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{{#Wiki_filter:
{{#Wiki_filter:NRC FORM 374                                                                                                                                        PAGE  1  OF 3 PAGES
                                                                      U.S. NUCLEAR REGULATORY COMMISSION
                                                                            MATERIALS LICENSE
Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93-438), and Title 10, Code of Federal Regulations, Chapter I,
Parts 30, 31, 32, 33, 34, 35, 36, 37, 39, 40, 70 and 71, and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued
authorizing the licensee to receive, acquire, possess, and transfer byproduct, source, and special nuclear material designated below; to use such material for the purpose(s)
and at the place(s) designated below; to deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the applicable Part(s). This
license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, as amended, and is subject to all applicable rules, regulations, and
orders of the Nuclear Regulatory Commission now or hereafter in effect and to any conditions specified below.
                              Licensee                                  In accordance with application                  4. Expiration Date: June 30, 2037
                                                                        dated March 8, 2022; and letter
  1. Alyeska Imaging Center
                                                                        dated June 22, 2022,
                                                                                                                        5. Docket No.: 030-39310
  2. 2480 S. Woodworth Loop                                            3. License No.: 50-35674-01                        Reference No.:
      Suite 140
      Palmer, AK 99645
  6.  Byproduct, source,              7.  Chemical and/or physical form              8.  Maximum amount that licensee      9.  Authorized use
      and/or special nuclear                                                              may possess at any one time
      material                                                                            under this license
  A.  Any byproduct material          A.  Any                                        A.  As Needed                        A.    For use in uptake, dilution and
      permitted by 10 CFR                                                                                                          excretion studies permitted by 10 CFR
      35.100                                                                                                                      35.100.
  B.  Any byproduct material          B.  Any                                        B.  As Needed                        B.    For use in imaging and localization
      permitted by 10 CFR                                                                                                          studies permitted by 10 CFR 35.200.
      35.200
 
NRC FORM 374A                                            U.S. NUCLEAR REGULATORY COMMISSION                              PAGE  2  OF 3 PAGES
                                              License No.: 50-35674-01                  Docket or Reference No.:
          MATERIALS LICENSE                                                              030-39310
        SUPPLEMENTARY SHEET
                                                                    CONDITIONS
10. Licensed material shall be used or stored at the licensee's facilities located at 2480 S. Woodworth Loop, Suite 140, Palmer, Alaska, 99645.
11. The Radiation Safety Officer (RSO) for this license is Jason Bernard Ivey.
12. Licensed material shall only be used by, or under the supervision of:
    A. Individuals permitted to work as authorized users in accordance with 10 CFR 35.13 and 10 CFR 35.14.
    B. The following individuals are authorized users for the material and medical uses as indicated:
        Authorized User (M.D.,D.O.,etc.)        Material and Use
        Daniel Andrew Davignon, Jr., D.O.        10 CFR 35.100,10 CFR 35.200
 
NRC FORM 374A                                                U.S. NUCLEAR REGULATORY COMMISSION                                PAGE  3  OF 3 PAGES
                                                License No.: 50-35674-01                  Docket or Reference No.:
          MATERIALS LICENSE                                                              030-39310
        SUPPLEMENTARY SHEET
13. Except as specifically provided otherwise in this license, the licensee shall conduct its program in accordance with the statements,
    representations, and procedures contained in the documents, including any enclosures, listed below. This license condition applies only to
    those statements, representations, and procedures that are required to be submitted in accordance with the regulations. Additionally, this
    license condition does not limit the licensee's ability to make changes to the radiation protection program as provided for in 10 CFR 35.26.
    The U.S. Nuclear Regulatory Commission's regulations shall govern unless the statements, representations, and procedures in the
    licensee's application and correspondence impose on the licensee requirements that are more restrictive than or in addition to the
    regulations.
    A. Application dated March 8, 2022 with enclosures (ML22117A097)
    B. Letter dated June 22, 2022 with enclosures (ML22173A174)
                                                                                    FOR THE U.S. NUCLEAR REGULATORY COMMISSION
                                                                                                                    Digitally signed by Roberto J.
                                                                                        Roberto J. Torres Torres    Date: 2022.06.23 09:36:33 -05'00'
Date:    June 23, 2022                                                            By:
                                                                                        Roberto J. Torres
                                                                                        Region IV
}}
}}

