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S e n t By: K; 4 1 06652074 ; A U G - 1 9 - 0 3 14: 5 7 ; Paae 5
3601 E. Joppa Road Baltimdre, Maryland 21 2 3 4
141 0-665-5447 147 0-665-2074 7. ACTNmES T U 88 CONDUCTED UNDER THE GENERAL LICENSE ONEN IN 10 CFR 160.20
0 WELL LOWING 8 LEAK TESTING AND/OR CALIBRATIONS 0 TELETHERAPYllRRADlATOR SERVICE
0 PORTABLEGAUQES 0 OTHER (Spwify)
REGISTERED A S USER OF DAGBUV~INO (CWTIPICATES OF COMCUANCP N U M W RADIOGRAPHY e
Nanticoke Memorial Hospital B O 1 Middleford Road Seaford, DE 19973
same as 8
CS-137 ICM MLD-01#309389, 250uCi ( 1 1 / 2 3 / 8 7 ) = Cs-137 NAS MED 3550 #1A7380, 1 8 2 . 5 uCi ( 1 7 / 1 / 9 7 )
S e n t By: K; 41 06652074; A U g - 1 9 - 0 3 14:59; Page 8 / 1 5
. Milford Memorial Hospital 21 W. Clark Avenue Milford, DE 19963
Xrueger-Gilbert Health Physics, Inc INITIAL REVISION CLARIFICATION kODRe69OPUCENSEE ( M a W n p a d W a o b Y I m b w h r a h - n s y b r b b d ) 4. U E S C O N T m AND TfnE *
same as # 8
11, WORKLOCAWNlE!.EPHOHE NUM- 10. p K - W < E NUMam pnQJwskaCMy
3 2-422- 311 302-422-331 1
3601 E. Joppa Road B a l t i m d r e , Maryland 21 234
la. NUMBEROF 14. 1 a. I I= D A ~ SctieouLm WORK DAYS ADD DCLETE
:OM m
141 0 -665-5447 141 0-665-2074 7. ACTTVITIES TO BE CONDUCTED UNDER THE GENERAL LICENSE QNEN IN i o CFR 16020
WELL LOGGING LEAK TESTING AND/OR CALIBRATIONS c] TELETHERAPYIIRR9DIATOA SERVICE
16. LOCATION R m N C E NUMBW
WMRW TO Oe melorn BY NRC
0 PORTABLEGAUGES 0 OTHER (Specify) =@
4 1 06652074 ; A u ~ - 19-03 15 : 03; Page 1 1 / 1 5 Sent By: K; . ,I
. . . -
Krueger-Gilbert Health Physics, f n c 3. MCRK'3E OF UCfiN9(;E; p d l n g rddnas CY ulhuIohx~if@~ w h r s h n m may be/oa&J
INITIAL 0 REVISION @ CLARIFICATION 4, UCEMEEcor(TAcTANDTI"LE
I .
