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p-_R                                                                                                                                                j N FORM Sf4A                          U.S. NUCLEAR REGULATORY COMMISSION g                                                                                                    PAGE 1    os 1            PAGES
                                                                                                                                                      $l g                                                                              License Number gl.
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e N    West Virginia University                                                                                                                  E N    Morgantown, West Virginia 26506                                                                                                              !
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                                                                  ,                                                                                E 5                                                                                                                                                        ,
E g    In accordance with the CertiGcate of Disposition of Materials dated January 20,1997, the fax dated February 21,1997, and g
g    telephone verification of receipt on February 24,1997, License Number SNM 1924 is hereby terminated,                                    g i                                                                                                                                              s s
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N FOR THE U.S. NUCLEAR REGULATORY COMMISSION                                      E
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  $                        N:\MLICENSE\TERMINA1TSNM 1924                      101 Marietta ' re t, N.W., Suite 2900                            E N                                                                            Atlanta, GA            -0199                                    E        .
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pn maag*                                                        UNITED STATES NUCLEAR REGULATORY COMMISSION 7*                                                                      REGION ll 7                  o                                      101 MARIETTA STREET. N.W., SUITE 2900
  %                  j                                            ATLANTA. GEORGtA 3o323-0199                                l
                  #                                  INFORMATIMNb                      ERIAL LICENSEES i
Please find enclosed:                              Your NRC material license
                                                  , Amendment to your NRC material license                                    ;
                                                / Amendment renewing your NRC material license                                !
;                                          V        Amendment terminating your NRC material license Notice for Radiographer Quality Assurance Approval Program              ]
                                                                                                                              )
l Please review the enclosed document carefully and be sure that you understand all conditions. If there are                  ;
any errors or questions, please notify this office (ATTN: Ms. Diane Heim at (404) 331-46731 so that we can                  I provide appropriate corrections and answers.
Please be advised that your license expires at the end of the day in the month and year stated in the license.
Unless your license has been terminated, you must conduct your program involving byproduct materials in accordance with the conditions of your NitC license, representations made in your license application, and NRC regulations. In particular, note that you must:
: 1.        Operate in accordance with NRC regulations 10 CFR 19, " Notice, instructions and Reports to Workers; inspections," 10 CFR Part 20, " Standards for Protection Against Radiation," and other applicable regulations.
: 2.        Not possess and use materials authorized in Items 6,7, and 8, on the license until:
: a.        you have constructed the facilities and obtained the equipment described in the license -              i application and supporting documentation; and                                                          I
: b.        you have notified the U. S. Nuclear Regulatory Commission, Region ll, ATTN: Materials Licensing \lnspection Branch, in writing, that activities authorized by the license will be initiated.
                                                                                                                              )
I
: c.        you have submitted & certified implementation of a Quality Management Program (10 CFR 35.32) for radiotherapy, or for administering > 30 uCl of 1125 or 1-131.
: 3.        Notify NRC, in writing, within 30 days:
: a.        when an authorized user, Radiation Safety Otticer, or Teletherapy Physicist permanently discontinues performance of duties under the license or has a name change; or i
: b.      when the licensee's mailing address changes (no fee is required if the location of byproduct material remains the same).
: 4.          In accordance with 10 CFR 30.36(b) and/or license condition, notify NRC, promptly, in writing, and request termination of the license:
: a.      when you decide to terminate all activities involving materials authorized under the license; or
: b.      if you decide not to complete the fecility, acquire equipment, or possess and use authorized material.
(Rev. 3/96)
 
  .                                                        2                                                  l
: 5.      Rsquest and obtain a license amendment before you;
: a. receive or uso byproduct material for a clinical procedure permitted under Part 35 but not permitted by your license issued pursuant to this part,
: b. permit anyone, not authorized under 10 CFR 35, Subpart J, to work as an authorized user under a license for medical use of byproduct material.
: c. permit anyone, not authorized under 10 CFR 35, Subpart J, to work as a Radiation Safety        ;
Officer, Teletherapy Physicist, or Nuclear Pharmacist, under a license for medical use of byproduct material,
: d.      order byproduct material in excess of the amount, or a different radionuclide or form, other than authorized on the license;
: e.      add or change the areas of use or address (or addresses) of use identified in the license application or on the license; or
: f.      change ownership of your organization.
: 6.      Submit a complete renewal application with proper fee or termination request at least 30 days before the expiration date of your license. You will receive a reminder notice approximately 90 days before the expiration date. Possession of byproduct material after your license expires is a violation of NRC regulations. Transfer of licensed materials must be consistent with 10 CFR 30,41,40.51 or 70.42, as applicabic. A license will not normally be renewed, except on a case-by-case basis, in instances where licensed material has never been possessed or used.
In addition, please note that NRC Form 313 requires the applicant, by his/her signature, to verify that the    !
applicant understands that all statements contained in the application are true and correct to the best of the applicant's knowledge. The signatory for the application should be the licensee or certifying official rather  j than a consultant.                                                                                            ;
l You will be periodically inspected by NRC. Failure to conduct your program in accordance with NRC              1 regulations, license conditions, and representations made in your license application and supplemental correspondence with NRC will result in enforcement action against you. This could include issuance of a Notice of Violation, or imposition of a Civil Penalty, or an order suspending, modifying or revoking your license as specified in the " General Statement of Policy and Procedures for NRC Enforcement Actions,"
NUREG-1600, (7/95). Since serious consequences to employees and the public can result from failure to comply with NRC requirements, prompt and vigorous enforcement action will be taken against those who do not achieve the necessary attention to detail and standard of compliance expected of licensees.
Thank you for your cooperation.
 
==Enclosures:==
: 1.      NRC License
: 2.      Category Marked Below for:
[}      New licenses: NUREG-1600 (7/95); 19; 20; 30; 40 or 70, as appropriate; 71; 170; NRC Form 3: Agreement State list; and NRC Form 313.
[]      New radiography licenses: Parts 34; 150.
[]      New medical and teletherapy licenses: Part 35.
[]      Amendments and renewals: NRC Fntm 313.
g:\dnms\mlib2\infofor. mat (Rev. 3/96)
 
                        ~
        ,  FEB-A1-9I F'RI' 12 3 2 5 ' 'P M RAD 1'AT!oH CAFETY oFPICE                NS4 295 4529          P.02 U9EC Mat'l L10/Insp        Fax 4% -331-7437                Feb 19 '97    15:19    P,01
                  /        ''%                      NUCLEAR RE          TO Y COMMISSION 4
nccion a
              'e          .
ATLA TA.        d%
N../                                    TELEFAX TO: GK On' wee &
f License #)lM/%!k Attn: /cfr //3vafMeg[
 
==Title:==
5 FAX:(/g)g7L- (fp9                          CITY                        , STATE FROM:jdfne.                //$ry/                        TITLE: 6c',//f[
DIVISION OF N'.'CI.E.R MATERIA'_S SAFEn DATE: d[/9[' 7/
FAX: @df/- 7x/ 7                              VOICE: (ph) g-ff 74
 
