03120, 03121, 03122, 03123, 03124, 03130, 03210, 03211, test samples and/or contamination shall be performed by persons 03214, 03219, 03220, 03221, 03222, 03225, 03226, 03234, specifically licensed by the U.S. Nuclear Regulatory Commission or an 03510, 03511, 03520, 03521, 03610, 03611, 03612, 03613, Agreement State to perform such services. The licensee is authorized 03614, 03620, 03710, 04010, 04011, 04110, 04111, 04210, to collect leak test samples but not perform the analysis. 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 Leak Test (I) Records of leak test results shall be kept in units of becquerels 01100, 01110, 01120, 02231, 02400, 02500, 02513, 03111, (microcuries) and shall be maintained for 3 years. 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 Leak Test Well Logging (A) Notwithstanding the periodic leak test required by 10 CFR 39.35, the 03110, 03111, 03112, 03113 requirement does not apply to sources, except sources containing plutonium, that are stored and not being used. The sources exempted from this periodic test shall be tested for leakage before use or transfer to another person.

Leak Test Well Logging (B) Sealed sources authorized for use other than well logging shall be 03110, 03111, 03112, 03113 tested for leakage and shall be inventoried in accordance with 10 CFR 39.35 and 10 CFR 39.37.

Leak Test Well Logging (C) No sealed source shall be stored for a period of more than 10 years 03110, 03111, 03112, 03113 without being tested for leakage and/or contamination.

Leak Test Exemption (A) Notwithstanding the periodic leak test required by 10 CFR 34.27(c)(1) 03310, 03320 and (e), the requirement does not apply to radiography sources that are stored and not being used. These radiography sources must be leak tested before they are used or transferred to another person.

No sealed source may be stored for a period of more than 10 years without being tested in accordance with 10 CFR 34.27(c)(1) and (e).

Leak Test Exemption (B) Sealed sources authorized for uses other than radiography shall be 03310, 03320 tested for leakage and shall be inventoried in accordance with 10 CFR 34.27 and 10 CFR 34.29, respectively.

Leak Test Exemption (C) This licensee is authorized to analyze leak test samples in accordance 03310, 03320 with the [application/letter] dated [insert date].

Leak Test for MML (A) The licensee shall require permittees to conduct leak tests of sealed 03614 sources and detector cells. Sealed sources and detector cells shall be tested for leakage and/or contamination at intervals not to exceed the intervals specified in the certificate of registration issued by the U.S. Nuclear Regulatory Commission under 10 CFR 32.210 or by an Agreement State. In the absence of a registration certificate, sealed sources shall be tested for leakage and/or contamination at intervals not to exceed 6 months, or at such other intervals as specified.

Leak Test for MML (B) Notwithstanding Paragraph A of this Condition, sealed sources 03614 designated to primarily emit alpha particles shall be tested for leakage and/or contamination at intervals not to exceed 3 months.

Licensee Shall Not Open/Remove Sources [Insert: Sealed sources, Source rods, Foil sources, or Detector cells] 01100, 01110, 01120, 02110, 02120, 02230, 02231, 02240, containing licensed material shall not be opened [Insert: or sources 02400, 02500, 03120, 03121, 03122, 03124, 03130, 03210, removed from source holders or detached from source rods, or foil 03211, 03219, 03220, 03221, 03222, 03225, 03234, 03310, sources removed from detector cells] by the licensee, except as 03320, 03510, 03511, 03520, 03521, 03610, 03611, 03612, specifically authorized. 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 Location of Storage Licensed material shall be stored at the licensees facilities located at: 03111, 03112, 03310, 03320, 03800, 03810, 04430, 04431, 04432, 04433 Location of Use Licensed material shall be used or stored at the licensee's facilities 01100, 01110, 01120, 02120, 02121, 02200, 02201, 02210, located at: <<!LicenseLocations!>> 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 Location of Use - Temporary Job Sites Licensed material may be [used or stored] only at temporary job sites 02220, 03120, 03121, 03123, 03124, 03211, 03219, 03225, of the licensee anywhere in the United States where the U.S. Nuclear 03226, 03234, 04010, 04011, 04414, 04415, 04416, 04417, Regulatory Commission maintains jurisdiction for regulating the use 04420, 04421, 04422, 04423, 04820, 04821, 11200, 11210, of licensed material, including areas of exclusive Federal jurisdiction 11220, 11221, 11230, 11300, 11800, 11810, 11900 within Agreement States. If the jurisdiction status of a Federal facility within an Agreement State is unknown, the licensee should contact the Federal agency controlling the job site in question to determine whether the proposed job site is an area of exclusive Federal jurisdiction. Authorization for use of radioactive materials at job sites in Agreement States not under exclusive Federal jurisdiction should be obtained from the appropriate state regulatory agency.

Location of Use and Temporary Job Sites Licensed material shall be used or stored at the licensee's facilities 03111, 03112, 03120, 03122, 03124, 03210, 03211, 03219, located at <<!LicenseLocations!>> and may be used at temporary job 03225, 03226, 03234, 03310, 03320, 03800, 03810, 04010, sites of the licensee anywhere in the United States where the U.S. 04011, 04414, 04415, 04418, 04419, 04422, 04423, 04430, Nuclear Regulatory Commission maintains jurisdiction for regulating 04431, 04432, 04433, 11200, 11210, 11220, 11221, 11230, the use of licensed material, including areas of exclusive Federal 11300, 11800, 11810, 11900, 03121, 04416, 04417 jurisdiction within Agreement States. If the jurisdiction status of a Federal facility within an Agreement State is unknown, the licensee should contact the Federal agency controlling the job site in question to determine whether the proposed job site is an area of exclusive Federal jurisdiction. Authorization for use of radioactive materials at job sites in Agreement States not under exclusive Federal jurisdiction should be obtained from the appropriate state regulatory agency.