3601 E. J o m a Road - - B a l t i m d r e , Maryland 21234
Donnn Thim ./Health Phys ic 1 -~ -. -
e. F K g M l c e m-%= 8. m P H N6NUMQtR ( * l d l p b . L - ,
4 1 0-665-5447 4 1 0-665-2074
0 WELL LOGGING LEAK TESTING AND/OR CALIBRATIONS 0 TELETHERAPYARRAD1ATOR SERVICE
0 PORTASLEQAUGES 0 OTHER (Specify) + 0 RADIOGRAPHY
Rl!GIST€!REO AS UCER OF PACWQWG (CER'TlIPIcATW W CQMPWNCE! NUb!0ERSJ
3, CUSHT NAIAE, A309ESS, arr/rCOUKn. S A = HP CCXX 0. ACTUAL PWYSICAL ADOW38 OF WORK LOCal7DN (SbrrlmdMnW&U~Wdhfhrl~&Wl, h a ? m p M h M .ddnar W d i a O l i w a5 p c X S d d
- Bayhealth Medical Center Kent General Hospital I same as #8
640 South State Street Dover, Delaware 19901 la alEHTlELEPt40NENUHBW , 11. WORKLOCA'ITQN T E l 6 P W N B N U M ~
fzndudn A m Cod.) (brckrd8h-d
302-674-4700 302-674-4700
CS-137 I C N MLD-O1#309389, 25OUCi (11/23/87) Cs-737 NAS MED 3550 #A7380, 182.5 uCi ( 1 1 / 7 / 9 7 )
THE UNDEIPSIGN~D, HERZRY cmnw THAT: All Infoimatlon In thla mart tS bum urd complrta. 1 haw rrad and U n a r M d the ptovlsbn of the gmnaral Ilcmm 10 CPR 1 6 0 3 rrprlntod on t h m InatnrcUons d t h l a farm: and I unduldsnd +hat I am required to cornplywtth these provlshna as tn all byproduct, sourer, or spdol nudsar mstarlal whldr I possaa and use tn non4grarmont strtas or oflshom WmtMs under tha gcnatd llcuua tor whlcn Lhls rrport 1s tlld Wm tho US. ~ c l r r Regvlatwy Comnbdon
E. I undwstand ~ h d actlvftlrn, lncludfng sturage, conducted In non4prmmntSUt.r undrr gmaral ilmnsc 10 CPR 18020 are Ilmtbd b a rotd d I80 Cp In calendar year. Wkh the excrprfon ol work candudd In d - x h w e watcm, whlch la wtho&sd for an unllmttad perlod af tfms In the a J e n h r p r .
I understand thhrt I may ba inspactad by NRC at the rbovr 1kad work a b I d o n s and at tho Uc- home otflce ad- tar advtt iW wormed In non.&mamozrt Statu or ofhhorr wltrr+.
e. I undmratmnd that cmdud d any sdvrtlas not Uwcdbed above. lncludlnp conduct cdadvttlm on aaNs or l o m o m amfemtmrn thoae drt~llb.d above or Mhout NRC ouMorlznWon, may subJact rn. to enforcement adan, indud&g dvll or cftmlnd pmsl t ler
b.
d.
I I I O A Y J - A /
S e n t Ey: K ; 41 06652074; AUg-19 -03 1 5 : O I ; Page 1 2 / 1 5 . ., . . \. , : . . .
Krueger-Gilbert Health P h y s i c s , Inc I. mo~wuC%iNBE€ ( ~ ~ ~ d a n o r a m r r o o r l Y o l r r ~ U c u u w ~ y b . l c c r * d )
. . / . ' . . ..,.. , . . . . . . !., . . . . v . : ' . ".
INlnAL 0 REVISION ClARlFICAnON I .
4. UCEMEECQNTACTA"D~
.- - . Bay;@ealth Medical Center Kent eeneral it3a'ricBr' Cehter 793 S. Queen Street Dove?, Delaware 1 9 9 0 4
same as # 8
11. V ~ U U X A I ' ~ O N E L D " E N U ~ ~ W 5wkJumhOPY . la cxIENll"PM?M NUHPgl
(baitdwAmlcdrJ
3601 E. Joppa Road . B a l t i m Q r e , Maryland 21 234
' Donna Thlm ./Health Phys ic LE MBQI I @a'Yd.-%
1. NUMBW W h M . J
14 10-665-544 7 141 0-665-2074 7. ACTWLTIES TO BE CONI3WCTU) UNDER THE GENERAL UCENSE GWEN IN 10 CFR 180.20
0 WELL LOQOING LEAK TESTING AND/OR CAUBRATfONS TELETHERAPYARfUDlATOR SERVlCE
I
c
Cs-137 ICN MLD-01W309369, 25OuCi (11 /23/87) Cs-137 NRS MED 3550 kdA7380,. 7 8 2 . 5 UCf ( 1 1 / 1 / 9 7 )
I
31
Sen t P y : K; 41 06652074; AUg-19-03 15:31; Paae 1 3 i 1 5
Baltimere, Maryland 21234
0 WELL LOGGING @ LEAK TESTING AND/OR CALIBRATIONS TELETHERAPYflRRADlATOR SERVICE
Molecular Ima.ging Services 613 High Street Seaford, DE 19973
CS-1 37 I C N MLD-01 ly309389, 250uC.i ( 1 1 /23/87) (3 -137 NAS NED 3 5 5 0 #A7380, 182.5 U C i ( 1 1 / 1 / 9 7 )
S e n t By: K; 41 06652074; A u ~ - 19- 03 15: 32; Page 14 /15
3601 E - Jappa. Road Baltimdre, Maryland 21 234
147 0-665-2074 7. ACTIVITIES TO BE CONDUCYeO UNDER THE QE)lWUV UCENGE QlVEN IN 10 CFp 19010
I CJ ~ L ~ L O ~ Q I N Q LEAKTESTING AND/OR CALlBRATlONS c] ..TELETHERAWIIR&UlATOR SERVICE .
