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INRC FORM 7 U.S. NUCLEAR REGULATORY COMMISSION
i(8-2007)-.10 CFR 110
APPLICATION FOR NRC EXPORT/IMPORTLICENSE, AMENDMENT, OR RENEWALI (See Instructions on Page 5)
APPROVED BY OMB: NO. 3150-0027 EXPIRES: 0613012009Estimated burden per response to co mply with this mandatory collection request: 2.4 hours. Thissubmittal is reviewed to ensure that the applicable statutory, regulatory, and policy considerationsare satisfied. Send comments regarding burden estimate to the Records and FOtA/PrivactServices Branch (T-5 F52), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001or by internet e-mail to [email protected], and to the Desk Officer, Office of Information ancRegulatory Affairs, NEOB-10202, (3150-0027), Office of Management and Budget, Washington.DC 20503. If a means used to impose an information collection does not display a currently valicOMB control number, the NRC may not conduct or sponsor, and a person is not required tcrespond to, the information collection.
PART B. TO BE.COMPLETED FOR ALL LICENSES, AMENDMENTS, RENEWALS OR NOTIFICATIONS(If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
1. NAME AND ADDRESS OF APPLICANT/LICENSEE la. NAME OF APPLICANT'S CONTACT lb. APPLICANT'S REFERENCE NUMBER
Alpha-Omega Services, Inc. Troy Hedger Amd-9 Request9156 Rose St. ic. PHONE NUMBER 1d. FAX NUMBER
Bellflower, CA 90706 (562) 804-0604 (562) 804-0610le. E-MAIL ADDRESS
2. TYPE OF ACTION REQUESTED (Check One)
EXPORT Z NOTIFICATION OF F- IMPORT [- COMBINED EXPORT/IMPORT FV AMEND)MENT/RENEWAL(Parts B, C, E) EXPORT OF (Parts B, D, E) (Parts B, C, D, E) Existing License Number:
INCIDENTALRADIOACTIVE PCB6.08MATERIAL (PART C, E)
3. CONTRACT NUMBER(S) FIRST SHIPMENT DATE 5. LAST SHIPMENT DATE 6. PROPOSED EXPIRATION DATE
I PART C. TO BE COMPLETED FOR EXPORT ONLY OR COMBINED LICENSES, AMENDMENTS, OR RENEWALS(If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
7 NAME(S)/-ADDRESS(ES) OF SUPPLIERS 8. NAME(S) ADDRESS(ES) OF INTERMED1ATE 9. NAME(S) /ADDRESS(ES) OF ULTIMATEAND/OR OTHER PARTIES TO THE EXPORT FOREIGN CONSIGNEE(S) FOREIGN CONSIGNEE(S)
7a. FUNCTION(S) PERFORMED/SERVICE(S) PROVIDED . 8a. INTERMEDIATE USE(S) 9a. ULTIMATE END USE(S)
10. DESCRIPTION OF RADIOACTIVE MATERIALS, SEALED SOURCES, 1Oa. MAX TOTAL VOLUME / 10b. MAX ENRICHMENT 10c. MAX.ISOTOPE 7NUCLEAR FACILITIES, EQUIPMENT, OR COMPONENTS; FOR ELEMENT WGT'(KG), OR OR WGT'% WGT-(KG)NUCLEAR EQUIPMENT INCLUDETOTAL DOLLAR VALUE OF TOTAL ACTI VITY (TBq)EQUIPMENT FOR EXPORT
11. FOREIGN OBLIGATIONS (BY COUNTRY AND BY PERCENTAGE OF MAXIMUM TOTAL VQLUME)
.... ...... .. ....... . ....O.R .. . ..LED PAPENRc FORBM 7 (8-2007') ,PRINTED ON REGY',;LEO IPAPER,
Page 2 of 9
NRC FORM 7 U.S. NUCLEAR REGULATORY COMMISSION
• 'APPLICATION FOR NRC EXPORT/IMPORTLICENSE, AMENDMENT, OR RENEWAL (Continued)
[UIC E N SE IN U M B E R~- 7. f • • ••' .. . •• • t ' . .............AS A C E SI N U M ER . . . . . .. . .. . .. . .... ... .. ... .. .