==SUBJECT:==
YOUR REQUEST FOR TRANSFER OR TERMINATION OF NRC LICENSE 4
Pleaso provide the foll0Ving certification, in addition to the NRO FORM 314 (Certificate of Disposition of Materialo):
All records important to the safe and effective decormissioning of the f acility ( 10 CFR 30. 3 5 (g) , 40. 3 6 (f) , 70.25(g), and 72.30(d)); and all records concerning public dose and waste disposal, have been transferred to:
: 1. Name: dor A/AAW3 /FMbr# /Agagg7pfP                  (EuCCessor]
License # Btwp1**            street: lyns Feat Rito L(Ji' city: p 3 /)Lamar              , Btate: 1/su Or eg r        ,
0D
: 2. USNRC, Attn: Nuclear Materials Licensing Section, at the above address, AND
: 3. There is no residual conta.mination of the facility or envir us from 1 censed naterials.
Signatures /d            .
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                                                                                          , J, ,$,V y-            -
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                            .                                                                                                                                                          .yr a                                                                                                                                                                          .h d JR f
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!                                              DOE AttrHORIZATION TO MHIP/RELINOUISHMENT OF OWNERMHiP                                                                    '
(
j                                                                                                                                                                                        1 i                                                          Sign Below and Return to the Following Address:                                                                                    ..
i                                                                          Sherry W. Jones, MS E524                                                                                          .h s
Les Alamos NationalLaboratory                                                                                      's J
P. O. Box 1663                                                                                      --
i                                                                        Los Alamos, New Mexico 87545                                                                                        D
                                                                                                                                                                                          .c i                                                                                                                                                                                        11 You are authorized by the Department of Energy (DOE) to ship the 239PuBe source (s) on the reverse side l                                                                                                                                                                                              y j                    form to the im Alamos NationalLaboratory.
l                                                                                                                                                                                      :if*
j                                                                                                                                                                                    s ygf;-e i                      NOTE:                  Name and signature must be of an official of the facility that has the authority to                                                                    /
l                      relinquish ownership of the              239 PuBe      source (s). This form must be signed and returned befor'e f I
Los Alamos will authorize the shipment of your source (s).                                                                                                                    j i
j
(                                                                                                                                                                                                ..
h                                                                                                                                                                                        kM kJ i
l      <
The West Vireinta Univeraltv--                        hereby relinquishes all ownership of the M9PuBe neut
'                      indicated on the reverse side of this form to the United States Department of Energy (DOE) teceipt/ acceptance of the souse (s) by the Los Alamos National Laboratory.
                                                                                                                                                                  .--            ww.
Q
                                                        .                                                                                                                                          .g l
i                      OmciAL NAuenirLE:                      E M Rnun wa a                                                                  RSo  twsr a w ,n un u wi &
ij                                                          'NAME (Pleno PtinVrype)                                                            TTTLE (Please Print /rype)
{
fi i                      SIGNATURE:                    J      l                                                                                      . DA'm'll    <
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                                                                                                                                                                                          .t, 9U        =
 
                      .  . _ _ _ _ . _        .._  _ _ , . _ _ . _ -    _ _    ._.        .    . _ _ _ . . _ _ . _ ~  _
  ,_..__..m__FE3-31-97 FR3    12124 PM RADIATION SAFETY OFFICE              304 293 4529                            P.04 1    .
1 1
l 1                                      IMPORTANT NOTICE READ CAREFULLY This document was prepared as an account of work sponsored by an agency of i          the United States Government. Neither the United States Government. The
!          Regents for the University of Cailfornia that operates the Los Alamos National i          Laboratory (LANL), nor any agency thereof, nor an of their employees, makes any warranty, express or implied, or assumes any I                  liability or responsibility
;          for the accuracy, completeness, usefulness or safety of any information, apparatus, product or process disclosed, or represents that its use would not
;          infringe privately owned rights. No warranty of safety or efficacy is made by The Regents of the University of California or the United States Department of Ener for any instrument or technique represented by this document. It is                                        1 sup cd at the request of the recipient, who assumes full responsibility for any                                  i instrument, apparatus, technique or process which arises from its use.
i                                                                                                                            i
(                                                                                                                            1 The los Alamos National Laboratory is a prime contractor to the Department of I
Energy under Contract Number W-7405-ENG 36, As a prime contractor to the Department of Energy, the Laboratory is exempt from all licensing requirements as detailed in Title 10 Part 30.12 " Persons using by-product                                      ,
material under certain Department of Energy and Nuclear Regulatory i;          Commission Contracts," and Part 70.11 '' Persons using special nuclear material j            under Department of Energy and Nuclear Regulatory Commission Contracts."
l            You as the shipper, and the carrier you choose, are responsible for following all
!            United States Department of Transportation (DOT), federal, state and local regulations governing nuclear material shipments, YOU MUST READ AND                                            l l
UNDERSTAND THIS PACKET BEFORE YOU SHIP (see CFR 49 R 172.700 -
172.704 Training subnart H in Apnendir A), Failure to do so will put you in i            violation of the above stated responsibilities.
You must abide by the following requirements before LANL will accept your source (s).
i
!      AUTHORTzATION TO SHIP INFORMATION:
NO11CE TO NRC UCBNSEES ONLY (Quality Assurance (QN Program )
V you are licensed by the NRC you must hnve a Quality Assurance (9N Program (10 CFR 71.) approved by the NRC. In Section 2 of this packet is (heform that you must complete and mall immediately, because it mi!! take 4 weeksfor approval to the NRC (see address below). y you have question pertaining to the QA Program, call John Jankovich/NRC. (301) 415-7274.
I 1
 