I ' I 0 PORTABLECXAUQES I? OTHER (Spedfyl
Habib . B q l & c h k , M. D ; 4503 Sjrlqhwav 'One . . .
abova or VAClrout
S e n t By: K;
5. ELEPHONE '+UMBER [krdda +VU# U&oJ
Baltimdre Maryland 21 234 47 0 -665-5447
4 1 06652074 ;
6. FAfXWIG NUMSR p m l d m h Cod.)
4 1 0-665-2074
A u ~ - 19-03 15: 0 3 ;
. c u m NAME. mmw. cnv~coum. SATE ZIP CODE
Page 1 5 / 1 5
9 ACTUAL P H W W AoDRE98 OF WORK LOCARON 1SbrtadNvmbUff amrral fM. Ghrur9mpI6leMed&ua UdbwliM6 rSOoalibk) c-
10. CUEMTELWHaW MlMES37
302- 892-6200 @xjtds A=U M o J
q i . WORKL03?lONlELEPHC"NUM9W @d&m CmwJ 302-892- 6200
I 0 PORTABLEGAUGES 0 OTHER (Spedty) + '
-"'SER OP PACKAQING (CGRWICATSJ OFCOhtRlANCENUMDSRS) --._.e
9 ACTUAL P H W W AoDRE98 OF WORK LOCARON 1SbrtmdNvmbuff amrral fM. Ghrur9mpl6leMed&ua udbwliM6 rspoal ibk)
d. I undbmmd that I mny be Inspectad by NRC at the sbwe llded work slta locatlons and at tho Llcenme home otnca ilddrana?oc ac(lVltI0s prflomsd In nort4grcement Statrs or offahore wntwa.
0. 1 undersrsnd that condud of any rctlvitiefi not dlrcrlbsd above. lncludlng conduct of rctlvWes on mfL8 or IocaUons dlffsrant from th!se dctlcrlbod &VE or wkhout NRC authorIration. may subled mo to rnf<
a NRC be compIPta and acmrat. in all material F8
41 06652074; A U a - 1 9 - 0 3 14 :55 ; Paae 2 S e n t B y : K;
TC FORM 201 1-
REPORT OF PROPOSED ACTIVfTlES IN
FEDERAL JURISDICTION, OR OFFSHORE WATERS \ION-AGREEMENT STATEB, AREAS OF €XCLUSIVE
~
NAME OF UCGNSEE m m r h n pwg tnawfucf tlm .obvlllu d&d bkw)
Krueger-Gilbert Health Physics, Inc INITIAL 0 REVISION C U R I FICATION A O D R E S ~ O F L I ~ ~ E E [ M u l k r p u l ~ ~ ~ ~ ~ o u L d n m t i v ~ w h l R I I o . M m ~ ~ ~ y & h ~ )
3601 E. Joppa Road B a l t i m d r e , Maryland 21 234
( 4 ? 0 -665-5447 141 0-665-2074 7. AcnvinEs TO BE CONDUCTED UNDER THE GENERAL LICENSE QWEN IN i a CFR iw2o
Genishpere/PoLyprobe . 2'807 - S t e r l i n g Drive H a t f i e l d , PA 1 9 4 4 0 same as # 8
12 - 9 9 6 - 3 0 0 6 121 5 996r3006 *a. wrmm?& 14. le. 18. LOCATION WORK DAYS ADD D a m REFEWNCE NUMBER 1 2 DATES SCHPDuLED
OM 1
Cs-I 37 I C N MLD-01#309389F 250uCi ( 11 /23/87) (25-137 NAS MED 3550 #A?380, 182.5 UCi ( 1 1 / 1 / 9 7 )
3601 E- Joppa Road Mw w d d f # H e a l t h Physi B a l t l m d r e , Maryland 21 234 NUMBER
b VU?PHWBNU la LF--, f%uwm-wF 141 0-665-5447 141 0-665-2074
7. ACTIVITIES TO ee CONDUCTED UNDER THE GENERAL UCWSE QNEN IN i o CFR 160.20
