APPLICATION FOR NRC EXPORT/IMPORT LICENSE, AMENDMENT, OR RENEWAL (See Instructions on Page 5)

Transcription

1 Page I of 3 10CFRR 110 APPLICATION FOR NRC EXPORT/IMPORT LICENSE, AMENDMENT, OR RENEWAL (See Instructions on Page 5) APPROVED BY OMB: NO EXPIRES: 06/ Estimated burden per response to comply with this mandatory collection request 2.4 hours. This submittal is reviewed to ensure that the applicable statutory, regulatory, and policy considerations are satisfied. Send comments regarding burden estimate to the Records and FOtA/Privacy Services Branch (T-5 F52). U.S. Nuclear Regulatory Commission, Washington, DC , or by internet e-mal to [email protected], and to the Desk Officer, Offico of Information and Regulatory Affairs, NEOB-102D2, ( ), Office of Management and Budget, Washington, DC ff a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the intormadon collection. PART B. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, RENEWALS OR NOTIFICATIONS 1. NAME AND ADDRESS OF APPLICANT/LICENSEE la. NAME OF APPLICANTS CONTACT lb. APPLICANTS REFERENCE NUMBER MCG Health, Inc James S. Davis Ph.D., CHIP License # GA BA-3306 ic. PHONE NUMBER 1 d. FAX NUMBER Augusta, GA (706) (706) le. ADDRESS [email protected] 2. TYPE OF ACTION REQUESTED (Check One) [ EXPORT D NOTIFICATION OF [ IMPORT COMBINED EXPORT/IMPORT [] AMENDMENT/RENEWAL (Parts B, C, E) EXPORT OF (Parts B, D, E) (Parts B, C, D, E). Existing License Number: INCIDENTAL RADIOACTIVE MATERIAL (PART C, E) 3.- CONTRACT NUMBER(S) 4. FIRST SHIPMENT DATE 5. LAST SHIPMENT DATE 6. PROPOSED EXPIRATION DATE 08/15/ /30/ PART C. TO BE COMPLETED FOR EXPORT ONLY OR COMBINED UCENSES, AMENDMENTS, OR RENEWALS 7. NAME(S) I ADDRESS(ES) OF SUPPLIERS 8. NAME(S) / ADDRESS(ES) OF INTERMEDIATE 9. NAME(S) / ADDRESS(ES) OF ULTIMATE AND/OR OTHER PARTIES TO THE EXPORT FOREIGN CONSIGNEE(S) FOREIGN CONSIGNEE(S) Best Theratronics 413March Road Ottawa, Ontario K2KOE4 Canada la. FUNCTION(S) PERFORMEDISERVICE(S) PROVIDED 8a. INTERMEDIATE USE(S),- 98 ULTIMATE END USE(S) -.. Unlimited End Use 10. DESCRIPTION OF RADIOACTIVE MATERIALS, SEALED SOURCES, loa. MAX TOTAL VOLUME I 10b. MAX ENRICHMENT 10c. MAX ISOTOPE NUCLEAR FACILITIES, EQUIPMENT, OR COMPONENTS; FOR ELEMENT WGT (KG), OR OR WGT % WGT (KG) NUCLEAR EQUIPMENT INCLUDE TOTAL DOLLAR VALUE OF TOTAL ACTIVITY (TBq) EQUIPMENT FOR EXPORT Cesium 137 Curent Activity: Sealed sources 29.5 TBq Chemical form: Element (796.9 Ci) Physical form: Solid Device: Gammacell FOREIGN OBLIGATIONS (BY COUNTRY AND BY PERCENTAGE OF MAXIMUM TOTAL VOLUME) NJr. ni nirlm la.. (lf7i ek c f~l[u'ltl or ) 'vj rv,-i rd^ C %