                                      ~
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3 U.S. NVCLEAR REQULATORY COMMIC.510N              APrnovto 8Y cme: No. 31eo co2e                            E XPfRt e: Ce/90/06 N.RC FORM 314                                                                          tlfNAft$ senate Pth RtqP9h88 te COMPtf sin TW8 UAf . ' ' tat oospM41!st te18ttfee 1 .Cfm. 33.344s)(1)(tv) 10 164Wik 10 tantrfts ms evthertAL si Uett er uns 4 PAnf af 114 easie ret IM                      i 10 Cie 43.42(e)(1)(lv)                                                                  etmaam nat at im mal Itf4 Citates W RAM 4&c%f W4't44t Wpes Ne                                  l to tra so.asteHI)(q f AulTV ti attAzte ie4 IAselfWcits Wet fenwaAO teedren 4tAatset smess (tiudaft                ;
CERTlFICATE OF DlSPOSITION OF MATERlALS Mg,'*","",,",          ,'e',",*"#e'f"f,eT,0 ',l%'d '2",7, w*e'e%
atwe m onct e uAeamwit so suoni.maetse,oc non u asee ar wt :
i swat u amm an a mm m ut mme is msnn 4 a tsume W !                                              j INsinvctioNs: Att rtEus Must BE CCMPtETE3 - PRM CM TYPE                      "'"8'*8""''8''*"'#"'"8"""""
seno ws courteTro cemmeAT: To tus NRc onicE SPECWoO ON THE RtVERSE                                                                                                                    ]
me.            u.owoma                                                                                      euweta                                                    ,,.            l
,              West Virginia University                                                                                  .SNM-1924                                              ^5
)              Radiation Safety Office                                                                                  " "' " " *"
Morgantown. WV 26506                                                                                                                                              d; Attn          Eric Raudenbuch                                                                                5/31/99                                              y; A. MATERtALS DATA (CheeA cne end corro/ ore es riecesserW j  l THE LICENSEE OR ANY INDIVlOUAL EXECUTING THis CERTIFICATE ON BEHALF OF THE LICENSEE CERTIFIES THAT:
(Check and/or complete the oppropriate iternis) below.)                                                              *1 '
I
          ]1. NO MATERIALS HAVE EVER BEEN PROCURE 3 OR POSSESSED BY THE LICENSEE UNDER THIS UCENSE.                                                                              d OR a
          ]2. ALL, ACTIVITIES AUTHORIZED BY THE LICEN$E HAVE CEASED AND ALL MATERIALS PROCURED AND/OR POSSESSED BY THE                                                              ]
LICENSE NUMBER CITED ABOVE HAVE BEEN DISPOSED OF IN THE FOLLOWING MANNER. (1/ edditionelepare is rteeded, t/se the 4 reverse side or provide attachr'sents.)                                                                                                                    ;
                                                                                                                                                                                  .e:
Descree specif c mete iel transfer actione end,if there were radioactive weites generated les termir etirig this iconse, the diepoeal actions mcluding the dispositten of low-level radicactrve weste, rnized weste, Greater-than Ctese.C weste, and Scaled sources,if 4;-          ,
appncetae.                                                          c                                                                                                        l I
For trenefore. opecify the date of the transfer, the name of the license recipient, and the recipient's NRC 11 cense twmber or Agreement-)
d' State name and ficense number.
Transferred 4/18/96 to:                    US Departinent of Energy                                                                                        Q Los Alamos National Laboratory                                                                                      4 Receiving Building SM-30 Bikini Atoll Road                                                                          .'
if m.terials we e d'icosed of directiv Ne Ikonsee rather then treneferred to another licensee,lleensed diepeest elte or weete contreetor, descr'be the speelfio displ et procedures (e.g., deceir ks otorage!
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Los Alamos, NM 87545                                                                                            Q
                                                                                                                                                                                  %)              I A            i B. OTHER DATA                                                                      __
y 1. CUR LICENSE HAS NOT YET EXPIRE 0; PLEASE TERMINATE IT.                                                                                                      9 .,
4 V
: 2. A RADIATION SURVEY WAS CONOUCTED SY THE UCENSEE TO CONFIRM THE ABSENCE OP LICENSED RADIOACTIVE MATERIALSC AN3 TO DtTERM!NE WHETHER ANY CONTAMINATION REMAINS ON THE PREM6SES COVERED BY THE LICENSE. (Cheet one)                                                      ),:
No Vittsch espisnation)
Lgs. THE RESULTS (Check ene)                                                                                                                                    3 y    ARE ATTACHED, or                                                                                                                                                  j WERE FORWARDED TO NRC ON (Dete)
(
: 5. THE PERSON TO BE CONTACTED
                                                                            #'                                                                  'a',E((cT["                        ;e REGAPDING THE INFORMATION PROVIDED ON THIS FORM                                Eric Raudenbush                                                    304-293-3413                    'f 4, MAIL A'.L PVTU81E CORRESPONDENCl REG ARDING THl3 UCENS6 TO                                                                                                            ,
Radiation Safety O!! ice g?;
West Virginia University                                                                                                                                    T      '
MorgAntown. WV 26506 CERilFYING CFFICIAL 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT                                              __
evulvf E3 hA48 ANO f #rLE                                      step.At                                                              cal (                                    )
hW                          /
WVfN*                                Jt$ Qp WAPNihG: FALSE STATEMENTS IN TNS CERTIFICATE MAY BE SUBJECT TO CIVIL ANO/OR CRIM:NA. FENALTIES. NRC .
RE0VLAtl0NS REQUIRE THAT SUBYlSSIONS TO THE NRC BE COMPLETE AND AccVRATE IN ALL MATErt1AL RES SECTION 1001 MAKE$ IT A CRIMNAL CFFENSE To MAKE A WLLFULLY FALSE STATEMENT OR REPRESENTATION TO                                                                            #    AW DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTIONS.                                              _
a.ac roan na 9-es) ma.rtu o8 mm.to pay
 
  .~.  -- .~.            ..      ...            .  . . . - . . ~ . . . - . - . . -        -          - - . . ~ . . . . . _            - - - . .      - -        . - . . . . . - - ~ . - .            - . . ~
M rah!ATION SAFETY OFFICE                                          3e4 293 4529                                                p,gg i
SENT BY:LOS ALAh05 MT'L LAB i 0-20-06 :10:23AM i                                                                        MfSMs                    004 293 4529:s 0/ 3 Y                lll. Om
!                  FE5t_.E/ fa ide ~                                                                                                                                                  P_a_rt 1
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:                                                  INFORMATION FROM LTS BETWEEN:                                                                                :                                                  --------------------
i              License Fee Management Branch, ARM                                                            Program Code: 23300 i                                  and                                                                : Status Code: 0
[97 E9 - 6 f'[ 0: 53  '
Regional Licensing Sections                                                            : Fee Category: EX 10
;                                                                                                      : Exp. Date: 20040531
: Fee Comments: 170.11(A)(4) STORAGE 8
!                                                                                                      : Decom Fin Assur Reqd: N LICENSE FEE TRANSMITTAL                                                                                                                                                                                                                                g A.      REGION 1                1.      APPLICATION ATTACHED l                        Applicant / Licensee: WEST VIRGINIA UNIVERSITY Received Date:                                          970127 1                        Docket No:                                                    7002990 Control No.:
                                  ~
257356 i                        License No.:                                            SNM-1924 l                        Action Type:                                            Termination
;                2.      FEE ATTACHED
;                      Amount:
;                      Check No.:
i
;                3. ComeENTS.
Signed A_                              lw[                                                                                                                                                                                                        ,
Date      /4/ /+? 7                                                                                                                                                                                                                                '
                                                                                                      / /
: 8. LICENSE FEE MANAGEMENT BRANCH (Check when milestonF 05s6s
                                                                                                                                                                                                                                              ]
: 1. Fee Category and Amount:                                                                                                                                                                                  I      f
                                                                                                                                                                                                                                    *=a: ;g g
: 2. Correct Fee Pa,id                                                  lication may be processed for:                                                                                                              'L Q
<                      Amendment          V Renewal i                      License
: 3. OTHER
                                                                                                                                                                                                                                      ,                                RECENED 1 i              BY LFMS                                      *
!                                                                                            Siened                                                                              / f                                                M                              rateA[$j7-B #g /
                                                                                                                                                                                                                                                                          ~-
Date                                                                                                                              /                                                                            ----
g      __L__________
1 B y -/- _N_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
                                                                                                                                                                                                                                                                ' cata ccmp'etedd                      p_,
9-e 1
        ._    .    . . . ~ , ...      ,,                                  . . . _ .          __                                                    . . . _ .                                                            _ _      . _  ,_ , _ . _ _ _ , . . _ .                                    _ _      . , _ _ _ _ _ . , _ _ _ . - -~
 
