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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
- 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 '
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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
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NRC FORM 313
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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
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Supplement #1 NRC License Renewal Application License #29-05185-25 11/21/86 page 2
, to radiation safety, industrial hygiene, sanitation, and general safety.
Primary responsibility for the radiation safety program lies with the University Health Physicist whose name and I qualifications follow:
Mr. Robert R. Milwicz, the University Health Physi- cist, holds a B.A. Degree in Physical Sciences from Montclair State College (1968). Mr. Milwicz was em- ployed on a part time basis, totaling about 18 months, during the period 1964 to 1968, as a Health Physics Technician. After obtaining his degree in 3 1968, he rejoined the Group as a full time profes- > sional staff member and has functioned in that capa- city since that date. While working full time.at j Princeton University he studied part time at Rutgers I University, earning his M.S. Degree in Radiological Science in 1976. Mr. Milwicz is normally assisted by an Assistant Health Physicist. This position is currently vacant. A recruitment effort is in process. I | Other Health Physics staff include two Health Physics Technical Specialists and a Health Physics Senior Technician: Mr. Kent Lambert, who holds a B.S. Degree from Texas A&M University (1978) in Radiation Protection Engineering and is pursuing his Masters Degree at Rutgers University; Mrs. Sue Dupre, who holds an M.S. Degree in Bionucleonics from Purdue University in 1977 and a B.S. Degree in Physics in 1974 from Northeastern University; Mr. ' Joseph Sundra, who has been with the University for I over 20 years, is a Certified Radiation Protection | Technologist. '
The two professore who are responsible for the irradia- tors have the following experience: J Prof. Thomas W. Cline, who has possession of and uses the Gammator B irradiator, attended an informal lecture on radioactivity measurements, standardiza- tion, monitoring, and instrumental techniques, at Harvard University and had on-the-job training regarding the same subject at the University of
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California, Irvine. He had three years of expe- rience using a 100 KV X-ray generator at the Univer- sity of California, Irvine studying irradiation of biological materials and in genetic and develop- mental studies. In addition, he had three months' experience in 1979 using an X-ray machine in Zurich. Switzerland, and has ten years' experience with the Model B Gammator for which this license renewal is being requested.
Prof. Tim Manser states that he has had both formal , and on-the-job training at the University of Cali- | fornia, University of Utah, and Massachusetts Insti- tute of Technology (MIT) and has used an AECL Gamma- cell 40 irradiator over a three year period at MIT for the purpose of irradiating mice. At the time of this renewal application the Gammacell 40 irradiator has not been shipped to Princeton by the manufac- turer.
Item 8 Training for individuals working in or frequenting Restricted Areas
The following procedure outlines the training require- I ments for irradiator operators and users: The authorized users (Professors Cline and_Manser) will designate persons whom they believe to have the personal and technical qualifications to become irradiator operators.
These persons will attend a training course of approxi- mate three hours duration presented by the Health Physics staff which deals with radiation safety and the safety features and the operation of the irradiator. Following the Health Physics training the designees will receive specific training, presented by the authorized user, or in the future experienced irradiator operators, relating to the use and operation of the irradiator, including hands-on training. An outline of the Health Physics training course for irradiator operators is. attached ~as Appendix A.
Following completion of the training, the authorized user will inform the Health Physics Office in writing of'the I ] ' - , . O O \
Supplement #1 NRC License Renewal Application License #29-05185-25 ,11/21/86 page 4 | i
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names of those individuals who have been approved as an "irradiator operator." The Office of Occupational Health and Safety will inform the Radiation Safety Committee of these appointments.
Only persons formally identified in writing as an "irradiator operator" will be permitted to operate or supervise the operation of the devices.
Item 9 Facilities and Equipment The Isomedix Gammator Model B is located on the second floor of Moffett Laboratory, Room A-2.
The present plans are to house the Gammacell 40 in the animal facilities (Room 026) on the ground floor of the Lewis Thomas Laboratory.
Professor Cline has a survey instrument for use with the Isomedix Gammator B irradiator.
For the Gammacell 40 irradiator, the Of fice of Occupa- ' tional Health and Safety has recommended and the Depart- ment Chairman has agreed to purchase a survey instrument so that routine surveys can be made around the irradia- , tor. The type of suitable instrument is presently under { study. The instrument will be calibrated by the Office of Occupational Health and Safety at nominal six month intervals.
