ML20207K360
| ML20207K360 | |
| Person / Time | |
|---|---|
| Site: | 07002953 |
| Issue date: | 01/25/1999 |
| From: | Tara Weidner NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | |
| References | |
| 126364, NUDOCS 9903170153 | |
| Download: ML20207K360 (19) | |
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"" 7"" * . - u.s. NUCLEAR RE!ULAToRY commission Am:ndment No.10 MATERIALS LICENSE Puriuant 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, 39,40, and 70, and in reliance on statements and representations l
' 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.
Ucensee In accordance with the letter dated December 4,1998, i
- 1. University of Connecticut 3. Ucense number SNM-1889 is amended in Environmer.tal Health and Safety is entirety to read as foitows:
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- 4. Expiration date October 31, 2002
- 2. 3102 Horse Bamhill Road, U-9(
Storrs, Connecticut 06269-4097- 5. Docket No. 07042953 h Reference No.
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- 6. Byproduct, source, and/or special 'Cl$mhland/oIp ysicalf$rn ' 8. bla$imum amount that licensee may nuclear material b
Li rO) /i' g 'j possess at any one time under this g , O%Cgg$(: )4 1 license s
A. Plutonium 238 Sealed neutron source f,! / A. t2 grams (20 curies)
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Q B. Plutonium 239
$ 'B)p$$aNid N50ftroES61irceW B.C80 grams (5 curies)
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- 3. Authorized use: '/ V a
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/f" A g A. and B. Research at:d development as difined in 10 CFR 30.4; teaching and training of students. 1
- }',jO3 CONDITIONS
- 10. Licensed material may be used only at the licensee's facilities located at the Department of Physics,2152 Hillside Road, University of Connecticut, Storrs, Connecticut or Department of Environmental Health and Safety Hazardous Waste Facility, Horse Barn Hill Road, University of Connecticut, Storrs, Connecticut.
11, Licensed material shall be used by, or under the supervision of, individuals designated by the Radiation l Safety Committee, Hedley C. Freake, Ph.D., Chairman.
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- 12. The Radiation Safety Officer for this license is Thomas Hasselbacher.
- 13. Licensed material shall not be used in or on human beings or in field applications where activity is released except as provided otherwise by specific condition of this license.
9903170153 990125 t PDR ADOCK 07002953 C PDR l . .-.
OFFICIAL RECORD COPY ML10 l
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NRC FORM 374A u.s. N R REGULATORY Commission PAGE 3 of 3 PAGEs Uconso Number SNM-1889 MATERIALS LICENSE Docket or Reference Number SUPPLEMENTARY SHEET 070-02953 Amendment No.10 l
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- 14. A. Sealed sources and detector cells containing licensed material shall be tested for leakage and/or !
contamination at intervals not to exceed six months or at such other intervals as are specified by the l certificate of registration referred to in 10 CFR 32.210, not to exceed three years. j B. Notwithstanding Paragraph A of this Condition, sealed sources designed to emit alpha particles shall l be tested for leakage and/or contamination atintervals not to exceed three months. I
, Q Y ' * * ' C Li ff , l C. In the absence of a certificate from a transfere: indicating that a leak test has been made within six months pnor to the transfeb a sealed source or detector celfr'eceived from another person shall not be put into use until tested.
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D. Each sealed source fabricated by the licensee shall be inspcted a tested for construction defects, as a sealed source.
leakage, and W conta'thinatio'n p(ribr'to any use or transfer,f 3 E.
Q Sealed sources aff detector cells need noMak testedTf:
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p c ' (! /> cy 1 0 (i) N ; .
5 they contaittoply hydrg[en-3; fg.og /' ; j ,
g oh lId (ii) they contain oTily a r& Q i.adioactiveigasj T %
b h5N kh { h kN (iii) the half-life of theisotope m'30~ days'or-lessEo W
.,, Co Q 'Y % [g g # y (iv) they contain not more than 100 microcurtes'of beta' and(o gamma emitting material or not more l
than 10 microcuries 6f alphaymitting m'aterial; or (v)
TAs 4i they are not designed to emit alpha particlesiare in storage, and are not being used. However, ,
when they are removed from storage for use or transfer to another person, and have not been tested within the required leak test interval, they shall be tested before use or transfer. No sealed source or detector cell shall be stored for a period of more than 10 years without being tested for leakage and/or contamination.
