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PAGE OF P..GES

$C ORM 37 U.S. NUCLEAR RE2ULATORY COMMilSiON ,

jAmendment No. 10p MATERIALS LICENSE

5eg Purzuant to the Atomic Energy Act of 1954, as amended, the Enerry Reorganisation Act of 1974 (Public Law 93-438), and Title 10, Code of i

Federal Regulations, Chapter 1, Parts 30,31,32. 33,34,35,36,3E 43, and 70, and in reliance on statements and represent,. ns heretofore made jgg by the licensee. a license is hereby iuued authorizing the licensee to receive, acquire, possess, and transfer byproduct. source, and special nuclear jg 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 2

persons authorized to receive it in accordance with the regulations of the applicable Part(s). This license shall be deemed to contain the conditir ns 3-

$ 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 R

$ Nuclear Regulatory Commission now or hereafter in effect and to any conditions specified below. E

B ORCIAl. RECORD 00PY E

B e' ,

9 Licensee In accordance with the application dated E.

9 February 21, 1997, E

$ 1. University Imaging Center 3. License Number 29-21382-01 is amended in f

B its entirety to read as follows: E

R iEN 2. 109 East Laurel Road

3 Stratford, New Jersey 08084 4. Expiration Date June 30, 2004 E5

955. Docket or > 030-205923 Reference No.4 > j,,

g

g 6. Bypro@ct, Source, and/or 7. Chemical and/or Physical 8. Maximum Amount that Licensee g

a Special Nuclear Material Form May Possess at Any One Time g. Under This Licensej

h e

B A. Any byproduct material LA.Anyradiopharmaceuticdl A.'As needed n,3 identified in 10 CFR identified >inc10 CFR ( l

3 35.100 35.100- g I9 B. Any byproduct material B.:Any radiopharmaceutical B. As needed g

9 identified in 10 CFR ' identified in:10 CFR g

3 35.200 35.200 except gas g

9 C. Iodine 131 C. As identified in 10 CFR C. As needed g

g 35.300- g

5 i'

is 9. Authorized use g

n9 .

in 10 CFR 35.100. i<

g A. Any uptake, dilution and excretion procedure approvedz ,

3 B. Any imaging and localization procedure approved in 10 CFR 35.200. ; ;

y C. Diagnosis and treatment of hyperthyroidism, and treatment of cardiac dysfunction. j '

|'

CONDITIONSb

,

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

j 109 East Laurel Road, Stratford, New Jersey, |11. The Radiation Safety Officer for this license is P. Todd Makler, M.D. ||

-

R Lice:ised material listed in Item 6 above is only authorized for use by, or under the !12.g supervision of, the following individuals for the materials and uses indicated: {g*-$ Authorized Users Material and Use 3 ;,,

b#

| Steven R. Allen, 0.0. 35.100; 35.200

[ih4 35.200 for cardiovascular clinical procedures |] Louis A. Papa, 0.0. -

_

Kalpana Sudhir Deshmukh, M.D. 35.100; 35.200 ML 10 |Alan K. Geisler, D.0. 35.200 for cardiovascular clinical procedures {_

,

9706130231 970406 i.gADOCK03020g2 ggggg(PDRC .,,q ;

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'M 374A U.S. . _ EAR RE2ULATORY COMMISSION PAGE p OF p PAGES; .

License Number g'

| g 4

1 29-21382-01 $| MATERIALS LICENSE Docket or Reference Number |_ i

i SUPPLEMENTARY SHEET 030-20592 WI N

I Amendment No. 10 N

I || Authorized Users Material and Use | ,

I t |

| Harvey A. Koolpe, M.D. 35.100; 35.200 g'

II .-

35.100; 35.200 g-i

.Sheldon R. Karasick, M.D.| ||

Milton Metzman, D.O. 35.100; 35.200; Iodine 131 for the treatment of ghyperthyroidism and cardiac dysfunction g

i

| P. Todd Makler Jr., M.D. 35.100; 35.200; Iodine 131 for the treatment of !"h er y,oidism and cardiac dysfunction ,

i

II.Inadditiontothepossessionilmts n Item 8 theI

the possession of license 6'p)iat6 rial to quantities b[. licensee shall further restrict13. I II low;the minimum limit specified

in 10 CFR 30.35(d), 40g(b , and 70.25(d) for establi'shjhg financial assurance for (j~

decommissioning. A O i,

Ithe possession ofQ'icensAd material at a single location'to[qu6ntities below the

