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'#0 - - O'-- " AGES4 pg.gg U.S. NUCLE AQ QEGULATORY COMMIS$loN

h MATERIALS LICENSE hi

hNd

q Pursuant to the Atomic Energy Act of 1954 as amended, the Energy Reorganintion Act of 1974 (Public law 93-438) ared Title 10

( Cc:le of Federal Regulations, Chapter 1. Parts 30,31. ',2,33,34,35,39,40 and 70, and in reliance on statements and representations heretofore p

( made by the licenser. a Ikense is hereby hsued authorizing the licensee to receive, acquire, possess, and transfer byproduct, source, and special >nuclear matenal designated below; to use such material for the purpose (s) and at the place (s) designated below; to deliver or trarafer such material >

10 persons authonrad to receise it in acordance with the regulations of the applicable Part(s). This license shall be deemed to contain the conditions $specified in Section 183 of the Atonne f.nergy Act of 1954, as amended, and is subject to all applicable rules, regulations and orders of the Nuclear

Regulatory Conmiinion now or hereafter in effect and to any conditions specified below. / pf

j ucensee

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| ll- Mohamad S. Kassir, M.D. 3. Ucense number 34-26383-01 !

4 >4 >

l4 2. 1330 Timkin Mercy Drive, N.W.>hi Suite 314 4. ExpirStion date November 30, 1997 h

% Canton, OH 44708 . 3, poctet or ,

030-32947p

f k'_ Reference No

4 6. liyprUuct, source, and/or 7. Chemical and/or physical 8. Maximum amount that hcensee'

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4 speaal nudear material form may possess at any one time !

%; under this bcense |t '

4|,4 A. Any byproduct A. An/ A. As needed4 material identified ri.diopharmaceutical$, in 10 CFR 35.100 iJentifled in 10 CFR I

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.5.10)'

f B. Any byproduct B. Any B. As needed

4! material identified radiopharmaceutical pW in 10 CFR 35.200 idertified in 10 CFR $/ 35.'!00 limited to ,

i. cardiovascular {,ii clinical procedures j

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4| 9. Authorized Use: $-

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A}dM A. Medical use described in 10 CFR 35.100. >

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(;fB. Medical use described in 10 CFR 35.200 limited to cardiovascular clinical! procedures.i < r> n 1 C G i

CONDITIONS !! J '"*""

d f10. Location of Use: 1330 Timkin Mer;y Drive, N,W., Suite 314, Canton, Ohio,

f11. Radiation Safety Officer: Mohamad S. Kassir, M.D. ;

!i3d12. Authorized User tLalerial and Use !"

| h%|S Mohamad S. Kassir, M.D. 10 CFR 35.100 and 35.200 limited to cardiovascular j h

A M[p clinical procedures.

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| 34-26383-01q MATERIALS LICENSE I---

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4 13. Notwithstanding the requirements of 10 CFR 35.22, the licensee is not required to || establish a Radiation Safety Committee. p

d 14. The licensee shall maintain records of information related to decommissioning at the |q location listed in item 2 of this license as specified in 10 CFR 30.35(g) until D

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I this license is terminated by the Commission. >

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Thelicenseemaynotpossessand[A.dematerials,authorizedinitems6,7,and8|d 15. us

| until: c i*LOQ >< c v- u ,4 1. Thelicenseehasconstructedthefacilitiesat.fobtainedtheequipment >

4 described in the application and supporting document'ation; and k

i >'l 2. The U. S. Nuclear Regulatory Commission, Region 111. ATIN: Chief, Materials- || Licensing Section, 799 Roosevelt Road, Glen Ellyn, IL .60137 has been notified g

4 that activities author,1 zed b{ the license willrbe initiated. p

Within 30 days of_the date df'a dehision not to c[ongilete the , facility, acquire% / O >4 m>< 16.

4 equipment, or possess and use au?thorized materi P, the licensee must notify the E

|| Commission in writing, of the de' cision' // ?.

