ML23338A221
| ML23338A221 | |
| Person / Time | |
|---|---|
| Site: | 03019521 |
| Issue date: | 12/04/2023 |
| From: | Latischa Hanson NRC Region 4 |
| To: | Peace Health Ketchikan Medical Center |
| References | |
| 637034 | |
| Download: ML23338A221 (1) | |
See also: IR 05000199/2013001
Text
NRC FORM 374 PAGE 1 OF 4 PAGES
U.S. NUCLEAR REGULATORY COMMISSION Amendment No. 53
MATERIALS LICENSE
Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93-438), and Title 10, Code of Federal Regulations, Chapter I,
Parts 30, 31, 32, 33, 34, 35, 36, 37, 39, 40, 70 and 71, and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued
authorizing the licensee to receive, acquire, possess, and transfer byproduct, source, and special nuclear material designated below; to use such material for the purpose(s)
and at the place(s) designated below; to deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the applicable Part(s). This
license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, as amended, and is subject to all applicable rules, regulations, and
orders of the Nuclear Regulatory Commission now or hereafter in effect and to any conditions specified below.
Licensee In accordance with letter dated 4. Expiration Date: October 31, 2037
August 30, 2023; and E-mail dated
1. Peace Health Ketchikan Medical Center
December 4, 2023 with attachment.
5. Docket No.: 030-19521
2. 3100 Tongass Avenue 3. License No.: 50-19913-01 is Reference No.:
Ketchikan, AK 99901-5794 amended in its entirety to read as
follows:
6. Byproduct, source, 7. Chemical and/or physical form 8. Maximum amount that licensee 9. Authorized use
and/or special nuclear may possess at any one time
material under this license
A. Any byproduct material A. Any A. As Needed A. For use in uptake, dilution and
permitted by 10 CFR excretion studies permitted by 10 CFR
35.100 35.100.
B. Any byproduct material B. Any B. As Needed B. For use in imaging and localization
permitted by 10 CFR studies permitted by 10 CFR 35.200.
35.200
NRC FORM 374A U.S. NUCLEAR REGULATORY COMMISSION PAGE 2 OF 4 PAGES
License No.: 50-19913-01 Docket or Reference No.:
MATERIALS LICENSE 030-19521
SUPPLEMENTARY SHEET Amendment No. 53
CONDITIONS
10. Licensed material shall be used or stored at the licensee's facilities located at 3100 Tongass Avenue, Ketchikan, Alaska, 99901-5794.
11. The Radiation Safety Officer (RSO) for this license is Lars Gustaf Crabo, M.D.
12. Licensed material shall only be used by, or under the supervision of:
A. Individuals permitted to work as authorized users in accordance with 10 CFR 35.13 and 10 CFR 35.14.
B. The following individuals are authorized users for the material and medical uses as indicated:
Authorized User (M.D.,D.O.,etc.) Material and Use
Sarah Anderson, M.D. 35.100; 35.200
Charles Ariz, M.D. 35.100; 35.200
Laura Kay Backer, M.D. 35.100; 35.200
Valerie Smith Behrndt, M.D. 35.100; 35.200
Michael Patrick Buetow, M.D. 35.100; 35.200
Peter Christopher Buetow, M.D. 35.100; 35.200
Stephen John Buetow, M.D. 35.100; 35.200
David Daskam Calahan, M.D. 35.100; 35.200
Alan Chu, M.D. 35.100; 35.200
Lars Gustaf Crabo, M.D. 35.100; 35.200
Christopher Green, M.D. 35.100; 35.200
Robert Milton Hughes, M.D. 35.100; 35.200
Dag Andre Jensen, M.D. 35.100; 35.200
NRC FORM 374A U.S. NUCLEAR REGULATORY COMMISSION PAGE 3 OF 4 PAGES
License No.: 50-19913-01 Docket or Reference No.:
MATERIALS LICENSE 030-19521
SUPPLEMENTARY SHEET Amendment No. 53
Authorized User (M.D.,D.O.,etc.) Material and Use
Asra Sultana Khan, M.D. 35.100; 35.200
Sarah E. Nobles 35.100; 35.200
Gita R. Rabbani, M.D. 35.100; 35.200
Elliot James Rapp, M.D. 35.100; 35.200
Jacob Clark Smith, M.D. 35.100; 35.200
Michael Ted Smith, M.D. 35.100; 35.200
Jason Marsh Stoane, M.D. 35.100; 35.200
Mathew Thomas Studley, M.D. 35.100; 35.200
NRC FORM 374A U.S. NUCLEAR REGULATORY COMMISSION PAGE 4 OF 4 PAGES
License No.: 50-19913-01 Docket or Reference No.:
MATERIALS LICENSE 030-19521
SUPPLEMENTARY SHEET Amendment No. 53
13. 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 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.
A. Application dated August 29, 2022 (ML22257A275) and letter dated September 29, 2022 (ML22276A083)
B. Letter dated December 2, 2022 with enclosed diagrams (ML22354A188)
FOR THE U.S. NUCLEAR REGULATORY COMMISSION
Digitally signed by Latischa M.
Latischa M. Hanson Hanson
Date: December 4, 2023 By: Date: 2023.12.04 12:08:10 -06'00'
Latischa M. Hanson
Region IV