ML23346A264
| ML23346A264 | |
| Person / Time | |
|---|---|
| Site: | 03033011 |
| Issue date: | 12/12/2023 |
| From: | Latischa Hanson NRC Region 4 |
| To: | Mat-Su Regional Medical Ctr |
| References | |
| 635950 | |
| Download: ML23346A264 (1) | |
See also: IR 05000290/1959001
Text
NRC FORM 374 PAGE OF1 3PAGES
U.S. NUCLEAR REGUL ATORY COMMISSION Amendment No. 26
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 application 4. Expiration Date: December 31, 2038
1. Mat-Su Regional Medical Center dated June 15, 2023 .
Imaging Department
5. Docket No.: 030-33011
2. P.O. Box 1687 3. License No.: 50-29059-01 is Reference No.:
Palmer, AK 99645 renewed in its entirety to read as
follows:
6. 7. 8.Byproduct, source,Chemical and/or physical form Maximum amount that licensee 9. Authorized use
and/or special nuclear may possess at any one time
material under this license
A. For use in uptake, dilution and Any byproduct materialA.Any As NeededA.A.
permitted by 10 CFR excretion studies permitted by 10 CFR
35.100 35.100.
B. For use in imaging and localization Any byproduct materialB.Any As NeededB.B.
permitted by 10 CFR studies permitted by 10 CFR 35.200.
35.200
C. For any use permitted by 10 CFR Any byproduct materialC.Any 400 millicuries totalC.C.
permitted by 10 CFR 35.300.
35.300
NRC FORM 374A U.S. NUCLEAR REGUL ATORY COMMISSION P AGE 32OFPAGES
License No.: Docket or Reference No.:50-29059-01
MATERIALS LICENSE 030-33011
SUPPLEMENTARY SHEET Amendment No. 26
CONDITIONS
10. Licensed material shall be used or stored at the licensee's facilities located at 2500 South Woodworth Loop, Palmer, Alaska, 99645.
11. The Radiation Safety Officer (RSO) for this license is Richard R. Gardner, CNMT.
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 User (M.D.,D.O.,etc.) Material and Use
Dirk C. Bringhurst, M.D. 35.100; 35.200; oral administration of sodium iodide I-131 in quantities less than or equal to
33 millicuries
Matthew V. Cronin, M.D. 35.100; 35.200
Chris T. Glenn, M.D. 35.100; 35.200; 35.300
Scott A. Harman, M.D. 35.100; 35.200; 35.300
Julee K. Holyater, M.D. 35.100; 35.200; 35.300
John P. Lubisich, M.D. 35.100; 35.200; oral administration of sodium iodide I-131
Andrew Moran, M.D. 35.100; 35.200
Jason Savikko, D.O. Oral administration of sodium iodide I-131
Douglas Swank, D.O. 35.100; 35.200
Lawrence P. Wood, M.D. 35.100; 35.200; oral administration of sodium iodide I-131
NRC FORM 374A U.S. NUCLEAR REGUL ATORY COMMISSION P AGE 33OFPAGES
License No.: Docket or Reference No.:50-29059-01
MATERIALS LICENSE 030-33011
SUPPLEMENTARY SHEET Amendment No. 26
13. 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 statements, representations, and 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 impose on the licensee requirements that are more restrictive than or in addition to the
regulations.
A. Application dated June 15, 2023 (ML23171A939)
FOR THE U.S. NUCLEAR REGULATORY COMMISSION
Date: December 12, 2023 By:
Latischa M. Hanson
Region IV