F. The test shall be capable of detecting the presence of 0.005 microcurie of radioactive material on the test sample. If the test reveah. the presence of 0.005 microcurie or more of removable contamination, a report shall be filed with the U.S. Nuclear Regulatory Commission and the source or detector cell shall be removed immediately from service and decontaminated, repaired, or disposed of in accordance with Commission regulations. The report shall be filed within five days of the date the leak test result is known with the U.S. Nuclear Regulatory Commission, Region I, ATTN: Director, Division of Nuclear Materials Safety,475 Allendale Road, King of Prussia, Pennsylvania 19406. The report shall specify the source or detector cell involved, the test results, and corrective action taken.
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NRC FORM 374A U.s. N R REGULATORY Commission PAGE 3 of 3 PAGEs License Number SNM-1889 )
MATERIALS LICENSE Ddet or Reference Number SUPPLEMENTARY SHEET 070-02953
! Amendment No.10 G. The licensee is authorized to collect leak test samples for analysis by the licensee. Attematively, tests for leakage and/or contamination may be performed by persons spc5c&lly licensed by the Commission or an Agreement State to perform such services.
- 15. Sealed sources or detector cells containing licensed material shall not be opened or sources removed from source holders by the licensee.
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- 16. The licensee shall conduct a physich1nventory every six montkto account for all sealed sources and j l
devices containing licensed mateEal received and possessed under)he license.
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- 17. Except as specifically prov,ided otherwise in this license, the licensee shaft, conduct its program in I
accordance with the statemen l any enclosures, listed tieldw. ts, representations, The Nuclear Regulatory Commission's and procedures contained regu'tations shall in the govern unless the docum statements, represent $tions, and'proce00res in,t ' nse'e's application arid correspondence are more restrictive than the regGlitions. [Y) T '($ 53 4 O A. Application gdated l- V kuw h April 24,1992,1r% yme 7) M <5,f B. f9 # ' f'a &
C. Application dated Octobeq18[}1993V/14+!
Application dated Ifiy 9,1995 f T # l ' " ![ D D.
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Letter dated May 5,g1997 'Cjlfk" Letterdated Augustf 8 i997 g #
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F. Letter dated August 24( 998 Y ' < %
G. Letter dated September)if1998 W
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/ 4s w/ Le e T %- g -g V For the U.S. Nuclear Regulatory Commission Originalsigned by Tara L. Weidner Date January 25 1999 By Tara L. Weidner Nuclear Materials Safety Branch 1 Division of Nuclear Materials Safety Region I King of Prussia, Pennsylvania 19406
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O O January 25,1999 Docket No. 030-10576 License No. 06-01450-47 030-11727 06-01450-48 OiD-02953 SNM-1869 Control No. 126362 126363 126364 Dale M. Dreyfuss Vice Chancellor for Business & Administration University of Connecticut-Department of Environmental Health & Safety 3102 Bamhill Road U-97 Storrs, CT 06269-4097
Dear Mr. Dreyfuss:
This refers to your license amendment request.. Enclosed with this letter are the amended licenses.
- Please revienw the enclosed documents carefully and be sure that you understand and fully implement all the conditions incorporated into the amended licenses. If there are any errors or
, questions, please notify the U.S. Nuclear Regulatory Commission, Region i Office, Licens!ng
~ Assistance Team, (610) 337-5093 or 5239, so that we can provide appropriate corrections and answers.
Thank you for your cooperation.
' Sincerely,
. Originalsignedby Tara L. Weidner Tara L. Weidner Health Physicist Nuclear Materials Safety Branch 1 Division of Nuclear Materials Safety
Enclosure:
Amendment Nos. 28,12 and 10 cc*
Thomas Hasselbacher, Radiation Safety Officer ML10 -
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D. Dreyfuss 3
. University of Connecticut i
i 46 -0/ '/60 ' #/6 BNm-) t X f DOCUMENT NAME: B:\DNMS Documents \Lic Cover Letter \LO6-01450-47.wpd 77847210 To seceive e cop' of this document Indcote in the hor: "C" - Copy w/o attach /enet *E' - Copy w/ ettech/enet *N' = No copy OFFICE DNMS/RI f, , 1 N DNMS/Ri l l l NAME TWeidneEdje DATE 01/25/99 01/ /99 01/ /99 01/ /99 i
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EnvironmentalHealth & Safety
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Phone: (860)486-3613 Fax: (860) 486-1106 Fax
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DEPARTMENT OF THE NAVY
^ ' CFFICE OF THE CHIEF OF N AVAL OPER ATIONS .