4 NRC FQHM 314
* U.S. NUCLEAR REGULATORY COMMISSION                APPROVED 87 OM8: NO. 3160 0038                                EXPIRES: 06/30/98 (6 95) lo CFR lo.36(c)(1)(1y)                                                                  ESTWAfl0 OLADEN PER RESPONSE 10 COMPLY MfH THIS MANDATORY NORMADON COLLEC110N to cFl4 4o.42(c)(4)(tv)                                                                llE0UF87. 30 R4NUTES. THIS SUNTTAL 18 USE0 EV imC As PART OF 1)lt BASIS FOR 1Y1 10 CFD 70,38(t) (1) ( t v)                                                              OETERA481ADON INAT THE f ACH.lTV NAS SEEN CLEAMD Of RA010ACTivt MATENAL EFORE YME f ACILITY 18 RELE ASED FOR L9mESTNCTED USE. FORWAA0 C0hE4Nf3 REGARDING BURDEN 881 Wall
                                                                                                                                    ^"* ' " ' " "
CERTlFICATE OF DISPOSITION OF MATERIALS                                            " '"', " "",' "'",,%"
A      '0C"."'"000, '"A f*0      ,,,'E ,"'d    "C'*^J";
(3150-0028L 0FilCf Of MANAEMENT AND BUDET. WASHINGTON. DC 20601 AN A&EllCV Mr NOT INSTRUCTIONS: ALL ITEMS MUST BE COMPLETED - PRINT OR TYPE                  CONouCr OR SPONSOR. A40 A PER$0N is NG'r At000REO 10 llESPOND TO A COLLECiloli of SEND THE COMPLETED CERTIFICATE TO THE NRC OFFICE SPECIFIED ON THE REVERSE              wCRMAm mess mart A Cmm m0 0ue Camt Nun lxiN5f t NAME ANu ADOHtW                                                                                        uCENSE huMBER West Virginia University Radiation Safety Office                                                                                      SNM-1924 Morgantown W 26506                                                                                        " ' ' " " * '
Attn:          Eric Raudenbush                                                                              5/31/99 A. MATERIALS DATA (Check one and complete as necessary)
THE LICENSEE OR ANY INDIVIDUAL EXECUTING THIS CERTIFICATE ON BEHALF OF THE LICENSEE CERTIFIES THAT:
(Check and/or complete the appropriate item (s) below.)
    ]1. NO MATERIALS HAVE EVER BEEN PROCURED OR POSSESSED BY THE LICENSEE UNDER THIS LICENSE.
OR
    ]2. ALL ACTIVITIES AUTHORIZED BY THE LICENSE HAVE CEASED AND ALL MATERIALS PROCURED AND/OR POSSESSED B LICENSE NUMBER CITED ABOVE HAVE BEEN DISPOSED OF IN THE FOLLOWING MANNER /// additionalspace is needed, use the reverse side or provide attachraents.)
Describe specific matenal transfer actions and, if there were radioactive wastes generated in terminating this license, the disposal actions including the disposition of low-level radioactive waste, mixed waste, Greater than-Class-C waste, and sealed sources, if applicable.
For transfers, specify the date of the transfer, the name of the license recipient, and the recipient's NRC license number or Agreement State name and license number.
Transferred 4/18/96 to:                      US Department of Energy Los Alamos National Laboratory Receiving Building SM-30 Bikini Atoll Road if materials were disposed of directly        e licensee rather than transferred to another heensee, licensed disposal site or waste contractor, desenbe the specific                    disp (salNM Los Alamos,            procedures 87545              (e.g., decayin storage)
: 8. OTHER DATA f 1. OUR LICENSE HAS NOT YET EXPIRED; PLEASE TERMINATE IT.
2J A RADIATION SURVEY WAS CONDUCTED BY THE LICENSEE TO CONFlRM THE ABSENCE OF LICENSED RADIOACTIVE MATERIALS AND TO DETERMINE WHETHER ANY CONTAMINATION REMAINS ON THE PREMISES COVERED BY THE LICENSE. (Check one)
NO (Attach explanation)
              ~
YES, THE RESULTS (Check one) y ARE ATTACHED, or WERE FORWARDED TO NRC ON (Date)
: 3. THE PERSON TO BE CONTACTED                                                                                                      ',$1"' "cQ'"
REGARDING THE INFORMATION PROVIDED ON THIS FORM                                  Eric Raudenbush                                                        304-293-3413
: 4. Mall ALL FUTURE CORRESPONDENCE REG ARDING THIS LICENSE TO                                                                                          p Radiation Safety Office West Virginia University M ObV Morgantown, W 26506 CERTIFYING OFFICIAL 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT Ml;4TED NAME AhD llTLE                                            SIGNA T U ~                                                            DATE hl$                  :WU&    /
WW f N '                              ,,js$    Qj WARNING; FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO civil AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY I
DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTIONS.
NAC form 314 t0-96)                                                                                                                          PHINitD ON titCYCLLU PAPEN
 
                                                                                                            .          l FILE CERTIFICATES AS FOLLOWS:                          IF YOU ARE LOCATED IN:                    ,            k IF YOU ARE A DISTRIBUTOR OF EXEMPT PRODUCTS, SEND TO:
ILLINOIS, INDIANA, IOWA, MICHIGAN, MINNESOTA, MISSOURI, OHIO, OR WISCONSIN, SEND APPLICATIONS TO:
DIVISION OF INDUSTRIAL AND MEDICAL NUCLEAR SAFETY OFFICE OF NUCLEAR MATERIAL SAFETY AND SAFEGUARDS U.S. NUCLEAR REGULATORY COMMISSION                    MATERIALS LICENSING SECTION WASHINGTON. DC 20666-0001                              U.S. NUCLEAR REGULATORY COMMISSION REGION lli 801 WARRENVILLE ROAD LISLE, IL 60632 4361 ALL OTHERS, IF YOU ARE LOCATED IN:
ALASKA, ARIZONA, ARKANSAS, CALIFORNIA, COLORADO, CONNECTICUT, DELAWARE, DISTRICT OF COLUMBIA, MAINE,    HAWAli, IDAHO, KANSAS, LOUISlANA, MONTANA NEBRASKA, MARYLAND, MASSACHUSETTS, NEW HAMPSHIRE, NEW            NEVADA, NEW MEXICO, NORTH DAKOTA, OKLAHOMA.
JERSEY, NEW YORK, PENNSYLVANIA, RHODE ISLAND, OR      OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, VERMONT, SEND APPLICATIONS TO:                        TEXAS, UTAH, WASHINGTON, OR WYOMING, SEND APPLICATIONS TO:
LICENSING ASSISTANCE SECTION NUCLEAR MATERIALS SAFETY BRANCH U S. NUCLEAR REGULATORY COMMISSION, RE0lON I                RM ROGM PROMION WW U.S. NUCLEAR REGULATORY COMMISSION. REGION IV KING OF PRUSSIA, PA 19406-1416                        011 RYAN PLAZA DRIVE. SUITE 400 ARLINGTON. TX 76011 8064 ALABAMA, FLORIDA, GEORGIA, KENTUCKY, MISSISSIPPI, NORTH CAROLINA, PUERTO RICO, SOUTH CAROLINA, TENNESSEE, VIRGINIA, VIRGIN ISLANDS, OR WEST VIRGINIA, SEND APPLICATIONS TO:
NUCLEAR MATERIALS SAFETY SECTION U.S. NUCLEAR REGULATORY COMMISSION REGION li 101 MARIETTA STREET NW. SUITE 2900 ATLANTA, G A 30323 0199
                                                                                                                      /
 
