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NIC FORM 313
U.S. NUCLEAR KEGULATORY COMMI5410N
APPEOVED 8Y OM8
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19 tib8
10 CFR 30,32,33,34,
31500 uo
APPLICATION FOR MATERIAL LICENSE
8 5 ** **
E.P e 3is,
INSTAUCTIONSI SEE THE APPROPRIATE LICENSE APPLICATION Gul0E FOR DETAILEO INSTRUCTIONS FOR COMPLETING APPLICATION. SEND TWO COPIES
OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED DELOW.
IF YOU ARE LOCATED IN:
7 EIEIAL AGENCit$ FILE APPLICATIONS WITH:
ILLINOl$. INDI ANA, IOWA, MICHIGAN, MINN ESOTA, MISSOURI, OHlo OR
Wl5 CON 5tN,$ENO APPLICATIONS TO:
U.5, NUCLE AR REGULATORY COMM.$$10N
DIYl%3ON OF FUEL CYCLE AND MATERIAL $APETY,NMS$
WASHINGTON OC 20$$5
U.S. NUCLE AR REGULATOSiY COMMIS$10N, REGION lli
M ATE RI ALS LICENSINO SECTION
799 RWSEVELT ROAD
ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS,IF YOU ARE
LOCATEDIN:
CONNECTICUT. DELAWARE , OtSTRICT OF COLUMBIA. MAINE. MARYLAND,,
M ASSACHU$ETTS. NEW HAMPSHIRE, NEW JER$EY, NEW YORK, PENNEYLV ANIA.
RHOOE ISLAND, OR VERMONT, SEND APPUCATIONS TO:
U S NUCLE AR REGULATORY COMMIS$10N, REGION I
NUCLE AR MATERIAL SECTION 8
E'31 PARK AVENUE
KING OF PRU$$1A,PA 19406
ALABAM A. FLORIDA, GtORGIA, KENTUCKY, MIS $1%$1PPI, NORTH CAROLIN A,
FUE RTO RICO, SOUTH CAROLIN A, T ENNES$t E, VIRGINI A, VIRGIN ISLANDS, OR
WE$7 YlRGINIA, $END APPLICATIONS Toi
U S. NUCLE AR REGULATORY COMMI553ON, R EGION il
MATERIAL RADIATION PROTECTION SECTION
101 M ARIETTA $TREET,$UITE 2900
ATLANTA,GA 30323
GLEN ELLYN.lL 60137
A R K ANSAS, COLO R ADO,10 AHO, K ANS AS, LOUls,=
'W NA,NE8RA$KA,
NEW ME xlCO, NORTH DAKOT A, CKLAHOMA, SOUTH b ..,C . A, TEXA$, UT AH,
OR WYOMING, SEND APPLICATIONS TO:
U $. NUCLE AR REGULATORY CCMMi$$10N. REGION IV
MATERIAL RADIATION PROF tCTION SECT'ON
611 RYAN PLAZ A ORivE,5UITE 1000
ARLINGTON.TX 76011
ALASKA ARIZONA, CALIFORNI A, M AW All, NEVAD A, OR EGON, WASHINGTON,
AND U.S.TERRITORita AND POS$ESSIONSIN THE PACIPM, SEND APPLICATIONS
TO:
U S NUCLE AR REGULATORY COMMISSION, REGION V
MATERI AL RADIATION PROTECTION SECTION
14SO MARIA LANE,5clTE 210
"MLNUT CREEK.CA 94596
.I
PEISONS LOCATED IN AGREEMENT ST ATES $END APPLICATIONS TO THE U S. NUCLEAR REC'JLATORY COMMIS$10N ONLY lF"THEY WIS4TO POS$ESS AND USE LICENSED MAf TRIAL
e
IN STAT ES SUBJECT TO U.S. NUCLE AR RIOULATORY COMMISSION JURISOlCTION.