Location of Use and Users Licensed material shall be used at [insert MML: (e.g., United States 03614 Air Force)] facilities by: (1) [United States Air Force] personnel as authorized by permits issued by the [insert name of Radiation Safety Committee, (e.g., National Radiation Safety Committee)]; and (2) users who are not [insert MML: (e.g., United States Air Force)]

personnel when such use is authorized by the [insert name of Radiation Safety Committee, (e.g., National Radiation Safety Committee)] and is conducted in work spaces under the control of the [insert MML: (e.g., United States Air Force)].

Location of Use Off-Shore Licensed Material shall be used at the licensee's facilities located at: 03110, 03111

[specify the Producer, Official Protraction Diagram Oil Field Name, Block Number, Gulf of Mexico (or Pacific Ocean), Platform OSC assigned number or latitude/longitude if the platform number has not been assigned or if the device is placed subsea.]

Location of Use/Specific Address for Material Licensed material listed in Subitem Nos. [insert subitem] through 01100, 01110, 01120, 02110, 02120, 02121, 02200, 02201,

[insert subitem] shall be used at the licensee's facilities located at 02210, 02220, 02230, 02231, 02240, 02300, 02310, 02400,

<<!LicenseLocations!>>. 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 Loss of Contact with Nuclear-Powered The licensee shall report to the U.S. Nuclear Regulatory Commission 04828, 04829, 22160 Pacemaker Patient using the contact information in Appendix D of 10 CFR Part 20, within 10 days after discovery of loss of contact with a nuclear-powered pacemaker patient.

Maintenance, Repair, Cleaning, Replacement, Maintenance, repair, cleaning, replacement, and disposal of foils 01120, 02110, 03123, 03124, 03211, 03610, 03611, 03612, and Disposal... contained in detector cells shall be performed only by the device 03620, 04010, 04011, 04420, 04421, 04422, 04423, 04610, manufacturer or other persons specifically authorized by the U.S. 04611, 04612, 04613, 04614, 04615, 04622, 04623, 04710, Nuclear Regulatory Commission or an Agreement State to perform 04711 such services.

Material Not for Use in Field Applications The licensee shall not use licensed material in field applications 01100, 01110, 01120, 02110, 03610, 03611, 03612, 03613, where activity is released except as provided otherwise by specific 03620, 04610, 04611, 04612, 04613, 04614, 04615, 04616, condition of this license. 04617, 04618, 04619, 04620, 04621, 04622, 04623, 04710, 04711 Material Not for Use In/On Humans The licensee shall not use the licensed material in or on humans. 01100, 01110, 01120, 02400, 03240, 03241, 03242, 03243,

[NOTE: if needed add the following: except as provided otherwise by 03244, 03610, 03611, 03612, 03613, 03620, 04410, 04411, specific condition of this license]. 04610, 04611, 04612, 04613, 04614, 04615, 04616, 04617, 04618, 04619, 04620, 04621, 04622, 04623 Mobile Nuclear Medicine Activities Licensed material incident to mobile nuclear medicine activities may 02220, 02231, 04820, 04821, 04824, 04825 be delivered to the licensee's mobile van located at temporary job sites when trained licensee personnel are present to receive the licensed material.

Modifications to the Source Rack The licensee is authorized to make modifications to the source rack 03521 as requested in [application/letter] dated [insert date]. The licensee shall test the movement of the source rack for proper operation in accordance with 10 CFR 36.41(f) and (i) prior to source loading.

No Irradiator Repairs The licensee shall not perform repairs or alterations of the irradiator 03510, 03511, 03520, 03521 involving removal of shielding or access to the licensed material.

Removal, replacement, and disposal of sealed sources in the irradiator shall be performed by persons specifically licensed by the U.S. Nuclear Regulatory Commission or an Agreement State to perform such services.

No Possession at Customer Facility The licensee may not take possession of the radioactive materials 03219, 03226, 03234 and/or sealed sources while at the customer's facility [insert as needed - for example "except for analytical samples"].

No Possession or Use This license does not authorize possession or use of licensed 02511, 02513, 03240, 03241, 03242, 03243, 03244, 03250, materials. 03251, 03252, 03253, 03254, 03255, 03256, 03257, 04212, 04213, 04214, 04215, 11240 No Temporary Job Sites Authorized If a customer also holds a license issued by the U.S. Nuclear 03219, 03234 Regulatory Commission or an Agreement State, the licensee shall establish a written agreement between the licensee and the customer specifying which licensee activities shall be performed pursuant to the customer's license and supervision, and which licensee activities shall be performed under the licensee's supervision pursuant to this license. A copy of this agreement shall be included in the notification required by license condition [insert number].

Non-Commercial Distribution This license does not authorize commercial distribution of licensed 03214, 03220, 03232, 03610, 03611, 04110, 04111, 04424, material. 04425, 04610, 04611, 04612, 04613 Non-Commercial Distribution 10 CFR 30 This license does not authorize commercial distribution to persons 03214, 04110, 04111 exempt from licensing pursuant to [insert applicable regulation, such as 10 CFR 30.19 or 10 CFR 30.14 through 30.21, inclusive].

Non-Commercial Distribution 10 CFR 31 This license does not authorize commercial distribution of licensed 03214, 04110, 04111 material to persons generally licensed pursuant to 10 CFR Part 31 or to persons exempt from licensing pursuant to [insert applicable regulation, such as 10 CFR 30.18].