    - -      -  -        -        ..                    . ~ _    .__                  .            _- _ - . . - _ .      . . - . - .-.
      , ,  y        ,
                              --                                          Y ROBERTC.BYRD
;                                              HEALTHSCIENCESCENTER OF WEST VIRGINIA UNIVERSITY Radiation Safety 2 -
l l
J Nuclear Materials Safety Section U.S. Nuclear Regulatory Commission, Region II                                                                  -
101 Marietta Street, NW                                                                                        !
Suite 2900 a                        Atlanta, GA 30323-0199 s
I I
 
==Dear Sir,==
 
A contamination survey of the two PuBe sources that were transferred to Los Alamos on 4/18/96                  )
from West Virginia University were surveyed with wipe tests and a gamma well counter. No contamination was noted. The exposure rate at one meter (TI) was 7.5 mR/hr (neutron & gamma).                  ,
Please contact me if addition information is needed.
Sincerely, VU)fS.0.
o..o j366 1267 Health Sciences South PO Box 9006 Morgantown WV 26506-9006 Telephone 348 293-3413 FAX 304 293-4529 Equal Opportunity / Affirmative Action Institution}}

Latest revision as of 15:12, 22 July 2020

Amend 7 to License SNM-1924 for West Virginia Univ.Control: 257356
ML20136E476
Person / Time
Site: 07002990
Issue date: 02/24/1997
From: Dan Collins
NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION II)
To:
References
257356, NUDOCS 9703130216
Download: ML20136E476 (11)


Text

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pn maag* UNITED STATES NUCLEAR REGULATORY COMMISSION 7* REGION ll 7 o 101 MARIETTA STREET. N.W., SUITE 2900

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  1. INFORMATIMNb ERIAL LICENSEES i

Please find enclosed: Your NRC material license

, Amendment to your NRC material license  ;

/ Amendment renewing your NRC material license  !

V Amendment terminating your NRC material license Notice for Radiographer Quality Assurance Approval Program ]

)

l Please review the enclosed document carefully and be sure that you understand all conditions. If there are  ;

any errors or questions, please notify this office (ATTN: Ms. Diane Heim at (404) 331-46731 so that we can I provide appropriate corrections and answers.

Please be advised that your license expires at the end of the day in the month and year stated in the license.

Unless your license has been terminated, you must conduct your program involving byproduct materials in accordance with the conditions of your NitC license, representations made in your license application, and NRC regulations. In particular, note that you must:

1. Operate in accordance with NRC regulations 10 CFR 19, " Notice, instructions and Reports to Workers; inspections," 10 CFR Part 20, " Standards for Protection Against Radiation," and other applicable regulations.
2. Not possess and use materials authorized in Items 6,7, and 8, on the license until:
a. you have constructed the facilities and obtained the equipment described in the license - i application and supporting documentation; and I
b. you have notified the U. S. Nuclear Regulatory Commission, Region ll, ATTN: Materials Licensing \lnspection Branch, in writing, that activities authorized by the license will be initiated.

)

I

c. you have submitted & certified implementation of a Quality Management Program (10 CFR 35.32) for radiotherapy, or for administering > 30 uCl of 1125 or 1-131.
3. Notify NRC, in writing, within 30 days:
a. when an authorized user, Radiation Safety Otticer, or Teletherapy Physicist permanently discontinues performance of duties under the license or has a name change; or i
b. when the licensee's mailing address changes (no fee is required if the location of byproduct material remains the same).
4. In accordance with 10 CFR 30.36(b) and/or license condition, notify NRC, promptly, in writing, and request termination of the license:
a. when you decide to terminate all activities involving materials authorized under the license; or
b. if you decide not to complete the fecility, acquire equipment, or possess and use authorized material.

(Rev. 3/96)

. 2 l

5. Rsquest and obtain a license amendment before you;
a. receive or uso byproduct material for a clinical procedure permitted under Part 35 but not permitted by your license issued pursuant to this part,
b. permit anyone, not authorized under 10 CFR 35, Subpart J, to work as an authorized user under a license for medical use of byproduct material.
c. permit anyone, not authorized under 10 CFR 35, Subpart J, to work as a Radiation Safety  ;

Officer, Teletherapy Physicist, or Nuclear Pharmacist, under a license for medical use of byproduct material,

d. order byproduct material in excess of the amount, or a different radionuclide or form, other than authorized on the license;
e. add or change the areas of use or address (or addresses) of use identified in the license application or on the license; or
f. change ownership of your organization.
6. Submit a complete renewal application with proper fee or termination request at least 30 days before the expiration date of your license. You will receive a reminder notice approximately 90 days before the expiration date. Possession of byproduct material after your license expires is a violation of NRC regulations. Transfer of licensed materials must be consistent with 10 CFR 30,41,40.51 or 70.42, as applicabic. A license will not normally be renewed, except on a case-by-case basis, in instances where licensed material has never been possessed or used.

In addition, please note that NRC Form 313 requires the applicant, by his/her signature, to verify that the  !

applicant understands that all statements contained in the application are true and correct to the best of the applicant's knowledge. The signatory for the application should be the licensee or certifying official rather j than a consultant.  ;

l You will be periodically inspected by NRC. Failure to conduct your program in accordance with NRC 1 regulations, license conditions, and representations made in your license application and supplemental correspondence with NRC will result in enforcement action against you. This could include issuance of a Notice of Violation, or imposition of a Civil Penalty, or an order suspending, modifying or revoking your license as specified in the " General Statement of Policy and Procedures for NRC Enforcement Actions,"

NUREG-1600, (7/95). Since serious consequences to employees and the public can result from failure to comply with NRC requirements, prompt and vigorous enforcement action will be taken against those who do not achieve the necessary attention to detail and standard of compliance expected of licensees.

Thank you for your cooperation.

Enclosures:

1. NRC License
2. Category Marked Below for:

[} New licenses: NUREG-1600 (7/95); 19; 20; 30; 40 or 70, as appropriate; 71; 170; NRC Form 3: Agreement State list; and NRC Form 313.

[] New radiography licenses: Parts 34; 150.

[] New medical and teletherapy licenses: Part 35.

[] Amendments and renewals: NRC Fntm 313.