2. NAME AND MAILlNG ADDRES$ OF APPLICANT (lacIvvele CoveJ
1. THis 68 AN APPLICAYlON FOR ICAset aPsroar,ese lese)
-it
O. AMENDMENT TO LICENSE NUMBEM
R and D Lab
2331 Su111vant Avenue
C. RENEWAt os uCENSE NUM8ER
Columbus, OH 43204
A. NEW LICENSE
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3. ADDRE$$1E$1 WHERE LICEN3ED MATERIAL WILL $$ USED OR POS$ES$tD.
,
same as provided in number 2
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4. NAME OF PE
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Kr, J.ine $NThC ED
c A3OUT THIS APPUCATION
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TELEPHONE NUMBER
|614-274-6467
SU8Mit ITEMS S THROUGH 11 ON 84 s tl'' PAPER, THE TYPE ANO SCOPE OF INFORuATION TO SE PRoylDEO is DESCRIBED IN THE LICENSE APPUCATION GUIDE,
.. Addendum B
Addendum A
L RADICACTIVE MATERIAL
a
8. PURPOSEIS) FOR WHICN LICENSED MATERIAL WILL st U$tD.
av
.snber,
b, CAeaucal and/ce peiYndal loem, and e. enssimum smov t
.a.EWent
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7. INDIVIDUAll$1 RESPONS18(E FCR RAOdbbMROG AM AND THEIR
TMAINING AND EXPERIENCE,
Addendum D
9. FACILITIES AND toulPMENT,
Addendum E
,,, RAo, AT,0N ,A,ETy ,ROOR,u,
' 3 uc'N55' "'5 4" " c" * a' 3**a "*
"
,E E CATEGORY new
|b"CTO$ED
Addendum F
n. waste uAN AGEMENT.
bN R FREOUENTING RESTRICTED ARE A$.
8. TRAINING FOR INDIVID
s 230.00
13 CERTIFICAflON. IMust be completed by sophcaer/ THE APPUCANT UNDER$7ANO3 THAT ALL $T ATEMENTS AND REPRESENTATIONS hADE IN THl3 APPLICATION ARE
SINDING UPON THE APPLICANT.
THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFIC ATION ON SEN ALF OF THE APPLICANT, NAMED IN ITEM 2. CERTIFY THAT THl4 APPLICATION 18
FREPARE D IN CONFORulTY WITH TITLE lo, CODE OF FEDERAL REGULATIONS PART8 30,32.33,34,35, AND 40 AND TH AT ALL INFORMATION CONTAINED HEREIN,
13 TRut AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND 8ELitF.
WARNING. l8 U $ C. SECTION 1001 ACT OF JUNE 2$, IS48. 62 87AT. 749 MAKES 17 A CRIMIN AL OF'ENSE TO MAKE A WILLFULLY F AL55 $TATEMENT OR REPRESENTATION
TO ANY OEPARTMENT OR ACENCY OF THE UNITt0 5 FATES AS TO ANY MATTER WITHIN ITS JUR.101CTION.
OATE
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TYPED / PRINTED NAME
$IGN ATURE-CERTIF YING OF FICER
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PuvACY ACT 8'
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FOR NRC USE ONLY
FE CA GORY
COMMENTS
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8807120555 871109
REG 3 LIC30
34-25E247=@R
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ON THE ECONOMIC IMPACT 07 "URR ENT NRC REGULATICNS OR ANY FUTURE
PROPOSED NRC REGULATIONS THAT MAY AFFECT YOUP (48Crerviersons arwif
of to 9tetett tenhdent el comniema! er financ>el=0recraets'y-interma toon hornrshed te
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Addendum A
Radioective Material
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00NTR0l. NO 8 4 2 8 5
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Element and Moss Number: Phosphorus - 32
Chemical and/or Physical Form: Aqueous nucleotides
Maximum possession: 1 millicurie
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CONTRCL NO.u
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285
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Addendum B
Purposes for Which Licensed Material Will be Used
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i ichnsed material used is incorporated in the GENE-TRAK
Systems pre-packaged, pre-labelled, and pre-tagged kit for
detection of microorganisms in test specimens. The test
f s an in-vitro diagnostic assay similar to clinical radio-
'
immunoassays. The usual amount of isotope handled at one
time will be 75.1terocuries or less.
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