i WASHINGTON. DC 20250 2000 IN BCPLY REFER TO
- 6470 Ser 455C/2U601984 2 Jul 92 From: Chairman, Navy Radiation Safety Committee To: Commanding Officer, Naval Hospital, Groton, CT 06349-5600 Subj: NAVY RADI0 ACTIVE MATERIAL PERMIT' AMEN 0 MENT ,
Ref: (a) NAVHOSP Groton ltr 6470 Ser 624/1898 of 9 Jun 92 06-61726-11NP, Amendment Enc 1: (1) Navy Radioactive Material Permit No.
No. 02
- 1. As requested by reference (a), Navy Radioactive Material Permit (NRMP) No.
06-61726-11NP is amended to name LCDR T. Hasselbacher, MSC, USN as Radiation Safety Officer, replacing LT G. A. Harris, MSC, USN.
- 2. Permit Condition 14 is also revised to reflect current reporting requirements for radiation incidents (10 CFR 30.50) and misadministrations (10 CFR35.33).
- 3. Enclosure (1) is forwarded as your amended authorization for the use of radioactive material under NRMP No. 06-61726-11NP.
Copy to: , , I og BUMED (MED-211) CAPT NSC USN NRC Region II Atlanta GA NAVENVIRHLTHCEN Norfolk VA Executive Secretary Navy Radiation Safety Committee 1
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ENV HLTH SAFEIT 003
' 01/07/99 1o:29 8J86o ( S 1106 (~
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'OPNAVMST MM ENERBEEERNE Pursuant to tne authority stated in OPNAVINST 6470.3, reliance on statements made by the applicant, permission h bjherebyh granted for t e h iiiNavy Radiation receipt, possession, use, storage and disposal of radioactive materiah l&ted conditiorts listed in this permit.
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2 - PERMIT NO.
1 - COMMAND 06-61726-11NP Naval Hospital Groton, CT 06349-5600 3 - AMENDMENT NO.
02 4 - DOCKET NO.
5 - EXPIRATION DATE 31 August 1995 8 - MAXIMON QUANTITY 7 -CHEMICAL / AtJTHORIZED 6 - RADI0 ACTIVE PHYSICAL FORM NATERIAL
- a. Byproduct or accelerator produced material in a radiopharmaceu diagnostic use involving measurements of uptake, dilution or ex in 10 CFR 35.100 in amounts as needed,
- b. Byproduct or accelerator produced mat.: rial, excluding gases, in a radiopharmaceutical for diagnostic use involving imaging and localizatio specified in 10 CFR 35.200 in amounts as needed.
PERMIT CONDITIONS:
9.
The Command's Radioactive Material Permit is reprinted in its entirety.
Additions and The revisions permit as a result application dated of 19 thisJuly amendment 1990, are letter dated denoted itted17 Aug respectively.
1990, and amendment requests dated 11 July 1991 and 9 June 19 information and procedures, are considered an integral part of(Rthis R Material Permit and shall be maintained on f tJe with the permit.
10.
Radioactive material authorized by this Permit shall be used only
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Hospital, Groton, CT. ,
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~ SUPPLEMENTARY SHEET _
. ~ -United States Navy Radiation Safety Committee RADIOACTIVE MATERIALS PERMIT PERMIT NO.
06-61726-11NP AMEN 0 MENT NO.
02 11.
The-Radiation Safety Officer for the use of radioactive material authorized (R- b this Permit is LCDR T. Hasselbacher, MSC, USN.
-12.
Radioactive material shall be used by, or under the supervision of, individ designated by the_tommand's Radiation Safety Committee,
- a. The use of radioactive materials in -or on humans shall be by a physician as defined in Section 35.2 of 10 CFR Part 35.
The Command's Radiation Safety Committee may designate authorized
_ . b.
radioactive material after certifying that the individual's trainingThe and experie levels meet the training and experience _ requirements of Subpart J of 10 CF Comand's Radiation Safety Committee records shall clearly document l the b granting the approval and specifically state the types ofActions use of radio authorized.- These records including supplements A and B of Regulatory G shall be maintained for later review by the Navy Radiation Safety Committee. be of the Command's Radiation Safety Committee in app 13.
