ML21078A044

Us Dept. of Commerce, National Institute of Standards & Technology, License Amendment Application

ML21078A044
Person / Time
Site:	07000398
Issue date:	03/12/2021
From:	Mackey E US Dept of Commerce, National Institute of Standards & Technology (NIST)
To:	NRC Region 4
Naquin T
Shared Package
ML21078A044	List: ML21078A044
References
Download: ML21078A044 (1)

Text

NRC FORM 313 U.S. NUCLEAR REGULATORY COMMISSION (01-2020J 10 cFR 30, 32, 33, 34, 35, 36, 37, 39, and 40 APPLICATION FOR MATERIALS LICENSE

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APPROVEDBYOMB: NO.3150{120 EXPIRES: 0113112023 Estimated burden per sponse to mply with this mandatory mllecton Equest: 4.3 hou6. Submittal of the applimtion is neessry lo detemine that he applicant is qualifed and that adequate pocedures exist to protect the public health aM sfety. Send @mrents regarding burden estimte to he lnformhon Seruics Banch [{ A10M),

U.S. Nucltrr Regulatory Commission, Washington, DC 2055+0001, or by e-mail to lnfomilsb.Resource@nrc.gov, and to the Desk Offrer, Offie ol lnforrolion and Regulatory Affairs, NE0B-10202, (315G0120), Offlce of Managemenl aM Budget, Washinglon, DC 20503. tl a means used lo impose an inforrotion collection d@s rct display a curenty valid OMB @nlrol number, t re NRC may not @nduct or spoMr, and a peMn ls not requtred to respond to, the informtjm Elltrton.

INSTRUCTIONS: SEETHECURRENTVOLUTESOFTHENUREG-I556TECHNICALREPORTSERlES('CONSOLIDATEDGUIDANCEABOUTTATERIALSLICENSES")FORDETAILED OFFICE SPECIFIEO BELOW.

MATERIALS SAFEry LICENSING BRANCH DIVISION OF MATERIAL SAFETY, STATE, TRIBAL AND RULEMAKING PROGRAMS OFFICE OF NUCLEAR MATERIALS SAFETY AND SAFEGUARDS U.S. NUCLEAR REGULATORY COMMISSION WASHINGTON, DC 20555.0001 ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS:

IF YOU ARE LOCATED IN:

ALABAIIA, CONNECTICUT, DELAWARE, DISTRICT OF COLUI'BIA, FLORIOA, GEORGIA, KEMTUCKY, TAINE, MARYLAND, MASSACHUSETIS, NEW HAXIPSHIRE, NEW JERSEY, NEW YORK, NORTH CAROLINA PENNSYLVANIA, PUERTO RICO, RHODE ISLANO, SOUTH CAROLINA, TENNESSEE, VERMONT, VIRGINIA, VIRGIN ISLANDS, OR WEST VIRGINIA, SEHD APPLICATIONS TO:

LICENSING ASSISTANCE TEAM DIVISION OF NUCLEAR MATERIALS SAFETY U-S. NUCLEAR REGULATORY COMMISSION. REGION I 21OO RENAISSANCE BOULEVARD, SUITE 1OO KING OF PRUSSIA. PA 19406-2713 APPUCATION FOR DISTRIBUTION OF EXETTPT PRODUCTS FILE APPUCATIONS WITH:

tLLlt{olS, lt{IxANA, lor{A, HtcHlGAN, stNt{EsoTA, tt3aouRt, oHto, oR wl3coHstil, sEl{D APPLIGATIONS TO:

MATERIALS LICENSING BRANCH U.S. NUCLEAR REGULATORY COMMISSION, REGION III 2443 WARRENWLLE ROAD, SUIIE 210 LlsLE, tL 60532-4352 IF YOU ARE LOCATED IN:

ALASXA, ARIZONA, ARKAN9AS, CALIFORNIA, COLORADO, HAWAII, IOAHO, KANSAS, LOUISIANA, HISSISSIPPI, MONTANA, NEBRASKA, NEVADA NEW MEXICO, NORTH DAKOTA, OKLAHOI'A, OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA, TEXAS, UTAH, WASHINGTON, OR WYOMING, IF YOU ARE LOCATED IN:

SEND APPLICATOilS TO:

NUCLEAR MATERIALS LICENSING BRANCH U.S. NUCLEAR REGUI-ATORY COMMISSION, REGION IV 1600 E-LAMAR BOULEVARD ARLINGTON, TX 76011-4511 PERSOXS LOCATED IN AGREET'ENT STATES SEilD APPLICAIIOilS TO THE U.S. NUCLEAR REGULATORY COITMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED iTATERIAL IIiI STATES SUAJECT TO U.S. IIUCLEAR REGULATORY COTTIISSION JURISDICTIONS.

1. THIS lS AN APPLICATION FOR fcheck awrcpiate item) l-l r. rrw r-rcrrusE B. AMENDMENT TO LICENSE NUMBER SNM-362 l-l c. nENEwlr-oF LrcENsE NUMBER

2. NAME AND MAILING ADDRESS OF APPLICANT (lnclude zip cuie)

National lnstitute of Standards and Technology Attn: Radiation Safety Officer 100 Bureau Drive, Mail Stop 1731 Gaithersburg, MD 20899 3, ADDRESS WHERE LICENSED MATERIALS WILL BE USED OR POSSESSED See ltem 2.

4. NAME OF PERSON TO BE CONTACTED ABOUI THIS APPLICATION Manny Mejias BUSINESS IELEPHONE NUMBER (301 ) 975-5800 BUSINESS CELLUTAR TELEPHONE NUMBER (202)253-3890 BUSINESS E-MAIL ADDRESS manny.mejias@nist.gov SUBMIT ITEMS 5 THROUGH 11 ON &1/2 X 11' PAPER. THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED IN THE LICENSE APPLICATION GUIDE, 5 RADIOACTIVE MATERIAL

a. Element and mass numbefi b-chemil andlor physil lorm; and c-maximum amount which will be possessed at any one tima.

6. PURPOSE(S) FOR WHICH LICENSED MATERIAL WILL BE USED-

7. INDIVIDUAL(S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND IHEIR IRAINING AND EXPERIENCE,

8. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS.

9-FACILITIES AND EOUIPMENT

10. RADIATION SAFETY PROGRAM.

11. WASTEMANAGEMENT

12. LICENSE FEES (F@s required or{y fq rew applications, with lew exeptions')

(See 10 CFR 170 and Soclion 17o.at FEE

'Amendments/Renflals that incrqse the scope of lhe axisting license to a new or highor fee tegory *ill,"qrir" " f*.

CAEGoRY AMOUNT ENCLOSED $

PERTHEDEBTCOLLECTIONIMPROVEI!ENTACTOF1996(PUBLlCLAWl04.13il),YOUAREREQUIREDTOPROVIDEYOURTAXPAYERIDENTIFICATIONNUTTBER.

PROVIDETHIS

13. CERTIFICATION. (Mustbecompletqdbyappticant) THEAPPLTCANTUNDERSIANOSIHATALLSIAIEME^/TSANDREPRESENTATTONSMADETNTHTSAPPLICATTONAREBTNDIN5UPON THE APPLICANT.

THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEHALF OF THE APPLICANT, NAMED IN ITEM 2, CERTIFY THAT THIS APPLICATION IS PREPARED IN CONFORMITY WITH TITLE 10, CODE OF FEDERAL REGULATIONS, PARTS 30, 32, 33, 34, 35, 36, 37, 39, AND 40, AND THAT ALL INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF.

WARNING: ISU.S.C.SECTIONI00IACTOFJUNE25.I94862STAT.T49MAKESITACRlMlNALOFFENSETOMAKEAWlLLFULLYFALSESTATEMENTORREPRESENTATlONTO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION, Elizabeth A. Mackey, NIST Chief Safety Officer CERTIFYING OFFICER _ TYPED/PRINTED NAME AND TITLE slrz/zt FOR NRC USE ONLY TYPE OF FEE FEE LOG FEE CATEGORY AMOUNT RECEIVED CHECK NUMBER COMMENTS APPROVED BY DATE NRC FORM 313 (01-2020)