ML18043A182
| ML18043A182 | |
| Person / Time | |
|---|---|
| Site: | 03038077 |
| Issue date: | 01/29/2018 |
| From: | Michelle Simmons NRC Region 4 |
| To: | Providence Imaging Ctr |
| References | |
| 601812 | |
| Download: ML18043A182 (3) | |
See also: IR 05000293/1957001
Text
NRC FORM 374 PAGE 1 OF 3 PAGES
U.S. NUCLEAR REGULATORY COMMISSION Amendment No. 4
MATERIALS LICENSE
Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93-438), and Title 10, Code of Federal Regulations, Chapter I,
Parts 30, 31, 32, 33, 34, 35, 36, 37, 39, 40, 70 and 71, and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued
authorizing the licensee to receive, acquire, possess, and transfer byproduct, source, and special nuclear material designated below; to use such material for the purpose(s)
and at the place(s) designated below; to deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the applicable Part(s). This
license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, as amended, and is subject to all applicable rules, regulations,
and orders of the Nuclear Regulatory Commission now or hereafter in effect and to any conditions specified below.
Licensee In accordance with letter dated 4. Expiration Date: October 31, 2019
December 04, 2017.
1. Providence Imaging Center
5. Docket No.: 030-38077
2. 3340 Providence Drive 3. License number: 50-29357-01 is Reference No.:
Anchorage, AK 99508 amended in its entirety to read as
follows:
6. Byproduct, source, 7. Chemical and/or physical form 8. Maximum amount that licensee 9. Authorized use
and/or special nuclear may possess at any one time
material under this license
A. Any byproduct material A. Any A. As Needed A. For use in imaging and localization
permitted by 10 CFR studies permitted by 10 CFR 35.200.
35.200
CONDITIONS
10. A. Licensed material may be used or stored at the licensee's facilities located at 3340 Providence Drive, Anchorage, Alaska.
B. Licensed material may be received and stored at the licensees facilities located at the loading dock of Providence Alaska Medical
Center, 3200 Providence Drive, Anchorage, Alaska.
11. The Radiation Safety Officer (RSO) for this license is Mark P. Winslow.
NRC FORM 374A U.S. NUCLEAR REGULATORY COMMISSION PAGE 2 OF 3 PAGES
License Number Docket or Reference Number
50-29357-01 030-38077
MATERIALS LICENSE
SUPPLEMENTARY SHEET Amendment No. 4
12. Licensed material shall only be used by, or under the supervision of:
A. Individuals permitted to work as authorized users in accordance with 10 CFR 35.13 and 10 CFR 35.14.
B. The following individuals are authorized users for the material and medical uses as indicated:
Authorized Users Material and Use
Heather C. Tauschek, M.D. 35.200
Scott R. Naspinsky, M.D. 35.200
Christopher M. Reed , M.D. 35.200
Wandal B. Winn, M.D. 35.200
David Allen Moeller, M.D. 35.200
Christopher L. Kottra, M.D. 35.200
Leonard D. Sisk, M.D. 35.200
Chakri S. Inampudi, M.D. 35.200
Denise Farleigh, M.D. 35.200
Jonathan P. Coyle, M.D. 35.200
Erik John Maurer, M.D. 35.200
13. In addition to the possession limits in Item 8, the licensee shall further restrict the possession of licensed material to quantities below the
minimum limit specified in 10 CFR 30.35(d) for establishing financial assurance for decommissioning.
NRC FORM 374A U.S. NUCLEAR REGULATORY COMMISSION PAGE 3 OF 3 PAGES
License Number Docket or Reference Number
50-29357-01 030-38077
MATERIALS LICENSE
SUPPLEMENTARY SHEET Amendment No. 4
14. Except as specifically provided otherwise in this license, the licensee shall conduct its program in accordance with the statements,
representations, and procedures contained in the documents, including any enclosures, listed below. This license condition applies only to
those procedures that are required to be submitted in accordance with the regulations. Additionally, this license condition does not limit the
licensee's ability to make changes to the radiation protection program as provided for in 10 CFR 35.26. The U.S. Nuclear Regulatory
Commission's regulations shall govern unless the statements, representations, and procedures in the licensee's application and
correspondence are more restrictive than the regulations.
A. Application dated July 2, 2009 (ML092330999)
B. Delegation of Authority dated July 1, 2009 (ML092800498)
C. Letter dated March 31, 2010 (ML100970546)
D. Letter dated January 14, 2013 (ML13183A268)
FOR THE U.S. NUCLEAR REGULATORY COMMISSION
/RA/
Date: January 29, 2018 By:
Michelle R. Simmons
Region 4