IR 05000293/1957001: Difference between revisions

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{{Adams
{{Adams
| number = ML18043A182
| number = ML24164A242
| issue date = 01/29/2018
| issue date = 06/12/2024
| title = Providence Imaging Center; Amendment 04, License 50-29357-01; Docket 030-38077; Control 601812
| title = 640304-Amendment 10 License 50-29357-01/030-38077 for Providence Imaging Center (PIC)
| author name = Simmons M R
| author name = Hanson L
| author affiliation = NRC/RGN-IV
| author affiliation = NRC/RGN-IV/DRSS/MLB
| addressee name =  
| addressee name =  
| addressee affiliation = Providence Imaging Ctr
| addressee affiliation = NRC/Document Control Desk
| docket = 03038077
| docket = 03038077
| license number = 50-29357-01
| license number = 50-29357-01
| contact person =  
| contact person =  
| case reference number = 601812
| case reference number = License-640304-219317
| document type = License-Materials Byproduct Amendment DKT 30
| document type = License-Approval for MATL Byproduct License (Amend/Renewal/New) DKT 30, 40, 70
| page count = 3
| page count = 1
}}
}}


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=Text=
=Text=
{{#Wiki_filter:U.S. NUCLEAR REGULATORY COMMISSIONMATERIALS LICENSENRC FORM 374PAGEOF13Amendment No. 4PAGESPursuant 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. LicenseeAnchorage, AK 995082.3340 Providence Drive1.Providence Imaging Center4.Expiration Date:October 31, 2019Docket No.:5.030-38077License number: 50-29357-01 is amended in its entirety to read as follows:Reference No.: 3.In accordance with letter dated December 04, 2017.6.7.8.Byproduct, source, and/or special nuclear materialChemical and/or physical formMaximum amount that licensee may possess at any one time under this license9.Authorized useA.A.A.A.For use in imaging and localization studies permitted by 10 CFR 35.200.AnyAs NeededAny byproduct material permitted by 10 CFR 35.200CONDITIONS10.A.Licensed material may be used or stored at the licensee's facilities located at 3340 Providence Drive, Anchorage, Alaska.B.Licensed material may be received and stored at the licensee's facilities located at the loading dock of Providence Alaska Medical Center, 3200 Providence Drive, Anchorage, Alaska.11.The Radiation Safety Officer (RSO) for this license is Mark P. Winslo License NumberDocket or Reference NumberU.S. NUCLEAR REGULATORY COMMISSIONNRC FORM 374AMATERIALS LICENSESUPPLEMENTARY SHEETPAGESOFPAGE3250-29357-01030-38077Amendment No. 4 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 UsersMaterial and UseHeather C. Tauschek, M.D.35.200Scott R. Naspinsky, M.D.35.200Christopher M. Reed , M.D.35.200Wandal B. Winn, M.D.35.200David Allen Moeller, M.D.35.200Christopher L. Kottra, M.D.35.200Leonard D. Sisk, M.D.35.200Chakri S. Inampudi, M.D.35.200Denise Farleigh, M.D.35.200Jonathan P. Coyle, M.D.35.200Erik John Maurer, M.D.35.20013.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 financial assurance for decommissionin License NumberDocket or Reference NumberU.S. NUCLEAR REGULATORY COMMISSIONNRC FORM 374AMATERIALS LICENSESUPPLEMENTARY SHEETPAGESOFPAGE3350-29357-01030-38077Amendment No. 414.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 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 andcorrespondence are more restrictive than the regulations.A.Application dated July 2, 2009 (ML092330999)B.Delegation of Authority dated July 1, 2009 (ML092800498)
{{#Wiki_filter:U.S. NUCLEAR REGULATORY COMMISSION MATERIALS LICENSE NRC FORM 374 PAGE OF
C.Letter dated March 31, 2010 (ML100970546)
 
D.Letter dated January 14, 2013 (ML13183A268)FOR THE U.S. NUCLEAR REGULATORY COMMISSIONBy:Date:Region 4Michelle R. SimmonsJanuary 29, 2018
3 Amendment No. 10 PAGES 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 Anchorage, AK 99508 2. 3340 Providence Drive 1. Providence Imaging Center (PIC)
4. Expiration Date: March 31, 2035 Docket No.:
5.
 
030-38077 License No.: 50-29357-01 is amended in its entirety to read as follows:
Reference No.:
3.
 
In accordance with letter dated March 13, 2024; and email dated April 4, 2024 with attachments.
 
6.
 
7.
 
8.
 
Byproduct, source, and/or special nuclear material Chemical and/or physical form Maximum amount that licensee may possess at any one time under this license 9.
 
Authorized use A.
 
A.
 
A.
 
A.
 
For use in imaging and localization studies permitted by 10 CFR 35.200.
 
Any As Needed Any byproduct material permitted by 10 CFR 35.200
 
License No.:
Docket or Reference No.:
U.S. NUCLEAR REGULATORY COMMISSION NRC FORM 374A MATERIALS LICENSE SUPPLEMENTARY SHEET PAGES OF PAGE
 
2 50-29357-01 030-38077 Amendment No. 10 CONDITIONS 10. A.
 
Licensed material may be used or stored at the licensee's facilities located at 3340 Providence Drive, Anchorage, Alaska.
 
B.
 
Licensed material may be received and stored at the licensees facilities located at the loading dock of Providence Alaska Medical Center, 3200 Providence Drive, Anchorage, Alaska.
 
11. A.
 
The Radiation Safety Officer (RSO) for this license is Natalie Shimasaki-Alenepi, M.S.
 
B.
 
The Associate Radiation Safety Officer (ARSO) for this license is Thomas H. Essig, M.S., CHP.
 