CS-137 ICN mD-01#309389, 25OuCi (11/23/87) Cs-137 NAS MED 3550 #A7380, 182.5 uCi ( 1 1 / 1 / 9 7 }
US. NUGLfAR REGULpTORY COMMESlON 3C FORM 141 leea)
REPORT OF PROPOSED ACTIVITIES IN qON-AGREEMENT STATES, AREAS OF EXCLUSIVE FEDERAL JURISDICTION, OR OFFSHORE WATERS
(Phse mad fho Insf~~~ctionc behm campleilng ihis form)
I 0 PORTABLEGAUGES 0 OTHER (Spacify) 39
BXPIIPLOS: 0713ln#n Wk5hl-l
PPeROMD SY O M L NO. S l y & whh Ihh wrmssdburdan W m J request- 16 m d a 4 Z Z t n a t t o n ia u i d ua 01.t NRC may
. snhdulo inupmdon df V ~ J Oawkbs -% l h T n d u u ? n d In Moordo~u wlyl rqulramota for p- d (ha puhlh Mlth and d a y . Sond cammams mrdin burdon bstlmnte lo the Ramrds
U d . Nudm mulptory Cornrnlatbn
NEOB-10202 (JlsO-dOl3 , Offloe of MMnaement and Bud * I , Wnehingbn. dc R a maam usmi loirnpm.e an infomrJ1w disclian dmn M! de ley P ownndg valld OM8 control numbrr. tttn NRC may not conduJor rponwr. and a p m o n 16 not raquirad to mpond to. Ihs lnbrmnhan 0olbdOn.
ment Branch E$$!%%&&, ~ ~ , ~ ~ ~ ~ { & ~ / ~ o ~ & ~ ~
CUEM NAME. ADORESS. CmiCOUNTy, S A T E IIP CODE
American Red Cross Blood Serv. Musser Blood Canter 700 Spr ing Garden Street
I I
16. LOCATION 13. NUMBOROF 14. 16. 1 2 DATES scneDuLm WORK DAY5 ADD nmmi R W R E N C E NUMBIW
x, M M B Q l ID BE ASlCNeD Bv NRC
I dllo3/03 q/dJ! d009SZ UST ADDITIONAL WORK SITES ON SGPARAfE SHEET(5) TO INCLUDE ALL INFORMATION CONTAINED IN ITEMS 8-16 ABOVE.
usT R C L D I O A ~ MATERIAL WHICH WILL is WSS~?~SFD, us=, IHSTALLPD, SERW, oa nwrm
a. ACTUAL PHYSICAL Aouam OP WORK LcanoN (sent we Numdr w Mhtw WbUm. 6 N a Y oompm. M rddrars dn-zbwx an poa81hh
same as # 8
(I- dmacrBWn Dp. Md qWrrmY OI ndfWUW l~Wm& x w h d m w a s . ut d.r/Gm m be mod}
CS-137 ICN MLD-O1#309389, 25OuCi ( 1 1 / 2 3 / 8 7 ) Cs-137 NAS MED 3550 #A7380, 1 8 2 . 5 uCi ( 1 1 / 1 / 9 7 )
'WE UNDERSIGNED, HEREBY CEATtM THAT:
,. All lnfa#matlon In thtu nport k 1rv1 and cornplate I have rand and undsratmd lhm pkimlon Mthb gansral Ikonor 10 CFR 150.20 nprlntod on t h m lndmetlons af thla form; and 1 und-,stand that I am required to comply Wlth thcie prwlsbns asto 811 bypmduct, source, or apmlsl Rucleir mstarlsl whlch I posmss and use In non+3ramrn@nt S t a t e or uffshorm waaw under the ganaral I I C l n f l for whlch thls report I8 ?lld wlth the U.S. Nudtrr RaguI~Iory Commtaeion.