Non-Commercial Distribution Pursuant to 10 This license does not authorize commercial distribution of licensed 03210, 03214, 04110, 04111 CFR 31 and/or 32 material pursuant to 10 CFR 32.72 or 10 CFR 32.74 to persons generally licensed pursuant to 10 CFR Part 31 or equivalent regulations of any Agreement State; or to persons exempt from licensing pursuant to 10 CFR 30.14 through 10 CFR 30.21 inclusive, or equivalent regulations of any Agreement State.

Non-Routine Maintenance Not Allowed The following services shall not be performed by the licensee: [Insert 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, which services are NOT authorized in this license, delete remaining:] 04436, 04437 (i) installation, (ii) initial radiation surveys, (iii) relocation, (iv) removal from service, (v) dismantling, (vi) alignment, (vii)replacement, (viii) disposal of the sealed source, and (ix) non-routine maintenance or repair of components related to the radiological safety of the gauge (i.e., the sealed source, the source holder, source drive mechanism, on-off mechanism (shutter), shutter control, shielding). These services shall be performed only by persons specifically licensed by the U.S. Nuclear Regulatory Commission or an Agreement State to perform such services.

Non-routine Maintenance of Gauges The licensee may detach the source rod from the gauge(s) for the 03121, 04416, 04417 purpose of cleaning, maintenance, or repair of the gauge(s) in accordance with procedures outline in the [application/letter] dated

[insert date].

Not Authorized to conduct source retrieval The licensee is not authorized to conduct source retrieval activities.03310, 03320, 04310, 04311, 04312, 04313

Not Authorized to Perform Source Changes The licensee is not authorized to perform source changes in 03310, 03320 radiographic exposure devices. These services shall be performed by persons specifically licensed by the U.S. Nuclear Regulatory Commission or an Agreement State to perform such activities.

Notification of Transferring or Disposing of The licensee shall inform the U.S. Nuclear Regulatory Commission, 11200, 11210, 11220, 11221, 11230, 11300, 11800, 11810, Depleted Uranium Shielding [insert name of Regional Office], prior to transferring or disposing of 11900 depleted uranium shielding.

Notification to NRC (A) The licensee shall notify the U.S. Nuclear Regulatory Commission, 03219, 03234 using contact information in Appendix D of 10 CFR Part 20, in writing, at least 14 days before initiating activities under this license at a temporary job site, excluding routine packaging or repackaging for purposes of transporting and not requiring a job or site specific work package, and characterization and/or final surveys where neither radioactive materials nor radiation are likely to be detected. This notification shall include: (1) The estimated type, quantity, and physical/chemical forms of licensed material to be used, (2) The specific site location, (3) A description of planned activities including waste management and disposition, (4) The estimated start date and completion date for the job, (5) The name and title of a point of contact for the job, including information on how to contact this individual, and (6) Copy of the written agreement between the licensee and the customer as described by license condition [insert number for license condition No Temporary Job Sites Authorized].

Notification to NRC (B) Within 30 days of completing activities at each job site location, the 03219, 03234 licensee shall notify the U.S. Nuclear Regulatory Commission, using contact information in Appendix D of 10 CFR Part 20, in writing, of the temporary job site status and the disposition of any licensed material used.

Nuclear-Powered Pacemakers The physician(s) responsible for follow-up, explantation and return of 04828, 04829, 22160 nuclear-powered pace makers to the manufacturer for proper disposal is [insert name(s)].

Operating Requirements The licensee shall operate each device containing licensed material 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, within the manufacturer's specified temperature and environmental 04436, 04437 limits such that the shielding and shutter mechanism of the source holder are not compromised.

Outdoor Target Area The total amount of depleted uranium contained in spent munitions 11221 which may remain in the Outdoor Target Area under the authorization of this license shall not exceed [insert amount]

kilograms. Records of inventory of material fired into and retrieved from the Outdoor Target Area shall be maintained.

Ownership/Possession Written Approval The licensee may not take ownership or possession of radioactive 03219, 03234 material(s) or source(s) originating from a client's site, without prior notification and written approval from the U.S. Nuclear Regulatory Commission.

Patient Follow-Up Nuclear-Powered The licensee shall continue patient follow-up and replacement 04828, 04829, 22160 Pacemakers procedures for the nuclear-powered pacemaker during the life of the patient. Procedures for recovery and authorized disposal of the nuclear-powered pacemaker by return to the manufacturer shall be followed upon the death of the patient. If return of the explanted pacemaker by return to the manufacturer is not possible, explanted pacemakers may be disposed of in accordance with the commitments, representations and procedures in the

[letter/application] dated [insert date].

Physical Inventory The licensee shall conduct a physical inventory every 6 months, or at 01100, 01110, 01120, 02110, 02400, 02500, 02513, 03120, other intervals approved by the U.S. Nuclear Regulatory Commission, 03121, 03122, 03123, 03124, 03130, 03210, 03211, 03214, to account for all sealed sources and/or devices received and 03219, 03220, 03221, 03222, 03225, 03226, 03240, 03241, possessed under the license. Records of inventories shall be 03242, 03243, 03244, 03510, 03511, 03520, 03521, 03610, maintained for 3 years from the date of each inventory, and shall 03611, 03612, 03613, 03710, 04010, 04011, 04110, 04111, include the radionuclides, quantities, manufacturer's name and 04210, 04211, 04214, 04215, 04410, 04411, 04414, 04415, model numbers, and the date of the inventory. 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 Physical Inventory MML (A) The licensee shall require permittees to conduct a physical inventory 03614 every 6 months to account for all sources and/or devices received and possessed under their respective permits.

