NRC FORM 374

U.S. NUCLEAR REGULATORY COMMISSION

MATERIALS LICENSE

PAGE 1 OF 4 PAGES

Amendment No. 69

Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93-438), and Title 10, Code of Federal Regulations, Chapter I, Parts 30, 31 , 32, 33, 34, 35, 36, 37, 39, 40, 70 and 71 , and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess, and transfer byproduct, source, and special nuclear material designated below; to use such material for the purpose(s) and at the place(s) designated below; to deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the applicable Part(s). This license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, as amended, and is subject to all applicable rules, regulations, and orders of the Nuclear Regulatory Commission now or hereafter in effect and to any conditions specified below.

Licensee

1. Franciscan Health - Lafayette East Nuclear Medicine Dept.

In accordance with letter dated 4. Expiration Date: November 30, 2023

t----------__.~:a,,,_--1 5. Docket No.: 030-01642

;g;w· rre Gu, C,'"" c..

~~ 2. 1701 S. Creasy Ln. Lafayette, IN 47905

6. Byproduct, source, and/or special nuclear material

A Any byproduct material permitted by 10 CFR 35.100

B. Any byproduct material permitted by 10 CFR 35.200

C. Any byproduct material permitted by 10 CFR 35.300

D. Any byproduct material permitted by 10 CFR 35.500

3. License number: 13-09788.:on amended in its entirety to rea~

" follows: .. ~wa , J...i

7. Chemical ~ r physical fer

A Any

B. Any

C. Any

NRC FORM 374A

MATERIALS LICENSE SUPPLEMENTARY SHEET

U.S. NUCLEAR REGULATORY COMMISSION

License Number

13-09788-01

Amendment No. 69

Docket or Reference Number

030-01642

6. Byproduct, source, and/or special nuclear material

7. Chemical and/or physical form 8. Maximum amount that licensee may possess at any one time

R Pri8~ tjiis license 9. Authorized use

PAGE 2 OF 4 PAGES

E. 1 Wrr«uft/ries total ~/"

E. Strontium-90 E. Sealed Sources (Atla_!l.tii 1(.. ~ p. E. For storage only incident to disposal.

/a 1 .•• 10. A. Lic;ensed material listed in Subitem ~ s. 6.A. th"r~

Creasy Lane, Lafayette, Indiana. ·

B. Licensed material listed in Subitem 'its. 6.A. and

0~

Research Corporati~d'del B-1) ~

~ CONDITIONS .,i_

tored at tijel licensee'sfacilities located at 1701 South

. 0 red at the 1ic,e11see's facilities located at 1104 East Grace

Street, Rensselaer, Indiana and 17ffl1 Lafayi e Re, .

. . (./) . -~ .' • I > l F . -i s 11. The Rad1at1on Safety Officer (RSO) for ttti)1cen~"1.ob- I , _.,, i;j

~ ~- , ,. \\ ,1 r-, // > \ " 1.:1· j ' .,,,.,

12. ~icensed material shall only be used by, or 1d(.PJtte supe'rvi · · 1,1: µi I, O' A. Individuals permitted to work as authorized ua inf'!'cordance with 1 O l>FR t 13 and 10 C FR 35 .14.

~ tr i:r~r B. The following individuals are authorized users for the material and medical uses as indicated:

Authorized User(M.D.,D.O.,etc.) Material and Use

David R. Schmidt, M.D.

AdelYaacoub, M.D.

Irene C. Gordon, M.D.

William J . Miller, M.D.

Sam Hansen, M.D.

10 CFR 35.200, 10 CFR 35.500

10 CFR 35.200, 10 CFR 35.500

10 CFR 35.300, 10 CFR 35.500

10 CFR 35.100,10 CFR 35.200,10 CFR 35.300

10 CFR 35.100, 10 CFR 35.200, 10 CFR 35.500

NRC FORM 374A

MATERIALS LICENSE SUPPLEMENTARY SHEET

Authorized User(M.D.,D.0.,etc.)

Robert Mehl, M.D.

Farouk E. Mercho, M.D.

Priit Jaagosild, M.D.

James M. Pearce, M.D.

Michael S. Skulski, M.D.

U.S. NUCLEAR REGULATORY COMMISSION

License Number

13-09788-01

Amendment No. 69

Material and Use

·~/A,.

"V/'\ ) '1 ,, , 0... . ~ ]\.... -,_,-.

£..{"" 1'} 1-r

NRC FORM 374A

MATERIALS LICENSE SUPPLEMENTARY SHEET

U.S. NUCLEAR REGULATORY COMMISSION

License Number

13~09788-01

Amendment No. 69

Docket or Reference Number 030-01642

PAGE 4 OF 4 PAGES

13. Except as specifically provided otherwise in this license, the licensee shall conduct its program in accordance with the statements, representations , and procedures contained in the documents, including any enclosures, listed below. This license condition applies only to those procedures that are required to be submitted in acw~cfiie6 !pijUlations. Additionally, this license condition does not limit the licensee's ability to make changes to the radiation P{ o~fio?i program as prnvi( e~ or in 10 CFR 35.26. The U.S. Nuclear Regulatory Commission's regulations shall govern unless \[lytM'ements, representations, a1t81..pcedures in the licensee's application and correspondence are more restrictive than the J... C. Letter dated February 26, 2015 (M~~63A576~ , ~-- . ~ C-> D. Letter dated March 23, 2015 (ML 1 S"9]'2A406)

\.

E. Letter dated April 11, 2016 (ML 161 ~ A231)

F. Letter dated June 14, 2017 (ML 17~.of-317) .,A

G. Letter dated November 2, 2017 (M~1317. i

I""\ -~.:,.~ .- ·. ~ *'~ '

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0 s

; .... :::, s :LY. ....... T¥: · C,

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Date: November 15, 2017

FOR THE U.S. NUCLEAR REGULATORY COMMISSION

By~~G,~ ennifer L. Bishop

Region 3