The Office of Occupational Health and Safety has a number of portable ionization chamber survey meters with sensitivity ranges from 3 mR/hr to 500 R/hr full scale; portable survey meters with geiger instruments (thick and thin walled), and scintillation probes; three low level automatic counters for smear and leak test analyses, two multichannel analyzer spectrometers with sodium iodide crystals (solid and well types); a thermoluminescent dosimetry system; high and low volume air sampling equipment; and the necessary electronic test bench | equipment for maintenance and repair. '
All survey meters are calibrated or checked for opera-
tional response every six months by the Health Physics ; staff. Ionization chamber survey meters are calibrated j
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Supplement #1 NRC License Renewal Application License #29-05185-25 ,11/21/86 page 5
using either Co-60 sources with activity ranging from 16 to 57 mC1, or a 25 mci Ra-226 source. These sources have calibrations traceable to the N.B.S. The calibrator consists of a source placed in a collimator at the end of a track with moving platform. The University's Broad License has been recently amended to allow the purchase of a 1 C1 Cs-137 calibration source. The response of an instrument can be checked at any point over those ranges appropriate to our needs. Instruments are normally calibrated at points located approximately 1/3 and 2/3 of the full scale for each appropriate range.
Survey meters of the G-M and proportional type are checked for operational response only and are not normally calibrated to indicate dose rates. They are checked for operational response with a variety of sources and/or pulse generators, as appropriate.
Personnel monitoring devices are not necessary for working near the Isomedix Gammator B irradiator; the radiation levels are background. As a precautionary measure, the area around the irradiator is monitored by
film badges supplied by a commercial organization. { l Personnel who use the Gammacell 40 irradiator will be I issued personnel monitors if this is deemed necessary. The irradiator will be routinely monitored with film badges to establish a record of area radiation levels. The number and location of the monitors will be deter- mined during an initial survey of the irradiator. The irradiator will be installed and made operational by the vendor. The irradiator will be leak tested at six month intervals by the Office of Occupational Health and Safety as per instructions provided by the vendor.
Item 10 Radiation Safety Program 4 ) The use of all radioactive materials, including the gamma | irradiators, is controlled by the University Radiation I Safety Committee, a sub-committee of the University | Committee on Occupational Safety and Health appointed by the University president. Internal authorization (licensing) is limited to responsible persons possessing adequate technical competence and adequate prev',ous experience. All proposed usage of radioactive materials
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must be reviewed by and have the approval of both.the Office of Occupational Health and Safety and the Radia- tion Safety Committee.
The procedure for authorization to use radioactive materials is as follows - All persons desiring to use radioactive materials must apply for internal authoriza- tion through the Office of Occupational Health and Safety. Application is made by completing all the appropriate Occupational Health and Safety forms. Form #20 (copy attached) calls for basic information regarding the intended use of the isotope (s) and must be signed by the Departmental Health and Safety Coordinator or Departmental Chairman signifying departmental acknowl- edgment and/or approval for such usage. The application and supporting information is forwarded to the Office of Occupational Health and Safety for review. The applicant is interviewed by a professional Health Physicist during which the proposed usage is discussed and evaluated. The investigator is also acquainted with the University Radiation Safety Guide, applicable NRC regulations, the New Jersey Radiation Protection Code, if appropriate, and informed of internal procedures. The laboratory space is inspected for adequacy of facilities such as hoods, impermeable bench tops, washable floors, disposal facilities, availability of adequate equipment to survey working areas, etc. When the application is approved by the Health Physicist, copies of the application, supporting information and a recommendation regarding approval are mailed to all available members of the Radiation Safety Committee for their review and approval. If all available members of the Committee unanimously approve the application, an authorization number is issued to the applicant for the specific isotope (s) in the possession limit requested. In the event a Committee member objects to the applica- tion, effort is then made to remove the objectionable situation in order to obtain unanimous approval. If this fails, this request is denied. The applicant may then request an extraordinary meeting of the Radiation Safety Committee to discuss the application and usage. Authori- zations are issued on a conditional basis when appro- priate. ' I I ' - .. O O | | |
Supplement #1 NRC License Renewal Application . License #29-05185-25 | ,11/21/86 page 7
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All purchases and acquisitions of radioactive material must be approved by the Office of Occupational Health and Safety. .The Purchasing Department will not process any order without prior Occupational Health and Safety Office approval. The individual users are responsible for radioisotope inventories and are responsible for insuring that they stay within their. authorized possession limits.
