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{{Adams
{{Adams
| number = ML18305B362
| number = ML22095A285
| issue date = 10/29/2018
| issue date = 04/05/2022
| title = Diagnostic Health Center of Anchorage, LLC; Amendment Request; License 50-23214-01; Docket 030-20372; Control 610350
| title = 627275-Amendment 24 License 50-23214-01/030-20372 for Diagnostic Health Center of Anchorage, LLC
| author name = Kassel K
| author name = Hanson L
| author affiliation = Alliance HealthCare Services
| author affiliation = NRC/RGN-IV/DNMS
| addressee name =  
| addressee name =  
| addressee affiliation = NRC/RGN-IV
| addressee affiliation = NRC/Document Control Desk
| docket = 03020372
| docket = 03020372
| license number = 50-23214-01
| license number = 50-23214-01
| contact person =  
| contact person =  
| case reference number = 610350
| case reference number = License-627275-165144
| document type = Letter, License-Application for (Amend/Renewal/New) for DKT 30, 40, 70
| document type = License-Approval for MATL Byproduct License (Amend/Renewal/New) DKT 30, 40, 70
| page count = 4
| page count = 1
}}
}}


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=Text=
=Text=
{{#Wiki_filter:ALLIANCE HEALTHC AR E S E RVI CES October 29 , 2018 lo) 1E t IE nD IE~ [\\ OCT 3 0 20lB M US NRC Region IV 1600 E. Lamar Bl v d. Arlington TX, 76011-4 5 11 RE: Radioactive Materials Lic e nse 5 0-232 1 4-01
{{#Wiki_filter:NRC FORM 374          PAGE 1 OF 3 PAGES U.S. NUCLEAR REGULATORY COMMISSION    Amendment No. 24 MATERIALS LICENSE Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93-438), and Title 10, Code of Federal Regulations, Chapter I, Parts 30, 31, 32, 33, 34, 35, 36, 37, 39, 40, 70 and 71, and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess, and transfer byproduct, source, and special nuclear material designated below; to use such material for the purpose(s)
and at the place(s) designated below; to deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the applicable Part(s). This license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, as amended, and is subject to all applicable rules, regulations, and orders of the Nuclear Regulatory Commission now or hereafter in effect and to any conditions specified belo Licensee  In accordance with letter dated  4. Expiration Date: March 31, 2025 July 6, 2021 1. Diagnostic Health Center of Anchorage, LLC A wholly owned subsidiary of Alliance HealthCare Services 5. Docket No.: 030-20372 2. 4100 Lake Otis Parkway #102  3. License No.: 50-23214-01 is  Reference No.:
Anchorage, AK 99508    amended in its entirety to read as follows: Byproduct, source, Chemical and/or physical form Maximum amount that licensee Authorized use and/or special nuclear    may possess at any one time material      under this license Any byproduct material Any As Needed For use in uptake, dilution and permitted by 10 CFR        excretion studies permitted by 10 CFR 35.100        35.10 Any byproduct material Any As Needed For use in imaging and localization permitted by 10 CFR        studies permitted by 10 CFR 35.20 .200 Iodine-131 Any millicuries total Any sodium iodide Iodine-131 use permitted by 10 CFR 35.300 for which the patient can be released under the provisions of 10 CFR 35.7 Any byproduct material Prepackaged Kits millicuries total For use in in-vitro studie permitted by 10 CFR 31.11


==Dear Sir or Madam,==
NRC FORM 374A    U.S. NUCLEAR REGULATORY COMMISSION  PAGE 2 OF 3 PAGES License No.: 50-23214-01  Docket or Reference No.:
DNMS As a result of the inspection conducted October 25 , 2018, by Jason Von Ehr , I w ould lik e t o submit this request to amend Radioactive Materials licens e nmnb e r 50-23214-0l to add th e P e t CT m o bil e unit as a location of use. Currently Pet CT 125 is a parked mobile at th e location. It is in t h e proce s s of b e ing decommissioned.
MATERIALS LICENSE    030-20372 SUPPLEMENTARY SHEET  Amendment No. 24 CONDITIONS 10. Licensed material may be used only at the licensees facilities located at Lake Otis Medical Plaza, 4100 Lake Otis Parkway #102, Anchorage, Alaska.


The mobile unit w ill be leaving th e location and s e t for r e sale in th e near future. I w ill submit the close out survey and source disposition once that process is compl e t e d. Contact me if you are in need of an y further information or clarification.
11. The Radiation Safety Officer for this license is Kay Kassel, MS, CNMT.


Sincerely, Kay Kassel MS, CNMT, NMTCB (RS) 561-701-1311 kkassel@alliancehealthcares e rvices-us.com PUBLIC a Immediate Release ~ormal Release NON-PUBLIC a A.3 Sensitive-Security Related a A.7 Sensitive Internal a Other: _____ _ 10.,3 .. 1 '7 Reviewer:~ uat c: ___ _ lb.610350 smart FedEx carbon-neutral
12. Licensed material shall only be used by, or under the supervision of:
* envelope shipping Cl) Cl) .***Q) '--,...--* m i:I . . -4 .... *.. . a.' . >< .. , * ... . * I . I * I FROM: Alliance Healthcare CARR: Federal Express TRK#: 00455391811411 RCVD: 10/30/2018 1341 TO: VonEhr, Jason PH: BDG: RM: PCS: 1 II 1111 1 1 1111 11 11111 II I I 99S9QCf002160$
A. Individuals permitted to work as authorized users in accordance with 10 CFR 35.13 and 10 CFR 35.1 B. The following individuals are authorized users for the material and medical uses as indicated:
' . I i ' . wU I-. Cf) . c::: 2 Al i gn top of FedEx Express shipping label here. ORIGIN ID:NZJA (949) 242-5445 MAILROOM ALLIANCE HEAL T HCARE 18201 VON KARMAN AVE. SUITE 600 IR V INE, CA 92612 UNITED STATES US TO US NRC REGION IV 1600 E. LAMAR BLVD. SHIP DATE: 290CT18 ACTWGT: 0.1 0 LB CAD: 108923304/CAFE3111 BIL L THIRD PARTY " " !(. " ... a: "' ' .: " .. "* ARLINGTON TX 760114511 (661) 701-1311 _____O_ffT:
Authorized Users  Material and Use Marc R. Beck, .100; 35.200; Oral administration of sodium iodide I-131; 31.11 Robert L. Bridges, .100; 35.200; Oral administration of sodium iodide I-131; 31.11 13. In addition to the possession limits in Item 8, the licensee shall further restrict the possession of licensed material to quantities below the minimum limit specified in 10 CFR 30.35(d) for establishing decommissioning financial assuranc NRC FORM 374A  U.S. NUCLEAR REGULATORY COMMISSION   PAGE 3 OF 3 PAGES License No.: 50-23214-01  Docket or Reference No.:
SQ -QB .. .. *a, ;a 0 Q. l;j !:: IC ... lo .. 4553 91811411 AD FWHA Fe d Ex Express -**-p STANDARD OVERNIGH T 76011 TX-US DFW .* ..., 0 \0 ('1) 0 .--co :.ii2 NRC FORM 532 U.S. NUCLEAR REGULATORY COMMISSION (05-2016)
MATERIALS LICENSE    030-20372 SUPPLEMENTARY SHEET  Amendment No. 24 14. Except as specifically provided otherwise in this license, the licensee shall conduct its program in accordance with the statements, representations, and procedures contained in the documents, including any enclosures, listed below. This license condition applies only to those procedures that are required to be submitted in accordance with the regulations. Additionally, this license condition does not limit the licensees ability to make changes to the radiation protection program as provided for in 10 CFR 35.26. The U.S. Nuclear Regulatory Commissions regulations shall govern unless the statements, representations, and procedures in the licensees application and correspondence are more restrictive than the regulation A. Application dated October 20, 2014 (ML14336A723)
t>IIIIIEO(, ~'(),' <.,> -~ ... o...c. ; g ACKNOWLEDGEMENT
B. Letter dated February 16, 2015 with enclosures (ML15061A178)
-RECEIPT OF CORRESPONDENCE . , , : 'l, ., '<-+.., ***** .,01_. Name and Address of Applicant and/or Licensee Date I 10/30/2018 I Kay Kassel, MS, CNMT License Number(s)
C. Letter dated July 6, 2021 (ML21196A052)
Radiation Safety Officer I 50-23214-01 I Diagnostic Health Center of Anchorage, LLC Mail Control Number{s)
FOR THE U.S. NUCLEAR REGULATORY COMMISSION Digitally signed by Latischa Latischa M. Hanson Hanson April 5, 2022      Date: 2022.04.05 19:20:39 -05'00'
A wholly owned subsidiary of Alliance HealthCare Services I 610350 I 4100 Lake Otis Parkway #102 Licensing and/or Technical Reviewer or Branch Anchorage, AK 99508 C. Hill This is to acknowledge receipt of your: [Z] Letter and/or D Application Dated: 10/29/2018 The initial processing, which included an administrative review, has been performed.
Date:     By:
 
Latischa M. Hanson Region IV ML22073A267
[Z] Amendment D Termination D New License D Renewal D There were no administrative omissions identified during our initial review. D This is to acknowledge receipt of your application for renewal of the material(s)
license identified above. Your application is deemed timely filed, and accordingly, the license will not expire until final action has been taken by this office. D Your application for a new NRC license did not include your taxpayer identification number. Please complete and submit NRC Form 531, Request for Taxpayer Identification Number, located at the following link: _l)tt g://www.nrc.gov/reading-
rm/doc-co l le cti ons/fo rm s/nrc531.gdf Follow the instructions on the form for submission. D The following administrative omissions have been identified:
Your application has been assigned the above listed MAIL CONTROL NUMBER. When calling to inquire about this action, please refer to this control number. Your application has been forwarded to a technical reviewer.
 
Please note that the technical review, which is normally completed within 180 days for a renewal application (90 days for all other requests), may identify additional omissions or require additional information. If you have any questions concerning the processing of your application, our contact information is listed below: Region IV U. S. Nuclear Regulatory Commission DNMS/NMSB
-B 1600 E. Lamar Boulevard Arlington, TX 76011-4511 (817) 200-1103 or (817) 200-1140 NRC FORM 532 (05-2016)
BETWEEN: Accounts Receivable/Payable and Regional Licensing Branches [ FOR ARPB USE ] INFORMATION FROM WBL Program Code: 02200 Status Code: Pending Amendment Fee Category:7C Exp. Date: 03/31/2025 Fee Comments:
Decom Fin Assur Reqd: N License Fee Worksheet
-License Fee Transmittal A. REGION 1. APPLICAT I ON ATIACHED ApplicanULicensee:
Diagnostic Health Center of Anchorage, LLC Received Date: 10/30/2018 Docket Number: 3020372 Mail Contro l Number: 610350 License Number: 50-23214-01 Action Type: Amendment 2. FEEATIAC=-r--HED Amount: Check No.: 3. COMMENTS I I Signed: Date: B. LICENSE FEE MANAGEMENT BRANCH (Check when milestone 03 is entered 1. Fee Category and Amount: ------------------2. Correct Fee Paid. Application may be processed for: Amendment:
Renewal: License: Signed: Date:
}}
}}

Latest revision as of 02:43, 11 May 2022

627275-Amendment 24 License 50-23214-01/030-20372 for Diagnostic Health Center of Anchorage, LLC
ML22095A285
Person / Time
Site: 05000232, 03020372
Issue date: 04/05/2022
From: Latischa Hanson
Division of Nuclear Materials Safety IV
To:
Document Control Desk
References
License-627275-165144
Download: ML22095A285 (1)


Text

NRC FORM 374 PAGE 1 OF 3 PAGES U.S. NUCLEAR REGULATORY COMMISSION Amendment No. 24 MATERIALS LICENSE Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93-438), and Title 10, Code of Federal Regulations, Chapter I, Parts 30, 31, 32, 33, 34, 35, 36, 37, 39, 40, 70 and 71, and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess, and transfer byproduct, source, and special nuclear material designated below; to use such material for the purpose(s)

and at the place(s) designated below; to deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the applicable Part(s). This license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, as amended, and is subject to all applicable rules, regulations, and orders of the Nuclear Regulatory Commission now or hereafter in effect and to any conditions specified belo Licensee In accordance with letter dated 4. Expiration Date: March 31, 2025 July 6, 2021 1. Diagnostic Health Center of Anchorage, LLC A wholly owned subsidiary of Alliance HealthCare Services 5. Docket No.: 030-20372 2. 4100 Lake Otis Parkway #102 3. License No.: 50-23214-01 is Reference No.:

Anchorage, AK 99508 amended in its entirety to read as follows: Byproduct, source, Chemical and/or physical form Maximum amount that licensee Authorized use and/or special nuclear may possess at any one time material under this license Any byproduct material Any As Needed For use in uptake, dilution and permitted by 10 CFR excretion studies permitted by 10 CFR 35.100 35.10 Any byproduct material Any As Needed For use in imaging and localization permitted by 10 CFR studies permitted by 10 CFR 35.20 .200 Iodine-131 Any millicuries total Any sodium iodide Iodine-131 use permitted by 10 CFR 35.300 for which the patient can be released under the provisions of 10 CFR 35.7 Any byproduct material Prepackaged Kits millicuries total For use in in-vitro studie permitted by 10 CFR 31.11

NRC FORM 374A U.S. NUCLEAR REGULATORY COMMISSION PAGE 2 OF 3 PAGES License No.: 50-23214-01 Docket or Reference No.:

MATERIALS LICENSE 030-20372 SUPPLEMENTARY SHEET Amendment No. 24 CONDITIONS 10. Licensed material may be used only at the licensees facilities located at Lake Otis Medical Plaza, 4100 Lake Otis Parkway #102, Anchorage, Alaska.

11. The Radiation Safety Officer for this license is Kay Kassel, MS, CNMT.

12. Licensed material shall only be used by, or under the supervision of:

A. Individuals permitted to work as authorized users in accordance with 10 CFR 35.13 and 10 CFR 35.1 B. The following individuals are authorized users for the material and medical uses as indicated:

Authorized Users Material and Use Marc R. Beck, .100; 35.200; Oral administration of sodium iodide I-131; 31.11 Robert L. Bridges, .100; 35.200; Oral administration of sodium iodide I-131; 31.11 13. In addition to the possession limits in Item 8, the licensee shall further restrict the possession of licensed material to quantities below the minimum limit specified in 10 CFR 30.35(d) for establishing decommissioning financial assuranc NRC FORM 374A U.S. NUCLEAR REGULATORY COMMISSION PAGE 3 OF 3 PAGES License No.: 50-23214-01 Docket or Reference No.:

MATERIALS LICENSE 030-20372 SUPPLEMENTARY SHEET Amendment No. 24 14. Except as specifically provided otherwise in this license, the licensee shall conduct its program in accordance with the statements, representations, and procedures contained in the documents, including any enclosures, listed below. This license condition applies only to those procedures that are required to be submitted in accordance with the regulations. Additionally, this license condition does not limit the licensees ability to make changes to the radiation protection program as provided for in 10 CFR 35.26. The U.S. Nuclear Regulatory Commissions regulations shall govern unless the statements, representations, and procedures in the licensees application and correspondence are more restrictive than the regulation A. Application dated October 20, 2014 (ML14336A723)

B. Letter dated February 16, 2015 with enclosures (ML15061A178)

C. Letter dated July 6, 2021 (ML21196A052)

FOR THE U.S. NUCLEAR REGULATORY COMMISSION Digitally signed by Latischa Latischa M. Hanson Hanson April 5, 2022 Date: 2022.04.05 19:20:39 -05'00'

Date: By:

Latischa M. Hanson Region IV ML22073A267