I undrrnond vlnt odVmes, lncludlno storage, conductad In nowlgmmrnt Statas undrr gmml llcansa 10 CPR 1S030 are flmtted Ua a totnl at 180 d w s In colwxiar year. Wlth ar rxtrptlon Ot work conducted In offshore waterq which is nuthodzed fur an onllmltad p d o d of t h e In M a alrndnr par .
I undarsLand tha! 1 may bo impacted by NRC at the aDwe llstcd worK site locadan6 and at thm Ucensas home D~RCU nddrua for ac(1vitIcs perfomad In non-Agmement 9LXw or affshora waters.
e.
d,
tlom dtthrentfrom those descdbmd
41 06652074; AuCJ-19-03 1 4 1 5 7 ; Page 6 1 ‘ 5 S e n t ey: K;
Riddle-Memorial Hospital 1068 W. Baltimore Pike Media, PA 19063
US. N U C W R RWULATORY COMMEiSION
same as 8
TE!B”ONe NUMISER 11. W ~ L ~ ~ ~ , ) W ~ E N V M B E E ~ lo. 3% h cad.)
61 0-566-9400 6 1 0 - 5 6 6 - 9 4 0 0
ST OF PROPOSED ACfNlTlES IN ,AMENT STATES, AREAS OF EXCLUSIVE
AL JURISDICTION, OR OFFSHORE WATERS ~.
(Phase mad #e lnsinrcflona bohm compleilng &is lam) N*MEW IXSlS66 (Pason c r t f r m ~ b&& scffhtm M a d
Krueger-Gilbert Health P h y s i c s , Inc Asaam OF UC6NBSE fU.* damu amMrkra&m w7wu bausL.inmyWIoD.BLd)
3 6 0 1 E. Joppa Road B a l t i m & ) r e , Maryland 2 1 2 3 4
7. A C ~ I E S Ta BE CONDUCTED UNDER THE QENEF
INrlAL REVISION @ CLARIFICATION L WSEECMvTAGTANOTRLE I -
&+Lp& -&Health P h y s i c i s
-LICENSE GIVEN IN 10 CFR 760.20 - I I n WELL LOGGING LEAK TESTING ANDGR CALIBRATlONS I TElFTHERAPY/IRRADlATOR SERWCE
- J ASSIGNED BY NRC q-)&h3 !&/& b o d N 8 SEPARATE SHEEt(3) TO lNCLClOE ALL INFORMATION CONTAINED IN ITEMS 9-18 ABOVE.
Cs-137 I C N MLD-01#309389, 250uCi ( 1 1 / 2 3 / 8 7 ) CS-137 NAS MED 3550 H A f 3 8 0 , 182.5 UCF ( 1 1 / 1 / 9 7 )
1. Ail hfomtnth h thIS IapoIl IS trOI J?ld comptds.
b, 1 have read and undtrabnd thc provldon d t h ~ general llcrnae 10 CFR l 6OZO rcprlntcd on tha Inmctlonr af mlr Ton: and I undanund ma! I om requlrad to complywkh them^ pmvldont asto all byproduct, source, or sprclol nuclrsf msterlal whlch I pocuess and u f a In nongagrearnent strnr of OflShotm wntcrs undar thr prnrril Ucanse kr which thls report lo n1.d wUh the U.S. Nudmr Rcgulstory Ccmmlnaion.
c. I und.ratand that advMas, Includhg otrrrqgc, condudad In non4grrement Slatas undw arneful I l m s r l a CFR 16020 am ItrnRed 10 a tutal In calendar ymar. W7th Ihs axcoplon of work condusted In olT-shcrcwmrrr, whkh fa nuthodzrd lor an unllmlted prrlod of tima In the cslandir p a r .
d. I unduztand that I may ba 1nsprct.d by NRC at Ihr obova llded worK aka Incatlons and at the Llcenrrr horn. offlcr addmas lor acllvklu pmfomed In nonAgrnmant 5Mss or &om watus.