The leak testing of sealed sources, smear testing of laboratory and work areas, personnel radiation history and exposure records program, isotope inventories, the administration of the authorization number procedure, radiation surveys and related Health Physics activities are line responsibilities of and are performed by the Office of Occupational Health and Safety under the direction of Mr. Jack Faust. Additional and more detailed information regarding the entire program may be found in the University Radiation Safety Guide, several copies of which are on file with the Nuclear Regulatory Commission. Item 11 Waste Management , I There is no waste associated with the usage of these ' irradiators. If it becomes necessary to dispose of one or both irradiators it will either: 1) be returned to the vendor; 2) be disposed of via a commercial waste disposal service (presently Teledyne Isotopes. Inc., Radiological Services Department, 50 Van Buren Avenue, Westwood, NJ 07675, NRC License No. 29-00055-14, removec University waste generated under other licenses, both NRC and the State of New Jersey); 3) be moved with existing | researcher to any possible future place of employment that is duly licensed; or 4) be sold to another duly licensed institution. j i
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| Attachments to Supplement:
Trat .ing Outline OHS Form #20 OHS Form #20a
...... - . . .. _- _ _ _ . . . ' APPENDIX A - . o o
RADIATION PROTECTION TRAINING
. FOR IRRADIATOR USERS ]
' TABLE OF CONTENTS
PART I. THEORY AND DISCUSSION
I. RADIATION QUANTITIES IN UNITS
A. CURIE - BECQUEREL - ACTIVITY B. SPECIFIC ACTIVITY C. - ROENTGEN - EXPOSURE D. RAD - ABSORBED DOSE E. REM - DOSE EQUIVALENT F. QUALITY FACTOR
II. CHARACTERISTICS OF CESIUM-137
A. RADIATIONS EMITTED i 1. DECAY SCHEME
2. BETA PARTICLES , 3. GAMMA RAYS J
III. MATHEMATICS
A. RADI0 ACTIVE DECAY l B. HALF-LIFE | C. INVERSE SQUARE LAW CALCULATIONS D. DOSE RATE CALCULATIONS E. TIME FOR LETHAL DOSE NEAR LARGE SOURCE F. SHIELDING CALCULATIONS , G. CPM - DPM - ACTIVITY >
IV. INTERACTION OF RADIATION WITH MATTER
A. GAMMA RAYS 1. PHOTOELECTRIC EFFECT 2. COMPTON SCATTERING 3. PAIR PRODUCTION B. BETA PARTICLES 1. COLLISIONAL LOSSES 2. BREMSSTRAHLUNG
V. RADIATION SHIELDING
A. HALF VALUE LAYERS B. TENTH VALUE LAYERS C. RELATIVE EFFECTIVENESS OF DIFFERENT MATERIALS D. DENSITY THICKNESS E. TIME F. DISTANCE ______-__
. " ' - , Page A.2 ', , Q ] VI. NONOCCUPATIONAL SOURCES OF RADIATION
A. NATURAL BACKGROUND RADIATION
, B. MANMADE SOURCES
VII. OCCUPATIONAL RADIATION EXPOSURE * .
A. MAXIMUM PERMISSIBLE DOSE FOR RADIATION WORKERS B. POPULATION DOSE | VIII. BIOLOGICAL EFFECTS OF RADIATION
A. SOMATIC 1. PROMPT 2. DELAYED B. GENETIC C. TERATOGENIC
IX. RISK FROM RADIATION EXPOSURE
X. ALARA - PHILOSOPHY
XI. APPLICABLE NRC AND UNIVERSITY REGULATIONS
A. TITLE 10. CHAPTER 1, CFR PART 19 B. TITLE 10 CHAPTER 1, CFR PART 20 ' C. IRRADIATOR LICENSE CONDITIONS D. UNIVERSITY RADIATION SAFETY GUIDE E. NRC FORM - 3 F. OHS EMERGENCY FORMS 12 AND 31.