Revision as of 08:21, 29 June 2022

630776-New License 50-35674-01 for Alyeska Imaging Center
ML22174A286
Person / Time
Site: 03039310
Issue date: 06/23/2022
From: Ricardo Torres
NRC/RGN-IV/DRSS
To:
Document Control Desk
References
License-630776-170719
Download: ML22174A286 (1)


See also: IR 05000356/1974001

Text

NRC FORM 374 PAGE 1 OF 3 PAGES

U.S. NUCLEAR REGULATORY COMMISSION

MATERIALS LICENSE

Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93-438), and Title 10, Code of Federal Regulations, Chapter I,

Parts 30, 31, 32, 33, 34, 35, 36, 37, 39, 40, 70 and 71, and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued

authorizing the licensee to receive, acquire, possess, and transfer byproduct, source, and special nuclear material designated below; to use such material for the purpose(s)

and at the place(s) designated below; to deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the applicable Part(s). This

license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, as amended, and is subject to all applicable rules, regulations, and

orders of the Nuclear Regulatory Commission now or hereafter in effect and to any conditions specified below.

Licensee In accordance with application 4. Expiration Date: June 30, 2037

dated March 8, 2022; and letter

1. Alyeska Imaging Center

dated June 22, 2022,

5. Docket No.: 030-39310

2. 2480 S. Woodworth Loop 3. License No.: 50-35674-01 Reference No.:

Suite 140

Palmer, AK 99645

6. Byproduct, source, 7. Chemical and/or physical form 8. Maximum amount that licensee 9. Authorized use

and/or special nuclear may possess at any one time

material under this license

A. Any byproduct material A. Any A. As Needed A. For use in uptake, dilution and

permitted by 10 CFR excretion studies permitted by 10 CFR

35.100 35.100.

B. Any byproduct material B. Any B. As Needed B. For use in imaging and localization

permitted by 10 CFR studies permitted by 10 CFR 35.200.

35.200

NRC FORM 374A U.S. NUCLEAR REGULATORY COMMISSION PAGE 2 OF 3 PAGES

License No.: 50-35674-01 Docket or Reference No.:

MATERIALS LICENSE 030-39310

SUPPLEMENTARY SHEET

CONDITIONS

10. Licensed material shall be used or stored at the licensee's facilities located at 2480 S. Woodworth Loop, Suite 140, Palmer, Alaska, 99645.

11. The Radiation Safety Officer (RSO) for this license is Jason Bernard Ivey.

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

A. Individuals permitted to work as authorized users in accordance with 10 CFR 35.13 and 10 CFR 35.14.

B. The following individuals are authorized users for the material and medical uses as indicated:

Authorized User (M.D.,D.O.,etc.) Material and Use

Daniel Andrew Davignon, Jr., D.O. 10 CFR 35.100,10 CFR 35.200

NRC FORM 374A U.S. NUCLEAR REGULATORY COMMISSION PAGE 3 OF 3 PAGES

License No.: 50-35674-01 Docket or Reference No.:

MATERIALS LICENSE 030-39310

SUPPLEMENTARY SHEET

13. Except as specifically provided otherwise in this license, the licensee shall conduct its program in accordance with the statements,

representations, and procedures contained in the documents, including any enclosures, listed below. This license condition applies only to

those statements, representations, and procedures that are required to be submitted in accordance with the regulations. Additionally, this

license condition does not limit the licensee's ability to make changes to the radiation protection program as provided for in 10 CFR 35.26.

The U.S. Nuclear Regulatory Commission's regulations shall govern unless the statements, representations, and procedures in the

licensee's application and correspondence impose on the licensee requirements that are more restrictive than or in addition to the

regulations.

A. Application dated March 8, 2022 with enclosures (ML22117A097)

B. Letter dated June 22, 2022 with enclosures (ML22173A174)

FOR THE U.S. NUCLEAR REGULATORY COMMISSION

Digitally signed by Roberto J.

Roberto J. Torres Torres Date: 2022.06.23 09:36:33 -05'00'

Date: June 23, 2022 By:

Roberto J. Torres

Region IV