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08fgN,RC FORM 374 U.S. NUCLEAR REGULATORY CoMMISSI NE 1 2& N ES

; Ig' MATERIALS LICENSE Amendment No. 04 8;i|4

! Q Pursuant to the Alomic Energy Act of 1954, as amended the Energy Reorgani/atmn Act of 1974 (Public Law \n-

j Federal Regulations. Chapter 1. Parts 30. 31,32. 33, 34. 35,36,39. 40, and 70, and in reliance on statements and rcpresentations heretof ore made93 4381, and Title 10. Code of jL| by the hcensee, a license h hereby iwued authorizing the bcensee to recene. acquire. powew, and transfer by product, wurce, and special nuclear b

. material designated below; to u-e such material for tPe purposeN and at the placeN desiFnated below; to delher or transfer such material toi

|'

persons authorized to recche it in accordance with the regulations of the applicable PartN. This license shall be deemed to contain the conditions

specified in Section 183 of the Atomic Energy Act of 1954, as amended, and h subject to all applicable rules, regulations, and orders of the f[|5.5$ Nuclear RcFulatory Comminion now or hereafter in effect and to any conditions specified below.g{{Q gQg gy j

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|s Licensee ClIn accordance with the letter dated |

"

3 November 18, 1996, $;,

PL The Neurology Center, Inc. 1 License Number 37-19220-01 is amended in'

j$. |$ its entirety to read as follows:|! esv ..,

$|5. 2. 32 South Morton Avenue ci

$| Morton, Pennsylvania 19070 4. Expiration Date January 31, 2001h.||y, 5. Docket or

Reference No. 030-17160 A!,

g4 6. Byproduct. Source, and/or 7. Chemical and/or Physical 8. Maximum Amount that Licensee Isj Special Nuct - Material Form May Possess at Any One Time 12Under This License g

@'s!|3 A. Any byproduct material A. Any radiopharmaceutical A. As needed |.)E identified in 10 CFR identified in 10 CFR

Y 35.100 35.100 2.i

|5! B. Any byproduct material B. Any radiopharmaceutical B. As needed I.3,

@. identified in 10 CFR identified in 10 CFR,

nIA 35.200|E'

35.200 except generators sand gas

o$'9.

sb

|s, Authorized use Ph g|h A. Any uptake, dilution and excretion procedure approved in 10 CFR 35.100.

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{Q{|3 B. Any imaging and localization procedure approved in 10 CFR 35.200.|

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|E' 10. Licensed material may be used only at the licensee's facilities located at ? i

ID 32 South Morton Avenue, Morton, Pennsylvania. $|,@ $H 11.

| 6 The Radiation Safety Officer for this license is Eugene B. Spitz, M.D.2|3

$ 12. Licensed material listed in Item 6 above is only authorized for use by, or under the ";I,

|E' supervision of, the following individuals for the materials and uses indicated: ;|,

|i''

ilfp Authorized Users Material and Use p'

@p s|Eugene B. Spitz, M.D. 35.100; 35.200v gP a

b'13. In addition to the possession limits in Item 8, the licensee shall further restrict [the possession of licensed material so that at no time is a quantity of radioactive p

'

( materici possessed in excess of a quantity which requires decommissioning funding in p,

p accordance with 10 CFR 30.35(d),10 CFR 40.36(b) or 10 CFR 70.25(d).>

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FR 3 4A N A O O S [pg

License NumberN 'g! ,37-19220-01 q; R MATERIALS LICENSE Docket or Reference Number

|!'gp SUPPLEMENTARY SHEET 030-17160 q

'

N

$ E!Amendment No. 04 g

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N 14. The licensee is authorized to transport licensed material in accordance with the g

$ provisions of 10 CFR Part 71, " Packaging and Transportation of Radioactive Material." g

N g i

E:g 15. Except as specifically provided otherwise in this license, the licensee shall conduct g')i

y its program in accordance with the statements, representations, and proceduresg contained in the documents, including any enclosures, listed below, except for cinor g

gy changes in the medical use radiation nafety procedures as provided in 10 CFR 35.31.g The U.S. Nuclear Regulatory Commission's regulations shall govern unless the ;g

q statements, representations, and proceiures in the licensee's application and g'

g correspondence are more restrictive than the regulations. 4'

g-

|| A. Letter dated May 22, 1990y B. Letter dated September 11, 1990.