XII. RADIATION MEASUREMENTS
A. TYPES OF MEASURING DEVICES
1. IONIZATION CHAMBER 1 2. GEIGER COUNTER 3. SCINTILLATION DETECTOR 4. FILM BADGE 5. TLD ! B. OPERATION OF INSTRUMENTS ! 1. TURN ON AND CHECK OUT PROCEDURE . 2. DETECTABLE LIMITS ! 3. RESPONSE TIME 4. DETECTION RANGE
5. SATURATION 1 C. CALIBRATION OF INSTRUMENTS
XIII. SURVEY AND AREA MONITORING TECHNIQUES
1. LEAK TESTS 2. INSTRUMENT SURVEYS 3. AREA MONITORS 4. MONITOR BADGES
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, XIV. PERSONAL MONITORING EQUIPMENT 1. A. PLACEMENT ON PERSONNEL
. 1 B. EXCHANGE FREQUENCY C. 00SIMETRY REPORTS
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XV., IRRADIATOR DESIGN {
XVI. IRRADIATION SAFETY SYSTEM
A. SAFETY INTERLOCKS B. OPERATION OF SAFETY INTERLOCKS C. SHIELDING
D. CONTINU0US MONITORING .
XVII. EMERGENCY PROCEDURES
A. SUSPECTED OVEREXPOSURES B. FAILURE OF SOURCE TO RETURN TO SAFE POSITION C. DAMAGED SOURCE i D. FIRE E. SUSPECTED CONTAMINATION F. HIGH OR UNUSUAL RADIATION LEVEL
XVIII. ADMINISTRATIVE CONTROLS
A. RECORDKEEPING 1. INVENTORY REPORT 2. RADIATION SURVEY REPORTS 3. IRRADIATOR USE LOG B. CONTROLLING ACCESS TO IRRADIATOR C. WARNING SIGNS
4 XIX. REASONS FOR CONTACTING HEALTH PHYSICIST OR SUPERVISOR
A. FOR PERSONAL EXPOSURE INFORMATION B. IF PROBLEMS ARE SUSPECTED | C. IF THERE ARE QUESTIONS ON RADIATION SAFETY ; D. IF THERE ARE SUSPECTED PROBLEMS WITH THE IRRADIATOR ' E. FOR REGULATIONS, LICENSE, AMENDMENTS, INSPECTION REPORTS. F. IF PREGNANT
' XX. DISCUSSION - QUESTIONS AND ANSWERS | PART II. PRACTICAL
I. FAMILIARI7ATION WITH IRRADIATOR
II. WARNING SIGNS i ! III. SAFETY' DEVICES
IV. SURVEY TECHNIQUES
V. IRRADIATOR OPERATION - APPENDIX B ' ~ - - . OrR1nCsTox ox1vtRSITr O OFFICE OF OCCUPATIONAL HEALTH 6 SAFETY Radioisotope Application
Applitant Position or Title ~ (Print or typeT ' Department. Building Room # Phone 1 !
. f) Physical Buildings (s) 6 Room (s) Isotope Possession (1) Type of Limit (mci) Source Fonn Khere Used and/or Stored
(1) Amount requested should be large enough to cover the maximum inventory which will be in your possession at any one time, including wastes and stores. (2) Indicate open or seaJed. _ _
Do you presently hold valid Authorization Number (s)? _ yes no _ _ Do you presently hold valid Limited Possession Number (s)?_ yes no _ On the back of this form or on a separate sheet, if necessary, provide answers for the following questions. Identify your answers by indicating the question number. N HE: It is necessary to explicitly answer each of the following questions for each isotope requested above. If the answers to the questions are the same for each isotope, requested, then please explicitly indicate this. If not, answer the questions for each isotope on a separate sheet, clearly referencing the relevant isotope.
1) In any case where this application is a request for an increase in the Possession Limit for an isotope already authorized, please identify that isotope and indicate your present possession limit. 2) Briefly describe your experiment. Indicate typical amounts (mci) of radioactive materials to be used, and frequency of use. Describe physical or chemical manipulations intended.