1 In addition to thq po session limits in Item 8, the licensee shall further restrict14. II

limits specified in 10 CFR:30}72swhich require cosidsration o'f the need for an 1lI~

II emergency plan for- respondingMo a release of 1'icsnsed material)f E

authorized to 'tfan) spor,t lidenselq Mm'aterial in a'c3rdance with theE

'iy> e/g1

The licensee is' yI 15.1 provisions of 10 CFR Part=71) " Packaging ahdrTraYsportation of-Radioactive Material." EE

h Ecn "'w il, . p'W '1 '.

Exceptasspecifi6allyJpro41ded'othersiSO..'nthislicense',the-licenseeshallconduct t:ii) 16.its program in accordance%ith theistat'einerit's,' representation 57~and procedures I:#

1 contained in the'documentshincludingpinHenclosures, listed 4elow, except for minor I:I changes in the medical use+ radiation safetf procedures as provided in 10 CFR 35.31. t;1 The U.S. Nuclear Regul_atory Commissionfs] regulations shallegovern unless the ti |

'

'| !| statements, representations, and proce'dureslin'the' licensee''s application and t1 correspondence are morerrestrictive thsn'the regulations'.) bi

/ Q~ p IApplicationdatedDe)cember1

N L'16,.199331 A.

'

1 B. ~ Letter dated May 11, 19947 3 ,m L4$ t4

1 C. Letter dated May 25, 1994 m 72, r i, j

l L: 1ii i

4 I*

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,: i [;

I [ ,

iFor the U.S. Nuclear Regulatory Commission L ;

I APR - 6 1997 OriginalSloned 88 c l'

Date- By- h*

iNuclear Materials Safety Branch [

[Region I g

| King of Prussia, Pennsylvania 19406 [!

l

. m E E E N E E E E EM E M M M M E E lm E E M M M M E M E E E E M E R E ER R E ERRRE: 1

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7''

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APR - 6 1997'

,

I-'

, - .

. . . !- Kenneth Smith, AdministratorDepartment of Radiology..University 1maging Center - UMDNJ .

' 109 East Laurel Road '.

Stratford, NJ . 08084 '

Dear Mr. Smith:

iThis refers to your license amendment request. Enclosed with this letter is the amendedlicense. Please note that as part of this amendment, in accordance with 10 CFR 30.36, :effective February. 15,1996, the expiration date of your license has been extended by a

.

. period of five years. The new expiration date is stated in item 4 of the license.'

Please review the enclosed document carefully and be sure that you understand and fullyimplement all the conditions incorporated into the amended license. If there are any i

errors or questions, please notify the U.S. Nuclear Regulatory Commission, Region I .)Office, Licensing Assistance Team, (610) 337-5093 or 5239, so that we can provideappropriate corrections and answers. ,

Thank you for your cooperation.

Sincerely,

- OriginalSigned By:Pamele J. Henderson

John D. Kinnaman, Chief. . .;

Nuclear Materials Safety Branch 2 !Division of Nuclear Materials Safety I

,

!

License No. 29-21382-01,

Docket No. 030 205924

Control No. 124385

' Enclosurei-" Amendment No - 10.

: DOCUMENT NAME:- R:\WPS\MLTR\L2921382.01i

c n, i . py .e vs. e ua.n. ine in m. wan c - copy wie att.ch/.nci e - caov i .it. chi.nci . n - no copy||

OFFICE - DNMS/RI y [N DNMS/RI @)//|p | | j

NAME- SLodhi (<ff kJKinnemanU1

.

h DATE 03/19/97 /| 03/9/97 03/ /97 03/ . /97.v ..

l

OFFICIAL RECORD COPY ML10.

Q - ;i

. _ . _ . . .- . _ . . . _ _ ._. , _ . . _ . - . - . , ,-

. _._ -_.. __ _ _ _ . . __ _ . _ . _ _. _.--

I

; O O, .