Command may use isotopes of 10 CFR 31.11 subject only to the requir 31.11 if:
a.. inventory limits of 31.11 are observed, and
- b. in vitro isotope usage is physically and administrative 1y separate fro medical isotope use involving internal or external administration to humans or animals.
- 14. 'The notifications specified in subparagraphs (a) and (b) will be m Nuclear Regulatory Commission reporting requirements of 10 CFR.
-(a) Immediate voice / message notification by OPREP-3 NAVY BLUE rep OPNAVINST 3100.6 series with Bureau cf Medicine and Surgery (MED-21) an Environmental Health Center as information addressees for the following:
(1) Excessive radiation levels or contamination on packages (1 (2)' Theft or loss of radioactive material (10 CFR 20.402). (R l (3) Radiation incidents as defined by 10 CFR 20.403 and 10 CFR cI 3 I
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01/07/99 10:30 @ 860 186 1106 ENV HLTH SAFETY @ ooS
., Page.L.of 2 P'558 SUPPLEMENTARY SHEET '
United States Navy Radiation Safety Conunittec RADIOACTIVE MATERIALS PERMIT PERMIT NO.
06-61726-11NP AMENOMENT NO.
02 (4) Defect or failure to comply (10 CFR 21).
(5) Reports of leaking sources (10 CFR 35.59).
(A (6) Misadministrations (10 CFR 35.33).
(b) Written notification' to Chief of Naval Operations (OP-45) within 15 An advance days copy and/or with an information copy to Navy Environmental Health center.
telephone report to OP-45 should also be made to ensure notification within 15 days for the following:
(1) Over exposure and excessive levels and concentrations (10 CFR 20.405)
- 15. The Command may make minor changes in radiation safety procedures as described in 10 CFR 35.31 after conducting an internal review and obtaining approval of the Command's Radiation Safety Committee, as long as compliance with NRC regulations is maintained. No formal amendment request is required but an informational copy An of any such approval should be forwarded to the Navy Environmental Health Center.
amendment request to this Permit is required for a change in Radiation Safety Officer, additional types of use of radioactive material, or new location of use of radioactive material.
- 16. Except as specifically provided otherwise by this Permit, the command shall possess and use radioactive material described in this Permit in accordance with:
- a. Statements, representations, and procedures contained in the command's application dated 19 July 1990, letter dated 17 August 1990, and amendment requests (R dated 11 July 1991 and 9 June 1992.
- b. Code of Federal Regulations, BUMEDINST 6470.20, OPNAVINST 6470.3 and NAYMED P-5055.
- c. The command shall maintain records for review by the Navy Radiation Safety Committee sufficient to document operational compliance with the above requirements and other conditions of this Permit. ,.
Date / PS C W. KALINOSKI _"'T5
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CAPT MSC USN
~ c. 'O t 7* cut 2.VC SCCIOtRIy OPNAV 6470/1 supplemeat (4-46)
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OFFICIALRECORDOOPY KL 10
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This is to acknowledge the receipt of your letter / application dated
/A~Y"[O , and to inform you that the initial processing which includes an administrative review has been performed.
kR)dND*
h There were no administrative omissions. Your application was assigned to a technical reviewer. Please note that the technical review may identify additional j omissions or require additionalinformation.
Please provide to this office within 30 days of your receipt of this card l
A copy of your action has been forwarded to our License Fee & Accounts Receivable Branch, who will contact you separately if there is a fee issue involved.
Your action has been assigned Mail Control Number When calling to inquire about this action, please refer to i r n r.
You may call us on (610) 337-5398, or 337-5260.
-,- ym sincerety, 126364 esem Licensing Assistance Team Leader l
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. ' University Of Connecticut Divhion ofBusiness andAdministration Environmental Heahh
'ad S4 December 4,1998 U.S. Nuclear Regulatory Commission, Region I Nuclear Material Section B 475 Allendale Road King of Prussia, PA 19406 License No. SNM-1889 Docket No. 070-02953
Subject:
License Amendment Application PLEASE EXPEDITE - Change in RSO Enclosed, please find two copies of an application for material license amendment and the supporting documentation to amend license no. SNM-1889.
The University of Connecticut has hired a full time Radiation Safety Officer, Mr. Thomas Hasselbacher, to begin employment on December 16,1998. During the transition period, Mr. Kenneth Price has been acting as interim RSO and was named on the license in amendment no. 9. We requeu that Mr. Thomas Hasselbacher be named as Radiation Safety Officer on or before December 16,1998.