Q ,~VI ~ . I~ Fi p"PI OR NO$-PIJBLIC
PART D. TO BE COMPLETED FOR IMPORT ONLY, OR COMBINED LICENSES, AMENDMENTS, OR RENEWALS(If more space is needed to complete any of the items, use Pages 3-4 first, and then attach additional sheets, if necessary.)
12. NAME(S) / ADDRESS(ES) OF FOREIGN 13. NAME(S) / ADDRESS(ES) OF INTERMEDIATE 14. NAME(S) / ADDRESS(ES) OF ULTIMATESUPPLIERS AND/OR OTHER PARTIES CONSIGNEE(S) CONSIGNEE(S)
• TO IMPORT
12a. NRC EXPORT LICENSE NUMBER(S) 13a. LICENSE NUMBER(S)I EXPIRATION DATE(S) 14a. LICENSE NUMBER(S) I EXPIRATION DATE(S)(if applicable)
13b. INTERMEDIATE USE(S) 14b. ULTIMATE END USE(S)
15. DESCRIPTION OF RADIOACTIVE MATERIALS, SEALED SOURCES, 15a. MAX TOTAL VOLUME I 15b. MAX ENRICHMENT 15c. MAX ISOTOPENUCLEAR FACILITIES ELEMENT WGT (KG), OR OR WGT % WGT (KG)
TOTAL ACTIVITY (TBq)
16. FOREIGN OBLIGATIONS (BY COUNTRY AND BY PERCENTAGE OF MAXIMUM TOTAL VOLUME)
... PART E.- TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, OR RENEWALS.
17. ADDITIONAL INFORMATIONP PROVIDED ON PAGES 3,4, Y• YES NO a TCOPIES OFRECIPIENTS' R D NOAND/OR ON SEPARATE SHEETS?
I the applicants authorized official, hereby certify that this application is prepared in conformity with TitlelO,18. CERTIFICATION: Cth e best of my knowledge.- . • " C~~ode of Federal Regulations, and that all information providedts -correct to-t eto ykolde
18a. PRINT NAME AND TITLE OF AUTHORIZED OFFICIAL .18b. SIGNATURE -- AUTHORIZED OFFICIAL 18c. DATE
Mandie Hedger, Administrative Assistant j
Page 3 of 9
Page 4 of 9
Alpha-Omega Services, Inc.1282 Starks RoadEdgerly, LA 70668
Baylor All Saints Medical Center Fort Worth1400 Eight Ave.Fort Worth, TX 76132
Caelian Medical, LLC .800 Century.DriveMechanicsburg, PA 17055
Cooper Health SystemRobert Wood Johnson MedicalSchool at Camden -
3 Cooper PlazaCamden, NJ 08103
Deaconess Medical CenterWest 910 5th Avenue; Suite 100Spokane, WA 99204
Doctors Hospital5000 University DriveCoral Gables, FL 33146
Froedtert Memorial Lutheran Hospital9200 Wisconsin Ave.Milwaukee, WI 53226
The Gamma Knife Center-Northwestern Memorial Hospital250 E. Superior StreetChicago, IL 60611
The Gamma Knife Radiosurgery Center.University of Arkansas for Medical Science4301- West Markham Street-Little Rock, AR 72205
Gamma Knife of St. LouisBarnes Jewish Hospital216 S. Kings Highway. BoulevardSt. Louis, MO 63110.