Physical Inventory MML(B) The licensee shall require that permittees maintain records of 03614 physical inventories for 3 years from the date of each inventory.

Records shall include the quantities and kinds of licensed material, manufacturer's name and model numbers, location of the sources and/or devices, and the date of the inventory.

Portable Gauge Barriers Each portable nuclear gauge shall have a lock or outer locked 03121, 04416, 04417 container designed to prevent unauthorized or accidental removal of the sealed source from its shielded position. The gauge or its container must be locked when in transport or storage, or when not under the direct surveillance of an authorized user.

Possession for Broad Type B If only one radionuclide is possessed, the possession limit is the 01110, 03611, 04612, 04613, 04620, 04621 quantity specified for that radionuclide in 10 CFR 33.100, Schedule A, Column I. If two or more radionuclides are possessed, then the possession limit is determined as follows: For each radionuclide, determine the ratio of the quantity possessed to the applicable quantity specified in 10 CFR 33.100, Schedule A, Column I, for that radionuclide. The sum of the ratios for all radionuclides possessed under the license shall not exceed unity.

Possession for Broad Type C If only one radionuclide is possessed, the possession limit is the 01120, 03612, 04614, 04615, 04622, 04623 quantity specified for that radionuclide in 10 CFR 33.100, Schedule A, Column II. If two or more radionuclides are possessed, then the possession limit is determined as follows: For each radionuclide, determine the ratio of the quantity possessed to the applicable quantity specified in 10 CFR 33.100, Schedule A, Column II, for that radionuclide. The sum of the ratios for all radionuclides possessed under the license shall not exceed unity.

Possession Limit for Nuclear-Powered The specified possession limit for nuclear-powered pacemakers 04828, 04829, 22160 Pacemakers includes all licensed material possessed by the licensee under this license whether in storage, implanted in patients, or otherwise in use.

Products under 10 CFR 32.11 Gemstones (A) Notwithstanding the requirements of 10 CFR 32.11(c), the licensee 03250 may distribute processed gemstones as described in the application dated [insert date], for the purpose of being worn by human beings.

These may contain radionuclides that do not appear in 10 CFR 30.70 at concentrations up to those specified in the application, applying NOTE 2 of 10 CFR 30.70; and Products under 10 CFR 32.11 Gemstones (B) The licensee shall evaluate any gemstones that the licensee has 03250 determined are below the exempt concentrations, and have subsequently been irradiated with an accelerator, using appropriate instrumentation and following appropriate procedures to ensure that any induced radionuclides do not exceed the concentration limits specified in 10 CFR 30.70, Schedule A, and the approved derived concentration limits for radionuclides not appearing in 10 CFR 30.70; or Products under 10 CFR 32.11 Gemstones (C) The licensee shall not accept any material unless it is accompanied by 03250 documentation indicating that the material has been analyzed and found to contain less than exempt concentrations as specified in 10 CFR 30.14 and 30.70, and in accordance with NOTE 2 to 10 CFR 30.70.

The licensee shall ensure that the measurement process was adequate to measure radioactivity below the exempt concentrations.

The licensee shall perform periodic confirmatory measurements, as approved, of the material received to ensure the regulatory requirements are met.

Program Changes to Procedures (A) The proposed revision is documented, reviewed, and approved by 01100, 02110, 03211, 03610, 04010, 04011, 04610, 04611, the licensee's Radiation Safety Committee in accordance with 04618, 04619, 04710, 04711 established procedures prior to implementation; Program Changes to Procedures (B) The revised program is in accordance with regulatory requirements, 01100, 02110, 03211, 03610, 04010, 04011, 04610, 04611, will not change the license conditions, and will not decrease the 04618, 04619, 04710, 04711 effectiveness of the Radiation Safety Program; Program Changes to Procedures (C) The licensee's staff is trained in the revised procedures prior to 01100, 02110, 03211, 03610, 04010, 04011, 04610, 04611, implementation; and 04618, 04619, 04710, 04711 Program Changes to Procedures (D) The licensee's audit program evaluates the effectiveness of the 01100, 02110, 03211, 03610, 04010, 04011, 04610, 04611, change and its implementation. 04618, 04619, 04710, 04711 Program Changes to Procedures (Header) Notwithstanding the requirements of License Condition [Insert Tie- 01100, 02110, 03211, 03610, 04010, 04011, 04610, 04611, Down Condition Number], the licensee is authorized to make 04618, 04619, 04710, 04711 program changes and changes to procedures specifically identified in the [application/letter] dated [insert date], which were previously approved by the U.S. Nuclear Regulatory Commission and incorporated into the license without prior Commission approval as long as:

Proposed Changes in Packaging, Labeling, Any proposed changes in packaging, labeling, shielding, or 02511, 02513, 03240, 03241, 03242, 03243, 03244, 04212, Shielding, Instructions instructions for use and storage shall be submitted for review to the 04213, 04214, 04215 U.S. Nuclear Regulatory Commission in accordance with Appendix D of 10 CFR Part 20. The approval of the changes shall be received by the licensee prior to implementing any of the changes.

Pulsed Neutron Generator Tool Not Energized The pulsed neutron generator tool should not be energized before 03110, 03111 going down-hole to a depth of at least 200 feet or into a calibration tank.

Pulsed Neutron Generator Tool Not Retracted The pulsed neutron generator tool should not be retracted to the 03110, 03111 surface or from the calibration tank until sufficient time has allowed for activation products in the tool to decay in accordance with

[application/letter] dated [insert date].