Mr. Hasselbacher's credentials are attached for your review. It should be noted that from 1984 through 1986 he was RSO on license number SNM-310 and on broad scope license number 06-1765-01. From 1986 through 1994 he was RSO on medical use license number 06-12193-02 at the U.S. Navel Hospital, Groton, Connecticut. During the period 1986 through 1989 he was RSO on the Naval Medical Research Lab's broad scope license number 06-01765-03.
If additional information is required or the University can provide further assistance, please contact Frank Labato, Director of the Department of Environmental Health and Safety, by telephone at (860) 486-3613 or at the mailing address on the attached Form 313.
Sincerely, Q& & ]'t . .
Dale M. Dreyfuss Vice Chancellor for Business an dministration n.ww n_, w l
3102 Horwbarn liili Road. U-97 s.c- - - 12eae4 '
Teicphone: (860) 486-3613
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I NR9 FORM $13 e
U. S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 31504120 O.93) EXPIREO S40-96 ;
10 CFR 30. 32. 33 ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THis l S4,35,36,30 and 40 NFORMATION COLLECTION REQUEST. 9 HOURS SUBMITTAL OF THE )
l APPLCATON IS NECESSARY TO DETERMNE THAT THE APPLCANT IS QUALIFIED AND THAT ADEOUATE PROCEDURES EXIST TO PROTECT THE PUBl lC HEALTH AND bAFETY. FORWARD COMMENTS APPLICATION FOR MATERIAL LICENSE REGARDiNG BURDEN ESTiuATE TO THE iNFORuATiON AND RECORDS MANAGEMENT BRANCH (MNDB 7714), U S. NUCLEAR REGULATORY i
COMMISSON, WASHINGTON, DC 20555 0001 AND TO THE PAPERWORK REDUCTON PROJECT (3150 0120). OFFCE OF MANAGEMENT ANDBUDGET WASHINGTON DC 20503 INSTRUCTIONS: SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPL ATGN.
SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW. () 7C - d R ,_
APPUCATION FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPUCATIONS WITH. IF YOU ARE LOCATED IN:
CNISION OF NOUSTRIAL AND MEDCAL NUCLEAR SAFETY ILUNOIS, INDIANA, IOWA, MICHIGAN, MINNESOT A, MISSOURt, OHIO, OR WISCONSIN, C7FCE OF NUCLEAR MATERIALS SAFETf AND SAFEGUARDS SEND APPUCATONS TO:
U S NUCLEAR REGULATORY COMMISSION WASHINGTON, DC 20555 0001 MATERIALS LICENSING SECTON ALL OTHEN PERSONS FILE APPUCATONS AS FOLLOWS:
799 ROOSEVELT ROAD IF YOU ARE LOCATED IN: GLEN ELLYN. IL 60137 5927 CONNECTICUT, DELAWARE, DISTRICT OF COLUMBIA, MAINE, MARYLAND, ARKANSAS, COLORADO, IDAHO, KANSAS, LOUISIANA, MONT ANA, NEBRASKA, NEW MASSACHUSETTS. NEW HAMPSHIRE, NEW JERSEY, NEW YORK, PENNSYLVANIA, MEXCO, NORTH DAKOTA, OKLAHOMA, SOUTH DAKOTA. TEXAS, UTAH. OR WYOMING, CHODE ISLAND, OR VERMONT, SEND APPUCATIONS TO: SEND APPUCATONS TO:
A St SECTON NUCLEAR MATERIALS LCENSING SECTION NL RRE OR COMM SON, REGION 1
- 475 ALLENDALE ROAD KING OF PRUSSIA, PA 19406 1415 gggy g , ,
l ALABAMA, FLORIDA, GEORGIA, KENTUCKY, MISSISSIPPI, NORTH CAROUNA, PUERTO ALASKA, ARIZONA, CAUFORNLA, KAWAll, NEVADA, OREGON, WASHINGTON AND U.S.