.*ung a >;'4 Except as specifically provided:other ise;in' this' li'conse, tho clicensee shall hq 17.conductitsprograminaccordance;wi(w'th6' statements,.repres'entations,andh >q

q procedures contained in theldocuments,1 including any enclosures, listed below, liexcept for minor changes in the: medical use radiation safety: procedures as provide 1 [,

j in 10 CFR 35.31. The U.S. Nuclear Regulatory Commission's regulations shall govern .g!

4 unless the statements,-representations, and procedures in the licensee's application-4 and correspondence are'more restrictive than the regulations.

~

Application dated January 4 , 1992; and, 4A. 26- ~ ,,

B. Letter dated Septemoer 22, 1992. p4

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j FOR THE U.S. NUCLEAR REGULATORY COMMISSION

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kDate NOV 9 1992 gy [. g f,g/,f}g g gii ~ Materials Licensing Section, Region 71T ! .

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: INFORMATION FROM LTSBETWEEN I --------------------

LICENSE FEE MANAGEMENT ERANCH. ARM PROCRAM CODE:AND STATUS CODE 3~~~~~

RECl0NAL LICENSING SECTIONS FEE CATECORY: .........,........ ...

EXP. DATE: 0FEE COMMENTSDECOM F IN ASSUR~REQDT-~~~~~~~~~~~~~

:::::::::::::::::::::::::::::::::::::

j LICENSE FEE TRANSMITTAL

(, . REC 10N

1. APPLlCATION ATTACHEDAPPL CANT / LICENSEE: KASSIR, MOHAMAD S., M.D.RECE VED DATE: 920928DOCKET NO: 3032947CONTROL NO. 394074LICENSE NO.ACil0N TYPE: NEW LICENSE

2. FEE ATTACHED :A.AMOUNT:CHECK NO. "[[~[~ , ,y.

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3. COMMENTS gg,[4L, ., a,

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b''WW(CZtTff'925a AQ2. CORRECT FEE PAID. APPLICATION MAY BE PROEES$ED~f' ort -

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REGIONAL LICENSING SECTIONS FEE CATECORY: 708.- ~. -.- - -.. - -EXP. DATE: 0: FEE COMMENTS: 861

: DECOM FIN ASSUR*REEDT-~~~~~~~~:::::::::::::::::::::::::::::::::::::

LICENSE FEE TRANSMITTAL

A. REGION

1. APPLICATION ATTACHEDAPPLICANT / LICENSEE KASSIR MOHAMAD S., M.D.RECEIVED DATE: 920928'DOCKET NO: 3032947

e CONTROL NO. 394074L LICENSE NO.1 ACTION TYF'E NEW LICENSE

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B. LICENSE FEE MANAGEMENT BRANCH (CHECK WHEN MILESTONE 03 IS ENTERED /../)1. FEE CATEGORY AND AMOUNT: , , , , , _ , , , , , , , , , , , , , , , , , , , , , , , , , , , _ , , _ , ,

2. CORRECT FEE PAID. APPLICATION MAY BE PROCESSED FOR:AMENDMENT **************RENEWALLICENSE [[ ~ ~, * ~ ~ ~~ ~

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procedures. My anticipated date to commence using radioactive materials !~or these purposesis June 1,1993 ~n

B 7n 4/b3/9 uRECEIVED . '- -

I SEP 2 81992

REGION Ill

w UuSP!00NIR0LN0.: 94OL74

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

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Hohamad S. Kassir, M.D. [*

^ ^ 11MKEN MERCY Clinical and invasive Cardiology -!REGIONAL suite 314

*

HEART 1330 Timken Mercy Dr. N W.canton OH 44708W CENTER .

September 22,1992 (216) 489 1461_*

,

1

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his. Deborah A. Piskurahiaterials Licensing SectionU.S. Nuclear Regulatory CommissionRegion 111 :

799 Roosevelt RoadiGlen Ellyn, IL 60137

REF: CONTROL NUhfBER 92933..