Radiation Safety Committee Licensed material shall only be used by, or under the supervision of, 01100, 03211, 03610, 03613, 04010, 04011, 04610, 04611, individuals designated, in writing, by the [Note: enter licensee's 04616, 04617, 04618, 04619 Radiation Safety Committee name]. The licensee shall maintain records of individuals designated as users for 3 years after the individual's last use of licensed material.

Radiation Safety Committee Requests [Insert name of Radiation Safety Committee, e.g., National Radiation 03614 Safety Committee] shall submit requests for approval to the U.S.

Nuclear Regulatory Commission for exemptions from the Commission's regulations.

Radiation Safety Criteria - Authorized Nuclear Pharmacists, as defined in 10 CFR 35.2, designated in writing to work 02500, 04210, 04211 Pharmacists as authorized nuclear pharmacists by the licensee's Radiation Safety Committee, shall meet the requirements in accordance with letter(s) dated [insert date]. The licensee shall maintain records of individuals designated as authorized nuclear pharmacists for 3 years following the last use of licensed material by the individual.

Records for Decommissioning The licensee shall maintain records of information important to 03219, 03234 decommissioning for each temporary job site pursuant to 10 CFR

[30.35(g), 40.36(f), and 70.25(g)]. The records shall be made available to the customer upon request. At the completion of activities at a temporary job site, the licensee shall transfer these records to the customer for retention.

Redistribution of Alpha-, Beta-, or Photon-Notwithstanding the requirements of 10 CFR 32.72(c), the licensee 02511, 04212, 04213 Emitting Radioactive Drugs may redistribute alpha-, beta-, or photon-emitting radioactive drugs, which have been initially distributed by another radiopharmaceutical supplier licensed pursuant to 10 CFR 32.72, without verifying the radioactivity of the dosage. The licensee must not manipulate the dosage, including the packaging and label.

Registration Certificate Reference The following device containing byproduct material designed and 03255 manufactured in accordance with NRC registration certificate Nos.

[NR-xxxx-D-101-E and NR-xxxx-D-101-E], may be distributed according to this license provided the amount of [e.g., americium-241] contained in the device does not exceed the amount specified in the following table:Device Model, Maximum Quantity Per Device Registration Certificate Reference-Industrial The following industrial device containing byproduct material 03257 Device designed and manufactured in accordance with NRC registration certificate No. [NR-xxxx-D-101-E], for the purpose of [e.g., measuring qualitative or quantitative chemical composition], may be distributed according to this license provided the amount of [e.g., Nickel-63]

contained in the device does not exceed the amount specified in the following table: Gas Chromatograph Model, Device Model, Maximum Quantity Per Device Registration under 10 CFR 32.210 The licensee shall not acquire licensed material in a sealed source or 02110, 03211, 03610, 03611, 03612, 03620, 04010, 04011, device unless the source or device has been registered with the U.S. 04610, 04611, 04612, 04613, 04614, 04615, 04710, 04711 Nuclear Regulatory Commission pursuant to 10 CFR 32.210 or equivalent regulations of an Agreement State.

Report of Nuclear-Powered Pacemaker Death The licensee shall report to the U.S. Nuclear Regulatory Commission 04828, 04829, 22160 or Issue in accordance with Appendix D of 10 CFR Part 20, within 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> of occurrence, discovery of the death of any nuclear-powered pacemaker patient, and any adverse reaction and/or malfunction involving a pacemaker system, including the leads. A written report giving details of the adverse reaction and/or malfunction shall be submitted within 30 days.

Requirements in 10 CFR 35.14 for MML Notwithstanding the requirements in 10 CFR 35.14 to notify the U.S. 03614 (notifications) Nuclear Regulatory Commission, the [insert MML name: e.g.,

Department of Veterans Affairs] medical use permittees are authorized to make the notification required in 10 CFR 35.14 to the

[insert MML entity e.g., Department of Veterans Affairs National Health Physics Program Director] provided the appropriate requirements in 10 CFR 35.13 (b) and 35.14 are met.

Requirements in 10 CFR 35.6 for MML (human [Insert name of Radiation Safety Committee, e.g., National Radiation 03614 research subjects) Safety Committee] shall assure that all uses of byproduct material on human research subjects are authorized and performed in accordance with the requirements in 10 CFR 35.6.

Restricted Possession for 10 CFR 30.72 for In addition to the possession limits in Item 8, the licensee shall 01100, 02110, 03211, 03212, 03213, 03214, 03219, 03232, Emergency Plan further restrict the possession of licensed material in the form of 03234, 03610, 03611, 03613, 04010, 04011, 04012, 04013, unsealed material and foil or plated sources to quantities below the 04014, 04015, 04110, 04111, 04610, 04611, 04612, 04613, limits specified in 10 CFR 30.72, which require consideration of the 04616, 04617, 04710, 04711 need for an emergency plan for responding to a release of licensed material.

Restriction of Irradiator Maintenance The licensee shall not repair, remove, replace, or alter any of the 03510, 03511, 03520, 03521 following: electrical and mechanical systems that control source or shielding movement, the irradiator's shielding or sealed source, safety interlocks, or any component that may affect safe operation of the irradiator. These activities shall be performed by a person specifically licensed by the U.S. Nuclear Regulatory Commission or an Agreement State to perform such services.