C. Letter dated October 23, 1990 E|!

: gD. Letter dated November 18, 1996 igy,

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' ORIGINAL SIGNED BY: EDEC | 51996 JO ANN V. STAMBAUGH EDate By E

huclear Materials Safety Branch EN Region 1 ER King of Prussia, Pennsylvania 19406 EN

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DEC I 51996 I

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.

Lorraine C. King, M.D.President |The Neurology Center, Inc. i

I32 South Morton Avenue -

Morton, PA 19070

Dear Dr. King:

This refers to your license amendment request. Enclosed with this letter is the !amended license. Please note that as part of this amendment, in accordence with i

10 CFR 30.36, effective February 15,1996, the expiration date of your license has I

been extended by a period of five years. Your new expiration date is stated in item 4of the license.

Please review the enclosed document carefully and be sure that you understand andfully implement all the conditions incorporated into the amended license. If there areany errors or questions, niease notify the U.S. Nuclear Regulatory Commission, Regioni Office, Licensing Assistance Team, (610) 337-5093 or 5239, so that we can provideappropriate corrections and answers.

Thank you for your cooperation.

Sincerely,

ORIGINAL SIGNED BY:JO ANN V. STAMBAUGH

JoAnn V. StambaughDivision of Nuclear Materials Safety

I

License No. 37-19220-01 I

Docket No. 030-17160Control No. 123946

Enclosure:Amendment No. 04DOCUMENT NAME: R:\WPS\MLTR\L3719220.01 ,

to r.c.sv. . copy of this docum.nt, indic i. in the box: c - copy w/o attach /enct *E* .= Copy w/ attach /.nce "N" - No copy |

OFFICE DNMS/RI |N DNMS/RI |NAME Stambaugh/jvs Qg L;

i DATE 12/05/96 i;l 6146 12/ /96 12/ /96 12/ /96|,

! OFFICIAL RECORD COPY!

|

| _ 1

. _ _ _ . _ - . _ - _ ..

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0 3 0 - rtIta D

.

THE NEUROLOGY CENTER,INC.| 32 SOUTH MORTON AVENUE

MORTON, PA 19070

Eugene B. Spitz. M.D. 610-544-9880

||

I

November 18, 1996

Nuclear tedicine Safety BranchDivision of Radiation Safety and Safeguards !

U.S. Nuclear Regulatory Commission i

475 Allendale Road |King of Prussia, PA 19406-1415

; RE: License Number: 37-19220-01 )Amendment Application'

Dear License Reviewer:

| Spitz Clinic has recently been purchased by Lorraine C. King, M.D. andAlan W. Skelly. The name of this institution has been changed to: "The'

! Neurology Center, Inc.". Please amend our radioactive license to recognize| this name change.

Dr. Spitz will remain as radiation safety officer and authorized user.In addition, all statements referenced within the license application will |

remain unchanged. At the present time, administrative representatives haveno intention to relocate and/or modify nuclear medicine operations.

| In addition, all license commitments established for this licensee will

| remain in effect. Only the facility name and ownership has been changed.

If you have additional questions, please contact Michael W. Lairmore orj myself. Mr. Lairmore may be reached at (201)447-3303.1' We thank you in advance for your assistance with this licensing action.

| Sincerely,i

'

|,

l' Lorraine C. King, M.D.

Presidenti The Neurology Center, Inc.

.