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DIVISION OF N'.'CI.E.R MATERIA'_S SAFEn DATE: d[/9[' 7/

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SUBJECT:

YOUR REQUEST FOR TRANSFER OR TERMINATION OF NRC LICENSE 4

Pleaso provide the foll0Ving certification, in addition to the NRO FORM 314 (Certificate of Disposition of Materialo):

All records important to the safe and effective decormissioning of the f acility ( 10 CFR 30. 3 5 (g) , 40. 3 6 (f) , 70.25(g), and 72.30(d)); and all records concerning public dose and waste disposal, have been transferred to:

1. Name: dor A/AAW3 /FMbr# /Agagg7pfP (EuCCessor]

License # Btwp1** street: lyns Feat Rito L(Ji' city: p 3 /)Lamar , Btate: 1/su Or eg r ,

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2. USNRC, Attn: Nuclear Materials Licensing Section, at the above address, AND
3. There is no residual conta.mination of the facility or envir us from 1 censed naterials.

Signatures /d .

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! DOE AttrHORIZATION TO MHIP/RELINOUISHMENT OF OWNERMHiP '

(

j 1 i Sign Below and Return to the Following Address: ..

i Sherry W. Jones, MS E524 .h s

Les Alamos NationalLaboratory 's J

P. O. Box 1663 --

i Los Alamos, New Mexico 87545 D

.c i 11 You are authorized by the Department of Energy (DOE) to ship the 239PuBe source (s) on the reverse side l y j form to the im Alamos NationalLaboratory.

l :if*

j s ygf;-e i NOTE: Name and signature must be of an official of the facility that has the authority to /

l relinquish ownership of the 239 PuBe source (s). This form must be signed and returned befor'e f I

Los Alamos will authorize the shipment of your source (s). j i

j

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The West Vireinta Univeraltv-- hereby relinquishes all ownership of the M9PuBe neut

' indicated on the reverse side of this form to the United States Department of Energy (DOE) teceipt/ acceptance of the souse (s) by the Los Alamos National Laboratory.

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i OmciAL NAuenirLE: E M Rnun wa a RSo twsr a w ,n un u wi &

ij 'NAME (Pleno PtinVrype) TTTLE (Please Print /rype)

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fi i SIGNATURE: J l . DA'm'll <

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. . _ _ _ _ . _ .._ _ _ , . _ _ . _ - _ _ ._. . . _ _ _ . . _ _ . _ ~ _

,_..__..m__FE3-31-97 FR3 12124 PM RADIATION SAFETY OFFICE 304 293 4529 P.04 1 .

1 1

l 1 IMPORTANT NOTICE READ CAREFULLY This document was prepared as an account of work sponsored by an agency of i the United States Government. Neither the United States Government. The

! Regents for the University of Cailfornia that operates the Los Alamos National i Laboratory (LANL), nor any agency thereof, nor an of their employees, makes any warranty, express or implied, or assumes any I liability or responsibility

for the accuracy, completeness, usefulness or safety of any information, apparatus, product or process disclosed, or represents that its use would not
infringe privately owned rights. No warranty of safety or efficacy is made by The Regents of the University of California or the United States Department of Ener for any instrument or technique represented by this document. It is 1 sup cd at the request of the recipient, who assumes full responsibility for any i instrument, apparatus, technique or process which arises from its use.

i i

( 1 The los Alamos National Laboratory is a prime contractor to the Department of I

Energy under Contract Number W-7405-ENG 36, As a prime contractor to the Department of Energy, the Laboratory is exempt from all licensing requirements as detailed in Title 10 Part 30.12 " Persons using by-product ,

material under certain Department of Energy and Nuclear Regulatory i; Commission Contracts," and Part 70.11 Persons using special nuclear material j under Department of Energy and Nuclear Regulatory Commission Contracts."

l You as the shipper, and the carrier you choose, are responsible for following all

! United States Department of Transportation (DOT), federal, state and local regulations governing nuclear material shipments, YOU MUST READ AND l l

UNDERSTAND THIS PACKET BEFORE YOU SHIP (see CFR 49 R 172.700 -

172.704 Training subnart H in Apnendir A), Failure to do so will put you in i violation of the above stated responsibilities.

You must abide by the following requirements before LANL will accept your source (s).

i

! AUTHORTzATION TO SHIP INFORMATION:

NO11CE TO NRC UCBNSEES ONLY (Quality Assurance (QN Program )

V you are licensed by the NRC you must hnve a Quality Assurance (9N Program (10 CFR 71.) approved by the NRC. In Section 2 of this packet is (heform that you must complete and mall immediately, because it mi!! take 4 weeksfor approval to the NRC (see address below). y you have question pertaining to the QA Program, call John Jankovich/NRC. (301) 415-7274.

I 1

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FEB-2}-97 FRI 12:27 PM RADIATION SAFETY OFFICE 304 293 4529 P.05 l

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3 U.S. NVCLEAR REQULATORY COMMIC.510N APrnovto 8Y cme: No. 31eo co2e E XPfRt e: Ce/90/06 N.RC FORM 314 tlfNAft$ senate Pth RtqP9h88 te COMPtf sin TW8 UAf . ' ' tat oospM41!st te18ttfee 1 .Cfm. 33.344s)(1)(tv) 10 164Wik 10 tantrfts ms evthertAL si Uett er uns 4 PAnf af 114 easie ret IM i 10 Cie 43.42(e)(1)(lv) etmaam nat at im mal Itf4 Citates W RAM 4&c%f W4't44t Wpes Ne l to tra so.asteHI)(q f AulTV ti attAzte ie4 IAselfWcits Wet fenwaAO teedren 4tAatset smess (tiudaft  ;

CERTlFICATE OF DlSPOSITION OF MATERlALS Mg,'*","",,", ,'e',",*"#e'f"f,eT,0 ',l%'d '2",7, w*e'e%

atwe m onct e uAeamwit so suoni.maetse,oc non u asee ar wt :

i swat u amm an a mm m ut mme is msnn 4 a tsume W ! j INsinvctioNs: Att rtEus Must BE CCMPtETE3 - PRM CM TYPE "'"8'*8""8*"'#"'"8"""""

seno ws courteTro cemmeAT: To tus NRc onicE SPECWoO ON THE RtVERSE ]

me. u.owoma euweta ,,. l

, West Virginia University .SNM-1924 ^5

) Radiation Safety Office " "' " " *"

Morgantown. WV 26506 d; Attn Eric Raudenbuch 5/31/99 y; A. MATERtALS DATA (CheeA cne end corro/ ore es riecesserW j l THE LICENSEE OR ANY INDIVlOUAL EXECUTING THis CERTIFICATE ON BEHALF OF THE LICENSEE CERTIFIES THAT:

(Check and/or complete the oppropriate iternis) below.) *1 '

I

]1. NO MATERIALS HAVE EVER BEEN PROCURE 3 OR POSSESSED BY THE LICENSEE UNDER THIS UCENSE. d OR a

]2. ALL, ACTIVITIES AUTHORIZED BY THE LICEN$E HAVE CEASED AND ALL MATERIALS PROCURED AND/OR POSSESSED BY THE ]

LICENSE NUMBER CITED ABOVE HAVE BEEN DISPOSED OF IN THE FOLLOWING MANNER. (1/ edditionelepare is rteeded, t/se the 4 reverse side or provide attachr'sents.)  ;

.e:

Descree specif c mete iel transfer actione end,if there were radioactive weites generated les termir etirig this iconse, the diepoeal actions mcluding the dispositten of low-level radicactrve weste, rnized weste, Greater-than Ctese.C weste, and Scaled sources,if 4;- ,

appncetae. c l I

For trenefore. opecify the date of the transfer, the name of the license recipient, and the recipient's NRC 11 cense twmber or Agreement-)

d' State name and ficense number.

