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{{#Wiki_filter:NRC FORM 374                                                                                                                                         PAGE  1  OF 3 PAGES
{{#Wiki_filter:NRC FORM 374                                                                                                                                                                                                                                                               PAGE         OF1          3   PAGES
                                                                      U.S. NUCLEAR REGULATORY COMMISSION
                                                                                                        U.S. NUCLEAR REGUL                    ATORY COMMISSION
                                                                            MATERIALS LICENSE
                                                                                                                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,
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
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
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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
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.
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
                                            Licensee                                                        In accordance with application                                           4.   Expiration Date:               June 30, 2037
                                              License No.: 50-35674-01                  Docket or Reference No.:
1.   Alyeska Imaging Center                                                                              dated March 8, 2022; and letter
          MATERIALS LICENSE                                                              030-39310
                                                                                                            dated June 22, 2022,
        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
                                                                                                                                                                                      5.  Docket No.:            030-39310
                                                License No.: 50-35674-01                 Docket or Reference No.:
2.    2480 S. Woodworth Loop                                                                              3.  License No.: 50-35674-01                                      Reference No.:
          MATERIALS LICENSE                                                               030-39310
      Suite 140
        SUPPLEMENTARY SHEET
      Palmer, AK 99645
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
6.                                                                7.                                                                                    8.Byproduct, source,Chemical and/or physical form                                                Maximum amount that licensee 9.    Authorized use
    licensee's application and correspondence impose on the licensee requirements that are more restrictive than or in addition to the
        and/or special nuclear                                                                                                            may possess at any one time
    regulations.
        material                                                                                                                          under this license
    A. Application dated March 8, 2022 with enclosures (ML22117A097)
 
    B. Letter dated June 22, 2022 with enclosures (ML22173A174)
A.                                                                                                                                                                                        For use in uptake, dilution and Any byproduct materialA.Any                                                                  As NeededA.A.
                                                                                    FOR THE U.S. NUCLEAR REGULATORY COMMISSION
        permitted by 10 CFR                                                                                                                                                                          excretion studies permitted by 10 CFR
                                                                                                                    Digitally signed by Roberto J.
        35.100                                                                                                                                                                                        35.100.
                                                                                        Roberto J. Torres Torres    Date: 2022.06.23 09:36:33 -05'00'
B.                                                                                                                                                                                        For use in imaging and localization Any byproduct materialB.Any                                                                  As NeededB.B.
  Date:   June 23, 2022                                                             By:
        permitted by 10 CFR                                                                                                                                                                          studies permitted by 10 CFR 35.200.
                                                                                        Roberto J. Torres
        35.200
                                                                                        Region IV
NRC FORM 374A                                                                               U.S.   NUCLEAR REGULATORY COMMISSION                                                                     PAGE                       32OFPAGES
                                                                            License No.:                                                  Docket or Reference No.:50-35674-01
                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 REGUL                    ATORY COMMISSION                                                  P AGE                      33OFPAGES
                                                                            License No.:                                                  Docket or Reference No.:50-35674-01
                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 (ML22                                  117A097)
        B.   Letter dated June 22, 2022 with enclosures (ML22173A174)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                                                                                                  FOR THE U.S. NUCLEAR REGULATORY COMMISSION
 
 
  Date:         June 23, 2022                                                                                                     By:
                                                                                                                                        Roberto J. Torres
                                                                                                                                        Region     IV
}}
}}

Latest revision as of 18:26, 17 November 2024

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 OF1 3 PAGES

U.S. NUCLEAR REGUL ATORY 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

1. Alyeska Imaging Center dated March 8, 2022; and letter

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

and/or special nuclear may possess at any one time

material under this license

A. For use in uptake, dilution and Any byproduct materialA.Any As NeededA.A.

permitted by 10 CFR excretion studies permitted by 10 CFR

35.100 35.100.

B. For use in imaging and localization Any byproduct materialB.Any As NeededB.B.

permitted by 10 CFR studies permitted by 10 CFR 35.200.

35.200

NRC FORM 374A U.S. NUCLEAR REGULATORY COMMISSION PAGE 32OFPAGES

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

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 REGUL ATORY COMMISSION P AGE 33OFPAGES

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

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 (ML22 117A097)

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

FOR THE U.S. NUCLEAR REGULATORY COMMISSION

Date: June 23, 2022 By:

Roberto J. Torres

Region IV