1.23946OFFICIAL RECORD COPY ML 10 lOf 261996

. - - - ..-_ _

k *3,-

NQC FORM 313 U.S. NUCLEAR REGULATORY COMMISS. "'dDyn Megs 6220E,

' "CFQ 30,33 33' '

10 " * 7 C "

RYo'R"o's"*uAD"$"seNf*'aEN$N 7MNea5Ti4%*NuCOUR' '34,39 and 40*

,"ASdi'Ez'REOu"C" tee"ROI$TYeo.M /Nila OUM'ASeIo"I." ' " ' ' " " " " " * * * * ' " " ' " ' " ' ' " ' -APPLICATION FOR MATERIAL LICENSEi

| ,

'INSTRUCTIONS: SEE THE APPROPRIATE LICENSE APPUCATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION. SEND TWO COPIES OF THEEfeTIRE COMPLETED APPUCATION TO THE NRC OFFICE SPECIFIED RELOW

b~APP.lCAflON FOR DISTRIBUTION ')F EXEMPT PRODUCTS FILE APPUCATION WITH: IF YOU ARE LOCATED IN:

OtVISION OF INDUSTRIAL AND MEDICAL NUCLEAR SAFETY 6LUNOtS. INDIANA. lOWA MICHIGAN. MINNESOTA. MISSOURI, Ohio, OR| OFFICE OF NUCLEAR MATERIAL SAFETY AND SAFEGUARDS WISCONSIN. SEND APPUCATIONS TO:

I V $ TON C 5 MAffRIALS UCENSINO SECTONgg Nurg F TORY COMMtBSiON. REOiON lil

ALL OTHER PERSONS FILE APPUCATION AS FOLLOWS. GLEN h.LVN IL 60137

iF YOU ARE LOCATED IN: ARKANSAS, COLORADO, IDAHO, r.ANSAS. Lou 1SIANA. MONTANA. NEBRASKA.NEW MEXICO. NORTH DAKOTA. OKLAHOMA, SOUTH DAKOTA, TEXAS UTAH.

CONNECTICUT DELAWARE. DISTRICT OF COLUMBIA MAINE. MARYLAND. OR WYOMING, SEND APPUCATIONS TD:MoSSACHUSETTS. NEW HAMPSHIRE, NEW JERSEY, NEW YORK. PENNSYLVANIA.RHODE ISLAND. OR VERMONT, SEND APPUCATIONS TO: R jA0 R TfC 1

a ye i N EQlON IVUCENSING ASSISTANT SECTION ALIN N A 7 i

LEAR FOR C M ION, REGION 1

KING OF PRuS&sA. PA 19406 1415 AND U.S. TERRITORIES AND POSSESSIONS IN THE PACIFIC SEND APPUCATIONSjTD:

- ALABAMA. FLORIDA. GEORGIA. KENTUCKY, MISSISSiPPt. NORTH CAROLINA.I PUERTO RICO. SOUTH CAROLINA. TENNESSEE. VIRGINIA, VIRGIN ISLANDS. OR NUCLEAR MATERIALS SAFETY 'iECTION |

| WEST VIRQiNIA, SEND APPUCATIONS TO: Mo"uT.AbgpVLATORY COMM4SS40N. REGION V

( NUCLEAR MAT!mALS SAFETY MCTION WALNUT CREEK. CA 94$96 5366'

?& uYRinr"A'|htn^'E M''E"'''*" * ,aA ILANT A. GA 30323 i

PERSONS LOCATED IN AGREEMENT STATES SENO APPUCATIONS TO THE U.S. NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE UCENSEDMATERIAL IN STATES SUBJECT TO U S NUCLE AR REGULATORY COMMISSION JUMISDICTIONS.

1. THIS IS AN APPUCATION FOR (Check accropnare stem / 2. NAME AND MAluNG ADDRESS OF APPUCANT //nchideslip Coael

Spitz Clinic32 MortOn Avenue McNL hMI ~A. NEW UCENSE

'

B. AMENDMENT TO UCENSE NUMBER 37 19220 01 Morton, PA 29070pd no E C*

! C. RENEWAL OF UCENSE NUMBER'

% mt 3 G..f3. ADDRESS (ESI WHERE UCENSED MATERIAL WILL DE USED OR POSSESSED.

Spite Clinic |;32 Morton Avenue 1:

''

MortOn, PA 29070_ _

4. NAME OF PERSON TO BE CONTACTED ABOUT THIS APPUCATION TELEPHONE NUMBER

|Michael W. LairmOre, Medical Physics Consultation (201) 447-3303 i

SUBMIT ITEMS 6 THROUGH 11 ON 8 % a 11* PAPER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDFD IS DESCRIRFD IN THE UCENSE APPLICATION GUIDE.