RICO, SOUTH CAROUNA. TENNESSEE, VIRGINIA, VIRGIN ISLANDS, OR WEST VIRGINIA, TERRff0 RIES AND POSSES $lONS IN THE PACIFIC, SEND APPLICATIONS 70:
SEND APPUCATIONS TO:
NUCLEAR MATERIALS LCENSING SECTION RADCACTIVE MATERIALS GAFETY BRANCH U S NUCLEAR REGULATORY COMMISSON, REGION 11 U.S NUCLEAR REGULATORY COMMISSION. REGON V 101 MARIETTA STREET, NW, SUITE 2900 1450 MARIA LANE CTLANTA, GA 30323 0199 l WALNUT CREEK, CA 94596-5368 '
PICSONS LOCATED IN AGREEMENT STATES SEND APPUCATIONS TO THE U t NUCLEAR REGULATORY COMMISSON ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL IN STATES SulWECT TO U.S. NUCLEAR REGULATORY COMMISSION JURISDICTONS.
- 1. THIS l$ AN APPUCATION FOR (CnecA appmpne8e Nem) A DDR OF A CANT pncludeZipcode)
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T B. AMENDMENT TO LEENSE NUMBER SM-18@ Envircnmental Health & Safety
_,C RENeWAt or uCENSe NUuBE" na m M&4W 3 CDDRESS(ES) WHEltE LCENSED MATERIAL WILL BE USED OR POSSESSEO 4 NAME OF PERSON TO BE CONTACTED ABOUT THIS APPLCATION Frank J. Labato NO CHANGES TELEPHONE NUMBER (860) 486-3613 CJBMIT ITEMS 6 THHOUGH 11 ON 8-1/2 X 11" PAPER. THE TYPE AND SCOPE OF INFORMATON TO BE PROVOED IS DESCRIBED N M LEENSE APPLCATON GUIDE q RADIOACTIVE MATERAL.
a Elew and mass number b chemmal and/or physical form, and c. maanmum armuni 6 PURPOSE (S) FOR WHCH UCENSED MATERIAL WILL BE USED.
whch wil be possessed at any one tme
- 7. NDIViDUAL(S) RESPONSIBLE FOR TIADIATON SAFETY PROGRAM AND THEIR TRAINING EXPERIENCE. 8 TRANING FOR INDIVIDUALS WORKING IN OR FREQUENTNG RESTRCTED AREAS.
O, FACluTiES AND EQUIPMENT. 10 RADIATON SAFETY PROGRAM 11 WASTE MANAGEMENT. 1 & P/ 1 FEE CATEGORY OUNT lENCtOSED$ Exempt 13 CERTIFICATION (Must be compleled by appecen0 THE APPLICANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENT ATIONS MADE IN THtS APPLCATION ARE BINDING UPON THE APPLCANT.
THE A DPLICANT AND ANY OFFICML EXECUTNG THIS CERTIFCATION ON BEHALF OF THE APPLCANT. HAMED IN ITEM 2. CERTIFY THAT THIS APPLCATON IS PREPARED N CONFWMITf WITH TITLE 10. CODE OF FEDERAL REGULATIONS, PARTS 30. 32,33,34. 35. 36,39 AND 40, AND THAT ALL NFORMATON CONTANED HEREIN IS TRUE AND CORRi CT TO THE BEST OF THEIR KNOWLEDGE AND BEUEF.
! WARNING 16 U.S C. SECTION 1001 ACT OFJUNE 25,1948 62 STAT. 749 MAKLS IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY F ALSE STATEMENT OR REPRESENTATION TO I
ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION CERTIFYING OFFCER - TYPED /PRNTED NAME AND TITLE w M. nmyruss, vue o-11nr far a-ss nn.(SIG"T"L 6- M n+W DATE FOR NRC USE ONLY h l TYPE OF FEE FEE LOG FEE CATEGORY AMOUNT RECEIVED CHECK NUMBER COMMENTS ,
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APPROVED BY DATE OMCIALRt/MD00PY ML 10 1 2 6 3 8 4""
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O l ITEM 7 -INDIVIDUAL (S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR TRAINING EXPERIENCE l
f ITEM 7* RADIATION SAFETY OFFICER Mr. Thomas Hasselbacher has been named as Radiation Safety Officer on license
! numbers SNM-310,06-1765-01, 06-12193-02 and 06-01765-03. He has had experience working with special nuclear materials, high level radiation sources, medical and broad scope programs. His statement of training and experience is attached.
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THOMAS HASSELBACHER ,
OBJECTIVE A position in radiation safety and protection that will capitalize on my health physics education and training expertise, excellent communication, leadership and n.anagement abilities, and strong technical background.