180 dtYa
RNING: False eatemranto in this cartiflcefa. may be subject lo c NRC ba carnolate and accurate in all material r r r~gacto. 1s U . t . b
’ Sactton 1 ~ 0 1 maker Pa criminal ohnsm to miin a WEII~UIIY raise
merit or repmsntatran l o any department or ngancy of the United Stet- as to any matter wlthln Its jurisdiction.
S e n t Ey : K; 41 06652074; A U g - 1 9 - 0 3 14 : 5 8 ; Pace 7 1 ' 5
Krueger-Gilbert Health Physics, Inc Or L
INITlAL c] REVISION @ CLARIFlCaTlON
3@R OF 14, 16. DAYS ADD D a n P
3601 E. Joppa Road Baltimdre, Maryland 21234
16. LOCATION REFERENCE NUMBER
NUMBER TO BE
I Malek DaneshJtas/ .
1 ) . l
141 0-665-5447 141 0-665-2074 7. ACTNITIES TO BE CONDUCTED UNDER THE Q'kNntAL LICENSE GIVEN IN 10 CFR 180.20
i I n39101iEO 8'1 NRC
0 WELL LOGGINQ a LEAKTESTING AND/OR CALIBRATIONS 0 TELEfHER4PYIIRWDiATOR SERVICE
0 PORTABLEGAUGES 0 OTHER (Sp~lfy) *
REVIEWINO OFFKIAL fTyp&n(ad Neme and EUoJ
-
R B 6 t S ~ A$ USER OF PACUGING {CWTlFICAm OF COMPUANCE NUMB- 0 RADIOGRAPHY *
TOTAL USAGE - OAYS TU DATE
6 6
Sacred.Beart Hospi ta l 421 Chew Street Allentown, PA 18102
13, NU WOR 12 DATK3 SCHEDULED
same as 8
S e n t By: K; 4106652074; AUCJ - 19-03 14: 59; P2Ge 9 / 7 5
3601 E. Joppa Road Baltlrndze, Maryland 21 234
.. '
I /Llm-m l/Kealth P h y s f c i s
0. FACSMUN M eR
41 0-665-2074 **- u.1 6. W H O N E N U -
41 0-665-5447 ( W o d . M
0 WELLLOGGING a LEAK T E S T " ANO/OR CALIBRATIONS TEL~ERAWI IRRADIATOR SERVICE
13 PORTABLEGAUQES OTHER (Spuffy)
American .Medical Laboratories, I n c t s a m ~ as 8 1 4 2 2 5 Mowbtook Drive P.O. Box 10841 S I
~~
41 06652074; A u ~ - 19-03 15: 33; P a s e 1 0 / 1 5 Sen t 0 y : K;
Xruegar-Gilbert Health Physics, Inc ClARIFlCAllON , . 3. moREsS OF UCENBEE ( u Y n r r r w a CY oYlrhbbwh*1 l h r f n q y M kumdJ 4. WS§ CONTACT #NO TmT
3601 E. Joppe Road I B s l t i m B r e , Maryland 21 234 1410-665-5447 141 0 - 6 6 5 - 2 0 7 4
7. ACTIVPTlES TO 86 CONDUCTED UNDER fCfE CIIENWL LJCCNSE ONEN IN 10 CFR 18030 1 0 WELLLOGGING WTESTtNG AND/OR CAUBRATtONS ..TELE-rrrERAPY/lXRADlATOR SERVICE
Cs-137 I C N MLD-01 d309389, 25OuCi ( 1 1 / 2 3 / 8 7 ) I CS-1.37 NAS MED 3550 5A7380, 1 8 2 . 5 UCi ( 1 1 / 1 / 9 7 )
. .
Recommended