Dear his. Piskura:

It is my understanding that a letter following our most recent telephone discussion, and after -the correspondence of April 1,1992, was mailed to my office. Please note that I have notreceived a copy of that letter. Would you forward a copy of the letter to the address on thisletterhead. Thank you.

,

in response to the questions as I understand them, by this letter I will reaffirm my intentionto pursue a radioactive materials license, per Control Number 92933. If my file has beenrendered inactive, please reactivate it at this time. I understand there .is no additional fee fordoing so. 3

:

iny, should be in your file,you dated April 1,1992, from which the Control Number wasnses to the letter fromh y res

liowever, if not, they as fol ws:o

1) I will maintain documentation of attipersonnel training, including thenames of attendees, dates, and topicggesentij@, 'y

+

The dose calibrator linearity test willN ' rf8med ham the maximum2)activity down to 10 microcuries as pe.d1hCIg 35.500 (b) (3).

_

:

3) .I will commit to the radioactive wastkdisposapprocedures as outlinedw.

i

in Appendix R, of the Regulatory Guide 10.87evision 2, dated August1987.

In reference to verbal communications, my intention b to use radioactive mhterials for nuclear''

cardiology imaging procedures, and scaled sources for quality control / quality assurancearoceduresc i:ty anticipated date to commence using radioactive materials for these purposes -Ls June 1,1993. .

.

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RECElVED BY Lf4iS

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Page 2RIIF: CONTROL NUh1BER 92933

At present, the floor plan and address submitted represent the location and structure where Iintend to perform the procedures. Ilowever, this facility is not yet complete, if there are anychanges from the planned arrangements that deviate from the plan submitted, I will notify youroffice prior to making any such changes.

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CONTROL 0. 94gg. - - - . . . - - . _ . . .

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NOV 101992

Mohamad S. Kassir, M.D.1330 Timkin Mercy Drive, N.W.Canton, OH 44708

Dear Dr. Kassir:

Enclosed is your NRC License Number 34-26383-01 in accordance with your request.

Please note Conditions 15. and 16. which pertain to your intent to use byproductmaterial.

Please review the enclosed document carefully and be sure that you understandall conditions. You must conduct your program involving radioactive materialsin accordance with the conditions of your NRC license, representations made inyour license application, and NRC regulations. In particular, note that youmust:

1. Operate in accordance with NRC regulations 10 CFR Part 19, " Notices,instructions and Reports to Workers; Inspections," 10 CFR Part 20," Standards for Protection Against Radiation," and other applicableregulations.

2. Possess radioactive material only in the quantity and form indicatedin your license.

3. Use radioactive material only for the purpose (s) indicated in yourlicense.

4. Notify NRC in writing of any change in mailing addresc.

5. Request and obtain appropriate amendment if you plan to change ownershipof your organization, change locations of radioactive material, or makeany other changes in your facility or program which are contrary to your >

license conditions or representations made in your license applicationand any supplemental correspondence with NRC. Any amendment requestshould be accompanied by the appropriate fee specified in 10 CFR Part 170.

b. Submit a complete renewal application with proper fee or terminationrequest ~at least 30 days before the expiration date on your license.You will receive a reminder notice approximately 90 days before the~expiration date. Possession of radioactive material after your licenseexpires | is a violation of NRC regulations. *

,

7. Request termination of your license if ve plan to permanentlydiscontinue activities involving radioact material prior too

your expiration date.

f~3

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,.. . .

- o o.

Mohamad S. Kassir, M.D. -2-

You will be periodically inspected by NRC. Failure to Onduct your program inaccordance with NRC regulations, license conditions, and representations in yourlicense application will result in enforcement action against you in accordance-with the General Policy and Procedures for NRC Enforcement Actions, 10 CFRPart 2 Appendix C.

If you have any questions or require clarification of any of the above statedinformation, contact us at (708) 790-5625.

Sincerely,

Original Signed ByDeborah A. PiskuraMaterials Licensing Section

Enclosures:1. License No. 34-26383-012. New License Package

Ril

P$(s)-ra/ jawL

_ 11/O'//92

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