SKILL
SUMMARY
Over seventeen years of distinguished military service as a Radiation Health and Safety Officer, Medical Service Corps, United States Navy.
Excallent interpersensi comn:,unication skills
- Accomplished instructor and curriculum developer
- Knowledgeable of federal and state radiation safety regulations and licensing requirements
- Experienced radiation safety program evaluator PROFESSIONAL EXPERIENCE
- Nine years experience as the Radiation Safety Officer of record on four USNRC licenses; including Medical Use of Byproduct Material, Broad Scope Material for Training and Research, and Special Nuclear Materials.
Experienced in license application, amendment, and termination.
- Five years as the Head of the Radiation Health Training Department, Naval Undersea Medical Institute, supervising the conduct and content of all U.S.
Navy Medical Department radiation health and safety training.
- Responsible for the planning and conduct of emergency casualty response procedures for Naval Hospitals and nuclear powered ships. Supervised casualty drills to evaluate effectiveness of emergency procedures and treatment.
- Responsible for the conduct of equipment performance QA surveys for over 100 medical and dental diagnostic X-ray machines in all naval hospitals and clinics throughout the Navy's seven state northeast region.
- Performed radiation health and safety program compliance and ALARA audits on naval nuclear propulsion, nuclear weapons, and nuclear medicine programs.
- Administered the radiation health and dosimetry programs for Naval Hospitals, two Submarine Tenders, and the USS NAUTILUS (SSN-571).
- Certified by the state of Rhode Island's radiation control agency to perform radiation physics services and diagnostic x-ray equipment surveys.
EDUCATION '
N.S. Radiological Sciencet University of Lowell, Lowell, MA B.A. Psychology Hobart College, Geneva, NY A.S. Medical Services George Washington University, Washington, Dc ,
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(: ?i..- o o Addendum to Resume THOMAS HASSELBACHER TRAINING Mammoeraohv X-ray Evaluation Procedures: U.S. Navy Environmental Health Center, Norfolk, VA Radiation Safety Officer: Radiation Safety Associates, Inc. Hartford, CT Medical DiaF:metic X-my Survev Techniane: U.S. Navy Environmental Health Center, Norfolk, VA I 12ser-Microwave Hazards: U.S. Army Envimamental Hygiene Agency, - Aberdeen, MD {
Biolonical Effarte ofIonizine Radiatian: Harvard School of Public Health, Cambridge, MA Certifientian Review for Health Physiciete: Skrable Enterprises, Inc. . Nashua, NH l
EMPLOYMENT EXPERIENCE ,
Febmary 1996 to Present:
Radiation Safety Associates, Hebron, CT.
Medical Health Physicist responsible for pmviding consulting service to medical and dental facilities, the nuclear industry, general industry; local, state, and federal governments; and sendemic institutions. These services include performing audits, radiological surveys, writing license applications and amendments, maintaining radiological safety and ALARA programs, providing technical advice and performing trainirg.
Certified by the state of Rhode Island's Radiation Control Agency to perform general radiation physics services for radioactive materials licensees and x-ray facilities and survey diagnostic x-ray equipment (RPS:4653)
Instructor for Fundamentals of Radiological Protection, Health Physics Tecimician Level I and II, Radiation Safety Officer, and Basic Radiation Worker Training.
April 1978 to November 1994 )
United States Navy, Radiation Health Offleer, Medical Service Corps; i Assignments and duties are described below in reverse chronological order. l
' 1989 to 1994:
Head of the Radiation Health and Safety Training Department of the Naval Undersea MedicalInstitute (NUMI). Responsible for the development and implementation of the health physics and radiation health / safety content of all courses of instruction taught at NUMI. NUMI is the only educational facility in the U.S. Navy to instruct doctors, nurses, and iadaaaadaat duty submarine corpsmen in the practice and principle of radiation health and safety, I was the principle administrator, supervisor, and technical advisor for all radiatian health training department functions: to include instmetor training, laboratory equipment acquisition and utilization, training methods, and testing. I developed and taught l courses designed to teach dia.eaantic x-ray machina performance testing, radiation safety (survey) inspection of radiology spaces, and health physics support and administrative supervision of Byproduct Material licenses for nuclear medicine departments. l c ;
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O O 1989 to 1994: cont.
