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Application for Renewal of License 29-05185-25,Authorizing Use Of - - , U,$. NUCLE AR REGULATORY COMMISSION NRC FDRM 313. APPROVED BY OMB a * 19 8M 3150 0120 10 E Pc + 3sB7 35.CFRnd ao 30,32. 33,34 AP ICATION FOR MATERIAL LICENSE INSTRUCTIONS: SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMFLETING APPLICATION. SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW. FEDERAL AGENCIES FILE APPLICATIONS WITH: IF YOU ARE LOCATED IN ILLINOIS INDI ANA, IOW A. MICHIGAN, MINNESOT A MISSOUR1, OHIO, OR U.S NUCLE AR REGULATORY COMMISSION DIVISION OF FUEL CYCLE AND MATERIAL SAFETY,NMSS WISCONSIN, SEND APPLICATIONS TO: WASHING 4 DN, DC 20555 U.S, NUCLE AR REGULATORY COMMIS$10N, REGION ill ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS,lF YOU ARE MATERI4.S LICENSING SECTlDN 799 ROOSEVELT ROAD LOCATEDIN: GLEN ELLYN,IL 60137 CONNECTICUT, DELAWARE , DISTRICT OF COLUMBIA MAINE. MARYLAND. MASSACHUSETTS. NEW HAMPSHIRE. NEW JERSEY, NEW YORK, PENNEYLVANIA, ARK ANSAS. COLOR ADO,lDAHO, KANSAS LOUISl AN A. MONTANA, NEBRASK A, RHOOE ISLAND, OR VERMONT, SEND APPLICATIONS 70. NEW MEXICO, NORTH DAKOTA. OK LAHOMA, SOUTH DAKOT4, TE XAS, UTAH, OR WYOMING, SEND APPLICATIONS TO: U.S. NUCLEAR REGULATORY COMMISSION, REGION I U.S NUCLEAR REGULATORY COMMFSSION, REGION IV NUCLEAR MATERI AL SECTION 8 631 PARK AVENUE MATERIAL RADI ATION PROTECTION SECTION KING OF PRUSSIA,PA 19406 611 RYAN PLAZA DRIVE, SUITE 1000 ARLINGTON,TX 76011 ALABAMA, FLORIDA, GEORGIA, KENTUCKY, MISSISSIPPI, NORTH CAROLINA, PUERTO RICO, SOUTH CAROLINA, TENNESSE E, VIRGINI A, VIRGIN ISLANDS, OR AL ASK A, ARIZONA, rALIFORNI A, MAW All, NEVADA, OREGON, WASHINGTON, WEST VIRGINlA, SEND APPLICATIONS TO AND U.S. TERRITORIES AND POSSESSIONS IN THE PACIFIC, SEND APPLICATIONS TO: U.S. NUCLEAR REGULATOR Y COMMISSION, REGION 11 MAT ERI AL RADI ATION PROTECTION SECTION U.S NUCLE AR REGULATORY COMWS$10N, REGION v 101 MARIETTA STREET suite 2900 MATERIAL RADIATION PROTECTION SECTION ATLANTA, GA 30323 1450 MARIA LANE. SUITE 210 WALNUT CREEK, CA 94596 *ERRONS LOCATED IN AGflIEMENT STATES SENO APPLICATIONS TO THE U.S. NUCLEAR REGULATORY COMMIS$10N ONLY IF THEY WlSH TO POSSESS AND USE LICENSED MATERIAL IN STATES SUBJECT TO U.S. NUCLEAR REGULATORY COMMISSION JURISDICTION, 1, THis is AN APPLICATION FOR (Check eparopnete erem) 2 NAME AND MAILING ADDRESS OF APPLICANT (/nctuaele Coas) - mRm A NEW LICENSE Een MunW -- Princeton University B AMENDMENTTO LICENSE NUMBER _ Office of Occupational Health & Safety X C, RENEWAL OF LICENSE NUMBER % OE194 9m James Forrestal Campus ~~ Princeton, NJ 08544 3. ADDRESS (ES1 WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED. Princeton University Princeton University Molecular Biology Dept. Biology Dept. Lewis Thomas Laboratory and Moffett Laboratory Washington Road Washington Road Princeton, NJ 08544 Princeton, NJ 08544 4. NAME OF PERSON TO BE CONT ACTED ABOUT THIS APPLICATION TELEPHONE NUMBER Mr. Jack C. Faust 609-452-5294 SUBMIT ITEMS 5 THROUGH 11 ON 8% a 11" PAPER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED 15 DESCNBED IN THE LICENSE APPLICATION GUIDE. 5 R ADIOACTIVE MATERI AL a Element and mais number, b, chemical and/or physicsi tom, and c. msomum smou t n 6. PURPOSE (S) FOR WHICH LICENSED MATERIAL WILL BE USED. wtuch will be possessed at say one time. '" 7" L A" I A 8. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED ARE AS, TR AIN NG A P E CE 9. F ACILITIES ANC B707080208 870206 10. R ADiATiON $AFETv eROGRAu. REG 1 LIC30 29-05185-25 PDR 11. WASTE MAN AGt... ,2.NA LyeNSE E FEES <see so CFe sio onatAMOUNT sect,on uro a>> FEE wATEGW170.11(a)(4) 10CFR IENCLOSED $ 13 CE RTIFICATION (Must De coms,efea ov opphenar/ THE APPLICANT UNDERST ANDS THAT ALL STATEMENTS AND REPRESENT ATIONS MADE IN THl3 APPLICATION ARE BINDING UPON THE APPLICANT THE APPLICANT AND ANY OF FICIAL E XECUTING THl3 CERTIFICATION ON BEH ALF OF THE APPLICANT, NAMED IN ITEM 2, CERTIFY THAT THis APPLICATION IS PREPARED IN CONFORMITY WITH TITLE 10. CODE OF FEDER AL REGULATIONS. PARTS 30,32,33,34,35, AND 40 AND THAT ALL INFORMATION CONTAINED HEREIN, 13 TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF. W ARNtNG 1B U $ C. SECTION 1001 ACT OF JUNE 26,1948,62 STAT. 749 MAKES IT A CRIMIN AL OFFENSE TO MAKE A WILLFULLY F ALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHiN ITS JURISDICTION. SIGNATURE-CERTIF YING OF FICER TYPED / PRINTED NAME TITLE gg gggg g DATE - Mr. Jack C. Faust e f i s v 0L LtN Y A 84 Y (CONOWC O A T A ~ a. AN N L A L p . CE #1 p. NUMBER OF EMPLOv E Eb tTow for o WOULD YOU BE WILLING TO FURNISH COST INFORMATION (Joner sna/er start nours) <$250K $1M-3SM entire reem enctuains wesiae contractors / ON THE ECONOMIC IMPACT OF CURRENT NRC REGULATIONS OR ANY FUTURE PROPOSED NRC REGULATIONS THAT MAY