Page 5 of 9Gamma Knife Center at Kettering Medical Center3535 Southern BoulevardKettering, OH 45429
Gamma Knife Center of the PacificSt. Francis Medical, CenterRadiation Oncology DepartmentMama Lau Cancer Care Center2230 Liliha St.Honolulu, HI 96817
.Good Samaritan Hospital1225 Wilshire Blvd.Los Angeles, CA 90017
Indiana University Medical Center541 Clinical DriveIndianapolis, IN 4620.6
John D. Archbold Memorial Hospital116 Mimosa DriveThomasville, GA 31792
MD Anderson Cancer Center1515 Holcombe BoulevardHouston,TX 77030
Medical University of South CarolinaMedical University Hospital - Dept of Radiation Oncology169 Ashley Ave. - Room 165C (Treatment Room 1)Charleston, SC 29425
Memorial Hermann the Woodlands-9250 Pinecroft DriveShenandoah, TX, 77380
Mercy Gamma Knife Center of Long IslandMercy Medical Center
-1000 North Village Avenue
Rockville Center, NY 11570
Neurologic & Orthopedic of Chicago4501 N. WinchesterChicago, IL 60640
Page 6 of 9New England Gamma Knife Center593 Eddy StreetProvidence, RI 02903
The New Jersey Neuroscience Instituteat JFK Medical Center65 Jamer StreetEdison, NJ 08818
New York University Medical Center560 First AvenueNew York,NY 10016
Northwest Hospital1560 North 11 5th Street
-Seattle, WA 98133
OSF Saint Francis- Medical Center530 NE Glen Oak AvenuePeoria, IL 61637
Presbyterian Hospital of Dallas Gamma Knife8200 Walnut Hill LaneDallas, TX 75231--
Providence Portland Medical Center4805 NE GlisanPortland, OR 97213
Puerto Rico Medical CenterCentro Medico de Rio PiedrasFirst Floor, Central BuildingCarr 22 Barrio MonacillosSan Juan, Puerto Rico 00921-
Richland Memorial Hospital7 Medical ParkColumbia, SC 29203
Rocky Mountain Gamma Knife Center4231 W. 16th Ave.Denver, CO 80204
Page 7 of 9Roswell Park Cancer InstituteElm & Carlton StreetBuffalo, NY 14263
St. Joseph Hospital611 St. Joseph AvenueMarshfield, WI 54449..
St. Joseph's Hospital5665 Peachtree Dunwoody RoadAtlanta, GA 30342
St. Luke's Medical Center2900 West Oklahoma AvenueMilwaukee, WI 53201
San Antonio Hospital999 San Bemadino RoadUpland, CA 91786
Sierra Medical Center1625 Medical Center DriveEl Paso, TX 79902
Skyline Medical Center3444 Dickerson PikeNashville, TN 37207
SUNY Upstate Medical Univ'ersity750 East Adams Street.Syracuse, NY 13210
Sutter Medical Center.5151 F StreetSacramento, CA 95602.
Terrebone General Medical Center.8166 Main St.Houma,-LA 70360
Tenet Good Samaritan, Inc ..d/b/a Good Samaritan Hospital1309 N. Flagler DriveWest Palm Beach, FL 33401
. - .' .r- .
Page 8 of 9UAB Highlands Hospital1201 11t Avenue SouthBirmingham, AL 35205
UC Davis Cancer Center4501 X Street, G126Sacramento, CA 95817
University Hospital of Cleveland11100 Euclid AvenueCleveland, OH 44106
University of Kentucky Hospital102 Animal PathologyLexington, KY 40536
University of OklahomaGamma Knife Center700 NE 13th St.Oklahoma City, OK 73104
University of PittsburghPresbyterian University Hospital
) •230 Lothrop St., Room G-102Pittsburgh, PA 15213°
University of PittsburghPresbyterian University Hospital
.230,Lothrop St., Room F-185Pittsburgh, PA 15213
University of PittsburghPresbyterian University Hospital230 Lothrop St., Room F179Pittsburgh, PA 15213
USC University Hospital1500 San Pablo StreetLos Angeles, CA 90033
Wake Forest University School of Medicine &,NC Baptist HospitalMedical Center BoulevardWinston-Salem, NC 27157 . .
Page 9 of 9Washington Hospital Center110 Irving Street, NWWashington, D.C. 20010
West Virginia University HospitalOne Medical Center DriveMorgantown, WV 26506
Yale-New Haven Ambulatory Services CorporationRadiosurgery Center40 Temple StreetNew Haven, CT 065 10
Alpha-Omega ServiCes, Inc.
/Ic 15 (10/
September 29, 2009
Deputy Director,.US Nuclear Regulatory CommissionOffice of International Programs11555 Rockville PikeRockville, MD 20852
Enclosed, please find our NRC Import/Export License Amendment applicationand the application fee.
Should you have any questions or comments regarding our application, pleasecontact Troy'Hedger at (562) 804-0604 x24.
.. Thainikyou,
Man'die Hedger
Administrative Assistant
4
4%ý 1804ý4061 h&64 060 ý31 - -i-Aw M
2 - ~
9 &~uBarnes, Robin
To:Subject:
Mandie HedgerRE: Response to Proposed Export/Import License Application PCB6.09
October 23, 2009
Dear Mandie,
Thanks for your quick response.
