_ _ - - - _ - - - - - - _ - - - - _ - - - - - _ .- ' _, , . ! Fonu NRC 313 I U.S. NUCLEAR REGULATORY COMMISSION 1. APPLICATION FOR: * (Check and/or complete as appropriate) (3-8 01 10 C F R 30 , .. APPLICATION FOR BYPRODUCT MATERIAL LICENSE INDUSTRIAL s. NEW LICENSE ; 1 | See strached instructions for details. b. AMENDMENT TO: LICENSE NUMBE R Completed applications are filed in duplicate with tne Division of fuel Cycle and Material Safety, ! ' office of Nuclear Material Safety, and Safeguards, U.S. Nuclear Regulatory Commission' R OF- washington, DC 20555 or applications may be filed in person at the Commission's office at g,ggngguvu,gn | 1717 H Street, NW, Washington, D. C. or 1915 Eastern Avenue, Siler Spring, Maryland. 20-09568-18 i * 2. APPLICANT'S NAME (institution, firm, person, etc.) 3. NAME AND TITLE OF PERSON TO BE CONTACTED Sidney Farber Cancer Institute REGARDING THIS APPLICA*!ON 44 Binney St. Frank Osborne i TELEPHONE NUMBER: AREA CODE - NUMBER EXTEPJSION TELEPHONE NUMBER: ARE A CODE - NUMBE R EXTENSION l 617-732-3000 617-735-7516 j 4. APPLICANT'S MAILING ADDRESS (include Zip Codel 5. STREET ADDRESS WHERE LICENSED MATERI AL WILL dE USED | (Address to which NRC correspondence, notices, bulletins, etc., (include Zip Codel ' '" "'# '''"'# Michael A. Redstone Building 44 Binney St. 462 Brookline Avenue Boston, MA 02115 Boston, MA 02115 (IF MORE SPACE IS NEEDED FOR ANY ITEM. USE ADDITIONAL PROPERLY KEYED PAGES.) ! 6. INDIVIDUAL (S) WHO WILL USE OR DIRECTLY SUPERVISE THE USE OF LICENSED MATERIAL (Sn trems 16 and 17 for recurred tramme and experience of each indivsdualnamed below) FULL NAME TITLE Physician, SFCI a. Stuart Schlossman, M.D. Prof, of Medicine, Harvard Med. School | Scientist, SFCI ' b.Harvey Cantor, M.D. Professor of Patholoay, Harvard Med. Sch. Assistant Physician, SFCI c. Robe rt Bast, M.D. ' Assistant Professor of Medicine. HMS 1. RAD 1ATION PROTECTlON OFFICER I Attach a resume of person's trommg and experience as outimed in items 16 and 17 and describe his responsibihties under item 15. Frank Osborne 1 8. LICENSED MATERIAL MAXIMUM NUMBER OF L ELEMENT CHEMICAL NAME OF MANUF ACTURER i AND AND/OR AND MILLICURIES ANDIOR SEALED N MASS NUMBER PHYSICAL FORM MODEL NUMBER SOURCES AND MAXIMUM ACTI- VITY PER SOURCE WHICH WILL E (t/ Sealed Source) BE POSSESSED AT ANYONETIME NO. A B C D '" 137-Cesium sealed source Atomic Eneroy of two AEC1 model C-161 Canada Ltd. type 8 sealed sources o (21 Gammacell 40 of 1550 Curies each (31 (4) DESCRIBE USE OF LICENSED MATERI AL E 10 For use in an AECL Gammacell 40 irradiator for the irradiation of small animals (28 and biolacic samoles (31 (41 FORu Nac 313 i 43 80) - p _-- % q 19Mo3oGR7 -- ! _ __ _ _ _ _ _ _ - - - - . - - - - - - - - - . - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - -- - - - - - - - - - -- -] - ) 9. STORAGE OF SEALED SOURCES I CONTAINER AND/OR DEVICE IN WHICH E ACH SEALED NAME OF MANUFACTURER N SOURCE WILL BE STORED OR USED. MODEL NUMBER No. A. B. C. (1) Gammacell 40 LTD. An (2) ! . (3) l (4) 10. RADIATION DETECTION INSTRUMENTS TYPE M ANU F ACTU R E R'S MODEL NUMBER RADIATION SENSITIVITY ( OF NAME NUMBER AVAILABLE DETECTED RANGE N INSTRUMENT E (stphs. bers, (milbroentoons/ hour ** n n, gamma, neutron) A or counts / minute / B C D E F Geiger- g33 Eberline E-120 i beta, gamma 0-50 mr/hr Mueller inst. En nann mr/hr : c2) d'!cto reen Innhati n , Inst. Cn. 440 ? hota_ namma (3) CbCMr ,J. (4) 11. CALIBRATION OF INSTRUMENTS LfSTED IN ITEM 10 Oa. CAllBRATED BY SERVICE COMPANY Cb. CALIERATED BY APPLICANT NAME, ADORESS, AND FREQUENCY A ttach a separate sheet oescrobong method, frecuency and standards Harvard University Health Services "''#'*'''^*'*"""""'"*''"'' 75 Mt. Auburn St. rnmhridno M3 n?19R ' 12. PERSONNEL MONITORING DEVICES (Check and/or compi$te es approproste.) (Serv ce C ony/ ' M "" W# A B C p1) FILM DADGE |QMONTHLY O (2) THE RMOLUMINESCENCE C QUARTERLY DOSIMETER (TLD/ D(3) OTHE R (Sosity): O OTHER (Specifyh 13. F ACILITIES AND EQUIPMENT (Check were appropriate and attach annotated sketch (es) and description (s). O a. LABORATORY F ACILITIES, PLANT F ACILl1sES, FUME HOODS (include farrarson,if enr /. ETC. Ob STOR AGE F ACILITIES, CONTAINE RS, SPEC; AL SHIE LDING (forad and/or temporary /. ETC. - O c. REMOTE H ANDLING TOOLS OR EQUIPMENT, ETC. O d RESPIRATORY PROTECTIVE EQUIPMENT. ETC 14. WASTE DISPOSAL a. NAME OF COMMERCI AL WASTE DISFOSAL LERVICE EMPLOYE 0 NOt applicable b. IF COMMERCIAL WASTE DISPOSAL SERVIC6 IS NOT EMPLOYED, SUBMIT A DETAILED DESCRIPTION OF METHODS WHICH WILL LE USED FOR DISPOSING OF RADIOACTIVE WASTES AND ESTIMATES OF THE TYPE AND AMOUNT OF ACTIVITY INVOLVED. IF THE APPLICATION IS FOR SE ALED SOURCES AND DEVICES AND THEY WILL BE RETURNED TO THE M MANUFACTURER, SO STATE. FORM NRC 313 I (3 80) . O - - - - - __ - _ _ _ _ _ - - - _ _ _ - - - - . _ . _ _ _ _ _ _ _ . ,. .,. , . INFOW.ATION REQUIRED FOR ITEMS 15,16 AND 17 ' Describe in detail' the information required for items 15,16 and 17. Begin each item on a separate page and key to the application as follows: 15. RADIATION PROTECTION PROGRAM. Describe the radiation protection program as appropriate for . the material to be used including the duties and responsibilities of the Radiation Protection Officer, control measures,' bioassay procedures (// nwded/, day to day general safety. Instruction to be followed, etc. If the application is for sealed source's also submit leak testing procedures, or if leak testing will be performed using a leak test kit, specify manufacturer and model number of the leak test kit. , 16. FORMAL TRAINING IN RADIATION SAFETY. Attach a resume for each individual named in items 6 and 7. Describe individual's formal training in the following areas where applicable. Include the name of person or institution providing the training, duration of training, when training was received, etc. a. Principles and practices of radiation protection. b. Radioactivity measurement standardization and monitoring techniques and instruments, c. Mathematics and calculations basic to the use and nyeasurement of radioactivity. , d. Biological effects of radiation. 17. EXPE9 FENCE. Attach a resume for each individual named in items 6 and 7. Describe individual's work experience with radiation, including where experience was obtained. Work experience or on- the-job training'should be commensurate with the proposed use, include list of radioisotopes and maximum activity of each used. 18. CERTIFICA1E (This item must be compiered by applicant) The applicant and any official executing this certificate on behalf of the applicant named in item 2, certify that this applicarron is prepsred in conformity w th Title 10, Code of Federal Regulations, e ,* art 30. and that all information contooned herein, including any supplements attached hereto, is true and correct to the best of our knowkedge and belief. WARNING.-18 US.C., Section 1001; Act of June 2S.1948: 62 Stat. 749: makes it a criminal offense to make a willfully falso statement or representation to any department or seeney of the un ted States at to any metter within its jurisdiction. I a. LICENSE FEE REQUIRED t). / ! | (See Section 170.31.10 CFR 170) CERTIFYING OFFICIAL (Signature) f2., Y.$.L ${ $40.00 c. Nave crype or print) Barbara Sanford, Ph.D. # ""'" (H LICENSE FEE CATEGORY: 36 Director for Research ' ' * ' (2) LICENSE FEE ENCLOSED: * 40.00 February 27, 1981 FORM NRC 313 I (FBO) :| | _ _ _ _ _ - _ _ _ _ . ' ' . O . ~ o ltem 15. Radiation Protection Program. ' This unit is used for the irradiation of small animals and biologic samples. No human use is involved. Attached is a sketch of the locked room which houses the irradiator. Keys to the room are issued to the Manager of the Animal Care Facility, the Chairman of the Animal Care Committee and the Security Department. Keys to the irradiator are issued only to the three individuals named in Item 6. | A list of the trained and approved users is maintained by the individuals named in Item 6. The source will continue to be leak tested semi-annually. Our records show that all leak tests to date have failed to reveal any detectable activity. These tests are performed by the Department of Environmental Health and Safety of the Harvard University Health Services, who are currently authorized to perform the leak tests at the Children's Hospital and have been approved by your office. The . manufacturer's recommended procedure are followed. The operating procedures are followed as set forth in the instruction manual accompanying the irradiator. A copy of this manual is' available to all authorized users. Emergency procedures will be posted in the room in a conspicuous location, primarily to notify the personnel of the emergency numbers to be called. Personnel will be monitored and monitor films will be posed around the source. i % ___-___ _ _ _ _ _ ' - O . O . Item 16 Formal Training in Radiation Safety S. Schlossman H. Cantor R. Bast F. Osborne a. Principles See below 28 28 30 b. Measurements See below 8 8 10 c. Calculations See below 40 40 50 d. Biological effects See below 4 4 10 Dr. Schlossman has had no formal training in radiation safety. He has ovey 15 years experience using and supervising others in the use of radioisotopes. He md a license from the AEC from 1965 to 1973 while at the Beth Israel Hospital. Dr. Cantor was trained at the National Institutes of Health in 1969-70. Dr. Bast was trained at the National Can-er Institute in 1974, ' F. Osborne was trained at the Harvard University Health Services in 1970 under Jacob Shapiro, Ph.D. - _ _ _ _ _ - - - - _ _ - _ _ _ _ _ _ - _ _ -_.