Restriction of Irradiator Maintenance ExceptionExcept for the repair or maintenance operations described in 03510, 03511, 03520, 03521

[letter/application] dated [insert date], the licensee shall not repair, remove, replace, or alter any of the following: electrical and mechanical systems that control source or shielding movement, the irradiator's shielding or sealed source, safety interlocks, or any component that may affect safe operation of the irradiator. These activities shall be performed by a person specifically licensed by the U.S. Nuclear Regulatory Commission or an Agreement State to perform such services.

Retrieve, Receive and Dispose of Radioactive The licensee is authorized to retrieve, receive and dispose of 02500, 04210, 04211 Waste radioactive waste from its customers, limited to radiopharmacy-supplied syringes and vials and their contents.

RSO The Radiation Safety Officer (RSO) for this license is <<!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 Sealed Sources Inspection/Test Prior to Each sealed source fabricated by the licensee shall be inspected and 01100, 01110, 01120, 03210, 03212, 03213, 03214, 03610, Transfer tested for construction defects, leakage, and contamination prior to 03611, 03612, 03613, 03620, 04012, 04013, 04014, 04015, any use or transfer as a sealed source. Records of leak test results 04110, 04111, 04610, 04611, 04612, 04613, 04614, 04615, shall be kept in units of microcuries and shall be maintained for 3 04616, 04617, 04618, 04619, 04620, 04621, 04622, 04623 years.

Separate Keys for Personnel Lock and Barrier Notwithstanding the requirements of 10 CFR 36.23(a), the licensee 03511, 03521 Entrance may use separate keys to operate the lock on the personnel entrance door or barrier and to move the sources in accordance with procedures described in the [letter/application] dated [insert date].

Shipment of Plutonium Except for plutonium contained in a medical device designed for 04828, 04829, 22110, 22111, 22120, 22140, 22150, 22151, individual human application, no plutonium, regardless of form, shall 22160, 22170, 22200, 23300, 23310 be delivered to a carrier for shipment by air transport or transported in an aircraft by the licensee except in packages the design of which U.S. Nuclear Regulatory Commission has specifically approved for transport of plutonium by air.

Shutter Locked The licensee shall assure that the shutter mechanism of each device 03120, 03124, 03130, 03310, 04414, 04415, 04422, 04423, containing licensed material is locked in the closed position during 04436, 04437 periods when a portion of an individual's body may be subject to the direct radiation beam. The licensee shall review and modify, as appropriate, its "lock-out" procedures whenever a new device is obtained to incorporate the device manufacturer's recommendations.

Site Remediation Special LC to Eliminate Need Except as provided for in paragraph B of this license condition, any 03219, 03234 for EA/NEPA Review (A) activity performed by the licensee at a temporary job site related to site characterization or the decontamination and decommissioning of facilities, equipment, and containers, including any waste packaging incidental to these activities, must be performed in accordance with the customer licensees NRC-approved decommissioning plan that pertains to that temporary job site.

Site Remediation Special LC to Eliminate Need If the customer licensee is not required to submit a decommissioning 03219, 03234 for EA/NEPA Review (B) plan to the NRC and if the customer licensees operations at a temporary job site have been limited to the use of: (1) small quantities of short-lived radioactive materials, or (2) radioactive materials in sealed sources provided there is no evidence of leakage of radioactive material from these sealed sources, then any activity performed by the licensee at that temporary job site related to site characterization or the decontamination and decommissioning of facilities, equipment, and containers, including any waste packaging incidental to these activities, must be performed in accordance with the licensees decommissioning procedures approved by the NRC under this license.

Site Remediation Special LC to Eliminate Need Any activity proposed to be performed by the licensee at a 03219, 03234 for EA/NEPA Review (C) temporary job site that is not covered by either paragraph A or B of this license condition must be approved by the NRC through a site-specific license amendment or exemption request.

Source Retrieval The licensee is authorized to conduct source retrieval activities in 03310, 03320 accordance with [application/letter] dated [insert date].

Storage of Waste Radioactive waste possessed under this license shall be stored in 01100, 01110, 02110, 03211, 03225, 03226, 03610, 03611, accordance with the statements, representations, and procedures 03620, 04010, 04011, 04610, 04611, 04612, 04613, 04618, included with the licensee's waste storage plan described in the 04619, 04620, 04621, 04710, 04711 licensee's [application/letter] dated [insert date].

Supervision 10 CFR 33.15(b) Licensed material shall only be used by or under the supervision of 01120, 03213, 03612, 04014, 04015, 04614, 04622, 04623 individuals meeting the requirements stated in 10 CFR 33.15(b) for the materials and uses as indicated: <<!AuthorizedUsers!>>

Supervision 10 CFR 35.13 and 35.14 (A) Individuals permitted to work as [insert either authorized users, 02120, 02121, 02200, 02201, 02210, 02220, 02230, 02231, authorized nuclear pharmacists, and/or authorized medical 02240, 02300, 02310, 04510, 04511, 04512, 04513, 04810, physicists, as appropriate] in accordance with 10 CFR 35.13 and 10 04811, 04812, 04813, 04814, 04815, 04816, 04817, 04818, CFR 35.14. 04819, 04820, 04821, 04822, 04823, 04824, 04825, 04826, 04827 Supervision 10 CFR 35.13 and 35.14 (B) The following individuals are authorized users for the material and 02120, 02121, 02200, 02201, 02210, 02220, 02230, 02231, medical uses as indicated: <<!AuthorizedUsers!>> 02240, 02300, 02310, 04510, 04511, 04512, 04513, 04810,

