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{{Adams | {{Adams | ||
| number = | | number = ML003740382 | ||
| issue date = | | issue date = 08/31/1979 | ||
| title = Guide for | | title = Guide for Preparation of Applications for Licenses for Laboratory & Industrial Use of Small Quantities of Byproduct Material | ||
| author name = | | author name = | ||
| author affiliation = NRC/ | | author affiliation = NRC/RES | ||
| addressee name = | | addressee name = | ||
| addressee affiliation = | | addressee affiliation = | ||
| Line 10: | Line 10: | ||
| license number = | | license number = | ||
| contact person = | | contact person = | ||
| document report number = RG-10. | | document report number = RG-10.7 Rev 1 | ||
| document type = Regulatory Guide | | document type = Regulatory Guide | ||
| page count = | | page count = 20 | ||
}} | }} | ||
{{#Wiki_filter:Aep ft!m" 1171 U.S. NUCLEAR REGULATORY COMMISSION | |||
REGULATORY GUIDE | |||
OFFICE OF STANDARDS DEVELOPMENT | |||
REGULATORY GUIDE 10.7 GUIDE FOR THE PREPARATION OF APPUCATIONS FOR UCENSES | |||
FOR LABORATORY AND INDU1STRIAL USE OF SMALL *R | |||
QUANTmES OF BYPRODUCT MATERIAL | |||
1. INTRODUCTION 10 CFR Part 170 to determine the amount of fee This guide describes the type of information that must accompany the application. Review of needed by the NRC staff to evaluate an the application will not begin until the proper appl fee is received by the NRC. | |||
cation for a specific license for laboratories and industries using millicurie quantities of by 3. FILING AN APPLICATION | |||
product material (reactor-produced radionu clides). This type of license is provided under Title 10, Code of Federal Regulations, for An applicant for a byproduct material Part 30. "Rules of General Applicability isotopes) license should complete Form (radio-j NRC | |||
to Do 3131 (see the appendix to this guide).' AUl mestic Licensing of Byproduct Material items on the application form should be com Paragraph. 20 1(c) of 10 CFH Part 20. "Stand pleted in sufficient detail for the NRC to deter ards for Protection Against Radiation," mine that the applicant's equipment, facilities, states and radiation protection Program are adequate that " . persons engaged in activities under licenses issued by the Nuclear Regulatory to protect health and minimize danger to life Com and property. | |||
mission pursuant to the Atomic Energy Act of | |||
19.54, as amended, and the Energy Reorganiza tion Act of 1974 should, in addition to comply Since the space provided on Form NRC-3131 ing with the requirements set forth in is limited, the applicant should append addi this tional sheets to provide complete information. | |||
part, make every reasonable effort to maintain radiation exposures, and releases of Each separate sheet or document submitted radio active materials in effluents to unrestricted with the application should be identified by a areas, as low as is reasonably achievable" heading indicating the appropriate item number (ALARA). Regulatory Guide R. 10, "Operating (on Form NRC-3131) and its purpose radiation, safety instructions). (e.g., | |||
Philosophy for Maintaining Occupational Radia tion Exposures As Low As Is Reasonably Achievable,", provides the NRC staff position The application should be completed in trip on this important subject. License applicants licate. The original and one copy should be should give consideration to the ALARA philos mailed to the Division of Fuel Cycle and Mate ophy, as described in Regulatory 3uide rial Safety, Office of Nuclear Material | |||
8. 10, Safety in the development of plans for work and Safeguards, U.S Nuclear Regulatory with Com licensed radioactive materials. mission. Washington, D.C. 20555. One copy of the application, with all attachments, should be | |||
2. LICENSE FEES retained by the applicant since the license will require, ab a condition, that the institution An application fee is required for most types follow the statements and representations o)f Licenses set The applicant should refer to forth in the application and any supplement | |||
§170 31, it to | |||
"Schedule of Fees for Materials Licenses and Other Regulatory Services," | |||
of | |||
'Applications (or" medical uses should be submitted on Form | |||
*1 "I*s '-n1dcate substantave changes from previoub .'.ue NRC-313M. and applications for use of selled sources in rad- raphy should beasu I. 1ri NRC-313R | |||
USNRC REGULATORY GUIDES | |||
ttagu0tory Guide -a-einu Comments should be sent to the Secretary of the Commen. | |||
to "-,,be mndineao .a bleeto uRgulatory U.S tuim | |||
"nothOd"acOc*ap to the NRC soft of C Conomatin Wwa Wo 0 C 2066 Atteintion OoClea leamenting 'vec1fac prts of the SW | |||
, rsion's regulations. to deline*te *eh*MKK used by the staff on evalu- The guides we rilsuidm the foliowu Itan hoad dairnons | |||
"'lng 'pcftIc rippicants W-11-16r~ Guides Regulatory Or postulated ae rnt accidents, gubseaae orfor fto Proside guidance Pliecs with them is riot raqaujed Maihods and regulaions. and corntt I Power Reactors ookn dffere f fyro tmhose 6 Products set out in fth guides will be erLcaputAte rf the provide 2 Resarch and Test Reactors 7 Transoration requiste to the isuance or continuance of a basie for tie woiadngs 3 Fuels and Martialo Feotms a perrNt or licanse by the 4 Enovrwnen'ta 8 OccuoiaaonWs and Sittru . Health Coa'-mHaon | |||
5 M410"ifis am Plant Protection 0 Gililrt and Fiancial Revew Comnnts i tlrr*s an*d suggestiOns andWu-des tor nprOvernts ,n thee guades are encouraged at placement an etutomat.c wet Uae resa as s*pWoprAte. to aCrorrmodante commentd Requests foror s-g*e copies ofd*'Uued Iuades fivhaCh | |||
*r*butiorist t*or aglerngy bi eWoduced, copaes or for of ftureL guaee nO tO ref*i fcr'e information or sotae n spi fc dvisons should be nuide a wating This guide *awasred mosta to the U S Nuclear Regulefory ComrnmraTtn Wasthington D C 205Mu of sobstant" curnmrents re..a. ed fromr the public and addrtional Alteanon Deoitor. ONvror, of staf reiew Tochn,~i into~rraitocn and Dorumlent Control | |||
4. CONTENTS OF AN APPLICATION model number of each sealed or plated source should be specified It a source will be used in Most items of Form NRC-313r are self a gas chromatograph. gauge, or other device. | |||
explanatory (see instructions with the form). the manufacturer and model number of the The following comments apply to the indicated device should be specified numbered items of the form. | |||
Item 8E and Item 9 The use to be made of' | |||
Items 2 and 4. Specify the applicant corpo the radioactive materials should be clearly ration or other legal entity by name and described Sufficient detail should he given to address of principal office. Individuals should allow a determination of the potential for expo be designated as the applicant only if the use sure to radiation and radioactive materials both of the byproduct material is not connected with of those working with the materials and of the the individual's employment with a corporation public or other entity If the applicant. is an individual, the individual should be specified Items 10 and 11. Specify for each radiation by full name and address, including state and detection instrument the manufacturer's name zip code -and model number, the number of each type of instrument available, the type of radiation Item 5. Specify the street address of the detected (alpha, beta, gamma, or neutron). | |||
location of use if the address differs from the the sensitivity range (milliroentgens per hour one given in Item 4. If use is to be at more or counts per minute). the window thickness in | |||
2 than one location, the specific address of each mg/cm . and the type of use. The type of use should be given Describe the extent of use would normally be monitoring, surveying, and the facilities and equipment at each assaying, or measuring. | |||
location. A post office box address is not acceptable. Describe the instrument calibration proce dure. State the frequency, and describe the Item 6 Specify the names of the persons who methods and procedures for the calibration of will directly supervise the use of radioactive survey and monitoring instruments, as well as material or who will use radioactive material any other instruments and systems used in the without supervision radiation protection program, such as measur ing instruments used to assay sealed-source Item 7. Specify the name of the person who leak-test samples (see Item 15). contaminationi will be designated as the radiation protection samples (e.g.. air samples. surface "wipe" | |||
officer. 2 Thispj5erson should be responsible for samples), and bioassay samples (see Item 12) | |||
implementing the radiation safety program and therefore readily available to the users in case An adequate calibration of survey instru of difficulty and should be trained and experi ments usually cannot be performed with built enced in radiation protection and in the use in check sources Electronic calibrations that | |||
1 and handling of radioactive materials. In a do not involve a source of radiation are also small program not requiring a full-time not adequate to determine the proper function ing and response of all components of an radiation protection officer, the duties of the radiation protection officer may be assigned to instrument. | |||
one of the persons named under Item 6 of Form I NRC-3131. Note, however, that it must be Daily or other frequent checks of survey instruments should be supplemented every established that the person acting as radiation protection officer will have the opportunity to 6 months with a two-point calibration on each devote sufficient time to the radiation safety scale of each instrument with the two points aspects of the program for the use of separated by at least 50% of the scale Survey radioactive materials. instruments should also be calibrated following repair. A survey instrument may be considered Items BA, B, C, and D. Describe the byprod properly caiibrated when the instrument read uct material by isotope, chemical and/or physi ings are within +/-10 percent of the calculated or cal form, and activity, in millicuries or micro known values for each point checked Readings curies A separate possession limit for each within +/-20 percent are considered acceptable if nuclide should be specified Possession limits a calibration chart or graph is prepared and requested should cover the total anticipated attached to the instrument inventory, including stored materials and If the applicant proposes to calibrate his waste, and shouid be commensurate with the needs and facilities for safe survey instruments, a detailed description of applicant's planned calibration procedures should be sub handling mitted The description of calibration proce dures should in(lude, as a minimum: | |||
If the use of sealed or plated sources is con tempiated, the isotope, manufacturer, and a The manufacturer and model number of | |||
'The terms radiation protection officer" and "radioiogrcal each radiation source to be used, safety officer" are synonv.aoul | |||
10 7-2 | |||
b. The nuclide and quantity of radioactive milliroentgens, the frequency of reading, and material contained in each source, the procedures for maintaining and calibrating the devices should be specified. | |||
c The accuracy of the source(s). The traceability of the source to a primary standard If personnel monitoring will not be used, the should be provided. applicant should submit calculations or docu mentation from radiation surveys demonstrating d The step-by-step procedures, including that it is unlikely that any individual will associated radiation safety procedures, and receive a dose equal to or greater than that indicated in 10 CFR Part 20. | |||
e The name and pertinent experience of each perstin who will perform the calibrations. The applicant should show that the need for bioassays has been thoroughly considered and If the applicant intends to contract out the should establish the adequacy of the proposed calibration of instruments, the name, address, bioassay program in relation to the proposed and license number of the firm should be speci program of use of radioactive material. Bio fied together with the frequency of calibration. assays are normally required when individuals The applicant should contact the firm that will work with miUicurie quantities of hydrogen-3, perform the calibrations to determine if infor iodine-125, or iodine-131 depending on the mation concerning calibration procedures has type of work, equipment, and procedures fol been filed with the Commission. If information lowed Regulatory Guide 8.20, "Applications of concerning calibration procedures has not been Bioassay for 1-125 and 1-131," and a document filed, it should be obtained and submitted. entitled "Guidelines for Bioassay Requirements for Tritium"- may be consulted. Other mate Quantitative measuring instruments used to rials may also be used in physical or chemical monitor the adequacy of containment and con forms and under conditions that present an tamination control such as those used for mea opportunity for uptake by the body through suring leak test, air, effluent, bioassay, work area, and equipment contamination samples ingestion, inhalation,, or absorption A bio | |||
3hould usually be calibrated prior to each use. assay program to determine and control the The procedures and frequency for calibration uptake of radioaetive material should be con of such instruments should be submitted and sidered and discussed in relation to each such material, procedure, etc, Regulatory Guide should include: 8 9, "Acceptable Concepts Models. Equations, a The name of the manufacturer and model and Assumptions for a Bioassay Program." | |||
may. | |||
number of each of the standards to be used, he consulted. | |||
b. The nuclide and quantity of radioactive The criteria tc be used in determining the material contained in each of the standard need for hiioassays, the type and frequency of bioassays that will be performed, and the sources, bio assay procedures should be specified and c A statement of the accuracy of each of the described in detail If a commercial bioassay standard sources. The source accuracy should service is u., be used, the name and address of be. as a minimum, +/-5 percent of the stated the firm should be provided. | |||
value and traceable to a primary standard, such as that maintained by the National Bureau Bioassays may not be substituted for other of Standards. elements of a safety program such as air moni toring and dispersion control (hoods, glove d. Step-by-step calibration procedures and, boxes. etc ) and for well-thought-out and if appropriate, associated radiation safety pro well-executed handling procedures cedures, and T | |||
Item 13 The facilities and equipment for e. The name and pertinent experience of each site of use should be described in detail. | |||
each person who will perform the instrument The proposed facilities and equipment for each | |||
"calibrations operation to be conducted should be adequate to protect health and minimize danger to life Item 12 Personnel monitoring is required to and property In describing available fa. ilities ensure .- mplianee with §§20 101 and 20 202 of and equipment. the following should be | |||
10 ('FR Part 20. Personnel monitoring is also included, as appropriate: | |||
required if a person enters a high radiation area (greater than 100 millirems per hour). If a Physical plant, laboratory. or working p'.sonnel monitoring equipment will be used, area facilities Fume hoods glove boxes, waste the ndine of the organization furnishing film receptacles, spenjal sinks, ventilation and con badge or thermoluminescent do.<'imeter (TLD) tainment systems. effluent filter systems, and service and the frequer , for changing badges, dosumeter.-, etc sh,uld be specified jA copy may be obtained by a written request Nuclear Regulatory to hte U S | |||
If pocket chambers ur pocket dosimeters will be C'.mmision. Office .)f Nuclear ?ateruidJ | |||
Safety and Safeguaro, Div-tsaon of Fuel CycLe and Materi.la used. the useful range of the devi(e. in Safety. Washington ! 20555, A:'enton Director. office of Nuclear Material Saifet, ant Safeguards | |||
arr permi.,sible The a,. hlc ju o,;it, . | |||
hd , pnf O 1 7'.I i I I !; | |||
' d t ý , -i hl' j~t . . o h n upon *h- radionu-Lide ' | |||
d Release into air or water in oncentrationf' | |||
A drawing or sketch should be submitted in conformance with §20 106 of 10 ('FR Part 20 | |||
showing the location of all such equipment and Possible exposure to persons offsite Limits the the relationship of areas where radioactive amount that may be released materi:is will be handled to unrestricted areas where rad'ioactive materials will not be handled e Treatment or disposal by incineration in In those programs where radioactive material conformance with §20 305 of 10 CFR Part 20 | |||
may become airborne or may be included in air This must be specifically approved by the br-ne effluents, the drawing or -ketch should Commission also include a schematic description of the ven tilation system annotated to show airflow rates, f Other methods specifically approved by differential pressures, filt ration and other | |||
'he Commission pursuant to §20.302 of 10 CFR | |||
effluent treatment equipment and air and Part 20 | |||
effluent monitoring instruments Drawings or sketches should be drawn to a specified scale, Item 15 or dimensiLons should be included on each drawing or sketch. Each drawing or sketch a Survey Program. Commission regulations should be labeled to specify the location of the require that surveys be made to determine if facilitles and equipment depicted with respect radiation hazards exist in a facility in which to the address(es) given in Item 5 of Form radioactive materials are used or stored (see NRC-3131 §20.201 of 10 ('FR Part 20) A survey should include the evaluation of external exposure to F- C(ontainets, devices. protective clothing. personnel, concentrations of a-iruorne radio auxiliary shielding, general laboratory equip active material in the facility, and radioactive ment. a. r sampling equipment. etc . actually effluents from the facility Although a theoreti employed in the daily use of material Special cal calculation is often used to demonstrate provisions for shielding and containment to compliance with regulations regarding airborne minimize personnel exposure should be de or external radiation, it cannot always be used scribed Storage containers and facilities in Lieu of a physical survey should provide both shielding and security for materials Except for those cases where sources of radiation and radioactive material are well c The number. type. and length of remote known and accurately and precisely controlled, handling devices it will usually be necessary that a physical survey be made with appropriate detection and d If respiratory protective equipment will measurement instruments to determine the be used to limit the inhalation of airborne nature and extent of radiation and radioactive radioactive material, the provisions of §20.103 material or, as a minimum, confirm the results of 10 CFR Part 20 should be followed and of a theoretical determination appropriate information should be submitted A radiation protection program should include the following surveys for radioactive Item 14 The procedures for disposing of contamination and radiation. | |||
byproduct material waste should be described Under NRC regulations, a licensee may dispose (I) In laboratory or plant areas (e g of waste in the following ways checking for contamination on bench tops, han dling and storage equipment, clothing, hands) | |||
a Transfer to a person properly licensed to receive such waste in conformance with para (2) While work is being done with radiation graph 20.301(a) of 10 CFR Part 20 The name or radioactive materials (e.g , breathing zone of the firm (which should be contacted in air surveys, general air surveys, personnel Luncluding eyes and advance to determine any Limitations that the exposure measurements. | |||
firm may ,iave on acceptance of waste) should extremities, checking shutters and "'ontain ment) | |||
be given f, Release into a sanitary sewer in confor (3) in areas associated with disposal or mance With §20 303 of t0 CFR Part 20 release of radioactive materials (e g . checking Depending on water usage. releases rf up to I 'The NRC has proposed an amendment .*hat would delete curie per year are permitted $20 304 of 10 CFlt Part 20 (43 F'R Ssi77 December 4. 19i 8) If this amendent is adopted. all b,,ne.ls of radionuclides in accord~ance with 120 304 of 10 CFR Part 20 wil require NRC | |||
c Buria, i" soil in contformance with §20 304 approval f 10 (-FR Part 20 Up to 12 hurials per year | |||
10 7-4 | |||
disposal containers and disposal sites; liquid, Agency's Technical Report Ses gas, and solid effluents, filters and filter-duct No 120, | |||
"Monitoring of Radioactive Contamination am systems) Surfaces. "' | |||
The frequency of surveys will depend on b. Records Management Progrm. Provision the nature of the radioactive mrterials and for keeping and reviewing record of surveys; | |||
their use. However, surveys should be per materials inventories; personnel exposures; | |||
formed prior to the use of radioactive materials receipt, use, and disposal of materials, in order to establisl a baseline. The surveys etc., | |||
should be described. Persons responsible for should be repeated when radioactive materials keeping and reviewing records should be iden are present, when the quantity or type of tified. | |||
material present changes, or when changes occur in their containment systems cr methods c Sealed-Source Leak-Test of use. Repetitive surveys may Procedures. | |||
also be Sealed sources containing more than 100 micro necessary to control the location of radioactive curies of a beta or gamma emitter or more than materials in the handling system and in the 10 microcuries of an alpha emitter must be leak case of the use of sealed sources outside a tested at 6-month intervals. Leak testing of shielded container. | |||
alpha-particle-emitting sources containing more For operations involving materials in gas, than 10 microcuries of an alpha emitter Is liquid, or finely divided forms, the required at 3-month intervals. If a commercial survey firm is to perform the leak tests, the program should be designed to monitor the name, adequacy of containment and control address, and license number of the firm of the should materials involved. "he program should be submitted If the tests are to be performed include using a commercial "kit," the nme of the kit air sampling, monitoring of effluents, and sur manufacturer or distributor and the kit moe veys to evaluate contamination of personnel, I facilities, and equipment designation should be given. If the applicant Physical effluent | |||
!measurements are essential to determine intends to perform his own leak tests without compli ance with Appendix B to 10 CFR Part 20. the use of a commercial kit, the following information should be submitted: | |||
The description of an air sampling program should include the area where samples (1) Qualifications of personnel who will will be taken, the frequency of sampling, and the perform the leak test, location of the sampler with respect to workers' | |||
breathing zones Assays performed to evaluate (2) Procedures and materials to be used in air samples and the methods used to taking test samples, relate results to actual personnel exposures should also be described (3) The type, manufacturer's name, model number, and radiation detection and measure The effluent monitoring program ment characteristics of the instrument for to be releases to unrestricted areas should encom used for assay of test samples, pass all airborne and liquid radioactive material releases Theoretical evaluations should be (4) Instrument calibration procedures, supplemented by stack monitoring, water including calibration source characteristics. | |||
sam pling, and other environmental monitoring make, and model number, and ap propriate for the planned and potential releases (5) The method, including a sample calcu lation, to be used to convert instrument read For operations involving only sealed ings to units of activity, e.g. . microcuries. | |||
sources, a survey program should include evaluation and/or measurement of radiation levels for storage and use configurations. d. Instructions to Personnel. | |||
When If a number of sources are used in devices having "on" individuals will use radioactive | |||
"off" positions, both positions and materials under should be eval the supervision of one or more of those persons uated at the tune of installation Supplemental named in Item 6 of Foim NRC-3131, written surveys should be performed following instructions should be prepared any and submitted changez. in operation, shielding, or use with the license application in the form in which they will be distributed to those working The types, methods, and frequency of with radioactive materials. | |||
These instructions surveys should be described in the application should cover, but not necessarily | |||
.'*uidance may be obtained from the be limited to: | |||
National Council on Radiation Protection Report (1) The availability. selection, No 1 | |||
===0. and use of=== | |||
"Radiological Monitoring Methods and Instru laboratory apparel and safety-related ment-s,' and the International Atomic Energy equip ment and devices (e g. , laboratory gloves, and remote pipetting coats, | |||
'CopIes may be ob asnedi devices). | |||
rrM NCRp P ublicaon, P o Box 4867 Washun 6Copies may be ohrain-- | |||
. D ( 20008 from "'IPUiB in. P 0 | |||
New .'jrx N"Y 0 Box 433, | |||
'oei | |||
10 7-5 | |||
(2) Limitations and conditions to be met in (12) The use of radioactive materials in handling liquid or uncontained (unencapsu animals. If radioactive materials will be used in | |||
1asdioactive animals, instructions concerning such use lated, dispersible, or volatile) | |||
be prepared and submitted with the materials and special laboratory equipment to should license application. Such instructions should be used in working with these types of mate rials. For example, the instructions should include (a) specification of the facilities to be explain when operations with materials should used to house the animals, (b) instructions to be confined to a radiochemical fume hood or be provided to animal caretakers for handling animals, animal wastes, and carcasses, (c) | |||
glove box and should specify the use of appro priate shielding and remote handling equipment instructions to appropriate personnel for clean when energetic beta- or gamma-emitting mate ing and decontaminating animal cages, and (d) | |||
rials are to be used. methods to be used to ensure that animal rooms will be locked or otherwise secured unless | |||
(3) The performance of radiation survey attended by authorized users of radioactive and monitoring procedures or each area in materials. A description of animal handling and housing facilities should be included uLnd'. | |||
which radioactive materials are to be used. | |||
Item 13 of Form NRC-3131. | |||
(4) Safely precautions to be observed in the movement of radioactive materials between (13) Emergency procedures. These instruc tions should be addressed to all persons in aV. | |||
buildings, rooms, and areas within rooms. | |||
laboratory or facility areas where radioactive! | |||
materials will be used and should cover actions : | |||
(5) Safety requirements for storage of including labeling of to be taken in case of such accidents involving! | |||
radioactive materials, radioactive materials as spills, fires, release or containers of radioactive materials and posting loss of material, or accidental contamination of and securing areas where radioactive materials these instructions personnel. Specifically, are to be stored. This should include the stor specify immediate actions to be should (a) | |||
age of contaminated laboratory equipment such as glassware. taken in order to prevent or limit the contami nation of personnel and areas, e.g.. the shut ting down of ventilation equipment, evacuation | |||
(6) Requirements for posting of areas in which radioactive materials are used. of contaminated and potentially contaminated i areas, containment of any spills of radioactive material, (b) give the telephone numbers of in | |||
(7) The availability and use of personnel dividuals to be notified in case of emergency. | |||
monitoring devices, including the recording of and (c) instruct personnel in proper entry, radiation exposures and the procedures to be decontamination, and recovery operations for I | |||
followed for the processing of personnel moni contaminated facilities. (Note: Only properly toring devices such as thermoluminescent dosi trained individuals should attempt decontamina meters .and film badges in order to obtain per tion and recovery operations. ) | |||
sonnel monitoring results | |||
(14) Requirements and procedures for pick | |||
(8) Waste disposal procedures to be fol ing up, receiving, and opening packages (see lowed, including limitations on the disposal of §20.205 of 10 CFR Part 20). | |||
liquid or other dispersible waste to the sani- tary sewer and proceaures for the LoUeLLLZI, | |||
storage, and disposal of other wastes Items 16 and 17. A resume of the training and experience of each person who will directly | |||
(9) The maintenance of appropriate rec supervise the use of material, who will use ords as required by 10 CFR Part 20 and material without supervision, or who will have | |||
10 CFR Part 30. responsibilities for radiological safety should be submitted. The resumi should include the | |||
(10) The requirements for and the method type (on-the-job or formal course work), loca of performing or having appropriate sealed tion, and duration of the training. Training source leak tests performed. should cover (a) principles and practices of radiation protection, (b) radioactivity measure | |||
(11) Good radiation safety practices, in ments, standardization, and monitoring tech cluding the control of contamination, specifica niques and instruments, (c) mathematics and tion of acceptable removable and fixed contami calculations basic to the use and measurement nation levels tor both restricted and unre of radioactivity, and (d) biological effects of stricted areas, prohibition of smoking and the radiation. The description of the use of radio consumption of food or beverages in areas active materials should include the specific iso where radioactive materials may be used, and topes handled, the maximum quantities of mate prohibition of the frequent transfer of poten rials handled, where the experience was tially contaminated equipment between poten gained, the duration of experience, and the tially contaminated areas and unrestricted type of use The qualifications, training, and areas. | |||
10 7-6 | |||
xiprrinr.* )4ýeach terson should be commensu | |||
,I:- w~th J1, mnatriwl arnd its use only have a background or, forma! traming r, as proposed all areas described in T , 'TphPb-ation The amount and type of tern 16 of F<orm NRý | |||
'a: ir'd 'xpe; ien(-' 3131 but should also h.ive -xten*,*ýn-- expe- with radiation and | |||
,e a raaterial.: working with rad*oactrve, material an i r1aliu1red to support a a | |||
,i('rrmIJ atin I ,f _ad-quauy by the Commission thorough working knowledge of the eqip | |||
====u. rmenrt==== | |||
.'. ,,.r mar kru dly with (.,rtain factors required to handle the material safely | |||
. - t -n:.ýh c h as technical assistants | |||
:ir~i iab.--rit,;r- workers will use radioactive 5. AMENDMENTS TO IhJENSES | |||
materials in the absenct: of persons specified | |||
*."*', a. , specification of the Licensees are required to cor.duct 4heir pr. | |||
training of such persc.rne! ',hould include grams in accordance with statements, (a) instruction in renrý. | |||
I IAf , -, qs: fr 1. sentations. and procedures contained In"udinr, topics covered and in ýtie by whom taught hb) on-the-job training in use license application and su.:P)>rtive aocuments | |||
,-If radlio,-tivt materials, and The license must therefore be amended (c) determination. if the of compeienciy to work without licensee plans to make any changes the presence of in faclt supervisory (ersOnnel ties, equipment (including. monitoring and sur vey instruments), procedures, personnel or | |||
"The is' of mitrocurie quantities of a few byproduct material t(; Le used nonvolaile radioactive materials by a person with a minimum of training Applications for license amendments may and experience e under precisely specified and filed either on the applicatior form or roliled conditions subject to the carefully con form. The application. should identify kn ler!tr surveillance of 1o | |||
-,Ompetent and adequately trained radiation license by number and should clearly de ;,.r t-. | |||
protection officer may be justified. the exact nature of the charges, mum training and experience Such mini additions, c"r may consist of a deletions. References to previously e: hours of training and experience submitted information and documents should | |||
,f crne or more radioactive materials in the use specific and should identify be clear and similar to the pertinent the use proposed in the -tpplication information by date, page. and under the paragraph sýupervision and tutorship of a Licensed user. | |||
===6. RENEWAL OF A LICENSE=== | |||
Persons using millicuzri quantities of a num Oer of radionuclideq for general An application for renewal of laboratory a License should tracer work under unspecified be filed at least 30 days prior conditions to the expiration should have more extensive training date This will ensure that and expe the license does not rience and, depending on the expire until final action on the exact nature of application ha6 ih.. proposed program of use been taken by the NRC as of radionuclides, provided for in zay need to have completed formal paragraph :30 37(b) of i9 CFP | |||
course work Part 30. | |||
at !he college or university level covering the areas listed under Item i6 of Renewal applications .hould Form NRC-3131. Le filed on Form NRC-3131, appropriately The use of larger suppI-mented, and quantities of material should contain compjete (dpproaching a curie) under and up-to-date infor conditions where a mation about the applicant's potential exists for significant current program. | |||
loss and inges uon. inhalation, or absorption In order to facilitate the review of the radio process, t+/-e a,-tive material by those working application for renewal should with rnal is normaUy done under carefuoly the mate without be submitte.j controlled reference to previously | |||
:onditionrs using specialized documents and information submitted equipment. A If such referene-5 person whO is to use radioactive cannot be avoided, they materials inde shoild be clear -ad pendently unnde these conditions should hot specific and should identify the per'tnp-.*.n information by date, page, and paragraph. | |||
10) 7-7 | |||
APPENDIX A | |||
Form NRC-31 3 (I) Form Apifroed by GAO | |||
B- ll32S(1tOS79) | |||
U.S. NUCLEAR REGULATORY 0O111611ON | |||
iO CFR 30 | |||
INSTRUCTIONS FOR PREPARATION OF | |||
APPLICATION FOR BYPRODUCT MATERIAL LICENSE | |||
FORM NRC-313 (I) | |||
GENERAL INFORMATION | |||
An applbcant lot a "Byproduct Material (Radioisotopes) License." 3 Broad License (research and development)-"Laceingm Guie should complete Form NRC-313 (1) m detail and submit in duplicate for Type-A Licenses of Broad Scope for Resmarch and )evelop to the U.S Nuclear Regulatory Commission. The applicant should ment ," | |||
endeavor to cover his entire radmastope program with one application, if possible. However, separate applhcationk should be submitted for 4. Licensing Guides for the performance of well l g eperatsoaa. | |||
gamma irradiators. Applicatmlos for medical uses should be submitted | |||
^n Form NRC-313 (M) aad applications for use of scaled sources m S Licunrin guide to: the use of scaled sourcs in portable and stint radiography should be submitted on Form NRC-313R. Supplemental portable gauging devices' | |||
sheets may be appened when necessary to provide complete mfoi mation. Item 18 must be completed on all applicatsios. Submission The Comm!son charges fees for filing of appblcaloa for hveoaes as of an incomplete application will often result en a delay in issuen*u ,t/ specified in Section 170 12, Title 10 Code of Fedwal Regitleioma. | |||
the license because of the correspondence necessary to obtain inhr Part 170. The applicant should refer to Section 170.31, Scaleduh. uf rnrionrequested on the applicatron fees Ior materialsIlc'n srs. to determine what fee should accompany the application No action can be taken on applications until fees are NOTE When the application incldde: one oi the special sises listed paid. ('hecks or money orders should be made payable to the U.S. | |||
below the applicant should request tihe appropruate pamphlet wlhch Nuclear Regulatory ( ommassion. | |||
provides additionul instructions rwo ,opr," of the ,ompleted Irorm NR(-313 (e) and two copies of I Industrial Radiography "'LIcensitng Requirements for Industrial ea.h atticlimeni thlicc-o should he eCnito the Division of I rael Cycle Radiography'" (use. application I orm NRC'-31 3R for Radi mnd i*iterial Silely. Ottice of Nuclear Material Safety and Safeguards. | |||
ography). IS Ni.lcat Regpilatury Commilsion Washington. DC 20555 One sopy liukiu bc retained for the appliLant's file Applications may | |||
2 Laboratory and Industrial Uses i Small Quantitis-"G(uidc for Ji.s be hited in person at the Comnitssion's office at 1717 H Street. | |||
Preparation ol Applications for Liboratory and Industrial N %,. Wishington. D C or at 7915 1 astern Avenue. Silver Spring. | |||
Uses of Small Quantities of Bypr-rduLt Material." M*r5 land EXPLANATION OF FORM NRC-313 (1) | |||
I-orm NR('-313 fl) is desgned for use in supplying information Thc actual s*ies of use should be listed as indicated. Per on program, nt varying complesty fhc applicant should provide tijnent A[A ilihlie such as field oflfis lot portable gauges or complete information on his proposed program or the possession devicei should be identified in Item S by Street. Address. | |||
and use of licensed material I or those items that do not apply. indicati. | |||
City and Stait Temporar, field locations of use should As N.A (not appli.able) | |||
be specified as "'temporary job sites of the pplicani" and list the States throughout which the tempora i job sites will Item No he h1,laed Attach additional properli, keyed sheet if miort spas is needed I Sell -exphndlory The -applicant'" i Ilhe organil.ation ii person legall ivc, 6 Sell \'eplanatory ponibk for possession and ue of the licensed materials specified in the application | |||
7 rhc "Radiation Protection Officer' is the nanied uilividual sho is expected to coordinatc the safe use of the licensed | |||
3 Sell-explanatory materi~al spekilied in the application and who will ensure srmphanme w!lh the applicable parts of Title 10. ('ode of | |||
4 SelU-tiplanalory I cderal Regulations I0 7-9 | |||
A List by name Ca,1iraditisotope it, he pose-r*ned and ised Attach .red~bonsa pi.perl% keyed sh-,.tsit 11 a ' | |||
under the license 1, ample needed | |||
1I Stale tile u itf cacti II, cnsed material hlated in 9 V 8.. | |||
B and D | |||
l) lodtne-I31 (l) Iodide t21 lodassc- | |||
* t | |||
12) lodinated Humani Scruti Albunpin I* etcript1ion ti | |||
.Urct* | |||
c tllcmtainre* an*d/or device% in ,vJjjh sealed e in Iltem h will be stored or uted. I %ample listd i | |||
13) Krypton-85 13) (.as | |||
141 Cesium-I 7 (4l Sealed SouC1. | |||
A | |||
II I 1 Source housing Io Curp D) | |||
0I) Nof Appliuable 41) 10 mihd:icurie.. | |||
(2) N A I aillicurnic Model 1-278 I,) (2) | |||
N A I inillIhuric I4) (4) 2 sou*icul ISO 10 18 SeIf-.xplanatory (I at those items that do not apply Model Z-78 mitlit. tolne Cacti indicate a* N A (not applicable) | |||
PRIVACY ACT STATEMENT | |||
Pursuant to 5 U S.( 55 2af*l(3). 'niacted into law by set,.lon 3 of the I'IVaLvy Act of 1974 (Public: Law 93-579). the Iollowing .-titcileti IS furrnishcd to rndividual% who surply information to the Nuclear Regulatory Commis*ion on I orms NRC-313M, NR(-3 13A, NR(-3131 or NR(_'- 313R I his mformalion is mainiained in a system of re!eoid designated as NRC-3 and descrihed at 40 1 ederal Register 45 114 (Otlober I. 1975) | |||
I AUTHORITY SIio n,81 and 1614b) of the Atomic Inerpy Act of 1954. a, amended (42 U.S.( 2111 and 2201ib(1 | |||
2 PRINCIPAL PURPOSI"S) The informatmon is e:valuated It, the HKC staif pursuant to the ritleria set forth in 10 ( I R Parts 30-36 to determine whether the application meet, the requircmenti of the Atomic I nergy Act uo 1954. as amctindsd. ap the C('ommisoon's rclgulsaions. lot the issuanice of a byproduct maleril license or amendment thereof | |||
3 ROUTINF tjSI S "he informawn itay be:used (0; to provide reuord& to State heaithk c.kpirtmeusi fop the intormpaipanand useand 4h)to provide intformation t4 I ederal. Stiart. and k),.al heafth officials and other p*;rsons in the event of incident of xposutic por thiir trifortnatilon, mvemiwzliarn. | |||
ind protection (it the publitc health and safety The nfotinalicn ma, dlv) be ditslotd to approptiate I .Jeral. Stile and local ait.ticies in the event that the information indicale* a vio~Ltioon of ptenlti viol*iAt of law and in the course of in ad"ministrative o luli cuialproceeding In Addition. this inlormation ri ay be transfeared to An approprate IFederal. State. or kical agency to i'c esxhint relevant and neest*,.ry f>r a NR( | |||
dn, ison or to an appropriate I ederal agnev to the .xtent relevant and ne lot that afenty'%dcJtioun about sou | |||
,LcesAfy A npli tit the hin"sc issued will routinely he placed in the NRC's Puhlic Doument Room. 1717 H Street. N W, Washington. DA | |||
4 WHI T1,11II DIStLOSLRI. IS MANDATORY OR VOLUNTARY AND. III FCT ON INDIVIDUAL 01 NOT PROVIDIN(; INI.ORMA rION | |||
Dit..losurc of the requested infrrmnation is voluntary It the request information is not furnished. hno*,w.vr. ti apptiation " horiI, producl mat 'rial lhcense or 3mendmenl thereof, will not he proceied | |||
5 SYSTIM MANAGFRISI ANI) ADDRI SS Dir."tor Division ti I ucl (Clee .aid Matarial Sat*t*. Ofti, ol Nu, tear Material Saetly a4ad S.afeguidf,. | |||
ki S Nuclear Regulallory ( ommission. Washington. D ( 2055 | |||
10 7-10 | |||
FORM NRC-313 I -U.S. NUCLEAR REGULATORY COMMUON 1. APPLICATION FOR: | |||
(1-79) | |||
(Chec* and/or conYiDe a opeteJ | |||
10 CFH 30 | |||
APPLICATION FOR BYPRODUCT MATERIAL LICENSE | |||
INDUSTRIAL | |||
====a. NEW LICENSE==== | |||
See erached 'nsrucrt,os for details b. AMENDMENT TO. | |||
L ICEiNSE NUUMBE | |||
n'fli)leted .p* is-i,,tins are tlile' in d(i/* otre with the Division of FIuel C'*rle and Material Safetr,. | |||
Offit r I'f Nit, lear Material Safetv. o.in Safeguards U.S. Noclear Regulatory Commisusion. | |||
Washington. DC 20555 or app/i,.*i5 'nay he, fed in person at the Comnrnision's office at c RENEWAL OFF | |||
I77 H Strepr NýW. Washinqtol/ 0 ,'" or 7915 Fastern Avenue. Silver Sprinq. Marylayri. | |||
2. APPLICANT'S NAME (institution. firm, person, etc.) | |||
===3. NAME OF PERSON TO B=== | |||
==E. CONTACT== | |||
ED REGARDING THIS | |||
APPLICATION | |||
TELEFPHONE NUMBER AREA CODE - NUMBER EXTE.NSION. LEPNONE NUMBER AREA CODE -- FJUMBER EXTENSION | |||
4APPLICANT'S MAILING ADDRESS (Include Zip Code)B STREET ADDRESS WHERE LICENSED MATERIAL WILL BE USED | |||
fIncludeO EECode) | |||
(IIF MORE SPACE IS NEEDED FOR ANY ITEM. USE ADDITIONAL PROPERI y V'lVV% bAfICC | |||
6. INDIVIDUAL(S) WHO WILL USE OR DIRECTLY SUPERVISE THE USE OF LICENSED MATERIAL | |||
(See Items 16 and 77 for required Frainingand experience of ech indjividul n4,,d be low) | |||
FULL NAME TITLE | |||
Ib C. | |||
7. RADIATION PROTECTION OFFICER I Attach e resume of person's trainingend exper.ence a outline if items I 16 and 17 and describe his responsib*t*tievs under Item 15. | |||
_____S. LICENSED MATERIAL | |||
I L ELEMENT CHEMICAL NAME OF MANUFACTURER MAXIMUM | |||
I N NIRAND , MILLICURIES AJ4DOMMEALED | |||
N MASS NUMBER PHYSICAL FORM MODEL NUMBER SOURCES AND MAXIMUM ACTI. | |||
(if Sealed Source) VITY PER SOURCE WHICH WILL | |||
NO. A CO BE POUSESSED AT ANY ONE TVME I | |||
UC 0 | |||
_ -4 | |||
!(31 DESCRIBE USE OF LICENSED MATERIAL | |||
(21 I 17 | |||
_33 F*IMNRC 313 i 1 -791--- | |||
_ ____ | |||
10.7-11 | |||
9. STORAGE OF SEALED SOURCES | |||
SCOftTAINtSR AND/OR DEVICE IN WHICH EACH SEALED NAME OF MANUFACTURER MODEL NUMefifR | |||
It SOURCE WILL BE STORIED OR USED | |||
I A. B. C. | |||
12) | |||
(3) | |||
(4) | |||
10. RADIATION DETECTION INSTRUMENTS | |||
- TYPE MANUFACTURER'S MODEL NUMffR RADIATION SENSITIVITY | |||
L OF NAME NUMIBR AVAILABLE DETECTED RANGE | |||
M INmsTRMmNT (alpha.beta. (fnbllfoenr.mrno/hour S gamma. neurron) or counts/mmnure) | |||
A C D E F | |||
121 | |||
(31 | |||
11. CALIBRATION OF INSTRUMENTS LISTED IN ITEM 10 | |||
0E. CALINRATDO NY SERVICE COMPANY [0b. CALIBRATED BY APPLICANT | |||
NAME. ADORESS. AND FREQUENCY Attach a Speorate sheet describing method, frequency Mnd staMdards used for caibratinginhtrumwen. | |||
12. PERSONNEL MONITORING DEVICES | |||
TYPE SLPPLIER EXCHANGE FREOUENCY | |||
fCheft* and/of cran)te as ^wP(OP-o- (Seiwce Company) C | |||
C | |||
A, | |||
0111 FIL*ISADIGE 0 MONTHLY | |||
D12) THERMILUVMINESCENCE | |||
0 QUARTERLY | |||
DO1308ITTER (TLD0 | |||
D OTHER (Specdy) | |||
S0011 OTHiER (Sw,_y) | |||
13. FACMILTtMS AND EQUIPMENT (Check were appropriate and attch annotated sketch(es) and description(s). | |||
dMany). ETC | |||
0 a LABORATORY FACILITIES. PLANT FACILITIES, FUME HOODS (Include foltreon, CONTAINERS. SPECIAL SHIELDING (fixed and/lor teorpoarry), ETC | |||
D bý STORAGE FACILITIES | |||
0 c REMOTE HANDLING TOOLS OR EQUIPMENT. ETC | |||
0l d RESPIRATORY PROTECTIVE EQ4JIPMENT. ETC | |||
1q. v1 PaiLr.IK . ,GMl_ | |||
Na | |||
--. OF CONMERCIAL WAST6 DISPOSAL SERVICE EMPLOYED | |||
A DETAILED DESCRIPTION OF METHODS WHICH WILL | |||
b tF COMMtRCIAL WASTE DISPOSAL SERVICE IS NOT EMPLOYED. SUBMIT | |||
OF THE TYPE AND AMOUNT OF ACTIVITY INVOLVED IF | |||
"85 US6D FOR D46POSING OF RADIOACTIVE WASTES AND ESTIMATES | |||
BE RETURNED TO THE MANUFACTURER. SO STATE. | |||
TE APPLICAlION IS FOR SEALED SOURCES AND DEVICES AND THEY WILL | |||
FO"M NOC 313 0 1-794 | |||
10.7-12 | |||
INFORMATION REOUIRED FOR ITEMS 15, 16 AND 17 Describe in detail the information required for Items 15, 16 and 17. Begin each item on a separate page and key to the application as follows: | |||
15. RADIATION PROTECTION PROGRAM. Describe the radiation protection program as appropriate for the material to be used including the duties and responsibilities of the Radiation Protection Officer, control measures, bioassay procedures fit needed), day-to-day general safety instruction to be followed. | |||
etc If the application is for sealed source's also submit leak testing procedures, or if leak testing will be performed using a leak test ki0, specify manufacturer and model number of the leak test kit. | |||
16. FORMAL TRAINING IN RADIATION SAFETY. Attach a resume for each individual named in Items 6 and 7 Describe individual's formal training in the following areas where appliable. Indude the name of person or institution providing the training, duration of training, when training was received, etc a. Principles and practices of radiation protection. | |||
b Radioactivity measurement standardization and monitoring techniques and instruments. | |||
c. Mathematics and calculations basic to the use and measurement of radioactivity d Biological effects of radiation. | |||
17. EXPERIENCE. Attach a resume for each individual named in Items 6 and 7. Describe individual's work experience with radiation, including where experience was obtained. Work experience or on the-job training should be commensurate with the proposed use. Include list of radioisotopes and maximum activity of each used. | |||
1 | |||
===8. CERTIFICATE=== | |||
(This trem must be completed try appiicant) | |||
Th e .ippl* canr and any official exocurJng this Ofril',cate on behalf ot the applicant named in /rem 2, certify that this application is prepared in confotmitry with Title 10, Code of Federal Regulations Parr 30I and that all 'nformation contained herein including any suPplements atrtached hereto is true and correct ro the best of our knowleade and belief. | |||
WARNING 18 U.S.C Section 1001, Act of June 25. 1948; 62 Stai 749; makes it a crimnal offense to nmke a willtully taiae stltemt or repreentation to any department or agency of the United States as to any matter within its ourisdiction. | |||
LII. FNSE FEE REQUIRED | |||
(See Secton 170.3? 10 CFR j0 ERTIFYING OFiCiAL | |||
c. NAME (Type or print) | |||
11 LICENSE FEE CATEGORY d TITLE | |||
12; LICENSE FEE eNC.:LOSED $ e DATE | |||
F0RM NRC-313 1 11 791 | |||
10 7-13 | |||
_1.. | |||
. UN TED STATES | |||
0 NUCLEAR REGULATORY COMMISSION | |||
WASHINGTON, D. C. 20555 July 1984 | |||
[[kRATA | |||
REGULATORY GUIDE 10.7, Revision 1 GUIDE FOR THE PREPARATION OF APPLICATIONS | |||
FOR | |||
LICENSES FOR LABORATORY AND INDUSTRIAL USE | |||
OF SMALL | |||
QUANTITIES OF BYPRODUCT MATERIAL | |||
Regulatory Guide 10.7, Revision 1, provides directions for using Form NRC-313I | |||
in preparing applications for licenses for laboratory and industrial use of small quantities of byproduct material. | |||
The NRC is now using a new NRC Form | |||
313 for all byproduct material applications Form NRC-313I. and is discontinuing the use of The NRC is developing Revision 2 of Regulatory conform to the new NRC Form 313. Guide 10.7 to Until Revision 2 is issued, this errata sheet provides the information needed to use the new NRC Form 313. | |||
The new NRC Form 313 does not have space for providing the information requested in Items 5 through 11. Please provide the information on 8-1/2 x | |||
11 inch paper. | |||
In the left-hand column of the following table are listed items of the old Form NRC-3131, most of which are also called out in Regulatory Guide 10.7, Revision 1. The right-hand column identifies the corresponding item of the new NRC Form 313 in which responses should be made. | |||
Guide and Old Form NRC-3131 New NRC Form 313 Item 1* | |||
Item Item 1 | |||
2 Item Item 2 | |||
3 Item Item 4 | |||
4 Item Item 2 | |||
5 Item Item 3 | |||
6 Item Item 8 | |||
7 Item 8 Item 7 Items 5 and 6 Item 9 Item 10 Item 9 Item 11 Item 10 | |||
Item 10 | |||
itei 12 Iter; 10 | |||
Item 13 Item 9 Item 14 Item 11 Item 15 Item 10 | |||
Item 16 Items 7 and 8 Item 17 Item 7 Item 18* Items 12 and 13 | |||
*Not called out in Regulatory Guide 10.7, Revision 1. | |||
The following cross-reference table may be helpful to you: | |||
New NRC Form 313 Old Form NRC-3131 Item 1 Item 1 Item 2 Items 2 and 4 Item 3 Item 5 Item 4 Item 3 Item 5 Items 8A, B, C, and D | |||
Item 6 Item 8E | |||
Item 7 Items 7, 16, and 17 Item 8 Items 6 and 16 Item 9 Items 9 and 13 Item 10 Items 10, 11, 12, and 15 Item 11 Item 14 Item 12 Items 18a(1) and (2) | |||
Item 13 Items 18b, c, d, and e ,,L_ | |||
Item 14 N/A | |||
2 | |||
NRC 'OPV 313 | |||
8' 32 33 34 US. NUCLEAR REGULATORY COMMISSION | |||
APPROVED BY OM8 | |||
3150-0120 | |||
... APPLICATION FOR MATERIAL LICENSE Elxpir,. 5-31-87 NSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR | |||
COMPLETING APPLICATION SEND TWO COPIES | |||
)' 'HE ENTIRE COMPLETED APPLICATION TO THE NRC | |||
OFFICE SPECIFIED BELOW. | |||
FEDERAL AGENCIES FILE APPLICATIONS WITH | |||
IF YOU ARE LOCATED IN: | |||
"I S NUCLEAR REGULATOR Y COMMISSION | |||
ILLINOIS, INDIANA, IOWA. MICHIGAN, MINNESOTA, MISSOURI | |||
3)IVISION OF FLEL CYCLE AND MATERIAL SAFETY. NMSS OHIO, OR | |||
WISCONSIN. SEND APPLICATIONS TO | |||
WASHINGTON DC 20555 U S. NUCLEAR REGULATORY COMMISSION, REGION III | |||
ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS, | |||
IF YOU ARE MATERIALS LEIUCENSTNG | |||
LOCATED IN SECTION | |||
799 ROOSEVELT ROAD | |||
CONNECTICUT. DELAWARE, DISTRICT OF COLUMBIA, MAINE, MARYLAND, GLEN ELLYN. IL 60137 MASSACHUSETTS, NEW JERSEY, NEW YORK, PENNSYLVANIA, | |||
On VERMONT. SEND APPLICATIONS TO, RHODE ISLAND. ARKANSAS, COLORADO, IDAHO, KANSAS, LOUISIANA, MONTANA, | |||
NEW MEXICO, NORTH DAKOTA, OKLAHOMA, SOUTH DAKOTA, NEBRASKA | |||
TEXAS, UTAH, | |||
S NUCLEAR REGULATORY COMMISSION. REGION I | |||
NUCLEAR MATERIAL SECTION B OR WYOMING, SEND APPLICATIONS TO: | |||
63! PARK AVENUE U.S. NUCLEAR REGULATORY COMMISSION. REGION IV | |||
KING OF PRUSSIA. PA 19406 MATERIAL RADIATION PROTECTION SECTION | |||
611 RYAN PLAZA DRIVE. SUITE 1000 | |||
ALARAMA FLORIDA GEORGIA KENTUCKY, MISSISSIPPI, NORTH CAROLINA, ARLINGTON, TX 76011 PUERTO RICO, SOUTH CAROLINA, TENNESSEE, VIRGINIA, VIRGIN | |||
WEST VIRGINIA. SEND APPLICATIONS TO: ISLANDS. OR ALASKA, ARIZONA, CALIFORNIA, HAWAII, NEVADA, OREGON, | |||
AND U.S. TERRITORIES AND POSSESSIONS IN THE PACIFIC, SEND WASHINGTON, | |||
APPLICATIONS | |||
'J.S NUCLEAR REGULATORY COMMISSION, REGION | |||
II | |||
TO: | |||
MATERIAL RADIATION PROTECTION SECTION | |||
'I MARIETTA STREET, SUITE 2900 U.S NUCLEAR REGULATORY COMMISSION, REGION V | |||
MATERIAL RADIATION PROTECTION SECTION | |||
ATLANTA. CA 30323 | |||
1450 MARIA LANE. SUITE 210 | |||
WALNUT CREEK, CA 94596 PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS | |||
TO THE U.S. NUCLEAR REGULATORY COMMISSION ONLY IF THEY | |||
WISH TO POSSESS AND USE LICENSED MATERIAL | |||
IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION | |||
JURISDICTION. | |||
I THIS IS AN APPLICATION FOR [Chock o'opritare itEm) | |||
2. NAME AND MAILING ADDRESS OF APPLICANT (Includ.Zip Code) | |||
A NEW LICENSE | |||
B AMENDMENT TO LICENSE NUMBE9 | |||
? AJDRESSiES! WHERE LICENSED MATERIAL WILL | |||
BE USED OR POSSESSED. | |||
4 NAME OF PERSON TO B | |||
==E. CONTACT== | |||
ED ABOUT THIS APPLICATION | |||
TELEPHONE NUMBER | |||
SUBMIT ITEMS 5 THROUGH II ON EN , 11 PAPER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED | |||
IS DESCRIBED IN THE LICENSE APPLICATION GUIDE | |||
E RADIOACTIVE MATERIAL | |||
Er'iinlband 5 nunibr aort. b Ihencal] | |||
tft andlor OnyIsciI and c. mano'" ionn 6. PURPOSEIS) FOR WHICH LICENSED MATEPIAL WILL | |||
,.rlcn wi,' be oo$$s~sec at any onn tinie BE USED | |||
'NDIVIDUALiSi RESPONSIBLE FOR RADIATION SAFETY | |||
TRA 'ýING AND EXPER:ENCE PROGRAM AND THEIR | |||
8. TRAINING FOR INDIVIDUALS WORKING IN OR FREOUENTING | |||
RESTRICTED AREAS | |||
ACILITIES AND EQUIPMENT 10. RADIATION SAFETY PROGRAM | |||
WASTE MANAGEMENT 12 LICENSEE FEES (Saw ro CFR I70nd S*eefon 170.31) | |||
WAMOUNT | |||
FEE CATEGORY ENCLOSED $ | |||
C'ERTIFICATU0N !AMiistbecornolotedbyaDphcandJ THE APPLICANT UNDERSTANDS | |||
THAT ALL STATEMENTS AND REPRESENTATIONS | |||
MADE IN THIS APPLICATION ARE | |||
Hl -ING .PO., Tn5 APPLICANT | |||
"-.E APPLICANT AND ANY OFFICIAL EXECUTING THIS | |||
cRyFPARLD :N CONFORMITY WITH TITLE CERTIFICATION ON BEHALF OF THE APPLICANT NAMED | |||
I0. CODE OF FEDERAL REGULATIONS, PARTS 30,32, 33,34,35. AND 40 AND IN ITEM 2, CERTIFY THAT THIS APPLICATION IS | |||
THAT ALL INFORMATION CONTAINED HEREIN | |||
'S'RI E AND CORRECT TO THE BEST OF THEIR KNOWLEDGE | |||
AND BELIEF | |||
PIARNING I6 ý -C SECTION I001 ACT OF JUNE 25 1948.62 STAT 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY | |||
T-AY DEPARTMENT OR AGENCY OF THE UNITED STATES FALSE STATEMENT OR REPRESENTATION | |||
AS TO ANY MATTER WITHIN ITS JURISDICTION | |||
.',R*J-'EH*T ... I.%GO:CSR TYPEDIPRNTEO NAME IIL DT | |||
$SOO. | |||
-,-I * TMIO | |||
8NUMBER OF EMPLOYEES (Totalio d WOULD YOU BE WILLING TO FURNIH COST | |||
$ ~ ittrn aciityPx~iJ~nECJttdfCflt*Ct,,) | |||
ON THE ECONOMIC IMPACT OP CURRENT NRC REGULATIONS | |||
INFORMATION ('Jolls, anditeho,, | |||
OR ANY FUTURE | |||
I 251K -500K S'5V35 7M PROPOSED NRC REGULATIONS THAT MAY AFFECT | |||
it t0O1eCitip,~lCn YDU? (NRC iwecilationn,'pi.n4 nena o iera~r~i,,.,ion.i, e-r,Ihld to | |||
: 5520K - 50K s7m - 1M c NUMBER OF BEDS th poyin contidenlcs) | |||
S-50K V>NO | |||
V,..A J YES | |||
FOR NRC USE ONLY | |||
3 i 'SE LOG 0P5 FEE CATEGORY COMMENTS APPROVED By | |||
2 | |||
4.', " . ECE .'C CHECK NUMBER | |||
DATE | |||
;'v"""*ACT S | |||
A | |||
S AT. T | |||
Y>TIE'T 0O4 THE E REVERSE | |||
REV | |||
PRIVACY ACT STATEMENT | |||
Pjrsuant to 5 U.S.C. 552a(e)(3), enacted into law by section 3 of the Privacy Act of 1974 JPublic Law 93-579), the follow | |||
!ng statement is furnished to individuals who supply information to the Nuclear Regulatory Commission on NRC | |||
Form | |||
313. This information ;s maintained in a system of records designated as NRC-3 and described at 40 Federal Register | |||
45334 (October 1, 19751. | |||
1 AUTHORITY: Sections 81 and 161(b) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2111 and 2201 (bll | |||
2 PRINCIPA | |||
==L. PURPOSE== | |||
(S): The information is evaluated by the NRC staff pursuant to the criteria set forth ;n 10 | |||
CFR | |||
Parts 30, 32, 33, 34, 35 and 40 to determine whether the application meets the requirements of the Atomic Energy Act of | |||
1954, as amended, and the Commission's regulations, for the issuance of a radioactive material license or amendment thereof. | |||
3. ROUTINE USES: The information may be (a) provided to State health departments for their information and use, and (b) provided to Federal, State, and local health officials and other persons in the event of incident or exposure, for their information, investigation, and protection of the public health and safety. The information may also be d1,s closed to appropriate Federal, State, and local agencies in the event that the information indicates a violation or potent:ai vwo'at~on of iaw and !n the course of an administrative or judicial proceeding. In addition, this information may be trans ferred to an appropriate Federal, State, or local agency to the extent relevant and necessary for an NRC decision or to an appropriate Federal agency to the extent relevant and necessary for that agency's decision about you. | |||
4ý WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVID | |||
ING INFORMATION: Disclosure of the requested information is voluntary. If the requested information is not furn ished, however, the application for radioactive material lik.ense, or amendment thereof, will not be processed. A request that :nformation be held from public inspection must be in accordance with the provisions of 10 CFR 2.790. Withhold ing from public inspection shall not affect the right, if any, of persons properly and directly concerned need to inspect the document. | |||
5. SYSTEM MANAGER(S) AND ADDRESS: U.S. Nuclear Regulatory Commission Director, Division of Fuel Cycle and Material Safety L | |||
Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555 NRC FORM 313 | |||
I NRC | |||
US NUCLEAR REGULATORY COMMISSION | |||
84 APPROVED BY OD4E | |||
C F 1,4"3, ý 1 3150-0120 | |||
APPLICATION FOR MATERIAL LICENSE E-pis 55-31.87 NSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING | |||
APPLICATION SEND TWO COPIES | |||
)l THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED | |||
BELOW. | |||
[ | |||
"FEDERALAGENCIES FILE APPLICATIONS WITH | |||
- S NUCLEAR REGULATORY COMMISSION | |||
ilVISION O FUEL CYCLE AND MATERIAL SAFETY. NMSS | |||
WNASHINGTON. DC 20555 IF YOU ARE LOCATED IN | |||
ILLINOIS, INDIANA, IOWA, MICHIGAN. MINNESOTA. MISSOURI, OHIO. OR | |||
WISCONSIN. SEND APPLICATIONS TO: | |||
U S. NUCLEAR REGULATORY COMMISSION. REGION III | |||
ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS. IF YOU ARE MATERIALS LICENSING SECTION | |||
LOCATED IN 799 ROOSEVELT ROAD | |||
CONNECTICUT. DELAWARE. DISTRICT Ol- COLUMBIA. MAINE. MARYLAND. GLEN ELLYN. IL 60137 MASSACHUSETTS, NEW JERSEY NEW YORK. PENNSYLVANIA, RHODE ISLAND, | |||
OPRVERMONT. SEND APPLICATIONS TO. ARKANSAS COLORADO, IDAHO, KANSAS. LOUISIANA, MONTANA, NEBRASKA, | |||
NEW MEXICOO,NORTH DAKOTA, OKLAHOMA, SOUTH DAKOTA. TEXAS, UTAH. | |||
OR WYOMING. SEND APPLICATIONS TO: | |||
S NUCLEAR REGULATORY | |||
NUCLEAR MATERIAL SECTIONCOMMISSION. B | |||
REGION IO | |||
U.S. NUCLEAR REGULATORY COMMISSION, REGION IV | |||
631 PARK AVENUE | |||
KING OF PRUSSIA. PA 19406 MATERIAL RADIATION PROTECTION SECTION | |||
611 RYAN PLAZA DRIVE, SUITE 1000 | |||
ALABAMA. FLORIDA, GEORGIA. KENTUCKY. MISSI.SIPPI, NORTH CAROLINA, ARLINGTON.TX 76011 PUERTO RICO, SOUTH CAROLINA. TENNESSEE, VIRGINIA, VIRGIN ISLANDS, | |||
OR ALASKA, ARIZONA, CALIFORNIA, HAWAII, NEVADA. OREGON, WASHINGTON. | |||
WEST VIRGINIA. SEND APPLICATIONS TO | |||
AND U.S. TERRITORIES AND POSSESSIONS IN THE PACIFIC, SEND APPLICATIONS | |||
'J S NUCLEAR REGULATORY COMMISSION. REGION II TO: | |||
MATERIAL RADIATION PROTECTION SECTION | |||
',71 MARIETTA STREET. SUITE 2900 U.S. NUCLEAR REGULATORY COMMISSION REGION V | |||
MATERIAL RADIATION PROTECTION SECTION | |||
ATLANTA GA 30323 | |||
1450MARIA LANE, SUITE 210 | |||
WALNUT CREEK. CA 94596 PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE | |||
U.& NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS | |||
AND USE LICENSED MATERIAL | |||
IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION JURISOICTION. | |||
THIS IS AN APPLICATION FOR lChoek aWmpriste it") | |||
2. NAME AND MAILING ADDRESS OF APPLICANT (OncludeeZ Code) | |||
A NEWLICENSE | |||
8 AMENDMENT TO LICENSE NUMBER_ | |||
C RENEWAL OF LICENSE NUMBER | |||
A--A)DRESSIES! WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED | |||
4 NAME OF PERSON TO B | |||
==E. CONTACT== | |||
ED ABOUT THIS APPLICATION | |||
J TELEPHONE NUMBER | |||
SUBMIT ITEMS S THROUGH 1 I ON E'i 11 - PAPER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED | |||
IN THE LICENSE APPLICATION GUIDE | |||
5 RADIOACTIVE MATERIAL | |||
a E emeni and mass 'iunibet" b cýhen,cal end/or physlcls for,. end c. | |||
n*,binusn 60.mn 6 PURPOSEIS) FOR WHICH LICENSED MATERIAL WILL BE USED | |||
ýt,' -C 11b5, Qosssed at anv one ti-e NIDIVNIUAL(S, RESPONSIBLE | |||
FOR RADIATION SAFETY PROGRAM | |||
TRA,.,ING AND EXPERIENCE AND THEIR | |||
8 TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS | |||
SACITIES AND EQUIPMENT | |||
10 RADIATION SAFETY PROGRAM | |||
" W | |||
WASTE MANAGEMENT | |||
N12. | |||
LICENSEE FEES (See I0CFR 170andSection 170.31/ | |||
iAMOUNT | |||
FEE CATEGORY jENCLOSED $ | |||
""ErTIF'CATION (Must beomo/eredby*Phl/cAntJ THE APPLICANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENTATIONS | |||
MADE IN THIS APPLICATION ARE | |||
8,,'E NGNUPON T.IE APPLICANT | |||
"iE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION | |||
PRFPAIIED ;N CONFORMITY WITH TITLE 10, CODE OF FEDERAL | |||
ON BEHALF OF THE APPLICANT NAMED IN ITEM | |||
===2. CERTIFY THAT=== | |||
THIS APPLICATION IS | |||
REGULATIONS, PARTS 30.32 33. 34 35. AND 40 AND THAT ALL | |||
ýS TOIJE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND INFORMATION CONTAINED HEREIN | |||
BELIEF | |||
.ARNINC. IS, U SC SECTION 1001 ACT OF JUNE 25. 1948, 62 STAT | |||
749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE | |||
Tr A%' ULEPARTMENT OR AGENCY OF THE UNITED STATES AS STATEMENT OR REPRESENTATIO.N | |||
TO ANY MATTER WITHIN ITS JURISDICTION | |||
.i" i E.(*T' 'NTI OFFICER I TYPED/PRINTED NAME ITITLE DATE | |||
P 14 V UNTAAY ECONOMIC DATA | |||
N'.. | |||
R Pb NUMBER OF EMPLOYEES (Tote/i'1o, d WOULD YOU BE WILLING TO FURNISH COST INFORMATION | |||
SIM I SM ... fre r(JOI8e,.doCImffh., , | |||
. ON THE ECONOMIC IMPACT OF CURRENT NRC REGULATIONS 5 OR ANY FUTURE | |||
25271K S35kEV7M PROPOSED NRC REGULATIONS THAT MAY AFFECT YOU' (NRC mru1/tionsjDenrmt It to Dfrorect coifdent"e1 Commn'itl or finncil-Drorietli/--,iiOrmet~on furniShod to S5OOK /501K M 1DM NUMBER OF BEDS c | |||
5j 'ýOK IV -ISIOM | |||
E | |||
FOR NRC USE ONLY | |||
' p I(F (FE LOG FEE CATEGORY COMMENTS APPROVED BY | |||
AV. ".-FCEiTE TO CHECK =NUMBER | |||
A'ý S TMENT Ory THE REVERSE | |||
PRIVACY ACT STATEMENT | |||
Privacy Act of 1974 (Public Law 93-579), the follow Pursuant to 5 U.S.C. 552a(e)(3). enacted into law by section 3 of the to the Nuclear Regulatory Commission on NRC Form | |||
,g statement is furnished to individuals who supply information as NRC 3 and described at 40 Federal Register 45334 | |||
313. This information is maintained in a system of records designated (October 1, 1975). | |||
Act of 1954, as amended (42 U.S.C. 2111 and 2201(b)). | |||
1, AUTHORITY: Sections 81 and 161(b) of the Atomic Energy CFR | |||
by the NRC staff pursuant to the criteria set forth in 10 | |||
===2. PRINCIPA=== | |||
==L. PURPOSE== | |||
(S): The information is evaluated of the Atomic Energy Act of the application meets the requirements Parts 30, 32, 33, 34, 35 and 40 to determine whether material license or amendment for the issuance of a radioactive | |||
1954, as amended, and the Commission's regulations, thereof, information and use; | |||
(a) provided to State health departments for their | |||
3. ROUTINE USES: The information may be of incident or exposure, and other persons in the event and (b) provided to Federal, State, and local health officials The iformation may also be dis of the public health and safety. | |||
for their information, investigation, and protection irdicates a violation or potential in the event that the information closed to appropriate Federal, State, and local agencies this information may be trans or judicial proceeding. in addition, violation of law and in the course of an administrative necessary for an NRC decision or to to the extent relevant and ferred to an appropriate Federal, State, or local agency about you. | |||
and necessary for that agency's decision an appropriate Federal agency to the extent relevant NOT PROVID | |||
VOLUNTARY AND EFFECT ON INDIVIDUAL OF | |||
4. WHETHER DISCLOSURE IS MANDATORY OR the requested information is not furn information is voluntary. If ING INFORMATION: Disclosure of the requested will not be processed. A request material license, or amendment thereof, ished, however, the application for radioactive the provisions of 10 CFR 2,790. Withhold must be in accordance with that information be held from public inspection and directly concerned need to inspect if any, of persons properly ing from public inspection shall not affect the right, the document. | |||
U.S. Nuclear Regulatory Commission | |||
5. SYSTEM MANAGER(S) AND ADDRESS: | |||
Director, Division of Fuel Cycle and Material Safety Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555 NRC FORM 313 | |||
NRBC *'*RM 313 US NUCLEAR REGULATORY COMMISSION | |||
'84C-I 3C 32 33 34 APPROVED BY Om B | |||
... 0APPLICATION I FOROR MATERIAL | |||
M31M0-0120 LICENSE E .... 5-31-87 NSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS | |||
FOR COMPLETING APPLICATION SEND TWO COPIES | |||
)I THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW. | |||
FEDERAL AGENCIES FILE APPLICATIONS WITH | |||
IF YOU ARE LOCATED IN | |||
NS U'CLEAR REGULATORY COMMISSION ILLINOIS. INDIANA. IOWA, MICHIGAN, MINNESOTA. MISSOURI. OHIO, OR | |||
'JIVISION OF FUEL CYCLE AND MATERIAL SAFETY. NMSS | |||
WISCONSIN, SEND APPLICATIONS TO | |||
WASHINGTC!q. DC 20555 ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS. IF YOU ARE U S. NUCLEAR REGULATORY COMMISSION. REGION III | |||
MATERIALS LICENSING SECTION | |||
LOCATED IN | |||
799 ROOSEVELT ROAD | |||
GLEN ELLYN, IL 60137 CONNECTICUT. DELAWARE, DISTRICT OF COLUMBIA, MAINE. MARYLAND, | |||
MASSACHUSETTS. NEW JERSEY, NEW YORK, PENNSYLVANIA. RHODE ISLAND, ARKANSAS. COLORADO, IDAHO. KANSAS, LOUISIANA, MONTANA, NEBRASKA. | |||
OR VERMONT. SEND APPLICATIONS TO. NEW MEXICO, NORTH DAKOTA. OKLAHOMA. SOUTH DAKOTA, TEXAS, UTAH. | |||
.S NUCLEAR REGULATORY COMMISSION, REGION I OR WYOMING, SEND APPLICATIONS TO: | |||
NUCLEAR MATERIAL SECTION B | |||
U.S. NUCLEAR REGULATORY COMMISSION. REGION IV | |||
631 PARK AVENUE | |||
MATERIAL RADIATION PROTECTION SECTION | |||
KING OF PRUSSIA. PA 19406 611 RYAN PLAZA DRIVE. SUITE 1000 | |||
ARLINGTON, TX 76011 ALABAMA FLORIDA GEORGIA. KENTUCKY, MISSISSIPPI, NORTH CAROLINA. | |||
PUERTO RICO, SOUTH CAROLINA. TENNESSEE, VIRGINIA, VIRGIN ISLANDS, OR | |||
WEST VIRGINIA. SEND APPLICATIONS TO ALASKA, ARIZONA, CALIFORNIA, HAWAII, NEVADA. OREGON, WASHINGTON, | |||
AND U.S. TERRITORIES AND POSSESSIONS IN THE PACIFIC, SEND APPLICATIONS | |||
'J S NUCLEAR REGULATORY COMMISSION, REGION It TO: | |||
MATERIAL RADIATION PROTECTION SECTION | |||
101 MARIETTA STREET. SUITE 2900 U.S. NUCLEAR REGULATORY COMMISSION, REGION V | |||
MATERIAL RADIATION PROTECTION SECTION | |||
AILANTA. GA 30323 | |||
1450 MARIA LANE. SUITE 210 | |||
WALNUT CREEK. CA 94596 PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR | |||
REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL | |||
IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION JURISOICTION. | |||
1 THIS IS AN APPLICATION FOR (Chock a'Copioreewt*t* , 2. NAME.AND MAILING ADDRESS OF APPLICANT (Includ.Zip Code) | |||
A NEW LICENSE | |||
B AMENDMENT TO LICENSE NUMBE_ | |||
C RENEWAL OF LICENSE NUMBER | |||
ADORESSIESI WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED | |||
4 NAME OF PERSON TO B | |||
==E. CONTACT== | |||
ED ABOUT THIS APPLICATION | |||
jTELEPHONE NUMBER | |||
SUBMIT iTEMS S TIROUGH 11 ON 8' , 11 'PAPER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED IN | |||
THE LICENSE APPLICATION GUIDE. | |||
S R-ýDIOACTIVE MATERIAL | |||
aEcment ecll mass numbe. b checal eImnd/orDfhys,Col 1orm.Iad c mTlS-.n, anooIt 6. PURPOSEBS) FOR WHICH LICENSED MATEPIAL WILL BE USED | |||
h .ch | |||
-Ii, o oos$ese4 at a"ny one tlme INDIVIDUALIS, RESPONSIBLE FOP | |||
RADIATION SAFETY PROGRAM AND | |||
TRA 'IG AND EXPERIENCE THEIR | |||
8, TRAINING FOR INDIVIDUALS WORKING IN OR FREQUEN'ING RESTRICTED AREAS | |||
AC:IITIES AND EQUIPMENT | |||
10. RADIATION SAFETY PROGRAM | |||
WASTE~~~ MNGMT | |||
"12 LICENSEE FEES (See ?0CFRt 1tTOrsdlSteor, 170.31) | |||
FEE CATEGORY AMOUNT | |||
lENCLOSED $ | |||
j '7EPTIFICATION fMus'beomplvridbVyliclnrJ THE APPLICANT UNDERSTANDS THAT Al L | |||
TATEMENT R* .... . . - | |||
BIN' -. 3 -PTEN APPLICANT . AND tP1EUNTI MADE IN THIS APPLICATION ARE | |||
-'E APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEHALF | |||
OF THE APPLICANT. NAMED IN ITEM 2. CERTIFY THAT THIS APPLICATION IS | |||
AEPARED :% CONFORMITY WITH TITLE 1 | |||
===0. CODE OF FEDERAL=== | |||
REGULATIONS, PARTS 30.32.33, 34, 35. AND 40 AND THAT ALL INFORMATION | |||
,F'IJ AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF CONTAINED HEREIN | |||
VARNINC 16 u S C SECTION 1301 ACT OF JUNE 25. 1948, 62 STAT 749 MAKES IT A CRIMINAL | |||
"TC, ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER | |||
OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION | |||
WITHIN ITS JURISDICTION | |||
SNn.* 'E*T . C | |||
GOFliCS 'TYPEDIPRINTED NAME TITLE DATE | |||
14VLUNTARY ECONOMIC DATA | |||
A. A ,*:- R CE'PTS I NUMBER OF EMPLOYEES (Tor for al d WOULD YOU BE WILLING TO FURNISH COST INFORMATION o rtIOII. -noo stfhow,,, | |||
1 | |||
"'SI'K vM 5v emt, fci,ty -excluoingOrsdi conftrlcrors ON THE ECONOMIC IMPACT OF CURRENT NRC REGULATIONS OR ANY FUTURE | |||
S251K NOOK PROPOSED NRC REGULATIONS THAT MAY AFFECT YOU' (NRCmoIlerio$s S 5MS ?M Irt ro votcr pe-.r confidenrti& commerns*I Or frinolal-oroorrr. --*t,,tofrnltton f-rnlthld to | |||
$5500K - 750K S7M -0M c NUMBER OF BEDS py ,nConfidrce) | |||
S 50K 'V S | |||
'0M F YES NO | |||
FOR NRC USE ONLY | |||
"PE- F6. FEEFOG PEECATEGORY COMMENTS APPROVED By | |||
. . T... CE "'E.D CHECK NUMBER | |||
.4 . A'T STATEMFNT ON THE REVERSE | |||
PRIVACY ACT STATEMENT | |||
93-579), the follow Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by section 3 of the Privacy Act of 1974 (Public Law Commission on NRC Forrr inq staxement is furnished to individuals who supply information to the Nuclear Regulatory described at 40 Federal Register 45334 | |||
313. This information is maintained in a system of records designated as NRC-3 and (October 1 1975). | |||
(42 U.S.C. 2111 and 2201(b)). | |||
1. AUTHORITY: Sections 81 and 161(b) of the Atomic Energy Act of 1954, as amended staff pursuant to the criteria set forth in 10 CFR | |||
===2. PRINCIPA=== | |||
==L. PURPOSE== | |||
(S): The information is evaluated by the NRC | |||
the requirements of the Atomic Energy Act of Parts 30, 32, 33, 34, 35 and 40 to determine whether the application meets of a radioactive material license or amendment | |||
1954, as amended, and the Commission's regulations, for the issuance thereof. | |||
health departments for their information and use; | |||
3. ROUTINE USES: The information may be (a) provided to State other persons in the event of incident or exposure, and (b) provided to Federal, State, and local health officials and and safety. The information may also be dis for their information, investigation, and protection of the public health that the information indicates a violation or potential closed to appropriate Federal, State, and local agencies in the event In addition, tt'fs information may be trans violation of law and in the course of an administrative or judicial proceeding. | |||
relevant and necessary for an NRC decision or to ferred to an appropriate Federal, State, or local agency to the extent that agency's decision about you. | |||
an appropriate Federal agency to the extent relevant and necessary for AND EFFECT ON INDIVIDUAL OF NOT PROVID | |||
4, WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY | |||
is voluntary. If the requested information is not furn ING INFORMATION: Disclosure of the requested information amendment thereof, will not be processed. A request ished, however, the application for radioactive material license, or with the provisions of 10 CFR 2.790. Withhold that information be held from public inspection must be in accordance persons properly and directly concerned need to inspect ing from public inspection shall not affect the right, if any, of the document. | |||
5. SYSTEM MANAGER(S) AND ADDRESS: U.S. Nuclear Regulatory Commission Director, Division of Fuel Cycle and Material Safety Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555}} | |||
{{RG-Nav}} | {{RG-Nav}} | ||
Latest revision as of 11:12, 28 March 2020
| ML003740382 | |
| Person / Time | |
|---|---|
| Issue date: | 08/31/1979 |
| From: | Office of Nuclear Regulatory Research |
| To: | |
| References | |
| RG-10.7 Rev 1 | |
| Download: ML003740382 (20) | |
{{#Wiki_filter:Aep ft!m" 1171 U.S. NUCLEAR REGULATORY COMMISSION
REGULATORY GUIDE
OFFICE OF STANDARDS DEVELOPMENT
REGULATORY GUIDE 10.7 GUIDE FOR THE PREPARATION OF APPUCATIONS FOR UCENSES
FOR LABORATORY AND INDU1STRIAL USE OF SMALL *R
QUANTmES OF BYPRODUCT MATERIAL
1. INTRODUCTION 10 CFR Part 170 to determine the amount of fee This guide describes the type of information that must accompany the application. Review of needed by the NRC staff to evaluate an the application will not begin until the proper appl fee is received by the NRC.
cation for a specific license for laboratories and industries using millicurie quantities of by 3. FILING AN APPLICATION
product material (reactor-produced radionu clides). This type of license is provided under Title 10, Code of Federal Regulations, for An applicant for a byproduct material Part 30. "Rules of General Applicability isotopes) license should complete Form (radio-j NRC
to Do 3131 (see the appendix to this guide).' AUl mestic Licensing of Byproduct Material items on the application form should be com Paragraph. 20 1(c) of 10 CFH Part 20. "Stand pleted in sufficient detail for the NRC to deter ards for Protection Against Radiation," mine that the applicant's equipment, facilities, states and radiation protection Program are adequate that " . persons engaged in activities under licenses issued by the Nuclear Regulatory to protect health and minimize danger to life Com and property.
mission pursuant to the Atomic Energy Act of
19.54, as amended, and the Energy Reorganiza tion Act of 1974 should, in addition to comply Since the space provided on Form NRC-3131 ing with the requirements set forth in is limited, the applicant should append addi this tional sheets to provide complete information.
part, make every reasonable effort to maintain radiation exposures, and releases of Each separate sheet or document submitted radio active materials in effluents to unrestricted with the application should be identified by a areas, as low as is reasonably achievable" heading indicating the appropriate item number (ALARA). Regulatory Guide R. 10, "Operating (on Form NRC-3131) and its purpose radiation, safety instructions). (e.g.,
Philosophy for Maintaining Occupational Radia tion Exposures As Low As Is Reasonably Achievable,", provides the NRC staff position The application should be completed in trip on this important subject. License applicants licate. The original and one copy should be should give consideration to the ALARA philos mailed to the Division of Fuel Cycle and Mate ophy, as described in Regulatory 3uide rial Safety, Office of Nuclear Material
8. 10, Safety in the development of plans for work and Safeguards, U.S Nuclear Regulatory with Com licensed radioactive materials. mission. Washington, D.C. 20555. One copy of the application, with all attachments, should be
2. LICENSE FEES retained by the applicant since the license will require, ab a condition, that the institution An application fee is required for most types follow the statements and representations o)f Licenses set The applicant should refer to forth in the application and any supplement
§170 31, it to
"Schedule of Fees for Materials Licenses and Other Regulatory Services,"
of
'Applications (or" medical uses should be submitted on Form
*1 "I*s '-n1dcate substantave changes from previoub .'.ue NRC-313M. and applications for use of selled sources in rad- raphy should beasu I. 1ri NRC-313R
USNRC REGULATORY GUIDES
ttagu0tory Guide -a-einu Comments should be sent to the Secretary of the Commen.
to "-,,be mndineao .a bleeto uRgulatory U.S tuim
"nothOd"acOc*ap to the NRC soft of C Conomatin Wwa Wo 0 C 2066 Atteintion OoClea leamenting 'vec1fac prts of the SW
, rsion's regulations. to deline*te *eh*MKK used by the staff on evalu- The guides we rilsuidm the foliowu Itan hoad dairnons
"'lng 'pcftIc rippicants W-11-16r~ Guides Regulatory Or postulated ae rnt accidents, gubseaae orfor fto Proside guidance Pliecs with them is riot raqaujed Maihods and regulaions. and corntt I Power Reactors ookn dffere f fyro tmhose 6 Products set out in fth guides will be erLcaputAte rf the provide 2 Resarch and Test Reactors 7 Transoration requiste to the isuance or continuance of a basie for tie woiadngs 3 Fuels and Martialo Feotms a perrNt or licanse by the 4 Enovrwnen'ta 8 OccuoiaaonWs and Sittru . Health Coa'-mHaon
5 M410"ifis am Plant Protection 0 Gililrt and Fiancial Revew Comnnts i tlrr*s an*d suggestiOns andWu-des tor nprOvernts ,n thee guades are encouraged at placement an etutomat.c wet Uae resa as s*pWoprAte. to aCrorrmodante commentd Requests foror s-g*e copies ofd*'Uued Iuades fivhaCh
*r*butiorist t*or aglerngy bi eWoduced, copaes or for of ftureL guaee nO tO ref*i fcr'e information or sotae n spi fc dvisons should be nuide a wating This guide *awasred mosta to the U S Nuclear Regulefory ComrnmraTtn Wasthington D C 205Mu of sobstant" curnmrents re..a. ed fromr the public and addrtional Alteanon Deoitor. ONvror, of staf reiew Tochn,~i into~rraitocn and Dorumlent Control
4. CONTENTS OF AN APPLICATION model number of each sealed or plated source should be specified It a source will be used in Most items of Form NRC-313r are self a gas chromatograph. gauge, or other device.
explanatory (see instructions with the form). the manufacturer and model number of the The following comments apply to the indicated device should be specified numbered items of the form.
Item 8E and Item 9 The use to be made of'
Items 2 and 4. Specify the applicant corpo the radioactive materials should be clearly ration or other legal entity by name and described Sufficient detail should he given to address of principal office. Individuals should allow a determination of the potential for expo be designated as the applicant only if the use sure to radiation and radioactive materials both of the byproduct material is not connected with of those working with the materials and of the the individual's employment with a corporation public or other entity If the applicant. is an individual, the individual should be specified Items 10 and 11. Specify for each radiation by full name and address, including state and detection instrument the manufacturer's name zip code -and model number, the number of each type of instrument available, the type of radiation Item 5. Specify the street address of the detected (alpha, beta, gamma, or neutron).
location of use if the address differs from the the sensitivity range (milliroentgens per hour one given in Item 4. If use is to be at more or counts per minute). the window thickness in
2 than one location, the specific address of each mg/cm . and the type of use. The type of use should be given Describe the extent of use would normally be monitoring, surveying, and the facilities and equipment at each assaying, or measuring.
location. A post office box address is not acceptable. Describe the instrument calibration proce dure. State the frequency, and describe the Item 6 Specify the names of the persons who methods and procedures for the calibration of will directly supervise the use of radioactive survey and monitoring instruments, as well as material or who will use radioactive material any other instruments and systems used in the without supervision radiation protection program, such as measur ing instruments used to assay sealed-source Item 7. Specify the name of the person who leak-test samples (see Item 15). contaminationi will be designated as the radiation protection samples (e.g.. air samples. surface "wipe"
officer. 2 Thispj5erson should be responsible for samples), and bioassay samples (see Item 12) implementing the radiation safety program and therefore readily available to the users in case An adequate calibration of survey instru of difficulty and should be trained and experi ments usually cannot be performed with built enced in radiation protection and in the use in check sources Electronic calibrations that
1 and handling of radioactive materials. In a do not involve a source of radiation are also small program not requiring a full-time not adequate to determine the proper function ing and response of all components of an radiation protection officer, the duties of the radiation protection officer may be assigned to instrument.
one of the persons named under Item 6 of Form I NRC-3131. Note, however, that it must be Daily or other frequent checks of survey instruments should be supplemented every established that the person acting as radiation protection officer will have the opportunity to 6 months with a two-point calibration on each devote sufficient time to the radiation safety scale of each instrument with the two points aspects of the program for the use of separated by at least 50% of the scale Survey radioactive materials. instruments should also be calibrated following repair. A survey instrument may be considered Items BA, B, C, and D. Describe the byprod properly caiibrated when the instrument read uct material by isotope, chemical and/or physi ings are within +/-10 percent of the calculated or cal form, and activity, in millicuries or micro known values for each point checked Readings curies A separate possession limit for each within +/-20 percent are considered acceptable if nuclide should be specified Possession limits a calibration chart or graph is prepared and requested should cover the total anticipated attached to the instrument inventory, including stored materials and If the applicant proposes to calibrate his waste, and shouid be commensurate with the needs and facilities for safe survey instruments, a detailed description of applicant's planned calibration procedures should be sub handling mitted The description of calibration proce dures should in(lude, as a minimum:
If the use of sealed or plated sources is con tempiated, the isotope, manufacturer, and a The manufacturer and model number of
'The terms radiation protection officer" and "radioiogrcal each radiation source to be used, safety officer" are synonv.aoul
10 7-2
b. The nuclide and quantity of radioactive milliroentgens, the frequency of reading, and material contained in each source, the procedures for maintaining and calibrating the devices should be specified.
c The accuracy of the source(s). The traceability of the source to a primary standard If personnel monitoring will not be used, the should be provided. applicant should submit calculations or docu mentation from radiation surveys demonstrating d The step-by-step procedures, including that it is unlikely that any individual will associated radiation safety procedures, and receive a dose equal to or greater than that indicated in 10 CFR Part 20.
e The name and pertinent experience of each perstin who will perform the calibrations. The applicant should show that the need for bioassays has been thoroughly considered and If the applicant intends to contract out the should establish the adequacy of the proposed calibration of instruments, the name, address, bioassay program in relation to the proposed and license number of the firm should be speci program of use of radioactive material. Bio fied together with the frequency of calibration. assays are normally required when individuals The applicant should contact the firm that will work with miUicurie quantities of hydrogen-3, perform the calibrations to determine if infor iodine-125, or iodine-131 depending on the mation concerning calibration procedures has type of work, equipment, and procedures fol been filed with the Commission. If information lowed Regulatory Guide 8.20, "Applications of concerning calibration procedures has not been Bioassay for 1-125 and 1-131," and a document filed, it should be obtained and submitted. entitled "Guidelines for Bioassay Requirements for Tritium"- may be consulted. Other mate Quantitative measuring instruments used to rials may also be used in physical or chemical monitor the adequacy of containment and con forms and under conditions that present an tamination control such as those used for mea opportunity for uptake by the body through suring leak test, air, effluent, bioassay, work area, and equipment contamination samples ingestion, inhalation,, or absorption A bio
3hould usually be calibrated prior to each use. assay program to determine and control the The procedures and frequency for calibration uptake of radioaetive material should be con of such instruments should be submitted and sidered and discussed in relation to each such material, procedure, etc, Regulatory Guide should include: 8 9, "Acceptable Concepts Models. Equations, a The name of the manufacturer and model and Assumptions for a Bioassay Program."
may.
number of each of the standards to be used, he consulted.
b. The nuclide and quantity of radioactive The criteria tc be used in determining the material contained in each of the standard need for hiioassays, the type and frequency of bioassays that will be performed, and the sources, bio assay procedures should be specified and c A statement of the accuracy of each of the described in detail If a commercial bioassay standard sources. The source accuracy should service is u., be used, the name and address of be. as a minimum, +/-5 percent of the stated the firm should be provided.
value and traceable to a primary standard, such as that maintained by the National Bureau Bioassays may not be substituted for other of Standards. elements of a safety program such as air moni toring and dispersion control (hoods, glove d. Step-by-step calibration procedures and, boxes. etc ) and for well-thought-out and if appropriate, associated radiation safety pro well-executed handling procedures cedures, and T
Item 13 The facilities and equipment for e. The name and pertinent experience of each site of use should be described in detail.
each person who will perform the instrument The proposed facilities and equipment for each "calibrations operation to be conducted should be adequate to protect health and minimize danger to life Item 12 Personnel monitoring is required to and property In describing available fa. ilities ensure .- mplianee with §§20 101 and 20 202 of and equipment. the following should be 10 ('FR Part 20. Personnel monitoring is also included, as appropriate: required if a person enters a high radiation area (greater than 100 millirems per hour). If a Physical plant, laboratory. or working p'.sonnel monitoring equipment will be used, area facilities Fume hoods glove boxes, waste the ndine of the organization furnishing film receptacles, spenjal sinks, ventilation and con badge or thermoluminescent do.<'imeter (TLD) tainment systems. effluent filter systems, and service and the frequer , for changing badges, dosumeter.-, etc sh,uld be specified jA copy may be obtained by a written request Nuclear Regulatory to hte U S If pocket chambers ur pocket dosimeters will be C'.mmision. Office .)f Nuclear ?ateruidJ
Safety and Safeguaro, Div-tsaon of Fuel CycLe and Materi.la used. the useful range of the devi(e. in Safety. Washington ! 20555, A:'enton Director. office of Nuclear Material Saifet, ant Safeguards
arr permi.,sible The a,. hlc ju o,;it, .
hd , pnf O 1 7'.I i I I !;
' d t ý , -i hl' j~t . . o h n upon *h- radionu-Lide '
d Release into air or water in oncentrationf'
A drawing or sketch should be submitted in conformance with §20 106 of 10 ('FR Part 20
showing the location of all such equipment and Possible exposure to persons offsite Limits the the relationship of areas where radioactive amount that may be released materi:is will be handled to unrestricted areas where rad'ioactive materials will not be handled e Treatment or disposal by incineration in In those programs where radioactive material conformance with §20 305 of 10 CFR Part 20 may become airborne or may be included in air This must be specifically approved by the br-ne effluents, the drawing or -ketch should Commission also include a schematic description of the ven tilation system annotated to show airflow rates, f Other methods specifically approved by differential pressures, filt ration and other
'he Commission pursuant to §20.302 of 10 CFR
effluent treatment equipment and air and Part 20 effluent monitoring instruments Drawings or sketches should be drawn to a specified scale, Item 15 or dimensiLons should be included on each drawing or sketch. Each drawing or sketch a Survey Program. Commission regulations should be labeled to specify the location of the require that surveys be made to determine if facilitles and equipment depicted with respect radiation hazards exist in a facility in which to the address(es) given in Item 5 of Form radioactive materials are used or stored (see NRC-3131 §20.201 of 10 ('FR Part 20) A survey should include the evaluation of external exposure to F- C(ontainets, devices. protective clothing. personnel, concentrations of a-iruorne radio auxiliary shielding, general laboratory equip active material in the facility, and radioactive ment. a. r sampling equipment. etc . actually effluents from the facility Although a theoreti employed in the daily use of material Special cal calculation is often used to demonstrate provisions for shielding and containment to compliance with regulations regarding airborne minimize personnel exposure should be de or external radiation, it cannot always be used scribed Storage containers and facilities in Lieu of a physical survey should provide both shielding and security for materials Except for those cases where sources of radiation and radioactive material are well c The number. type. and length of remote known and accurately and precisely controlled, handling devices it will usually be necessary that a physical survey be made with appropriate detection and d If respiratory protective equipment will measurement instruments to determine the be used to limit the inhalation of airborne nature and extent of radiation and radioactive radioactive material, the provisions of §20.103 material or, as a minimum, confirm the results of 10 CFR Part 20 should be followed and of a theoretical determination appropriate information should be submitted A radiation protection program should include the following surveys for radioactive Item 14 The procedures for disposing of contamination and radiation.
byproduct material waste should be described Under NRC regulations, a licensee may dispose (I) In laboratory or plant areas (e g of waste in the following ways checking for contamination on bench tops, han dling and storage equipment, clothing, hands)
a Transfer to a person properly licensed to receive such waste in conformance with para (2) While work is being done with radiation graph 20.301(a) of 10 CFR Part 20 The name or radioactive materials (e.g , breathing zone of the firm (which should be contacted in air surveys, general air surveys, personnel Luncluding eyes and advance to determine any Limitations that the exposure measurements.
firm may ,iave on acceptance of waste) should extremities, checking shutters and "'ontain ment)
be given f, Release into a sanitary sewer in confor (3) in areas associated with disposal or mance With §20 303 of t0 CFR Part 20 release of radioactive materials (e g . checking Depending on water usage. releases rf up to I 'The NRC has proposed an amendment .*hat would delete curie per year are permitted $20 304 of 10 CFlt Part 20 (43 F'R Ssi77 December 4. 19i 8) If this amendent is adopted. all b,,ne.ls of radionuclides in accord~ance with 120 304 of 10 CFR Part 20 wil require NRC
c Buria, i" soil in contformance with §20 304 approval f 10 (-FR Part 20 Up to 12 hurials per year
10 7-4
disposal containers and disposal sites; liquid, Agency's Technical Report Ses gas, and solid effluents, filters and filter-duct No 120,
"Monitoring of Radioactive Contamination am systems) Surfaces. "'
The frequency of surveys will depend on b. Records Management Progrm. Provision the nature of the radioactive mrterials and for keeping and reviewing record of surveys;
their use. However, surveys should be per materials inventories; personnel exposures;
formed prior to the use of radioactive materials receipt, use, and disposal of materials, in order to establisl a baseline. The surveys etc.,
should be described. Persons responsible for should be repeated when radioactive materials keeping and reviewing records should be iden are present, when the quantity or type of tified.
material present changes, or when changes occur in their containment systems cr methods c Sealed-Source Leak-Test of use. Repetitive surveys may Procedures.
also be Sealed sources containing more than 100 micro necessary to control the location of radioactive curies of a beta or gamma emitter or more than materials in the handling system and in the 10 microcuries of an alpha emitter must be leak case of the use of sealed sources outside a tested at 6-month intervals. Leak testing of shielded container.
alpha-particle-emitting sources containing more For operations involving materials in gas, than 10 microcuries of an alpha emitter Is liquid, or finely divided forms, the required at 3-month intervals. If a commercial survey firm is to perform the leak tests, the program should be designed to monitor the name, adequacy of containment and control address, and license number of the firm of the should materials involved. "he program should be submitted If the tests are to be performed include using a commercial "kit," the nme of the kit air sampling, monitoring of effluents, and sur manufacturer or distributor and the kit moe veys to evaluate contamination of personnel, I facilities, and equipment designation should be given. If the applicant Physical effluent !measurements are essential to determine intends to perform his own leak tests without compli ance with Appendix B to 10 CFR Part 20. the use of a commercial kit, the following information should be submitted:
The description of an air sampling program should include the area where samples (1) Qualifications of personnel who will will be taken, the frequency of sampling, and the perform the leak test, location of the sampler with respect to workers' breathing zones Assays performed to evaluate (2) Procedures and materials to be used in air samples and the methods used to taking test samples, relate results to actual personnel exposures should also be described (3) The type, manufacturer's name, model number, and radiation detection and measure The effluent monitoring program ment characteristics of the instrument for to be releases to unrestricted areas should encom used for assay of test samples, pass all airborne and liquid radioactive material releases Theoretical evaluations should be (4) Instrument calibration procedures, supplemented by stack monitoring, water including calibration source characteristics.
sam pling, and other environmental monitoring make, and model number, and ap propriate for the planned and potential releases (5) The method, including a sample calcu lation, to be used to convert instrument read For operations involving only sealed ings to units of activity, e.g. . microcuries.
sources, a survey program should include evaluation and/or measurement of radiation levels for storage and use configurations. d. Instructions to Personnel.
When If a number of sources are used in devices having "on" individuals will use radioactive "off" positions, both positions and materials under should be eval the supervision of one or more of those persons uated at the tune of installation Supplemental named in Item 6 of Foim NRC-3131, written surveys should be performed following instructions should be prepared any and submitted changez. in operation, shielding, or use with the license application in the form in which they will be distributed to those working The types, methods, and frequency of with radioactive materials.
These instructions surveys should be described in the application should cover, but not necessarily .'*uidance may be obtained from the be limited to:
National Council on Radiation Protection Report (1) The availability. selection, No 1
0. and use of
"Radiological Monitoring Methods and Instru laboratory apparel and safety-related ment-s,' and the International Atomic Energy equip ment and devices (e g. , laboratory gloves, and remote pipetting coats,
'CopIes may be ob asnedi devices).
rrM NCRp P ublicaon, P o Box 4867 Washun 6Copies may be ohrain--
. D ( 20008 from "'IPUiB in. P 0
New .'jrx N"Y 0 Box 433,
'oei
10 7-5
(2) Limitations and conditions to be met in (12) The use of radioactive materials in handling liquid or uncontained (unencapsu animals. If radioactive materials will be used in
1asdioactive animals, instructions concerning such use lated, dispersible, or volatile)
be prepared and submitted with the materials and special laboratory equipment to should license application. Such instructions should be used in working with these types of mate rials. For example, the instructions should include (a) specification of the facilities to be explain when operations with materials should used to house the animals, (b) instructions to be confined to a radiochemical fume hood or be provided to animal caretakers for handling animals, animal wastes, and carcasses, (c)
glove box and should specify the use of appro priate shielding and remote handling equipment instructions to appropriate personnel for clean when energetic beta- or gamma-emitting mate ing and decontaminating animal cages, and (d) rials are to be used. methods to be used to ensure that animal rooms will be locked or otherwise secured unless
(3) The performance of radiation survey attended by authorized users of radioactive and monitoring procedures or each area in materials. A description of animal handling and housing facilities should be included uLnd'.
which radioactive materials are to be used.
Item 13 of Form NRC-3131.
(4) Safely precautions to be observed in the movement of radioactive materials between (13) Emergency procedures. These instruc tions should be addressed to all persons in aV.
buildings, rooms, and areas within rooms.
laboratory or facility areas where radioactive!
materials will be used and should cover actions :
(5) Safety requirements for storage of including labeling of to be taken in case of such accidents involving!
radioactive materials, radioactive materials as spills, fires, release or containers of radioactive materials and posting loss of material, or accidental contamination of and securing areas where radioactive materials these instructions personnel. Specifically, are to be stored. This should include the stor specify immediate actions to be should (a)
age of contaminated laboratory equipment such as glassware. taken in order to prevent or limit the contami nation of personnel and areas, e.g.. the shut ting down of ventilation equipment, evacuation
(6) Requirements for posting of areas in which radioactive materials are used. of contaminated and potentially contaminated i areas, containment of any spills of radioactive material, (b) give the telephone numbers of in
(7) The availability and use of personnel dividuals to be notified in case of emergency.
monitoring devices, including the recording of and (c) instruct personnel in proper entry, radiation exposures and the procedures to be decontamination, and recovery operations for I
followed for the processing of personnel moni contaminated facilities. (Note: Only properly toring devices such as thermoluminescent dosi trained individuals should attempt decontamina meters .and film badges in order to obtain per tion and recovery operations. )
sonnel monitoring results
(14) Requirements and procedures for pick
(8) Waste disposal procedures to be fol ing up, receiving, and opening packages (see lowed, including limitations on the disposal of §20.205 of 10 CFR Part 20).
liquid or other dispersible waste to the sani- tary sewer and proceaures for the LoUeLLLZI,
storage, and disposal of other wastes Items 16 and 17. A resume of the training and experience of each person who will directly
(9) The maintenance of appropriate rec supervise the use of material, who will use ords as required by 10 CFR Part 20 and material without supervision, or who will have
10 CFR Part 30. responsibilities for radiological safety should be submitted. The resumi should include the
(10) The requirements for and the method type (on-the-job or formal course work), loca of performing or having appropriate sealed tion, and duration of the training. Training source leak tests performed. should cover (a) principles and practices of radiation protection, (b) radioactivity measure
(11) Good radiation safety practices, in ments, standardization, and monitoring tech cluding the control of contamination, specifica niques and instruments, (c) mathematics and tion of acceptable removable and fixed contami calculations basic to the use and measurement nation levels tor both restricted and unre of radioactivity, and (d) biological effects of stricted areas, prohibition of smoking and the radiation. The description of the use of radio consumption of food or beverages in areas active materials should include the specific iso where radioactive materials may be used, and topes handled, the maximum quantities of mate prohibition of the frequent transfer of poten rials handled, where the experience was tially contaminated equipment between poten gained, the duration of experience, and the tially contaminated areas and unrestricted type of use The qualifications, training, and areas.
10 7-6
xiprrinr.* )4ýeach terson should be commensu
,I:- w~th J1, mnatriwl arnd its use only have a background or, forma! traming r, as proposed all areas described in T , 'TphPb-ation The amount and type of tern 16 of F<orm NRý
'a: ir'd 'xpe; ien(-' 3131 but should also h.ive -xten*,*ýn-- expe- with radiation and
,e a raaterial.: working with rad*oactrve, material an i r1aliu1red to support a a
,i('rrmIJ atin I ,f _ad-quauy by the Commission thorough working knowledge of the eqip
u. rmenrt
.'. ,,.r mar kru dly with (.,rtain factors required to handle the material safely
. - t -n:.ýh c h as technical assistants
:ir~i iab.--rit,;r- workers will use radioactive 5. AMENDMENTS TO IhJENSES
materials in the absenct: of persons specified
*."*', a. , specification of the Licensees are required to cor.duct 4heir pr.
training of such persc.rne! ',hould include grams in accordance with statements, (a) instruction in renrý.
I IAf , -, qs: fr 1. sentations. and procedures contained In"udinr, topics covered and in ýtie by whom taught hb) on-the-job training in use license application and su.:P)>rtive aocuments
,-If radlio,-tivt materials, and The license must therefore be amended (c) determination. if the of compeienciy to work without licensee plans to make any changes the presence of in faclt supervisory (ersOnnel ties, equipment (including. monitoring and sur vey instruments), procedures, personnel or
"The is' of mitrocurie quantities of a few byproduct material t(; Le used nonvolaile radioactive materials by a person with a minimum of training Applications for license amendments may and experience e under precisely specified and filed either on the applicatior form or roliled conditions subject to the carefully con form. The application. should identify kn ler!tr surveillance of 1o
-,Ompetent and adequately trained radiation license by number and should clearly de ;,.r t-.
protection officer may be justified. the exact nature of the charges, mum training and experience Such mini additions, c"r may consist of a deletions. References to previously e: hours of training and experience submitted information and documents should
,f crne or more radioactive materials in the use specific and should identify be clear and similar to the pertinent the use proposed in the -tpplication information by date, page. and under the paragraph sýupervision and tutorship of a Licensed user.
6. RENEWAL OF A LICENSE
Persons using millicuzri quantities of a num Oer of radionuclideq for general An application for renewal of laboratory a License should tracer work under unspecified be filed at least 30 days prior conditions to the expiration should have more extensive training date This will ensure that and expe the license does not rience and, depending on the expire until final action on the exact nature of application ha6 ih.. proposed program of use been taken by the NRC as of radionuclides, provided for in zay need to have completed formal paragraph :30 37(b) of i9 CFP
course work Part 30.
at !he college or university level covering the areas listed under Item i6 of Renewal applications .hould Form NRC-3131. Le filed on Form NRC-3131, appropriately The use of larger suppI-mented, and quantities of material should contain compjete (dpproaching a curie) under and up-to-date infor conditions where a mation about the applicant's potential exists for significant current program.
loss and inges uon. inhalation, or absorption In order to facilitate the review of the radio process, t+/-e a,-tive material by those working application for renewal should with rnal is normaUy done under carefuoly the mate without be submitte.j controlled reference to previously
- onditionrs using specialized documents and information submitted equipment. A If such referene-5 person whO is to use radioactive cannot be avoided, they materials inde shoild be clear -ad pendently unnde these conditions should hot specific and should identify the per'tnp-.*.n information by date, page, and paragraph.
10) 7-7
APPENDIX A Form NRC-31 3 (I) Form Apifroed by GAO
B- ll32S(1tOS79)
U.S. NUCLEAR REGULATORY 0O111611ON
iO CFR 30
INSTRUCTIONS FOR PREPARATION OF
APPLICATION FOR BYPRODUCT MATERIAL LICENSE
FORM NRC-313 (I)
GENERAL INFORMATION
An applbcant lot a "Byproduct Material (Radioisotopes) License." 3 Broad License (research and development)-"Laceingm Guie should complete Form NRC-313 (1) m detail and submit in duplicate for Type-A Licenses of Broad Scope for Resmarch and )evelop to the U.S Nuclear Regulatory Commission. The applicant should ment ,"
endeavor to cover his entire radmastope program with one application, if possible. However, separate applhcationk should be submitted for 4. Licensing Guides for the performance of well l g eperatsoaa.
gamma irradiators. Applicatmlos for medical uses should be submitted
^n Form NRC-313 (M) aad applications for use of scaled sources m S Licunrin guide to: the use of scaled sourcs in portable and stint radiography should be submitted on Form NRC-313R. Supplemental portable gauging devices' sheets may be appened when necessary to provide complete mfoi mation. Item 18 must be completed on all applicatsios. Submission The Comm!son charges fees for filing of appblcaloa for hveoaes as of an incomplete application will often result en a delay in issuen*u ,t/ specified in Section 170 12, Title 10 Code of Fedwal Regitleioma.
the license because of the correspondence necessary to obtain inhr Part 170. The applicant should refer to Section 170.31, Scaleduh. uf rnrionrequested on the applicatron fees Ior materialsIlc'n srs. to determine what fee should accompany the application No action can be taken on applications until fees are NOTE When the application incldde: one oi the special sises listed paid. ('hecks or money orders should be made payable to the U.S.
below the applicant should request tihe appropruate pamphlet wlhch Nuclear Regulatory ( ommassion.
provides additionul instructions rwo ,opr," of the ,ompleted Irorm NR(-313 (e) and two copies of I Industrial Radiography "'LIcensitng Requirements for Industrial ea.h atticlimeni thlicc-o should he eCnito the Division of I rael Cycle Radiography'" (use. application I orm NRC'-31 3R for Radi mnd i*iterial Silely. Ottice of Nuclear Material Safety and Safeguards.
ography). IS Ni.lcat Regpilatury Commilsion Washington. DC 20555 One sopy liukiu bc retained for the appliLant's file Applications may
2 Laboratory and Industrial Uses i Small Quantitis-"G(uidc for Ji.s be hited in person at the Comnitssion's office at 1717 H Street.
Preparation ol Applications for Liboratory and Industrial N %,. Wishington. D C or at 7915 1 astern Avenue. Silver Spring.
Uses of Small Quantities of Bypr-rduLt Material." M*r5 land EXPLANATION OF FORM NRC-313 (1)
I-orm NR('-313 fl) is desgned for use in supplying information Thc actual s*ies of use should be listed as indicated. Per on program, nt varying complesty fhc applicant should provide tijnent A[A ilihlie such as field oflfis lot portable gauges or complete information on his proposed program or the possession devicei should be identified in Item S by Street. Address.
and use of licensed material I or those items that do not apply. indicati.
City and Stait Temporar, field locations of use should As N.A (not appli.able)
be specified as "'temporary job sites of the pplicani" and list the States throughout which the tempora i job sites will Item No he h1,laed Attach additional properli, keyed sheet if miort spas is needed I Sell -exphndlory The -applicant'" i Ilhe organil.ation ii person legall ivc, 6 Sell \'eplanatory ponibk for possession and ue of the licensed materials specified in the application
7 rhc "Radiation Protection Officer' is the nanied uilividual sho is expected to coordinatc the safe use of the licensed
3 Sell-explanatory materi~al spekilied in the application and who will ensure srmphanme w!lh the applicable parts of Title 10. ('ode of
4 SelU-tiplanalory I cderal Regulations I0 7-9
A List by name Ca,1iraditisotope it, he pose-r*ned and ised Attach .red~bonsa pi.perl% keyed sh-,.tsit 11 a '
under the license 1, ample needed
1I Stale tile u itf cacti II, cnsed material hlated in 9 V 8..
B and D
l) lodtne-I31 (l) Iodide t21 lodassc-
- t
12) lodinated Humani Scruti Albunpin I* etcript1ion ti
.Urct*
c tllcmtainre* an*d/or device% in ,vJjjh sealed e in Iltem h will be stored or uted. I %ample listd i
13) Krypton-85 13) (.as
141 Cesium-I 7 (4l Sealed SouC1.
A
II I 1 Source housing Io Curp D)
0I) Nof Appliuable 41) 10 mihd:icurie..
(2) N A I aillicurnic Model 1-278 I,) (2)
N A I inillIhuric I4) (4) 2 sou*icul ISO 10 18 SeIf-.xplanatory (I at those items that do not apply Model Z-78 mitlit. tolne Cacti indicate a* N A (not applicable)
PRIVACY ACT STATEMENT
Pursuant to 5 U S.( 55 2af*l(3). 'niacted into law by set,.lon 3 of the I'IVaLvy Act of 1974 (Public: Law 93-579). the Iollowing .-titcileti IS furrnishcd to rndividual% who surply information to the Nuclear Regulatory Commis*ion on I orms NRC-313M, NR(-3 13A, NR(-3131 or NR(_'- 313R I his mformalion is mainiained in a system of re!eoid designated as NRC-3 and descrihed at 40 1 ederal Register 45 114 (Otlober I. 1975) I AUTHORITY SIio n,81 and 1614b) of the Atomic Inerpy Act of 1954. a, amended (42 U.S.( 2111 and 2201ib(1 2 PRINCIPAL PURPOSI"S) The informatmon is e:valuated It, the HKC staif pursuant to the ritleria set forth in 10 ( I R Parts 30-36 to determine whether the application meet, the requircmenti of the Atomic I nergy Act uo 1954. as amctindsd. ap the C('ommisoon's rclgulsaions. lot the issuanice of a byproduct maleril license or amendment thereof 3 ROUTINF tjSI S "he informawn itay be:used (0; to provide reuord& to State heaithk c.kpirtmeusi fop the intormpaipanand useand 4h)to provide intformation t4 I ederal. Stiart. and k),.al heafth officials and other p*;rsons in the event of incident of xposutic por thiir trifortnatilon, mvemiwzliarn.
ind protection (it the publitc health and safety The nfotinalicn ma, dlv) be ditslotd to approptiate I .Jeral. Stile and local ait.ticies in the event that the information indicale* a vio~Ltioon of ptenlti viol*iAt of law and in the course of in ad"ministrative o luli cuialproceeding In Addition. this inlormation ri ay be transfeared to An approprate IFederal. State. or kical agency to i'c esxhint relevant and neest*,.ry f>r a NR(
dn, ison or to an appropriate I ederal agnev to the .xtent relevant and ne lot that afenty'%dcJtioun about sou
,LcesAfy A npli tit the hin"sc issued will routinely he placed in the NRC's Puhlic Doument Room. 1717 H Street. N W, Washington. DA
4 WHI T1,11II DIStLOSLRI. IS MANDATORY OR VOLUNTARY AND. III FCT ON INDIVIDUAL 01 NOT PROVIDIN(; INI.ORMA rION
Dit..losurc of the requested infrrmnation is voluntary It the request information is not furnished. hno*,w.vr. ti apptiation " horiI, producl mat 'rial lhcense or 3mendmenl thereof, will not he proceied
5 SYSTIM MANAGFRISI ANI) ADDRI SS Dir."tor Division ti I ucl (Clee .aid Matarial Sat*t*. Ofti, ol Nu, tear Material Saetly a4ad S.afeguidf,.
ki S Nuclear Regulallory ( ommission. Washington. D ( 2055
10 7-10
FORM NRC-313 I -U.S. NUCLEAR REGULATORY COMMUON 1. APPLICATION FOR:
(1-79)
(Chec* and/or conYiDe a opeteJ
10 CFH 30
APPLICATION FOR BYPRODUCT MATERIAL LICENSE
INDUSTRIAL
a. NEW LICENSE
See erached 'nsrucrt,os for details b. AMENDMENT TO.
L ICEiNSE NUUMBE
n'fli)leted .p* is-i,,tins are tlile' in d(i/* otre with the Division of FIuel C'*rle and Material Safetr,.
Offit r I'f Nit, lear Material Safetv. o.in Safeguards U.S. Noclear Regulatory Commisusion.
Washington. DC 20555 or app/i,.*i5 'nay he, fed in person at the Comnrnision's office at c RENEWAL OFF
I77 H Strepr NýW. Washinqtol/ 0 ,'" or 7915 Fastern Avenue. Silver Sprinq. Marylayri.
2. APPLICANT'S NAME (institution. firm, person, etc.)
3. NAME OF PERSON TO B
E. CONTACT
ED REGARDING THIS
APPLICATION
TELEFPHONE NUMBER AREA CODE - NUMBER EXTE.NSION. LEPNONE NUMBER AREA CODE -- FJUMBER EXTENSION
4APPLICANT'S MAILING ADDRESS (Include Zip Code)B STREET ADDRESS WHERE LICENSED MATERIAL WILL BE USED
fIncludeO EECode)
(IIF MORE SPACE IS NEEDED FOR ANY ITEM. USE ADDITIONAL PROPERI y V'lVV% bAfICC
6. INDIVIDUAL(S) WHO WILL USE OR DIRECTLY SUPERVISE THE USE OF LICENSED MATERIAL
(See Items 16 and 77 for required Frainingand experience of ech indjividul n4,,d be low)
FULL NAME TITLE
Ib C.
7. RADIATION PROTECTION OFFICER I Attach e resume of person's trainingend exper.ence a outline if items I 16 and 17 and describe his responsib*t*tievs under Item 15.
_____S. LICENSED MATERIAL I L ELEMENT CHEMICAL NAME OF MANUFACTURER MAXIMUM
I N NIRAND , MILLICURIES AJ4DOMMEALED
N MASS NUMBER PHYSICAL FORM MODEL NUMBER SOURCES AND MAXIMUM ACTI.
(if Sealed Source) VITY PER SOURCE WHICH WILL
NO. A CO BE POUSESSED AT ANY ONE TVME I
UC 0
_ -4
!(31 DESCRIBE USE OF LICENSED MATERIAL (21 I 17
_33 F*IMNRC 313 i 1 -791---
_ ____
10.7-11
9. STORAGE OF SEALED SOURCES
SCOftTAINtSR AND/OR DEVICE IN WHICH EACH SEALED NAME OF MANUFACTURER MODEL NUMefifR
It SOURCE WILL BE STORIED OR USED I A. B. C.
12) (3) (4)
10. RADIATION DETECTION INSTRUMENTS
- TYPE MANUFACTURER'S MODEL NUMffR RADIATION SENSITIVITY L OF NAME NUMIBR AVAILABLE DETECTED RANGE M INmsTRMmNT (alpha.beta. (fnbllfoenr.mrno/hour S gamma. neurron) or counts/mmnure)
A C D E F
121 (31
11. CALIBRATION OF INSTRUMENTS LISTED IN ITEM 10
0E. CALINRATDO NY SERVICE COMPANY [0b. CALIBRATED BY APPLICANT
NAME. ADORESS. AND FREQUENCY Attach a Speorate sheet describing method, frequency Mnd staMdards used for caibratinginhtrumwen.
12. PERSONNEL MONITORING DEVICES
TYPE SLPPLIER EXCHANGE FREOUENCY
fCheft* and/of cran)te as ^wP(OP-o- (Seiwce Company) C
C
A,
0111 FIL*ISADIGE 0 MONTHLY D12) THERMILUVMINESCENCE
0 QUARTERLY
DO1308ITTER (TLD0
D OTHER (Specdy)
S0011 OTHiER (Sw,_y)
13. FACMILTtMS AND EQUIPMENT (Check were appropriate and attch annotated sketch(es) and description(s).
dMany). ETC
0 a LABORATORY FACILITIES. PLANT FACILITIES, FUME HOODS (Include foltreon, CONTAINERS. SPECIAL SHIELDING (fixed and/lor teorpoarry), ETC
D bý STORAGE FACILITIES
0 c REMOTE HANDLING TOOLS OR EQUIPMENT. ETC
0l d RESPIRATORY PROTECTIVE EQ4JIPMENT. ETC
1q. v1 PaiLr.IK . ,GMl_
Na
--. OF CONMERCIAL WAST6 DISPOSAL SERVICE EMPLOYED
A DETAILED DESCRIPTION OF METHODS WHICH WILL
b tF COMMtRCIAL WASTE DISPOSAL SERVICE IS NOT EMPLOYED. SUBMIT
OF THE TYPE AND AMOUNT OF ACTIVITY INVOLVED IF
"85 US6D FOR D46POSING OF RADIOACTIVE WASTES AND ESTIMATES
BE RETURNED TO THE MANUFACTURER. SO STATE.
TE APPLICAlION IS FOR SEALED SOURCES AND DEVICES AND THEY WILL FO"M NOC 313 0 1-794
10.7-12
INFORMATION REOUIRED FOR ITEMS 15, 16 AND 17 Describe in detail the information required for Items 15, 16 and 17. Begin each item on a separate page and key to the application as follows:
15. RADIATION PROTECTION PROGRAM. Describe the radiation protection program as appropriate for the material to be used including the duties and responsibilities of the Radiation Protection Officer, control measures, bioassay procedures fit needed), day-to-day general safety instruction to be followed.
etc If the application is for sealed source's also submit leak testing procedures, or if leak testing will be performed using a leak test ki0, specify manufacturer and model number of the leak test kit.
16. FORMAL TRAINING IN RADIATION SAFETY. Attach a resume for each individual named in Items 6 and 7 Describe individual's formal training in the following areas where appliable. Indude the name of person or institution providing the training, duration of training, when training was received, etc a. Principles and practices of radiation protection.
b Radioactivity measurement standardization and monitoring techniques and instruments.
c. Mathematics and calculations basic to the use and measurement of radioactivity d Biological effects of radiation.
17. EXPERIENCE. Attach a resume for each individual named in Items 6 and 7. Describe individual's work experience with radiation, including where experience was obtained. Work experience or on the-job training should be commensurate with the proposed use. Include list of radioisotopes and maximum activity of each used.
1
8. CERTIFICATE
(This trem must be completed try appiicant)
Th e .ippl* canr and any official exocurJng this Ofril',cate on behalf ot the applicant named in /rem 2, certify that this application is prepared in confotmitry with Title 10, Code of Federal Regulations Parr 30I and that all 'nformation contained herein including any suPplements atrtached hereto is true and correct ro the best of our knowleade and belief.
WARNING 18 U.S.C Section 1001, Act of June 25. 1948; 62 Stai 749; makes it a crimnal offense to nmke a willtully taiae stltemt or repreentation to any department or agency of the United States as to any matter within its ourisdiction.
LII. FNSE FEE REQUIRED
(See Secton 170.3? 10 CFR j0 ERTIFYING OFiCiAL
c. NAME (Type or print)
11 LICENSE FEE CATEGORY d TITLE
12; LICENSE FEE eNC.:LOSED $ e DATE F0RM NRC-313 1 11 791
10 7-13
_1..
. UN TED STATES
0 NUCLEAR REGULATORY COMMISSION
WASHINGTON, D. C. 20555 July 1984
[[kRATA
REGULATORY GUIDE 10.7, Revision 1 GUIDE FOR THE PREPARATION OF APPLICATIONS
FOR
LICENSES FOR LABORATORY AND INDUSTRIAL USE
OF SMALL
QUANTITIES OF BYPRODUCT MATERIAL
Regulatory Guide 10.7, Revision 1, provides directions for using Form NRC-313I
in preparing applications for licenses for laboratory and industrial use of small quantities of byproduct material.
The NRC is now using a new NRC Form
313 for all byproduct material applications Form NRC-313I. and is discontinuing the use of The NRC is developing Revision 2 of Regulatory conform to the new NRC Form 313. Guide 10.7 to Until Revision 2 is issued, this errata sheet provides the information needed to use the new NRC Form 313.
The new NRC Form 313 does not have space for providing the information requested in Items 5 through 11. Please provide the information on 8-1/2 x
11 inch paper.
In the left-hand column of the following table are listed items of the old Form NRC-3131, most of which are also called out in Regulatory Guide 10.7, Revision 1. The right-hand column identifies the corresponding item of the new NRC Form 313 in which responses should be made.
Guide and Old Form NRC-3131 New NRC Form 313 Item 1* Item Item 1
2 Item Item 2
3 Item Item 4
4 Item Item 2
5 Item Item 3
6 Item Item 8
7 Item 8 Item 7 Items 5 and 6 Item 9 Item 10 Item 9 Item 11 Item 10
Item 10
itei 12 Iter; 10 Item 13 Item 9 Item 14 Item 11 Item 15 Item 10 Item 16 Items 7 and 8 Item 17 Item 7 Item 18* Items 12 and 13
- Not called out in Regulatory Guide 10.7, Revision 1.
The following cross-reference table may be helpful to you: New NRC Form 313 Old Form NRC-3131 Item 1 Item 1 Item 2 Items 2 and 4 Item 3 Item 5 Item 4 Item 3 Item 5 Items 8A, B, C, and D Item 6 Item 8E Item 7 Items 7, 16, and 17 Item 8 Items 6 and 16 Item 9 Items 9 and 13 Item 10 Items 10, 11, 12, and 15 Item 11 Item 14 Item 12 Items 18a(1) and (2) Item 13 Items 18b, c, d, and e ,,L_ Item 14 N/A
2
NRC 'OPV 313
8' 32 33 34 US. NUCLEAR REGULATORY COMMISSION
APPROVED BY OM8
3150-0120
... APPLICATION FOR MATERIAL LICENSE Elxpir,. 5-31-87 NSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR
COMPLETING APPLICATION SEND TWO COPIES
)' 'HE ENTIRE COMPLETED APPLICATION TO THE NRC
OFFICE SPECIFIED BELOW.
FEDERAL AGENCIES FILE APPLICATIONS WITH
IF YOU ARE LOCATED IN:
"I S NUCLEAR REGULATOR Y COMMISSION
ILLINOIS, INDIANA, IOWA. MICHIGAN, MINNESOTA, MISSOURI
3)IVISION OF FLEL CYCLE AND MATERIAL SAFETY. NMSS OHIO, OR
WISCONSIN. SEND APPLICATIONS TO
WASHINGTON DC 20555 U S. NUCLEAR REGULATORY COMMISSION, REGION III
ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS,
IF YOU ARE MATERIALS LEIUCENSTNG
LOCATED IN SECTION
799 ROOSEVELT ROAD
CONNECTICUT. DELAWARE, DISTRICT OF COLUMBIA, MAINE, MARYLAND, GLEN ELLYN. IL 60137 MASSACHUSETTS, NEW JERSEY, NEW YORK, PENNSYLVANIA,
On VERMONT. SEND APPLICATIONS TO, RHODE ISLAND. ARKANSAS, COLORADO, IDAHO, KANSAS, LOUISIANA, MONTANA,
NEW MEXICO, NORTH DAKOTA, OKLAHOMA, SOUTH DAKOTA, NEBRASKA
TEXAS, UTAH,
S NUCLEAR REGULATORY COMMISSION. REGION I
NUCLEAR MATERIAL SECTION B OR WYOMING, SEND APPLICATIONS TO:
63! PARK AVENUE U.S. NUCLEAR REGULATORY COMMISSION. REGION IV
KING OF PRUSSIA. PA 19406 MATERIAL RADIATION PROTECTION SECTION
611 RYAN PLAZA DRIVE. SUITE 1000
ALARAMA FLORIDA GEORGIA KENTUCKY, MISSISSIPPI, NORTH CAROLINA, ARLINGTON, TX 76011 PUERTO RICO, SOUTH CAROLINA, TENNESSEE, VIRGINIA, VIRGIN
WEST VIRGINIA. SEND APPLICATIONS TO: ISLANDS. OR ALASKA, ARIZONA, CALIFORNIA, HAWAII, NEVADA, OREGON,
AND U.S. TERRITORIES AND POSSESSIONS IN THE PACIFIC, SEND WASHINGTON,
APPLICATIONS
'J.S NUCLEAR REGULATORY COMMISSION, REGION
II
TO:
MATERIAL RADIATION PROTECTION SECTION
'I MARIETTA STREET, SUITE 2900 U.S NUCLEAR REGULATORY COMMISSION, REGION V
MATERIAL RADIATION PROTECTION SECTION
ATLANTA. CA 30323
1450 MARIA LANE. SUITE 210
WALNUT CREEK, CA 94596 PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS
TO THE U.S. NUCLEAR REGULATORY COMMISSION ONLY IF THEY
WISH TO POSSESS AND USE LICENSED MATERIAL
IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION
JURISDICTION.
I THIS IS AN APPLICATION FOR [Chock o'opritare itEm)
2. NAME AND MAILING ADDRESS OF APPLICANT (Includ.Zip Code)
A NEW LICENSE
B AMENDMENT TO LICENSE NUMBE9
? AJDRESSiES! WHERE LICENSED MATERIAL WILL
BE USED OR POSSESSED.
4 NAME OF PERSON TO B
E. CONTACT
ED ABOUT THIS APPLICATION
TELEPHONE NUMBER
SUBMIT ITEMS 5 THROUGH II ON EN , 11 PAPER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED
IS DESCRIBED IN THE LICENSE APPLICATION GUIDE
E RADIOACTIVE MATERIAL
Er'iinlband 5 nunibr aort. b Ihencal]
tft andlor OnyIsciI and c. mano'" ionn 6. PURPOSEIS) FOR WHICH LICENSED MATEPIAL WILL
,.rlcn wi,' be oo$$s~sec at any onn tinie BE USED
'NDIVIDUALiSi RESPONSIBLE FOR RADIATION SAFETY
TRA 'ýING AND EXPER:ENCE PROGRAM AND THEIR
8. TRAINING FOR INDIVIDUALS WORKING IN OR FREOUENTING
RESTRICTED AREAS
ACILITIES AND EQUIPMENT 10. RADIATION SAFETY PROGRAM
WASTE MANAGEMENT 12 LICENSEE FEES (Saw ro CFR I70nd S*eefon 170.31)
WAMOUNT
FEE CATEGORY ENCLOSED $
C'ERTIFICATU0N !AMiistbecornolotedbyaDphcandJ THE APPLICANT UNDERSTANDS
THAT ALL STATEMENTS AND REPRESENTATIONS
MADE IN THIS APPLICATION ARE
Hl -ING .PO., Tn5 APPLICANT
"-.E APPLICANT AND ANY OFFICIAL EXECUTING THIS
cRyFPARLD :N CONFORMITY WITH TITLE CERTIFICATION ON BEHALF OF THE APPLICANT NAMED
I0. CODE OF FEDERAL REGULATIONS, PARTS 30,32, 33,34,35. AND 40 AND IN ITEM 2, CERTIFY THAT THIS APPLICATION IS
THAT ALL INFORMATION CONTAINED HEREIN
'S'RI E AND CORRECT TO THE BEST OF THEIR KNOWLEDGE
AND BELIEF
PIARNING I6 ý -C SECTION I001 ACT OF JUNE 25 1948.62 STAT 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY
T-AY DEPARTMENT OR AGENCY OF THE UNITED STATES FALSE STATEMENT OR REPRESENTATION
AS TO ANY MATTER WITHIN ITS JURISDICTION
.',R*J-'EH*T ... I.%GO:CSR TYPEDIPRNTEO NAME IIL DT
$SOO.
-,-I * TMIO
8NUMBER OF EMPLOYEES (Totalio d WOULD YOU BE WILLING TO FURNIH COST
$ ~ ittrn aciityPx~iJ~nECJttdfCflt*Ct,,)
ON THE ECONOMIC IMPACT OP CURRENT NRC REGULATIONS
INFORMATION ('Jolls, anditeho,,
OR ANY FUTURE
I 251K -500K S'5V35 7M PROPOSED NRC REGULATIONS THAT MAY AFFECT
it t0O1eCitip,~lCn YDU? (NRC iwecilationn,'pi.n4 nena o iera~r~i,,.,ion.i, e-r,Ihld to
: 5520K - 50K s7m - 1M c NUMBER OF BEDS th poyin contidenlcs)
S-50K V>NO
V,..A J YES
FOR NRC USE ONLY
3 i 'SE LOG 0P5 FEE CATEGORY COMMENTS APPROVED By
2
4.', " . ECE .'C CHECK NUMBER
DATE
;'v"""*ACT S
A
S AT. T
Y>TIE'T 0O4 THE E REVERSE
REV
PRIVACY ACT STATEMENT Pjrsuant to 5 U.S.C. 552a(e)(3), enacted into law by section 3 of the Privacy Act of 1974 JPublic Law 93-579), the follow
!ng statement is furnished to individuals who supply information to the Nuclear Regulatory Commission on NRC
Form
313. This information ;s maintained in a system of records designated as NRC-3 and described at 40 Federal Register
45334 (October 1, 19751.
1 AUTHORITY: Sections 81 and 161(b) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2111 and 2201 (bll 2 PRINCIPA
L. PURPOSE
(S): The information is evaluated by the NRC staff pursuant to the criteria set forth ;n 10
CFR Parts 30, 32, 33, 34, 35 and 40 to determine whether the application meets the requirements of the Atomic Energy Act of 1954, as amended, and the Commission's regulations, for the issuance of a radioactive material license or amendment thereof.
3. ROUTINE USES: The information may be (a) provided to State health departments for their information and use, and (b) provided to Federal, State, and local health officials and other persons in the event of incident or exposure, for their information, investigation, and protection of the public health and safety. The information may also be d1,s closed to appropriate Federal, State, and local agencies in the event that the information indicates a violation or potent:ai vwo'at~on of iaw and !n the course of an administrative or judicial proceeding. In addition, this information may be trans ferred to an appropriate Federal, State, or local agency to the extent relevant and necessary for an NRC decision or to an appropriate Federal agency to the extent relevant and necessary for that agency's decision about you.
4ý WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVID
ING INFORMATION: Disclosure of the requested information is voluntary. If the requested information is not furn ished, however, the application for radioactive material lik.ense, or amendment thereof, will not be processed. A request that :nformation be held from public inspection must be in accordance with the provisions of 10 CFR 2.790. Withhold ing from public inspection shall not affect the right, if any, of persons properly and directly concerned need to inspect the document.
5. SYSTEM MANAGER(S) AND ADDRESS: U.S. Nuclear Regulatory Commission Director, Division of Fuel Cycle and Material Safety L
Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555 NRC FORM 313
I NRC
US NUCLEAR REGULATORY COMMISSION
84 APPROVED BY OD4E
C F 1,4"3, ý 1 3150-0120
APPLICATION FOR MATERIAL LICENSE E-pis 55-31.87 NSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING
APPLICATION SEND TWO COPIES
)l THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED
BELOW.
[
"FEDERALAGENCIES FILE APPLICATIONS WITH
- S NUCLEAR REGULATORY COMMISSION
ilVISION O FUEL CYCLE AND MATERIAL SAFETY. NMSS
WNASHINGTON. DC 20555 IF YOU ARE LOCATED IN
ILLINOIS, INDIANA, IOWA, MICHIGAN. MINNESOTA. MISSOURI, OHIO. OR
WISCONSIN. SEND APPLICATIONS TO:
U S. NUCLEAR REGULATORY COMMISSION. REGION III
ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS. IF YOU ARE MATERIALS LICENSING SECTION
LOCATED IN 799 ROOSEVELT ROAD
CONNECTICUT. DELAWARE. DISTRICT Ol- COLUMBIA. MAINE. MARYLAND. GLEN ELLYN. IL 60137 MASSACHUSETTS, NEW JERSEY NEW YORK. PENNSYLVANIA, RHODE ISLAND,
OPRVERMONT. SEND APPLICATIONS TO. ARKANSAS COLORADO, IDAHO, KANSAS. LOUISIANA, MONTANA, NEBRASKA,
NEW MEXICOO,NORTH DAKOTA, OKLAHOMA, SOUTH DAKOTA. TEXAS, UTAH.
OR WYOMING. SEND APPLICATIONS TO:
S NUCLEAR REGULATORY
NUCLEAR MATERIAL SECTIONCOMMISSION. B
REGION IO
U.S. NUCLEAR REGULATORY COMMISSION, REGION IV
631 PARK AVENUE
KING OF PRUSSIA. PA 19406 MATERIAL RADIATION PROTECTION SECTION
611 RYAN PLAZA DRIVE, SUITE 1000
ALABAMA. FLORIDA, GEORGIA. KENTUCKY. MISSI.SIPPI, NORTH CAROLINA, ARLINGTON.TX 76011 PUERTO RICO, SOUTH CAROLINA. TENNESSEE, VIRGINIA, VIRGIN ISLANDS,
OR ALASKA, ARIZONA, CALIFORNIA, HAWAII, NEVADA. OREGON, WASHINGTON.
WEST VIRGINIA. SEND APPLICATIONS TO
AND U.S. TERRITORIES AND POSSESSIONS IN THE PACIFIC, SEND APPLICATIONS
'J S NUCLEAR REGULATORY COMMISSION. REGION II TO:
MATERIAL RADIATION PROTECTION SECTION
',71 MARIETTA STREET. SUITE 2900 U.S. NUCLEAR REGULATORY COMMISSION REGION V
MATERIAL RADIATION PROTECTION SECTION
ATLANTA GA 30323
1450MARIA LANE, SUITE 210
WALNUT CREEK. CA 94596 PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE
U.& NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS
AND USE LICENSED MATERIAL
IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION JURISOICTION.
THIS IS AN APPLICATION FOR lChoek aWmpriste it")
2. NAME AND MAILING ADDRESS OF APPLICANT (OncludeeZ Code)
A NEWLICENSE
8 AMENDMENT TO LICENSE NUMBER_
C RENEWAL OF LICENSE NUMBER
A--A)DRESSIES! WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED
4 NAME OF PERSON TO B
E. CONTACT
ED ABOUT THIS APPLICATION
J TELEPHONE NUMBER
SUBMIT ITEMS S THROUGH 1 I ON E'i 11 - PAPER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED
IN THE LICENSE APPLICATION GUIDE
5 RADIOACTIVE MATERIAL
a E emeni and mass 'iunibet" b cýhen,cal end/or physlcls for,. end c.
n*,binusn 60.mn 6 PURPOSEIS) FOR WHICH LICENSED MATERIAL WILL BE USED
ýt,' -C 11b5, Qosssed at anv one ti-e NIDIVNIUAL(S, RESPONSIBLE
FOR RADIATION SAFETY PROGRAM
TRA,.,ING AND EXPERIENCE AND THEIR
8 TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS
SACITIES AND EQUIPMENT
10 RADIATION SAFETY PROGRAM
" W
WASTE MANAGEMENT
N12.
LICENSEE FEES (See I0CFR 170andSection 170.31/
iAMOUNT
FEE CATEGORY jENCLOSED $
""ErTIF'CATION (Must beomo/eredby*Phl/cAntJ THE APPLICANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENTATIONS
MADE IN THIS APPLICATION ARE
8,,'E NGNUPON T.IE APPLICANT
"iE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION
PRFPAIIED ;N CONFORMITY WITH TITLE 10, CODE OF FEDERAL
ON BEHALF OF THE APPLICANT NAMED IN ITEM
2. CERTIFY THAT
THIS APPLICATION IS
REGULATIONS, PARTS 30.32 33. 34 35. AND 40 AND THAT ALL
ýS TOIJE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND INFORMATION CONTAINED HEREIN
BELIEF
.ARNINC. IS, U SC SECTION 1001 ACT OF JUNE 25. 1948, 62 STAT
749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE
Tr A%' ULEPARTMENT OR AGENCY OF THE UNITED STATES AS STATEMENT OR REPRESENTATIO.N
TO ANY MATTER WITHIN ITS JURISDICTION
.i" i E.(*T' 'NTI OFFICER I TYPED/PRINTED NAME ITITLE DATE
P 14 V UNTAAY ECONOMIC DATA
N'..
R Pb NUMBER OF EMPLOYEES (Tote/i'1o, d WOULD YOU BE WILLING TO FURNISH COST INFORMATION
SIM I SM ... fre r(JOI8e,.doCImffh., ,
. ON THE ECONOMIC IMPACT OF CURRENT NRC REGULATIONS 5 OR ANY FUTURE
25271K S35kEV7M PROPOSED NRC REGULATIONS THAT MAY AFFECT YOU' (NRC mru1/tionsjDenrmt It to Dfrorect coifdent"e1 Commn'itl or finncil-Drorietli/--,iiOrmet~on furniShod to S5OOK /501K M 1DM NUMBER OF BEDS c
5j 'ýOK IV -ISIOM
E
FOR NRC USE ONLY
' p I(F (FE LOG FEE CATEGORY COMMENTS APPROVED BY
AV. ".-FCEiTE TO CHECK =NUMBER
A'ý S TMENT Ory THE REVERSE
PRIVACY ACT STATEMENT
Privacy Act of 1974 (Public Law 93-579), the follow Pursuant to 5 U.S.C. 552a(e)(3). enacted into law by section 3 of the to the Nuclear Regulatory Commission on NRC Form
,g statement is furnished to individuals who supply information as NRC 3 and described at 40 Federal Register 45334 313. This information is maintained in a system of records designated (October 1, 1975).
Act of 1954, as amended (42 U.S.C. 2111 and 2201(b)).
1, AUTHORITY: Sections 81 and 161(b) of the Atomic Energy CFR
by the NRC staff pursuant to the criteria set forth in 10
2. PRINCIPA
L. PURPOSE
(S): The information is evaluated of the Atomic Energy Act of the application meets the requirements Parts 30, 32, 33, 34, 35 and 40 to determine whether material license or amendment for the issuance of a radioactive
1954, as amended, and the Commission's regulations, thereof, information and use;
(a) provided to State health departments for their
3. ROUTINE USES: The information may be of incident or exposure, and other persons in the event and (b) provided to Federal, State, and local health officials The iformation may also be dis of the public health and safety.
for their information, investigation, and protection irdicates a violation or potential in the event that the information closed to appropriate Federal, State, and local agencies this information may be trans or judicial proceeding. in addition, violation of law and in the course of an administrative necessary for an NRC decision or to to the extent relevant and ferred to an appropriate Federal, State, or local agency about you.
and necessary for that agency's decision an appropriate Federal agency to the extent relevant NOT PROVID
VOLUNTARY AND EFFECT ON INDIVIDUAL OF
4. WHETHER DISCLOSURE IS MANDATORY OR the requested information is not furn information is voluntary. If ING INFORMATION: Disclosure of the requested will not be processed. A request material license, or amendment thereof, ished, however, the application for radioactive the provisions of 10 CFR 2,790. Withhold must be in accordance with that information be held from public inspection and directly concerned need to inspect if any, of persons properly ing from public inspection shall not affect the right, the document.
U.S. Nuclear Regulatory Commission
5. SYSTEM MANAGER(S) AND ADDRESS:
Director, Division of Fuel Cycle and Material Safety Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555 NRC FORM 313
NRBC *'*RM 313 US NUCLEAR REGULATORY COMMISSION
'84C-I 3C 32 33 34 APPROVED BY Om B
... 0APPLICATION I FOROR MATERIAL
M31M0-0120 LICENSE E .... 5-31-87 NSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS
FOR COMPLETING APPLICATION SEND TWO COPIES
)I THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW.
FEDERAL AGENCIES FILE APPLICATIONS WITH
IF YOU ARE LOCATED IN
NS U'CLEAR REGULATORY COMMISSION ILLINOIS. INDIANA. IOWA, MICHIGAN, MINNESOTA. MISSOURI. OHIO, OR
'JIVISION OF FUEL CYCLE AND MATERIAL SAFETY. NMSS
WISCONSIN, SEND APPLICATIONS TO
WASHINGTC!q. DC 20555 ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS. IF YOU ARE U S. NUCLEAR REGULATORY COMMISSION. REGION III
MATERIALS LICENSING SECTION
LOCATED IN
799 ROOSEVELT ROAD
GLEN ELLYN, IL 60137 CONNECTICUT. DELAWARE, DISTRICT OF COLUMBIA, MAINE. MARYLAND,
MASSACHUSETTS. NEW JERSEY, NEW YORK, PENNSYLVANIA. RHODE ISLAND, ARKANSAS. COLORADO, IDAHO. KANSAS, LOUISIANA, MONTANA, NEBRASKA.
OR VERMONT. SEND APPLICATIONS TO. NEW MEXICO, NORTH DAKOTA. OKLAHOMA. SOUTH DAKOTA, TEXAS, UTAH.
.S NUCLEAR REGULATORY COMMISSION, REGION I OR WYOMING, SEND APPLICATIONS TO:
NUCLEAR MATERIAL SECTION B
U.S. NUCLEAR REGULATORY COMMISSION. REGION IV
631 PARK AVENUE
MATERIAL RADIATION PROTECTION SECTION
KING OF PRUSSIA. PA 19406 611 RYAN PLAZA DRIVE. SUITE 1000
ARLINGTON, TX 76011 ALABAMA FLORIDA GEORGIA. KENTUCKY, MISSISSIPPI, NORTH CAROLINA.
PUERTO RICO, SOUTH CAROLINA. TENNESSEE, VIRGINIA, VIRGIN ISLANDS, OR
WEST VIRGINIA. SEND APPLICATIONS TO ALASKA, ARIZONA, CALIFORNIA, HAWAII, NEVADA. OREGON, WASHINGTON,
AND U.S. TERRITORIES AND POSSESSIONS IN THE PACIFIC, SEND APPLICATIONS
'J S NUCLEAR REGULATORY COMMISSION, REGION It TO:
MATERIAL RADIATION PROTECTION SECTION
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MATERIAL RADIATION PROTECTION SECTION
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1450 MARIA LANE. SUITE 210
WALNUT CREEK. CA 94596 PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE U.S. NUCLEAR
REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL
IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION JURISOICTION.
1 THIS IS AN APPLICATION FOR (Chock a'Copioreewt*t* , 2. NAME.AND MAILING ADDRESS OF APPLICANT (Includ.Zip Code)
A NEW LICENSE
B AMENDMENT TO LICENSE NUMBE_
C RENEWAL OF LICENSE NUMBER
ADORESSIESI WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED
4 NAME OF PERSON TO B
E. CONTACT
ED ABOUT THIS APPLICATION
jTELEPHONE NUMBER
SUBMIT iTEMS S TIROUGH 11 ON 8' , 11 'PAPER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED IN
THE LICENSE APPLICATION GUIDE.
S R-ýDIOACTIVE MATERIAL
aEcment ecll mass numbe. b checal eImnd/orDfhys,Col 1orm.Iad c mTlS-.n, anooIt 6. PURPOSEBS) FOR WHICH LICENSED MATEPIAL WILL BE USED
h .ch
-Ii, o oos$ese4 at a"ny one tlme INDIVIDUALIS, RESPONSIBLE FOP
RADIATION SAFETY PROGRAM AND
TRA 'IG AND EXPERIENCE THEIR
8, TRAINING FOR INDIVIDUALS WORKING IN OR FREQUEN'ING RESTRICTED AREAS
AC:IITIES AND EQUIPMENT
10. RADIATION SAFETY PROGRAM
WASTE~~~ MNGMT
"12 LICENSEE FEES (See ?0CFRt 1tTOrsdlSteor, 170.31)
FEE CATEGORY AMOUNT
lENCLOSED $
j '7EPTIFICATION fMus'beomplvridbVyliclnrJ THE APPLICANT UNDERSTANDS THAT Al L
TATEMENT R* .... . . -
BIN' -. 3 -PTEN APPLICANT . AND tP1EUNTI MADE IN THIS APPLICATION ARE
-'E APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEHALF
OF THE APPLICANT. NAMED IN ITEM 2. CERTIFY THAT THIS APPLICATION IS
AEPARED :% CONFORMITY WITH TITLE 1
0. CODE OF FEDERAL
REGULATIONS, PARTS 30.32.33, 34, 35. AND 40 AND THAT ALL INFORMATION
,F'IJ AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF CONTAINED HEREIN
VARNINC 16 u S C SECTION 1301 ACT OF JUNE 25. 1948, 62 STAT 749 MAKES IT A CRIMINAL
"TC, ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER
OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION
WITHIN ITS JURISDICTION
SNn.* 'E*T . C
GOFliCS 'TYPEDIPRINTED NAME TITLE DATE
14VLUNTARY ECONOMIC DATA
A. A ,*:- R CE'PTS I NUMBER OF EMPLOYEES (Tor for al d WOULD YOU BE WILLING TO FURNISH COST INFORMATION o rtIOII. -noo stfhow,,,
1
"'SI'K vM 5v emt, fci,ty -excluoingOrsdi conftrlcrors ON THE ECONOMIC IMPACT OF CURRENT NRC REGULATIONS OR ANY FUTURE
S251K NOOK PROPOSED NRC REGULATIONS THAT MAY AFFECT YOU' (NRCmoIlerio$s S 5MS ?M Irt ro votcr pe-.r confidenrti& commerns*I Or frinolal-oroorrr. --*t,,tofrnltton f-rnlthld to
$5500K - 750K S7M -0M c NUMBER OF BEDS py ,nConfidrce)
S 50K 'V S
'0M F YES NO
FOR NRC USE ONLY
"PE- F6. FEEFOG PEECATEGORY COMMENTS APPROVED By
. . T... CE "'E.D CHECK NUMBER
.4 . A'T STATEMFNT ON THE REVERSE
PRIVACY ACT STATEMENT
93-579), the follow Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by section 3 of the Privacy Act of 1974 (Public Law Commission on NRC Forrr inq staxement is furnished to individuals who supply information to the Nuclear Regulatory described at 40 Federal Register 45334
313. This information is maintained in a system of records designated as NRC-3 and (October 1 1975).
(42 U.S.C. 2111 and 2201(b)).
1. AUTHORITY: Sections 81 and 161(b) of the Atomic Energy Act of 1954, as amended staff pursuant to the criteria set forth in 10 CFR
2. PRINCIPA
L. PURPOSE
(S): The information is evaluated by the NRC
the requirements of the Atomic Energy Act of Parts 30, 32, 33, 34, 35 and 40 to determine whether the application meets of a radioactive material license or amendment 1954, as amended, and the Commission's regulations, for the issuance thereof.
health departments for their information and use; 3. ROUTINE USES: The information may be (a) provided to State other persons in the event of incident or exposure, and (b) provided to Federal, State, and local health officials and and safety. The information may also be dis for their information, investigation, and protection of the public health that the information indicates a violation or potential closed to appropriate Federal, State, and local agencies in the event In addition, tt'fs information may be trans violation of law and in the course of an administrative or judicial proceeding.
relevant and necessary for an NRC decision or to ferred to an appropriate Federal, State, or local agency to the extent that agency's decision about you.
an appropriate Federal agency to the extent relevant and necessary for AND EFFECT ON INDIVIDUAL OF NOT PROVID 4, WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY
is voluntary. If the requested information is not furn ING INFORMATION: Disclosure of the requested information amendment thereof, will not be processed. A request ished, however, the application for radioactive material license, or with the provisions of 10 CFR 2.790. Withhold that information be held from public inspection must be in accordance persons properly and directly concerned need to inspect ing from public inspection shall not affect the right, if any, of the document.
5. SYSTEM MANAGER(S) AND ADDRESS: U.S. Nuclear Regulatory Commission Director, Division of Fuel Cycle and Material Safety Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555}}