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
U.S. NUCLEAR REGULATORY COMMISSION
MATERIALS LICENSE
PAGE
OF
1
3
Amendment No. 26
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
Palmer, AK 99645
2. P.O. Box 1687
Imaging Department
1. Mat-Su Regional Medical Center
4. Expiration Date: December 31, 2038
Docket No.:
5.
030-33011
License No.: 50-29059-01 is
renewed in its entirety to read as
follows:
Reference No.:
3.
In accordance with application
dated June 15, 2023.
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 uptake, dilution and
excretion studies permitted by 10 CFR
35.100.
Any
As Needed
Any byproduct material
permitted by 10 CFR 35.100
B.
B.
B.
B.
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
C.
C.
C.
C.
For any use permitted by 10 CFR
35.300.
Any
400 millicuries total
Any byproduct material
permitted by 10 CFR 35.300
License No.:
Docket or Reference No.:
U.S. NUCLEAR REGULATORY COMMISSION
MATERIALS LICENSE
SUPPLEMENTARY SHEET
PAGES
OF
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3
2
50-29059-01
030-33011
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
License No.:
Docket or Reference No.:
U.S. NUCLEAR REGULATORY COMMISSION
MATERIALS LICENSE
SUPPLEMENTARY SHEET
PAGES
OF
PAGE
3
3
50-29059-01
030-33011
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
By:
Date:
Latischa M. Hanson
Region IV
December 12, 2023
Latischa M.
Hanson
Digitally signed by Latischa M.
Hanson
Date: 2023.12.12 18:46:03 -06'00'