I

DNMS TELEPHONE CONVERSATION RECORD;

Person Called: Kenneth Smith Phone No.: (609) 627 06001

. I'

Person Calling: Sattar Lodhi Date: 3/19/97

Facility Name: University Imaging Center-UMDNJ Time: 9:00 a.m.Stratford, NJ

||'License No. 29-21382-01 Docket No. 030-20592

1I- Subject: Additional Information

Summary: I called Mr.. Smith to ask (1) if Dr. Koolpe's name is also to be deleted fromtne license, and (2) if Dr. Jeffrey Leitman is still the President of the facility.

Ms. Trish Maldoon answered the call and stated that (1) Dr. Koolpe is still with thepractice, and Dr. Leitman has not been with the facility since they became part of UMDNJand now Kenneth Smith (Manager of Radiology) is the management representative to i

'

handle all correspondence of the department.

Action Reauired/Taken: Document |

m/J

Signaturei [ Mail Control No. 124385-

4

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|

.

!

ORIC)M.RECORDCOPYML 10 !

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fi f W jfK4iY s to f1p $L-OlUniversity of Medicine and Dentistry of New Jersey y

Schooi of Osteopathic Medicine b

University Imaging Center 109 East Laurel Road - Suite #2Department of Radiology Stratford, New Jersey 030841504

Phonef (609) 6274 LOOf a x: . (609) 627M886

February 21, 1997

Nuclear Ragulatory CommissionDivision of Material Licensing475.Allendale Road

' King of Pruscia, PA 19406

i REijCHANGEINRADIATIONSAFETYOFFICER'

,

TO WHOM'IT MAY CONCERN:

Effective immediately please change our Radiation Safety Officer from

Harvey Koolpe, M.D. to P. T000 MAKLER, M.D.

Since Dr. Makler is already on our current license, all necessary quali-

fientions should be on file.

Please find' enclosed the required check in the amount of $440.00 fori,

' payment in full for the license amendment. |

Thank you in advance for your attention to this titatter. Please feel

free to contact me with any questions.,

Shnce ly,7

h& bKe n6th Smith, A6ministratorDeMrtment of RadiologyUniversity Imaging Center-UMDNJ-

,

:KS/ksw

i

' s ;

1

1 2 4 3 8.5~ OFFICIALRECORDCOPY 'Mt 10 II

&

' W.; .;. Ad - The Unh4rsity is an effirmative action / equal opportunity employer ' i#,

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i- : -(FOR LFMS USE)'' : INFORMATION FROM LTS" -

,

BETWEEN:a .

:LICENSE FEE MAN AGEMENT SRANCH,' ARM : PROGRAM-CODE: .02200

AND' : ST ATUS CODE: 0 '

REGIONAL- LIC ENSING SECTIONS : FEE CATEGORY: 7C .

: EXP. DATE: 20040630, '

: FEE COMMENTS:'' _____________________'

.: DECOM~ FIN ASSUR REQD: N:: : :: :: ::: ::: : :: :::: : ::: : :::: ::::::: ::

!LICENSE FEE TRANSMITTAL

A. R E GIO N y.

1. APPLICATION ATTACHED;' APPLIC ANT / LICE NS EE:- U NIV E R S IT Y IMAGING CENTERRECEIVED DATE: '970317DOCKET /NO: 3020592 4a-

, CONTROL"NO.:. 124385- - LICENSE: NO.~: 29-21392-01

ACTION TYPE: AMENDMENT

2. FEE. ATTACHED-AMOUNT: . fffo *CHECK NO.: MElf

_

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<3. . COMMENT S ,

b.4SIGNE0',

DATE _______.E d &.7___________.' \

-

;

4 S = LICENSE FEE: MANAGEMENT BRANCH (CHECK WHEN MILESTONE 03 IS ENT ER ED / _,L/ )f

i 1, , FEE C ATEGOR Y ; AND AHOUNT: ._b___________________________ ____

.

- ,2s- CORRECT-FEE PAID. A PPLp4 TION M AY ~ B E PROCES SED FOR:_

. AMEN 0 MENT ______________ .

; renew 4L :-._______._____

$ tuCENSe ______________

5 10THER. _.. __ .. ..______________________

u __________________________________

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',DATE ____________.;3 _____- -- y; ,_,

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