Transferred 4/18/96 to: US Departinent of Energy Q Los Alamos National Laboratory 4 Receiving Building SM-30 Bikini Atoll Road .'

if m.terials we e d'icosed of directiv Ne Ikonsee rather then treneferred to another licensee,lleensed diepeest elte or weete contreetor, descr'be the speelfio displ et procedures (e.g., deceir ks otorage!

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Los Alamos, NM 87545 Q

%) I A i B. OTHER DATA __

y 1. CUR LICENSE HAS NOT YET EXPIRE 0; PLEASE TERMINATE IT. 9 .,

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2. A RADIATION SURVEY WAS CONOUCTED SY THE UCENSEE TO CONFIRM THE ABSENCE OP LICENSED RADIOACTIVE MATERIALSC AN3 TO DtTERM!NE WHETHER ANY CONTAMINATION REMAINS ON THE PREM6SES COVERED BY THE LICENSE. (Cheet one) ),:

No Vittsch espisnation)

Lgs. THE RESULTS (Check ene) 3 y ARE ATTACHED, or j WERE FORWARDED TO NRC ON (Dete)

(

5. THE PERSON TO BE CONTACTED
  1. ' 'a',E((cT[" ;e REGAPDING THE INFORMATION PROVIDED ON THIS FORM Eric Raudenbush 304-293-3413 'f 4, MAIL A'.L PVTU81E CORRESPONDENCl REG ARDING THl3 UCENS6 TO ,

Radiation Safety O!! ice g?;

West Virginia University T '

MorgAntown. WV 26506 CERilFYING CFFICIAL 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT __

evulvf E3 hA48 ANO f #rLE step.At cal ( )

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WVfN* Jt$ Qp WAPNihG: FALSE STATEMENTS IN TNS CERTIFICATE MAY BE SUBJECT TO CIVIL ANO/OR CRIM:NA. FENALTIES. NRC .

RE0VLAtl0NS REQUIRE THAT SUBYlSSIONS TO THE NRC BE COMPLETE AND AccVRATE IN ALL MATErt1AL RES SECTION 1001 MAKE$ IT A CRIMNAL CFFENSE To MAKE A WLLFULLY FALSE STATEMENT OR REPRESENTATION TO # AW DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTIONS. _

a.ac roan na 9-es) ma.rtu o8 mm.to pay

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M rah!ATION SAFETY OFFICE 3e4 293 4529 p,gg i

SENT BY:LOS ALAh05 MT'L LAB i 0-20-06 :10:23AM i MfSMs 004 293 4529:s 0/ 3 Y lll. Om

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MAR. 70; 052 GROUPi NM AC00UNTING $5CTl0N 741 #! EYR.ADA-/

us sees,13bt* HONE:7 5846 7AX) 54548 VENLOR NAMg: see viratais tiniversiev

- PHONE e {3041 2ps-M13 VENDOR GONTAGTI _ _Hric Raudenbush MATERIAL 19 DEING _PURCHA$30 LOANED _OTHER (SPECIFY):

bk Ng AVIHORIZADON REFSMENCE:

U22-26/04

~ l i PROJECTED RECEIPT DATE:

4, wN NUCLEAR MATERIAL. DESCRIPfleN AND EttMATED WusbeyQUANTmES:of S urcess 2 M pn ..e n.9,...

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DAYS AFitR MICEIPT.

g CONPNIMAMON MEASUREMENT W11. BE PERPORMED I VERiPICAMON MEASUREMENTS WILL BE PERPORMED _ DAYS AFTRA RECEIP t

MEASVRIMENTTECHNIQUETO BE USED:

Tat .unnen viti be received seeerd;ns se v

N the Recalving Plan for cat. IV Sealed Neutron mrces sated 4/1/s3'

% WILL ACCOUm CATEGORY UMits FOR $PECIAL NUCLEAR MATERIAL DE EXCEEDEDUPONRECEIPTOFMATERIALT_Ytt JL No.

IFYSS. ATTACH SECURITY PLAN.

COMMENf5:

cueT001AN 56eMATURE: bo

  • b2 bb N!44 OATE' DATE: k"N b NM MANAGEMENT APPROVbdA All2bl #' 2/M LANLHM MgyngsgmAnyg3 if _b 28%LM 6 DAT8d"845 LO8 ALAM08 AVrHORIEAMON
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(FOR LFMS USE)
INFORMATION FROM LTS BETWEEN:  : --------------------

i License Fee Management Branch, ARM Program Code: 23300 i and  : Status Code: 0

[97 E9 - 6 f'[ 0: 53 '

Regional Licensing Sections  : Fee Category: EX 10

Exp. Date: 20040531
Fee Comments: 170.11(A)(4) STORAGE 8

!  : Decom Fin Assur Reqd: N LICENSE FEE TRANSMITTAL g A. REGION 1 1. APPLICATION ATTACHED l Applicant / Licensee: WEST VIRGINIA UNIVERSITY Received Date: 970127 1 Docket No: 7002990 Control No.:

~

257356 i License No.: SNM-1924 l Action Type: Termination

2. FEE ATTACHED
Amount
Check No.

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3. ComeENTS.

Signed A_ lw[ ,

Date /4/ /+? 7 '

/ /

8. LICENSE FEE MANAGEMENT BRANCH (Check when milestonF 05s6s

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1. Fee Category and Amount: I f
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2. Correct Fee Pa,id lication may be processed for: 'L Q

< Amendment V Renewal i License

3. OTHER

, RECENED 1 i BY LFMS *

! Siened / f M rateA[$j7-B #g /

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Date / ----

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4 NRC FQHM 314

  • U.S. NUCLEAR REGULATORY COMMISSION APPROVED 87 OM8: NO. 3160 0038 EXPIRES: 06/30/98 (6 95) lo CFR lo.36(c)(1)(1y) ESTWAfl0 OLADEN PER RESPONSE 10 COMPLY MfH THIS MANDATORY NORMADON COLLEC110N to cFl4 4o.42(c)(4)(tv) llE0UF87. 30 R4NUTES. THIS SUNTTAL 18 USE0 EV imC As PART OF 1)lt BASIS FOR 1Y1 10 CFD 70,38(t) (1) ( t v) OETERA481ADON INAT THE f ACH.lTV NAS SEEN CLEAMD Of RA010ACTivt MATENAL EFORE YME f ACILITY 18 RELE ASED FOR L9mESTNCTED USE. FORWAA0 C0hE4Nf3 REGARDING BURDEN 881 Wall

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CERTlFICATE OF DISPOSITION OF MATERIALS " '"', " "",' "'",,%"

A '0C"."'"000, '"A f*0 ,,,'E ,"'d "C'*^J";

(3150-0028L 0FilCf Of MANAEMENT AND BUDET. WASHINGTON. DC 20601 AN A&EllCV Mr NOT INSTRUCTIONS: ALL ITEMS MUST BE COMPLETED - PRINT OR TYPE CONouCr OR SPONSOR. A40 A PER$0N is NG'r At000REO 10 llESPOND TO A COLLECiloli of SEND THE COMPLETED CERTIFICATE TO THE NRC OFFICE SPECIFIED ON THE REVERSE wCRMAm mess mart A Cmm m0 0ue Camt Nun lxiN5f t NAME ANu ADOHtW uCENSE huMBER West Virginia University Radiation Safety Office SNM-1924 Morgantown W 26506 " ' ' " " * '

Attn: Eric Raudenbush 5/31/99 A. MATERIALS DATA (Check one and complete as necessary)

THE LICENSEE OR ANY INDIVIDUAL EXECUTING THIS CERTIFICATE ON BEHALF OF THE LICENSEE CERTIFIES THAT:

(Check and/or complete the appropriate item (s) below.)