12. Licensed material shall only be used by, or under the supervision of:
A.
 
Individuals permitted to work as authorized users as appropriate 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 Users Material and Use Max W. Berry, M.D.
 
35.200 Jonathan P. Coyle, M.D.
 
35.200 Chakri S. Inampudi, M.D.
 
35.200 Christopher L. Kottra, M.D.
 
35.200 Erik John Maurer, M.D.
 
35.200 Scott R. Naspinsky, M.D.
 
35.200 Brittany L. O'Steen, M.D.
 
35.200 Christopher M. Reed, M.D.
 
35.200 Heather C. Tauschek, M.D.
 
35.200 Wandal B. Winn, M.D.
 
35.200
 
License No.:
Docket or Reference No.:
U.S. NUCLEAR REGULATORY COMMISSION NRC FORM 374A MATERIALS LICENSE SUPPLEMENTARY SHEET PAGES OF PAGE
 
3 50-29357-01 030-38077 Amendment No. 10 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 financial assurance for decommissioning.
 
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 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 are more restrictive than the regulations.
 
A. Application dated September 23, 2019 (ML19290D016) (excluding radiation safety program, policies, and procedures)
B. Letter dated March 19, 2020 (ML20090A630)
C. Letter dated September 30, 2020 (ML20293A451)
D. E-mail dated December 10, 2020 with attachments (ML21021A066)
E. Letter dated April 13, 2023 (ML23116A118)
F. Letter dated March 13, 2024 (ML24101A057)
G. Email dated April 4, 2024 with attachments (ML24164A216)
FOR THE U.S. NUCLEAR REGULATORY COMMISSION By:
Date:
Latischa M. Hanson Region IV June 12, 2024 LATISCHA HANSON Digitally signed by LATISCHA HANSON Date: 2024.06.12 13:37:01 -05'00'
}}
}}

Latest revision as of 18:00, 24 November 2024

640304-Amendment 10 License 50-29357-01/030-38077 for Providence Imaging Center (PIC)
ML24164A242
Person / Time
Site: Pilgrim, 03038077
Issue date: 06/12/2024
From: Latischa Hanson
NRC/RGN-IV/DRSS/MLB
To:
Document Control Desk
References
License-640304-219317
Download: ML24164A242 (1)
v • d • e


Text

U.S. NUCLEAR REGULATORY COMMISSION MATERIALS LICENSE NRC FORM 374 PAGE OF

3 Amendment No. 10 PAGES 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 Anchorage, AK 99508 2. 3340 Providence Drive 1. Providence Imaging Center (PIC)

4. Expiration Date: March 31, 2035 Docket No.:

5.

030-38077 License No.: 50-29357-01 is amended in its entirety to read as follows:

Reference No.:

3.

In accordance with letter dated March 13, 2024; and email dated April 4, 2024 with attachments.

6.

7.

8.

Byproduct, source, and/or special nuclear material Chemical and/or physical form Maximum amount that licensee may possess at any one time under this license 9.

Authorized use A.

A.

A.

A.

For use in imaging and localization studies permitted by 10 CFR 35.200.

Any As Needed Any byproduct material permitted by 10 CFR 35.200

License No.:

Docket or Reference No.:

U.S. NUCLEAR REGULATORY COMMISSION NRC FORM 374A MATERIALS LICENSE SUPPLEMENTARY SHEET PAGES OF PAGE

2 50-29357-01 030-38077 Amendment No. 10 CONDITIONS 10. A.

Licensed material may be used or stored at the licensee's facilities located at 3340 Providence Drive, Anchorage, Alaska.

B.

Licensed material may be received and stored at the licensees facilities located at the loading dock of Providence Alaska Medical Center, 3200 Providence Drive, Anchorage, Alaska.

11. A.

The Radiation Safety Officer (RSO) for this license is Natalie Shimasaki-Alenepi, M.S.

B.

The Associate Radiation Safety Officer (ARSO) for this license is Thomas H. Essig, M.S., CHP.

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

A.

Individuals permitted to work as authorized users as appropriate 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 Users Material and Use Max W. Berry, M.D.

35.200 Jonathan P. Coyle, M.D.

35.200 Chakri S. Inampudi, M.D.

35.200 Christopher L. Kottra, M.D.

35.200 Erik John Maurer, M.D.

35.200 Scott R. Naspinsky, M.D.

35.200 Brittany L. O'Steen, M.D.

35.200 Christopher M. Reed, M.D.

35.200 Heather C. Tauschek, M.D.

35.200 Wandal B. Winn, M.D.

35.200

License No.:

Docket or Reference No.:

U.S. NUCLEAR REGULATORY COMMISSION NRC FORM 374A MATERIALS LICENSE SUPPLEMENTARY SHEET PAGES OF PAGE

3 50-29357-01 030-38077 Amendment No. 10 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 financial assurance for decommissioning.

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 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 are more restrictive than the regulations.

A. Application dated September 23, 2019 (ML19290D016) (excluding radiation safety program, policies, and procedures)

B. Letter dated March 19, 2020 (ML20090A630)

C. Letter dated September 30, 2020 (ML20293A451)

D. E-mail dated December 10, 2020 with attachments (ML21021A066)

E. Letter dated April 13, 2023 (ML23116A118)

F. Letter dated March 13, 2024 (ML24101A057)

G. Email dated April 4, 2024 with attachments (ML24164A216)

FOR THE U.S. NUCLEAR REGULATORY COMMISSION By:

Date:

Latischa M. Hanson Region IV June 12, 2024 LATISCHA HANSON Digitally signed by LATISCHA HANSON Date: 2024.06.12 13:37:01 -05'00'

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