AF FECT YOU) (hRC repusations permst '*'#*""'*''' "#'* "''## '*^*#'* $2$0K -6CDK $36M-7M #'*#'## W*'*' ''the '# spenO''c'*y'o'n##"contraencel #* 5500K-750K $7M -10M c NWBER M BEM $750K-1M >$10M YIS NO j FOR NRC USE ONLY " TYPE OF FEE FEE L G / FEE TEGORY COMMENTS $$ 1 * APPR VED BY - - . -_ . a} Y - mJ . _ ,RECE' * gg'h "'' tt ' 10647 w t"tTMde # % i > f PRIV ACY ACT STATE. MENT ON THE REVERSE / l (/ l ' - O O - , PRIVACY ACT STATEMENT - Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by section 3 of the Privacy Act of 1974 (Public Law 93-579), the follow. ing statement is furnished to individuals who supply information to the Nuclear Regulatory Commission on NRC Form 313. This information is maintained in a system of records designated as NRC-3 and described at 40 Federal Register 45334 (October 1,1975). 1. AUTHORITY: Sections 81 and 161(b) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2111 and 2201(b)). 2. PRINCIPAL PURPOSE (S): The information is evaluated by the NRC staff pursuant to the criteria set forth in 10 CFR Parts 30,32,33,34,35 and 40 to determine whether the application meets the requirements of the Atomic Energy Act of 1954, as amended, and the Commission's regulations, for the issuance of a radioactive material license or amendment thereof. 3. ROUTINE USES: Tha information may be (a) provided to State health departments for their information and use; and (b) provided to Federal, State, and local health officials and other persons in the event of incident or exposure, for their information, investigation, and protection of the public health and safety. The information may also be dis- closed to appropriate Federal, State, and local agencies in the event that the information indicates a violation or potential violation of law and in the course of an administrative or judicial proceeding. In addition, this information may be trans- 1 ferred to an appropriate Federal, State, or local agency to the extent relevant and necessary for an NRC decision or to an appropriate Federal agency to the extent relevant and necessary for that agency's decision about you. 4. WHETHER DISCLOEURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVID- ING INFORMATION: Disclosure of the requested information is voluntary, if the requested information is not furn. ished, however, the application for radioactive material license, or amendment thereof, will not be processed. A request that information be held from public inspection must be in accordance with the provisions of ?O CFR 2.790. Withhold- ing from public inspection shall not affect the right, if any, of persons properly and directly concerned need to inspect the document. 5. SYSTEM MANAGER (S) AND ADDRESS: U.S. Nuclear Regulatory Commission Director, Division of Fuel Cycle and Material Safety Office of Nuclear Material Safety and Safeguards Washington, D.C. 20555 I i mp ' td' - i s,4 ; NRC FORM 313 J " . O O . Supplement #1 NRC License Renewal Application i License #29-05185-25 ' 11/21/86 page1 Item 5 Radioactive Material Isotope Physical Form Quantity Cs-137 Sealed Source (Model RAMC0 400 Ci 50-ORNL) in Isomedix, Inc. Gammator B Irradiator Cs-137 Sealed Source (AECL Model'C-161) 4200 Ci in Atomic Energy of Canada Gamma- cell 40 Item 6 Purpose for which licensed material will be used The primary purposes of the irradiators are to produce immune deficient mice using the AECL Gammc- cell 40 and to irradiate drosophila using the Gammator B. Additionally, they may be used in other biological research, education, training and educa- tional-related research. There are no plans to irradiate food, explosives, flammables or corrosives. Item 7 Individuals responsible for the radiation safety program and their training and experience The individuals responsible for the radiation safety program at the University are members of the Office of Occupational Health and Safety and are named below with a description of their training and experience. The Office of Occupational Health and Safety is directed by Mr. Jack C. Faust, who holds a i Masters Degree in Health Physics (A.E.C. Fellow) from the University of Rochester (1959). Mr. Faust was employed by Brookhaven National Laboratory as a Health Physicist'from-August, ; 1959, until he was appointed University Health ' Physicist at Princeton University in July of i 1963. He was appointed Director of the Health ' Physics Group in July of 1967. Since September 30, 1971, he has been.the Director of the Office of Occupational Health and Safety, with broadened | safety responsibilities, including, in addition , " . O O Supplement #1 NRC License Renewal Application License #29-05185-25 11/21/86 page 2 , to radiation safety, industrial hygiene, sanitation, and general safety.
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