<<!AuthorizedUsersMDMO!>> 04811, 04812, 04813, 04814, 04815, 04816, 04817, 04818, 04819, 04820, 04821, 04822, 04823, 04824, 04825, 04826, 04827 Supervision 10 CFR 35.13 and 35.14 (C) The following individuals are authorized users for nonmedical uses as 02120, 02121, 02200, 02201, 02210, 02220, 02230, 02231, indicated: <<!AuthorizedUsers!>> <<!NonMedicalUsers!>> 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 Supervision 10 CFR 35.13 and 35.14 (D) The following individuals are authorized medical physicists [or 02120, 02121, 02200, 02210, 02220, 02230, 02231, 02240, ophthalmic physicists] for the materials and uses as indicated: 02300, 02310, 04510, 04511, 04512, 04513, 04810, 04811,

<<!AuthorizedUsers!>> <<!MedicalPhysicists!>> 04812, 04813, 04814, 04815, 04818, 04819, 04820, 04821, 04822, 04823, 04824, 04825, 04826, 04827 Supervision Medical with RSC (A) Medical use shall be by an authorized user as defined in 10 CFR 35.2.02110, 04710, 04711

Supervision Medical with RSC (B) Individuals designated to work as [insert either authorized users, 02110, 04710, 04711 authorized nuclear pharmacists, or authorized medical physicists, as applicable] as defined in 10 CFR 35.2, shall meet the training, experience and recentness of training criteria established in 10 CFR Part 35 and shall be designated in writing by the licensee's Radiation Safety Committee.

Supervision Medical with RSC (C) Licensed material for other than human use shall be used by, or 02110, 04710, 04711 under the supervision of, individuals designated by the Radiation Safety Committee.

Supervision Medical with RSC (D) [AS NEEDED] Licensed material [in item #] shall only be used by, or 02110, 04710, 04711 under the supervision of, individuals who have received the training described in the [application/letter] dated [insert date], and have been designated in writing by the Radiation Safety Officer. The licensee shall maintain records of individuals designated as users for 3 years following the last use of licensed material by the individual.

Supervision 10 CFR 32.72 (A) A pharmacist working or designated as an authorized nuclear 02500, 04210, 04211 pharmacist in accordance with 10 CFR 32.72(b)(2)(i) or (4).

Supervision 10 CFR 32.72 (B) Authorized Nuclear Pharmacists: <<!NuclearPharmacists!>> 02500, 04210, 04211 Supervision 10 CFR 32.72 (C) Authorized Users for Non-Medical Use: <<!NonMedicalUsers!>> 02500, 04210, 04211 Supervision 10 CFR 32.72 (Header) Licensed material shall only be used by, or under the supervision of:02500, 04210, 04211

Supervision and Physical Presence by Trained Licensed material shall only be used by, or under the supervision and 03510, 03511, 03520, 03521 Individuals Designated by the RSO in the physical presence of, individuals who have received the training described in the [application/letter] dated [insert date], and have been designated in writing by the Radiation Safety Officer. The licensee shall maintain records of individuals designated as users for 3 years following the last use of licensed material by the individual.

Supervision and Physical Presence of Licensed material shall only be used by, or under the supervision and 03310, 03320 Individuals Designated by RSO in the physical presence of, individuals who have been designated in writing by the Radiation Safety Officer and have been trained: (A) As specified in the [application/letter] dated [insert date]; and (B) In accordance with the provisions of 10 CFR 34.43 Supervision and Physical Presence of Name Licensed material shall only be used by, or under the supervision and 03221, 03222, 03232, 03900, 04426, 04427, 04428, 04429, Listed in the physical presence of, [insert name(s)]. 22120 Supervision and Physical Presence of Trained Licensed material shall only be used by, or under the supervision and 03121, 04416, 04417, 22140 Individuals in the physical presence of, individuals who have received the training described in the [application/letter] dated [insert date]. The licensee shall maintain records of individuals designated as users for 3 years following the last use of licensed material by the individual.

Supervision by Individuals Designated by the Licensed material shall only be used by, or under the supervision of 03614 RSC MML individuals designated by [insert name of Radiation Safety Committee, e.g., National Radiation Safety Committee].

Supervision by Individuals Designated by the Licensed material shall only be used by, or under the supervision of, 01110, 03212, 03611, 04012, 04013, 04612, 04613, 04620, RSO individuals designated, in writing, by the Radiation Safety Officer. The 04621 licensee shall maintain records of individuals designated as users for 3 years after the individual's last use of licensed material.

Supervision by Name Listed Licensed material shall only be used by, or under the supervision of: 02400, 02410, 02513, 03122, 03123, 03124, 03210, 03214,

<<!AuthorizedUsers!>>. 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 Supervision by Trained Individuals Designated Licensed material shall only be used by, or under the supervision of, 03120, 03122, 03130, 03220, 03225, 03226, 03234, 03710, by the RSO individuals who have received the training described in the 04414, 04415, 04418, 04419, 04424, 04425, 04436, 04437

[application/letter] dated [insert date], and have been designated in writing by the Radiation Safety Officer. The licensee shall maintain records of individuals designated as users for 3 years following the last use of licensed material by the individual.

Supervision of the RSO or Trained Individuals Licensed material shall only be used by, or under the supervision and 03110, 03111, 03112 Well Logging in the physical presence of the Radiation Safety Officer, or individuals who have been trained in accordance with the [application/letter]

dated [insert date]. The licensee shall maintain records of individuals designated as logging supervisor(s) and logging assistant(s).