3) Explain briefly your intended use. - - j i 4) Will this material by used by persons other than you? _ yes no If yes, provide infonnation to identify these persons, their qualifications, and indicate how you intend to insure that they receive adequate supervision. t
5) Will animals be used in this work? _ yes _ no. If yes, indicate . the number and types of animals and describe how they will be used. If this work I involves in vivo use of radioisoto lan 1 with respect to the instruction o[es,animal indicate caretakers, the special ventilation, precautions the cont youSI of | contaminated cages and other equipment, and the disposal of the excreta wastes and | carcasses. 1
0. H. 6 S. Fonn #20 (Rev. 7/77)
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DOCUMENTATION REQUIRED IN ADDITION TO THIS FORM: 1) If this is your first application for either type of radioisotope authorization, complete and submit O. H. 6 S. Foms #1, #1a, #2a, #4, and #20a. 2) If this is your first application for an Authorization Number, complete and submit O. H. 6 S. Foms #4 and #20s, even though you hold a Limited Possession Number. 3) If you hold a valid Authorization Number, no additional infomation is required. Fonas are available from the Office of Occupational Health 6 Safety (ext. 5294) or from your Departmental Safety Coordinator. | CERTIFICATION: I certify that the work perfonned with the materials requested in this application will be done in accordance with the rules and regulations contained in the Radiation Safety Guide. , ) Applicant's Signature Date |
Acknowledgement and/or | Approval by: Date
(Departmental Safety Coordinator) |
Approval by: Date (Health Physics Officer)
Appmval by: Date , (Radiation Safety Committee Member)
REMARKS: 1 i ' )
' . , OHS,Fonn #20 (back) (Rev. g) $ - . --_ - APPENDIX C * * ,, .
PRINCETON UNIVERSITY OFFICE'0F OCCUPATIONAL HEALTH 6 SAFE 1Y
f Applicant Phone * (typed or printed)
Department Building Room
Application for: Isotope Amount mci
Irradiation to pmduce Amount mci | In the spaces provided below, please answer the following questions and provide a masonable amount of detail. 1. Do you have in your possession and are you familiar with the provisions and regulations in the: University Radiation Safety Guide, Federal Regulations 10 CFR Parts 20 and 30, University's NRC and/or State Licenses and the New Jersey Radiation Protection Code?
2. hhat survey and manitoring equipment do you have? Itemi::e specific items owned i or those which you plan to order if this application is approved. A monitoring i device is generally required if millicurie amounts are requested,
l 3. hhat are your specific plans for the disposal of radioactive waste and for the keeping of receipt, use, and disposal records? l
4. What arrangements have you made with the Office of Occupational Health 6 Safety with respect to personnel monitoring requirements?
0. H. 6 S. Form #20a (Rev. 7/77)
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1 5. ht plans do you have for the orientation of assistants, staff, students, jani- tors or visitors in relation to Items 1 and 3 above and 'with respect to radio- logical safety in general? ; I 1
\ 6. h t storage facilities do you plan to use and how do you plan to secure your I isotope (s) to prevent use or possession by unauthorized personnel or to prevent | accidental loss' ' l
i 7. ht facilities and protective equipnent are available to you? (Hoods, absorbent paper, labels, tags, shielding, etc.)
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8. h t precautions will be taken to test for leakage and/or contamination upon receipt of these materials?
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9. ht measures will be taken to prevent, detect, and handle a " spill"? ]
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10. Please provide any other relevant infomation.
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. | Applicant's signature- Date !
' , , OHS, Fom #20a (back) (Reg 7/77) g
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John E. Glenn, Chief , ' ' ' Nuclear Materials Section B Division of Engineering and Technical Programs
LICENSE FEE TRANSMITTAL
A. : AE N , REGION [ 1. APPLICATION ATTACHED
Applicant / Licensee: [\OCTMID Wi\lPr9 | Application Dated: \l 34 W Control No.: 1 Gd70 License No.: QC[_ n q jg 5 - Q 9
2. FEE ATTACHED
Amount: h Check No.: O
3. COMMENTS Signed h40 man bnkM
Date \Q a SR C|
B. LICENSE FEE MANAGEMENT BRANCH r., , q P g'** 1. Fee Category and Amount: EP 3F / 7 e. //(n [ $ b / 8% h b r/i' 2. Correct Fee Paid. Application nay be processed for I'O' '{ p-p
Amendment ,
Renewal N
License s
- Signed - hW $
, Date _ hh I 320 [?:| Ei dAG33U
(MARCH 1983)
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