Okay--so this is how we propose to draft your amended license (PCB6.09) based on this new information:
1. -Change the name of one of your "Other Parties to Export"Was: Gamma Knife Center of St. Joseph's Hospital of Atlanta
5665 Peachtree Dunwoody RoadAtlanta, GA 30342
Now: St. Joseph's Hospital(Same address as above)
2. Add ten (10) new "OtherParties to Export"
Okay!Robin
- ---- Original Message -----From: Mandie Hedger [mailto:[email protected]]Sent: Friday, October 23, 2009 10:14AMTo: Barnes, RobinSubject: RE: Response to Proposed Export/Import License Application PCB6.09
Hi. Robin,
Thanks for catching this. That site was originally listed as "Gamma Knife Center of St.Joseph's Hospital ofAtlanta" and should be listed on our license as:
St. Joseph's Hospital5665 Peachtree Dunwoody RoadAtlanta, GA 30342
I have attached a revised copyOVf all new sites that are to be added-to our license including St.Josephs(withname change).
I apologize for the confusion. Please feel free to contact me if you have any questions or-need further
clarification. Thank you, for your assistance.
Hope you have a pleasant weekend!
Kind, Regards,Mandie. C
-Original. Message -----From: Barnes, Robin [mailto:[email protected]]
1
Sent: Friday, October 23, 2009 6:24 AMTo: Mandie HedgerSubject: Response to Proposed Export/Import License Application PCB6.09Importance: High
October 23, 2009
Hi Mandie,
I just now reviewed your updates, and noticed one discrepancy.
On your last license (PCB6.08), you had listed the following supplier's name. However, this one does notappear on your proposed license PCB.09. Please advise.
Gamma Knife Center of St. Joseph's Hospital of•Atlanta5665 Peachtree Dunwoody RoadAtlanta, GA 30342
I'm thinking you just accidentally left it off your proposed PCB.09.
Please respond back in writing, and I'll begin processing your application immediately.
Thanks!Robin
- ---- Original Message -----From: Mandie Hedger [mailto:[email protected]]Sent: Thursday, October 22, 2009 4:25 PM..To: Barnes, RobinCc: Troy HedgerSubject: RE: Your Applicant's Reference Nunmber (Amd 9 Request) - PCB6.09
Hi Robin,
We just wanted to-follow-up on the status of our Import/Export license Amd 9 Request- PCB6.09. Can youplease advise?
Thanks,Mandie
----- Original Message -----From: Barnes, Robin [mailto:[email protected]]Sent: Friday, October 09, 2009 12:01 PMTo: Mandie HedgerSubject: RE: Your Applicant's -Reference Number (Amd 9 Request) - PCB6.09
.got it.. thanks
- ---- Original Message -----From: Mandie Hedger [mailto:[email protected]]Sent: Friday, October 09, 2009 1:36 PM
: .To:Barnies, RobinCc: Troy HedgerSubject: RE: Your Applicant's Reference Number (Amd 9 Request) - PCB6.09
Hi Robin,2
Attached is the revised list of new sites to be added to Import/Export License (Amd 9 Request). We haveadded Chippenham and Johnston-Willis Hospitals, Inc. d/b/a CJW Medical Center.
Thank you again for accepting the last-minute addition. We really appreciate it! Hope-you have a niceweekend.
Sincerely,Mandie
-Original Message-----From: Barnes, Robin [mailto: Robin. [email protected]]Sent: Friday, October 09, 2009 •9:52 AMTo: Mandie HedgerSubject: RE: Your Applicant's Reference Number (Amd 9 Request) - PCB6.09Importance: High
Sure - go ahead
just send me another email with the complete "new add ons"
Robin
----- Original Message -----. From: Mandie Hedger [mailto:[email protected]]
Sent: Friday, October 09, 2009 11:28 AMTo: Barnes, RobinCc: Troy Hedger
. Subject: RE: Your Applicant's Reference Number (Amd.9 Request) - PCB6.09Importance: High
Hello Robin,
Would it be possible to add one additional site to our license? We just received a request this morning fromour customer asking if it would be possible.
We apologize for the last minute request.