Tiedown Except as specifically provided otherwise in this license, the licensee 01100, 01110, 01120, 02400, 02410, 02500, 02511, 02513, shall conduct its program in accordance with the statements, 02600, 02700, 02710, 03110, 03111, 03112, 03113, 03120, representations, and procedures contained in the documents, 03121, 03122, 03123, 03124, 03130, 03210, 03211, 03212, including any enclosures, listed below. This license condition applies 03213, 03214, 03215, 03219, 03220, 03221, 03222, 03225, only to those statements, representations, and procedures that are 03226, 03232, 03234, 03235, 03236, 03240, 03241, 03242, required to be submitted in accordance with the regulations. The 03243, 03244, 03250, 03251, 03252, 03253, 03254, 03255, U.S. Nuclear Regulatory Commission's regulations shall govern unless 03256, 03257, 03310, 03320, 03510, 03511, 03520, 03521, the statements, representations, and procedures in the licensee's 03610, 03611, 03612, 03613, 03620, 03710, 03800, 03810, application and correspondence impose on the licensee 03900, 04010, 04011, 04012, 04013, 04014, 04015, 04110, requirements that are more restrictive than or in addition to the 04111, 04112, 04113, 04210, 04211, 04212, 04213, 04214, regulations. 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 Except as specifically provided otherwise in this license, the licensee 02110, 02120, 02121, 02200, 02201, 02210, 02220, 02230, shall conduct its program in accordance with the statements, 02231, 02240, 02300, 02310, 04510, 04511, 04512, 04513, representations, and procedures contained in the documents, 04710, 04711, 04810, 04811, 04812, 04813, 04814, 04815, including any enclosures, listed below. This license condition applies 04816, 04817, 04818, 04819, 04820, 04821, 04822, 04823, only to those statements, representations, and procedures that are 04824, 04825, 04826, 04827 required to be submitted in accordance with the regulations.

Additionally, this license condition does not limit the licensee's ability to make changes to the radiation protection program as provided for in 10 CFR 35.26. The U.S. Nuclear Regulatory Commission's regulations shall govern unless the statements, representations, and procedures in the licensee's application and correspondence impose on the licensee requirements that are more restrictive than or in addition to the regulations.

Tiedown - MML Except as specifically provided otherwise in this license, the licensee 03614 shall conduct its program in accordance with the statements, representations, and procedures contained in the documents, including any enclosures, listed below ([insert any disclaimers, if necessary, e.g., excluding VHA Directive 1105.1, VHA Handbook 1105.1, and the internal procedures listed in NHPP Internal Procedure No. 1, etc.]). This license condition applies only to those statements, representations, and procedures that are required to be submitted in accordance with the regulations. The U.S. Nuclear Regulatory Commissions regulations shall govern unless the statements, representations, and procedures in the licensees application and correspondence impose on the licensee requirements that are more restrictive than or in addition tothe regulations.

Tiedown for 35.1000 Uses [USE THIS TIE-DOWN LICENSE CONDITION IF THE LICENSEE IS 02240, 04826, 04827 APPROVED TO CHANGE/REVISE LICENSE COMMITMENTS FOR 35.1000 USE (IF NRC GUIDANCE IS UPDATED AT LATER DATE)]

Except as specifically provided otherwise in this license, the licensee shall conduct its program in accordance with the statements, representations, and procedures contained in the documents, including any enclosures, listed below. This license condition applies only to those statements, representations, and procedures that are required to be submitted in accordance with the regulations.

Additionally, this license condition does not limit the licensees ability to make changes to the radiation protection program as provided for in 10 CFR 35.26 and applicable guidance updates for 10 CFR 35.1000 uses. The U.S. Nuclear Regulatory Commissions regulations shall govern unless the statements, representations, and procedures in the licensees application and correspondence impose on the licensee requirements that are more restrictive than or in addition to the regulations.

Transportation Public Roads Except for vehicle maintenance, the licensee shall not move mobile 03130, 04436, 04437 non-intrusive inspection systems on public roads unless specific authorization is obtained from the U.S. Nuclear Regulatory Commission.

Use of Licensed Material [Insert MML name: e.g., United States Air Force] requirements, 03614 policies, and directives governing the use of licensed material must be consistent with the Nuclear Regulatory Commission's regulations.

Use of Material Licensed material shall only be used by, or under the supervision and 03121, 04416, 04417 in the physical presence of, individuals who have received the training described in the [application/letter] dated [insert date]. The licensee shall maintain records of individuals designated as users for 3 years following the last use of licensed material by the individual.

Use of Radioactive Markers for Subsurface Notwithstanding the requirement of 10 CFR 39.47, pursuant to 10 03110, 03111 Monitoring CFR 39.91, and in accordance with statements, representations, and procedures contained in [insert reference: e.g., the letters dated Month, DD, YYYY, Month, DD, YYYY, and Month, DD, YYYY], the licensee may use radioactive markers with activities of 100 microcuries or less of cobalt-60 and 50 microcuries or less of cesium-137 for subsurface monitoring in surface cased oil and/or gas wells, provided that a member of the public would not receive more than 100 millirems annually, in the event the sources ruptured.

Utilization Facility on Human Subjects This license does not authorize the use of radiation from an NRC 03614 licensed utilization facility on human subjects.

Watches under 30.15 The timepieces, hands, and dials have been manufactured in 03250 accordance with the International Atomic Energy Agency, International Standards Organization, OECD Nuclear Energy Agency, American National Standards Institute or equivalent industry standard; and the amount of tritium on the timepieces, hands, and dials is not in excess of the maximum permissible amounts authorized in 10 CFR 30.15(a)(1).

Watches under 30.15 (Header) Each lot of timepieces, hands and dials received, containing tritium 03250 for distribution for use under 10 CFR 30.15, must be accompanied by a certificate which attests to the following: