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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

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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

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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.

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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

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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

fl1 LE

TYPED / PRINTED NAME

$IGN ATURE-CERTIF YING OF FICER

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u votvwvaav Ecewevec O AT A

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$$coK.750K

$7M-iCM

$750st -lM

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entus tachty eacAue,ap outsde coalractoral

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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a WOULO YOU SE W. LUNG TO PURIJ 5H CO$T INFORMATION /bar #9d/or fraff acur5J

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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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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