..Thank you, .Mandie
---- Original Message---.From: Barnes, Robin [mailto: Robin. [email protected]]Sent: Thursday, October08, 2009 12:19 PMTo: Mandie HedgerCc: Troy Hedger-Subject: RE: Your Applicant's Reference Number (Arnd9 Request) - PCB6.09
Thanks Mandie."'This is exactly what Ineeded.Have a great evening.Robin
-.--,-Original Messagers.-'From: Mandie Hedger [mailto:[email protected]]Sent: Thursday, October 08, 2009 2:29 PMTo: Barnes, Robin -
Cc:-Troy Hedger3
Subject: RE: Your Applicant's Reference Number (Amd 9 Request) - PCB6.09
Hello Robin,
Attached is a word document listing just the new sites to be added to our Import/Export License (Amd 9Request). We can also send you a word document listing all the sites, if needed. Please let me know and Iwill forward a copy to you right away.
Please feel free to contact me if you have any questions or comments.
Kind Regards,Mandie Hedger
----- Original Message -----From: Troy HedgerSent: Wednesday, October 07, 2009 2:07 PMTo: Barnes, RobinCc: Mandie HedgerSubject: Re: Your Applicant's Reference Number (Amd 9 Request) -PCB6.09
Robin:
I am sorry about that. I will have Mandie send you just the sites we want to add.
Best Regards,•-Troy Hedger
÷-Sent from my iPhone-
On Oct 7, 2009, at 11:31 AM, "Barnes, Robin" <[email protected]>wrote:
> October 7, 2009
> Dear Troy,
>. I just now left you a voice message with regard to your recent> application (dated 9/29/09) requestingAmendment No. 09 for PCB6.08.
> Our office received your original application and check payment for> $770 on October 2, 2009; however, may I request that you put in> writing EXACTLY what you are adding to this amendment request. You> have indicated that you are adding additional suppliers, but it is> difficult to rec6ognize-exactly which one(s) you are actually
.>, requesting to add.
4
> My intention is to include your written response as part of your
> application to be made publicly available in ADAMS.
> Your assistance is greatly appreciated.
> Ms. Robin K. Barnes
> Licensing Assistant
> Export Controls and International Organizations
> Office of International Programs
> Mail Stop 04-E21
> U.S. Nuclear Regulatory Commission
> Washington, DC 20555-0001
> WK: 301-415-3433
> FX: 301-415-2395
> Email: [email protected]
,5
Additional Party(ies) to Import and/or Export (Page 1, Part C, #7; Page 2, Part D, # 12):
Chippenham and Johnston-Willis Hospitals, Inc.d/b/a CJW Medical Center- Johnston-Willis CampusChippenham Campus7101 Jahnke RoadRichmond, VA 23225
Chippenham and Johnston-Willis Hospitals, Inc.dib/a CJW Medical Center- Johnston-Willis CampusJohnston-Willis Campus1401 Johnston-Willis DriveRichmond, VA 23235
Gamma Knife Center of the PacificSt. Francis Medical CenterRadiation Oncology Department-Mama Lau Cancer Care Center2230 Liliha St.Honolulu, HI 96817
Good Samaritan Hospital1225 Wilshire Blvd.Los Angeles, CA 90017
Medical University of South CarolinaMedical University Hospital - Dept. of Radiation Oncology169 Ashley Ave. - Room 165C (Treatment Room 1)Charleston, SC 29425
Z 36,
St. Joseph's Hospital5665 Peachtree Dunwoody Road.Atlanta, Georgia 30342
Tenet Good Samaritan, Inc.d/b/a Good Samaritan Hospital1309 N. Flagler DriveWest Palm Beach, FL 33401
-SI OY-fg /7c//G1
.(See //ncl d/c- 4c/O0-,-A3- OYUniversity of Pittsburgh
Presbyterian University Hospital230 Lothrop St., Room G-102Pittsburgh, PA 15213
University of PittsburghPresbyterian University Hospital230 Lothrop St., Room F-185Pittsburgh, PA 15213
University of PittsburghPresbyterian University Hospital230 Lothrop St., Room F179Pittsburgh, PA 15213
Yale-New.Haven Ambulatory Services CorporationRadiosurgery Center40 Temple StreetNew Haven, CT 06510
".,()I