]1. NO MATERIALS HAVE EVER BEEN PROCURED OR POSSESSED BY THE LICENSEE UNDER THIS LICENSE.

OR

]2. ALL ACTIVITIES AUTHORIZED BY THE LICENSE HAVE CEASED AND ALL MATERIALS PROCURED AND/OR POSSESSED B LICENSE NUMBER CITED ABOVE HAVE BEEN DISPOSED OF IN THE FOLLOWING MANNER /// additionalspace is needed, use the reverse side or provide attachraents.)

Describe specific matenal transfer actions and, if there were radioactive wastes generated in terminating this license, the disposal actions including the disposition of low-level radioactive waste, mixed waste, Greater than-Class-C waste, and sealed sources, if applicable.

For transfers, specify the date of the transfer, the name of the license recipient, and the recipient's NRC license number or Agreement State name and license number.

Transferred 4/18/96 to: US Department of Energy Los Alamos National Laboratory Receiving Building SM-30 Bikini Atoll Road if materials were disposed of directly e licensee rather than transferred to another heensee, licensed disposal site or waste contractor, desenbe the specific disp (salNM Los Alamos, procedures 87545 (e.g., decayin storage)

8. OTHER DATA f 1. OUR LICENSE HAS NOT YET EXPIRED; PLEASE TERMINATE IT.

2J A RADIATION SURVEY WAS CONDUCTED BY THE LICENSEE TO CONFlRM THE ABSENCE OF LICENSED RADIOACTIVE MATERIALS AND TO DETERMINE WHETHER ANY CONTAMINATION REMAINS ON THE PREMISES COVERED BY THE LICENSE. (Check one)

NO (Attach explanation)

~

YES, THE RESULTS (Check one) y ARE ATTACHED, or WERE FORWARDED TO NRC ON (Date)

3. THE PERSON TO BE CONTACTED ',$1"' "cQ'"

REGARDING THE INFORMATION PROVIDED ON THIS FORM Eric Raudenbush 304-293-3413

4. Mall ALL FUTURE CORRESPONDENCE REG ARDING THIS LICENSE TO p Radiation Safety Office West Virginia University M ObV Morgantown, W 26506 CERTIFYING OFFICIAL 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT Ml;4TED NAME AhD llTLE SIGNA T U ~ DATE hl$ :WU& /

WW f N ' ,,js$ Qj WARNING; FALSE STATEMENTS IN THIS CERTIFICATE MAY BE SUBJECT TO civil AND/OR CRIMINAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY I

DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTIONS.

NAC form 314 t0-96) PHINitD ON titCYCLLU PAPEN

. l FILE CERTIFICATES AS FOLLOWS: IF YOU ARE LOCATED IN: , k IF YOU ARE A DISTRIBUTOR OF EXEMPT PRODUCTS, SEND TO:

ILLINOIS, INDIANA, IOWA, MICHIGAN, MINNESOTA, MISSOURI, OHIO, OR WISCONSIN, SEND APPLICATIONS TO:

DIVISION OF INDUSTRIAL AND MEDICAL NUCLEAR SAFETY OFFICE OF NUCLEAR MATERIAL SAFETY AND SAFEGUARDS U.S. NUCLEAR REGULATORY COMMISSION MATERIALS LICENSING SECTION WASHINGTON. DC 20666-0001 U.S. NUCLEAR REGULATORY COMMISSION REGION lli 801 WARRENVILLE ROAD LISLE, IL 60632 4361 ALL OTHERS, IF YOU ARE LOCATED IN:

ALASKA, ARIZONA, ARKANSAS, CALIFORNIA, COLORADO, CONNECTICUT, DELAWARE, DISTRICT OF COLUMBIA, MAINE, HAWAli, IDAHO, KANSAS, LOUISlANA, MONTANA NEBRASKA, MARYLAND, MASSACHUSETTS, NEW HAMPSHIRE, NEW NEVADA, NEW MEXICO, NORTH DAKOTA, OKLAHOMA.

JERSEY, NEW YORK, PENNSYLVANIA, RHODE ISLAND, OR OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, VERMONT, SEND APPLICATIONS TO: TEXAS, UTAH, WASHINGTON, OR WYOMING, SEND APPLICATIONS TO:

LICENSING ASSISTANCE SECTION NUCLEAR MATERIALS SAFETY BRANCH U S. NUCLEAR REGULATORY COMMISSION, RE0lON I RM ROGM PROMION WW U.S. NUCLEAR REGULATORY COMMISSION. REGION IV KING OF PRUSSIA, PA 19406-1416 011 RYAN PLAZA DRIVE. SUITE 400 ARLINGTON. TX 76011 8064 ALABAMA, FLORIDA, GEORGIA, KENTUCKY, MISSISSIPPI, NORTH CAROLINA, PUERTO RICO, SOUTH CAROLINA, TENNESSEE, VIRGINIA, VIRGIN ISLANDS, OR WEST VIRGINIA, SEND APPLICATIONS TO:

NUCLEAR MATERIALS SAFETY SECTION U.S. NUCLEAR REGULATORY COMMISSION REGION li 101 MARIETTA STREET NW. SUITE 2900 ATLANTA, G A 30323 0199

/

- - - - - .. . ~ _ .__ . _- _ - . . - _ . . . - . - .-.

, , y ,

-- Y ROBERTC.BYRD

HEALTHSCIENCESCENTER OF WEST VIRGINIA UNIVERSITY Radiation Safety 2 -

l l

J Nuclear Materials Safety Section U.S. Nuclear Regulatory Commission, Region II -

101 Marietta Street, NW  !

Suite 2900 a Atlanta, GA 30323-0199 s

I I

Dear Sir,

A contamination survey of the two PuBe sources that were transferred to Los Alamos on 4/18/96 )

from West Virginia University were surveyed with wipe tests and a gamma well counter. No contamination was noted. The exposure rate at one meter (TI) was 7.5 mR/hr (neutron & gamma). ,

Please contact me if addition information is needed.

Sincerely, VU)fS.0.

o..o j366 1267 Health Sciences South PO Box 9006 Morgantown WV 26506-9006 Telephone 348 293-3413 FAX 304 293-4529 Equal Opportunity / Affirmative Action Institution