2 I Page 2 of 3 10 CFR 110 APPLICATION FOR NRC EXPORT/IMPORT LICENSE, AMENDMENT, OR RENEWAL (Continued) TI(CENSE NUM9BE OOCKTTNUMBE ADAMS ACCESSION NUMBER Uý L O PUBLIC PART D. TO BE COMPLETED FOR IMPORT ONLY, OR COMBINED LICENSES, AMENDMENTS, OR RENEWALS 12. NAME(S) / ADDRESS(ES) OF FOREIGN 13. NAME(S) / ADDRESS(ES) OF INTERMEDIATE 14. NAME(S) I ADDRESS(ES) OF ULTIMATE SUPPLIERS AND/OR OTHER PARTIES CONSIGNEE(S) CONSIGNEE(S) TO IMPORT Best Theratronics MCG Health, Inc 413 March Road BA-3306 Ottawa, Ontari Augusta, GA K2KOE4 Canada 12a. NRC EXPORT LICENSE NUMBER(S) 13a. LICENSE NUMBER(S) I EXPIRATION DATE(S) 14a. LICENSE NUMBER(S) I EXPIRATION DATE(S) (ff appicable) GA /Expiration date: November 30, b. INTERMEDIATE USE(S) 14b. ULTIMATE END USE(S) Irradiation of biological material 15. DESCRIPTION OF RADIOACTIVE MATERIALS, SEALED SOURCES, 15a. MAX TOTAL VOLUME / 15b. MAX ENRICHMENT 15c. MAX ISOTOPE NUCLEAR FACILITIES ELEMENT WGT (KG), OR TOTAL ACTIVITY (TBq) OR WGT % WGT (KG) Cesium TBq Sealed sources 110 TN/ Chemical form: Element Physical form: Solid Gammacell 3000 Elan- Type II 16. FOREIGN OBLIGATIONS (BY COUNTRY AND BY PERCENTAGE OF MAXIMUM TOTAL VOLUME) PART E. TO BE COMPLETED FOR ALL LICENSES, AMENDMENTS, OR RENEWALS 17. ADDITIONAL INFORMATION PROVIDED ON PAGES 3, 4, YES ~l F _ O 1 a C PE O R CPE T 'F, AND/OR ON SEPARTE SHEETS? OAUTHORIZATIONS PROVIDED? YES,,N 18. CERTIFICATION: 1, the applicants authorized official, hereby certify that this application is prepared in conformity with Title10, Code of Federal Regulations, and that all information provided is correct to th e best of my. knowledge. 18a. PRINT NAME AND TITLE OF AUTHORIZED OFFICIAL V 18b. SIGNATURE - Don Snell President & Chief Executive Officer U

3 Page 3 of 3 10 CFR 110 LICENSE NUMBER- APPLICATION FOR NRC EXPORTIIMPORT LICENSE, AMENDMENT, OR RENEWAL (Continued) E D NUMBER ' ADAMS!ACCESSION NUMBERI 4 i O NO.:N6N-PUBLIC ADDITIONAL INFORMATION (Reference applicable block numbers from page 1 and/or page 2 for each entry) Block 10. Disposal of Gammacell 1000 S/N 0089 in conjunction with new Gammacell Elan-Type H Self-Contained Blood Irradiator. ~&uclina isttuio. ccrdngy, thsapcation, 'unr ft-~p h(4) of 10 CCFR4&70.t1ý,j ATTACHMENTS: Following attachments are included with this application: 1. Copy of U.S. Nuclear Regulatory Commission License issued to Best Theratronics Ltd.; License number ; expiration date May 30, , Copy of Georgia Radioactive Materials License Number GA Amendment Number 4 issued to Medical College of Georgia Health, Inc; Expiration Date November 30, Copy of letter dated June 27, 2008 requesting amendment to Georgia Radioactive Materials License Number GA to include the Gammacell 3000 Elan Type H Blood Irradiator (2990 Curie sources activity).

4 Environmental Health and Safety Division S TM June 27, 2008 Mr. Scott Moore, Deputy Director Office of International Programs Mail Stop: 4E21 U.S. Nuclear Regulatory Commission One White Flint North Rockville Pike Rockville, Maryland Dear Mr. Moore,.Enclosed is a completed U.S. Nuclear Regulatory Commission NRC Form 7, Application for NRC Export/Import License, Amendment, or Renewal. The Medical Colleg of Georgia Health, Inc. has issued a purchase order to Best Theratronics (formerly MDS Nordion) to replace the Gamnmacell 1000 SN0089 Blood Irradiator, currently listed on Georgia Radioactive Materials License, Number GA with a Gammacell 3000 Elan Type II Self-Contained Blood Irradiator (two cesium 137 sources totaling a maximum of 2990 curies). Best Theratronics, Canada, will deliver and install the new Blood Irradiator as well as take possession and dispose of the existing Gammacell 1000 unit with sources. During the installation and disposal operations, radiation safety and public safety/security will be provided by MCG/MCGHI to ensure safe and secure operations. Enclosed are the following documents in support of this application: 1. Copy of U.S. Nuclear Regulatory Commission License issued to Best Theratronics Ltd.; License number ; expiration date May 30, , Copy of Georgia Radioactive Materials License Number GA AmendmentNumber-4 issued to Medical College -of Georgia Health;--Inc; Expiration Date November 30, Copy of letter dated June 27, 2008 requesting amendment to Georgia Radioactive Materials License Number GA to include the Ganimacell 3000 Elan Blood Irradiator (2990 Curie sources activity). The Medical College of Georgia Heat Inc. is a not for. profit, tax exempt educational institution. Accordin''ly'tjiis application under parag (4 of1 EI , is conjdrn f4eeo e10mpt Goss Lane Augusta, Georgia (706) FAX (706) An Affirmative Action/Equal Opportunity Educational Institution

5 If you have any questions or need additional information, please do not hesitate to contact me or Dennis A. Stevenson Ph.D. CHP, Deputy Radiation Safety Officer at Thank you very much for your consideration of this application. Sincerely, James S. Davis, Ph. D., CLP Radiation Safety Officer cc. Carlotta Coates