ML21026A116

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Providence Imaging Center; Amendment 06, License 50-29357-01; Docket 030-38077; Controls 623388 and 623423
ML21026A116
Person / Time
Site: 03038077
Issue date: 12/22/2020
From: Latischa Hanson
Division of Nuclear Materials Safety IV
To:
Providence Imaging Ctr
References
623388, 623423
Download: ML21026A116 (4)


See also: IR 05000293/1957001

Text

U.S. NUCLEAR REGULATORY COMMISSION

MATERIALS LICENSE

NRC FORM 374

PAGE

OF

1

4

Amendment No. 6

PAGES

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

Parts 30, 31, 32, 33, 34, 35, 36, 37, 39, 40, 70 and 71, and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued

authorizing the licensee to receive, acquire, possess, and transfer byproduct, source, and special nuclear material designated below; to use such material for the purpose(s)

and at the place(s) designated below; to deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the applicable Part(s). This

license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, as amended, and is subject to all applicable rules, regulations,

and orders of the Nuclear Regulatory Commission now or hereafter in effect and to any conditions specified below.

Licensee

Anchorage, AK 99508

2. 3340 Providence Drive

1. Providence Imaging Center

4. Expiration Date: March 31, 2035

Docket No.:

5.

030-38077

License No.: 50-29357-01 is

amended in its entirety to read as

follows:

Reference No.:

3.

In accordance with letter dated

September 30, 2020; and E-mail

dated December 10, 2020 with

attachments

6.

7.

8.

Byproduct, source,

and/or special nuclear

material

Chemical and/or physical form

Maximum amount that licensee

may possess at any one time

under this license

9.

Authorized use

A.

A.

A.

A.

For use in imaging and localization

studies permitted by 10 CFR 35.200.

Any

As Needed

Any byproduct material

permitted by 10 CFR 35.200

License No.:

Docket or Reference No.:

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 374A

MATERIALS LICENSE

SUPPLEMENTARY SHEET

PAGES

OF

PAGE

4

2

50-29357-01

030-38077

Amendment No. 6

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 Joseph F. Harmon, Jr., Ph.D., DABR.

License No.:

Docket or Reference No.:

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 374A

MATERIALS LICENSE

SUPPLEMENTARY SHEET

PAGES

OF

PAGE

4

3

50-29357-01

030-38077

Amendment No. 6

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

Jonathan P. Coyle, M.D.

35.200

Chakri S. Inampudi, M.D.

35.200

Christopher L. Kottra, M.D.

35.200

Erik John Maurer, M.D.

35.200

David Allen Moeller, M.D.

35.200

Scott R. Naspinsky, M.D.

35.200

Christopher M. Reed, M.D.

35.200

Heather C. Tauschek, M.D.

35.200

Wandal B. Winn, M.D.

35.200

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.

License No.:

Docket or Reference No.:

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 374A

MATERIALS LICENSE

SUPPLEMENTARY SHEET

PAGES

OF

PAGE

4

4

50-29357-01

030-38077

Amendment No. 6

14. Except as specifically provided otherwise in this license, the licensee shall conduct its program in accordance with the statements,

representations, and procedures contained in the documents, including any enclosures, listed below. This license condition applies only to

those procedures that are required to be submitted in accordance with the regulations. Additionally, this license condition does not limit the

licensee's ability to make changes to the radiation protection program as provided for in 10 CFR 35.26. The U.S. Nuclear Regulatory

Commission's regulations shall govern unless the statements, representations, and procedures in the licensee's application and

correspondence are more restrictive than the regulations.

A. Application dated September 23, 2019 (ML192900016) (excluding radiation safety program, policies, and procedures)

B. Letter dated March 19, 2020 (ML20090A630)

C. Letter dated September 30, 2020 (ML20293A451)

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

FOR THE U.S. NUCLEAR REGULATORY COMMISSION

By:

Date:

Latischa M. Hanson

Region IV

December 22, 2020

/RA/