ML20238E728

Corrected Amend 19 to License 50-17838-01 for Providence Hosp,Authorizing Possession & Use of Matls Identified in 10CFR35.100,200,300,400,500,U-235,10 Mci Sr-90 & 100 Mci Cs-137

ML20238E728
Person / Time
Site:	03013426
Issue date:	08/19/1987
From:	Riedlinger B NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION V)
To:
Shared Package
ML20234A766	List: IR 05000178/2038001 ML20234A760 ML20238E728
References
50-17838-01, 50-17838-1, NUDOCS 8801050315
Download: ML20238E728 (3)

See also: IR 05000178/2038001

Text

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NRC Form 374 PAGE 1 OF 3 PAGES

(3-Q3) U.S. NUCLEAR REGULATORY COMMISSIOM

MATERIALS LICENSE Amendment No. 19

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

! Code of Federal Regulations, Chapter I, Parts 30,31,32,33,34,35,40 and 70, and in reliance on statements and representations

j heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess, and transfer byproduct, y

source, and special nuclear material designated below; to use such material for the purpose (s) and at the place (s) designated below;to

l 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 g

conditions specified below. y

Licensee CORRECTED COPY I

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1. Providence Hospital 3. Ucense number 50-17838-01 lg

Radiation Safety Office

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2. 3200ProvidenceDrive, Pouch 6604x(., . ,, ., i

Anchorage, Alaska 99502 n , gf~ 4. Eipira, tion date August 31, 1988 i

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5. Docket or

. ', Reference No. 030-13426

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6. Byproduct, source, and/or O., 7. Chemical and/or physical 1.,8. Maximum amount that licensee 5

special nuclear material N form <[" may possess at any one time N

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A. Any byproduct mater'i'l a QA.hAnyradiopharmach6tical , ; A. As needed

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identified in 10,CFR 35.100 l

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in 10:CFR 35.100k #

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B. Any byproduct maiehial .

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identifiedin10jCFR35.200. Qdentified;in 10 CFR 35.200 C R

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Any byproduct mater'ial 6 R yC. N Ahy;r'adio' pharmaceutical'

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D. Any byproduct material i M DL , Any m , brachytherapy 7sourcer's D. As needed

identified in 10 CFRt35.400 u identified ,in 10;CFR t

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E. Any byproduct material 'l/n E. E. 1.5 curies

identified in 10 CFR 35.500r

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Sealed sources

diagnostic devices

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for [V" per source

F. Uranium depleted in FM C$dmiu'm'plbted detal F. As needed

Uranium-235

G. Strontium 90 G. Sealed source (fluclear G. 10 millicuries

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H. Cesium 137 H. Sealed source (J.L. Shepherd H. 100 millicuries N

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l MATERIALS LICENSE Doc rR l

l SUPPLEMENTARY SHEET _ 3[2[" " ' N  ;

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l Amendment No. 19 l

CORRECTED COPY l

9. Authorized use: I

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A. Medical use described in 10 CFR 35.100. l

l B. Medical use described in 10 CFR 35.200. y

C. Medical use described in 10 CFR 35.300. .g

D. Medical use described in 10 CFR 35.400, i

E. Medical use described in 10 CFR 35.500. I

F. Shielding in a linear accelerator. >

G. and H. Instrument calibration. l

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10. Location of use: sV ^/ L I

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l B. Licensed mat 5 rial descr16ed:in License C3 on81$ibns 6.E., 75E. 8.E., and 9.E. E

j may also be used in Room 132' of the Providence Medical Office Building, E

g 3340ProvidenceDrive,Ancho, rage,Mlaska.)!. -

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9 11. Radiation Safety Officere :Darwn LI ZellmerLPh.D. ,

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12. Authorized users: n R

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Maurice J. Coyle,,M.D.Kfor materials identified in 10,CFR 35.100, 35.200,

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i 35.4001 35.500;1Io_ dine 131 for(treatment of,hyperthyr'oidism or cardiac l

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dysfunction f <

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l B. JohnJ.Kottra,M.D.'f6rmaterialsidentifiedinil0CFR35.100,35.200, lp

g 35.500; Iodine 131 for treatment off hyperthyroidism or cardiac dysfunction

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C. Charles Sternhagen, M.D. for materials identified in 10 CFR 35.300, and W

35.400 h

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f D. Denise Farleigh, M.D. for materials identified in 10 CFR 35.100, 35.200, E

35.500; Iodine 131 for treatment of hyperthyroidism or cardiac dysfunction l,

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f E. David Allen Moeller, M.D. for materials identified in 10 CFR 35.100, N

9 35.200, 35.300, and 35.500. i

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j F. Kenneth A. Fox, M.D. for materials identified in 10 CFR 35.300 and 35.400. l

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i G. Darwin L. Zellmer, Ph.D. for non-human uses of licensed material. p

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5 13. The licensee may use the Lineator device for doing linearity tests of its dose

N calibrator provided it folicws the procedures in the Atomic Products Corporation

Lineator Instructions Manual dated June 20, 1983.

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14. The licensee may transport licensed material in accordance with the provisions

ly of 10 CFR Part 71, " Packaging and Transportation of Radioactive Material". g

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NRC Form 374A U.S. NUCLEAR REGULATORY COMMISSION PACE OF PAGES I

_* License number l

50-17838-01 1

MATERIALS LICENSE oocket or Reference number I

SUPPLEMENTARY SHEET 030-13426 h

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CORRECTED COPY Amendment No. 19 l

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CONDITIONS I

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(continued) l

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15. This license is based on the licensee's statements and representations in the p

~following documents: 1

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A. Application dated November 30, 1982

B. Application dated February 21, 1983 l

C. Letter dated July 13, 1983 n DC , p

D. Letter dated August 17; 19831 * * A' 4p /['* e b

E. Letter dated January,20', 1984 d, ^ I

F. Letter dated February 13, 1984 !x I

G. Telegram dated + February 22, 1984 ,, i

H. Letter dated ~ March 6, 1984 V, l

I. Letter dated May 15, 1986 y

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J. Letterdated'Julpt 28bl986 .g 1, 7 %.

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K. Letter dated September.18, 1986 ,. ' / T/ I

L. Letter dated June 3',.1987\ s- /' -

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FOR THE V.S. NUCLEAR REGULATORY COMMISSION N

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original signed by B. A. Riedlinger l

t Date August 19 , 1987 By ',

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Beth A. Riedlinger p

Health Physicist (Licensing) p

Nuclear Materials Safety Section p

Region V N

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