I S. RADIOACTIVE MATERIAL. 6. PURPOSE (S) FOR WHICH UCENSED MATERIAL WILL BE USED.| a. Element and mass number, b. chemical and/or physical form, and C. maximumi amDunt WIWCh will be potteS$6d St AnY one time.

7. INOlVIDUALtSi RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR 8. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS.j TRAINING AND E XPERIFNCE.

9 FACILrflES AND EQUIPMENT. 10 RADIATION SAFETY PROGRAM

12. UCENSEE FEES ISee to CFR 770 amt Sectico 770.37711. WASTE MANAGEMENT.| | AMOUNT

| FEE CATIOORY 7C | ENCLOSED $440 |

|13. CERTIFICATION. /Must be comgwered by apstacanff THE APPUCANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENTATIONS MADE IN THIS APPUCATION ARE

j BINDING UPON THE APPUCANT.THE APPUCANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEHALF OF THE APPUCANT. NAMED IN ITEM 2. CERTIFY THAT THl$ APPUCATION ISi

I PREPARED IN CONFORMITY WITH TITLE 10. CODE OF FEDERAL REGULATIONS, PARTS 30,32,33.34.35. AND AO AND THAT ALL INFORMATION CONTAINED HEREIN.IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BEUEF. ,

WARNING: 18 U S.C. SECTION 1001 ACT OF JUNE 25.19A8. 62 STAT. 7A9 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY F ALSE STATEMENT OR REPRESENTATION |TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATFS AS TO ANY MATTER WITH4N ITS JURtSDicTtON |

SIGNATURE CERTIFYING OFFICIAL | TYPED / PRINTED NAME | TITLE | DATE

i

t

M Lorraine C. King, M.D. Presidem

{f' / FOR NRC USE ONLY

TYPE OF FEE FEE LOG FEE CATEGORY COMMENTSi

|

AMOUNT RECElVED CHFCK NUMOERi

1

QPPROVED BY | DATE .

1

i~

[2]h}NRC FORM 313(3-92)

NOV 2 61996 4,

i

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...y e s19 9

| 9 *

: (FOR LFMS USE)1

: INFORMATION FROM LTS |,

1' --. BETWEEN: : - - - - - - - - - - - - - - - - - - - -

- : i

1LICENSE FEE MANAGEMENT BRANCH, ARM : PROGRAM CODE: 02201 i

AND : ST ATUS CODE: 0 ,

' - -

REGIONAL LIC ENSING SECTIONS : FEE CATEGORT: 7C I"

'r : EXP. DATE: 20010131r : FEE COMMENTS: ...____ .__________

M : DECOM FIN ASSUR REQD: NH ::::::::::::::::::::::::::::::::::::::,

|p

%. LICENSE FEE TRANSMITTAL

A. REGION I

1,..

- 1. APPLIC AT ION ATTACHEDAPPLICANT / LICENSEE: S PITZ CLINIC+-

RECEIVED DATE: 961126.

l+- DOCKET NO: 3017160 I

H CONTROL NO.: 123946LICENS E NO. : 37-19220-01-

ACTION TYPE: A MENOMENT-

: r-

:- 2 FEE ATTACHED|-- AMOUNT: _y_Q do..

CHECK No.: _LQ Z2._ _ _ ,

y i

j- 3. COMMENTS

Ns.p _c 7 kcqy]]__ ___ ______d-SIGNED

6________________OAre-,

-- 8 . LICENSE FEE MANAGEMENT BRANCH (CHECK WHEN MILESTONE 03 IS ENTERED )_

1. FEE C ATEGORT AND AMOUNT: _ [_b . . . . . _ _ _ _ _ _ _ _ _ _, _ _ _ _ _ _ _ _ _ _ _ _ _ _bVp_ _ _y

I- 2. CORRECT FEE PA*D. APPLIC ATION M AY BE PROCESSED FOR:AMENDMENT _________{____RENENAL ______________

LICENSE-_ _ _ _ _ _ _ _ _ _ _ _ , , _ _

;:43. OTHER Q__________________________________

p;H __________________________________

U SIGNED ___________________________c___I

~ DATe _____ _______________________.___

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