During my tour of duty at NUMI, I performed additional duties as Radiation Safety Officer of record for the Naval Hospital at Groton, Cr. I trained and mentored Medical Service Corps Officers for their required one year supervised training prior to assuming >
duties as RSO. Supervised the conduct of X-ray machine performance testing until the I incumbent officer was ready to act independently. I performed duties of the laser Systems Safety Officer (LSSO) at the Naval Hospital until my relief received proper training.
Served as a member of the U.S. Atlantic Fleet Nuclear Weapons Inspection Team performing health physics evaluations of weapons handling practices. I terminated NUMI's Special Nuclear Materials License and shipped their PuBe source to les Almos National ,
I Imboratory in 1990.
1986 to 1989:
Radiation Safety Officer at the Naval Hospital Groton, CT where I supervised the radiation i health and safety programs for the radiology and nuclear medicine departments. I
! administered the dos'i metry programs for the hospital, a large dental command, the Naval L
Underwater Research I2boratory, and the naval contingent at the General Dynamics Electric l Boat Facility. I performed dose estimations in the event of lost of damaged dosimetry.
Performed duties as the Radiation Safety Officer of record on the U.S.NRC licenses for the Naval Hospital (Medical Use of Byproduct Material 06-12193-02), and the Naval Medical Research 12boratory (Broad Scope Material for Research 06-01765-03). Developed, reviewed, and monitored hospital plans for the treatment and management of radiological casualties. I trained emergency room staff in the duties involved with radiological casualty treatments, and made radiological assessments and recommendations in these cases. I conducted drills and exercises to evaluate and insure proper performance of hospital response teams. I was the Laser Systems Safety Officer (LSSO) for the hospital's Ophthalmology department.
i During my tour of duty at the Naval Hospital Groton, I also served as the Navy's N:rtheast Regional Radiation Health and Safety Officer (this region include all naval activities in the states of NY, NJ, PA, CT, VT, NH, MA, RI, and ME). I provided these facilities with technical advise and guidance, on-site support, and inspections to insure compliance with state, federal, and navy regulations for all matters involving ionizing and non-ionizing radiation. Supervised the radiation safety programs for the nuclear medicine and radiology departments at the U. S. Naval Hospitals in Philadelphia, PA, and Newport, RL I conducted the required radiation protection survey and equipment performance testing of more than 100 diagnostic medical and dental X-ray _ machines in all the naval hospitals and clinics in this nine state region. I made recommendations for calibration, repair, and/or replacement as warranted. Performed health physics evaluations as a member of the U.S. Atlantic Fleet Nuclear Weapons Inspection Team. In September 1988, I performed all the duties associated with the termination of the Broad Scope Byproduct Materials license at the Naval Underwater Research laboratory, and decommissioned their nuclear laboratory spaces, allowing them to be released for unrestricted use.
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.: o b.;- O 1984 to 1986:
Instructor: My initial assignment after graduate school was to the Naval Undersea Medical Institute in Groton, CT, where I instructed naval medical personnel in the fundamentals of
- radiation health and safety in the Naval Nuclear power Program. I was the lead instructor for courses in radiation Biology, Nuclear Physics, Non-ionizing radiation, and Radiation health Program Administration. My students were hospital corpsmen and physicians who l
would support fleet units around the world. I received, and continue to hold, appointment as l
an Adjunct Instructor in Health Care Sciences on the staff of George Washington University.
l During this assignment I also performed duties a the Radiation Safety Officer of record on i two U.S. NRC radioactive materials licenses. One for Special Nuclear Materials (SI'04-310), and one for Broad Scope Byproduct Material (06-1765-01). All materials were used f:r training at NUMI. I passed Part One of the American Board of Health Physics Certification Examination in 1984 l
E 10 126364 0FFICIALRECOR000fT J
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- INFORMATION FROM LTS BETWEEN:
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License Fee Management Branch, ARM : Program Code: 22150
. .and : Status Code: 0 f Regional Licensing Sections : Fee Category: EX ID
- Exp. Date: 20021031
- Fee Comments: 170.11 ( A ) (4 ) STORAGE 11/9
- Decom Fin Assur Reqd: N LIr" 5E FEE TRANSMITTAL A. REGION
- 1. APPLICATION ATTACHED Applicant / Licensees CONNECTICUT, UNIVERSITY OF
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Received Date: 19981214 1 Docket No: 7002953 l Control No.: 126364 License No.: SNM-1889 Action Type: Amendment
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Amendment ______________
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