novamed corporation, new license application dated …

NRC FORM 313 US NUCLEAR REGULATORY COMMISSION (05-2012) 10 CFR 30 32 33 34 35 36 39 and 40

APPLICATION FOR MATERIALS LICENSE

APPROVED BY OMB NO 31500120 EXPIRES (05312015)

Estimated burden per response to comply with this mandatory collection request 43 hours Submittal of the application is necessary to determine that the applicant is qualified and that adequate procedures exist to protect the public health and safety Send comments regarding burden estimate to the Information Services Branch (T-5 F53) Us Nuclear Regulatcry Commission Washington DC 20555-0001 or by internet e-mail to InfocoliectsResourcenrcgov and to the Desk Officer Office of Information and Regulatory Affairs NEOBmiddot10202 (3150-0120) Office of Management and Budget Washington DC 20503 If a means used to impose an information collection does not display a currently valid OMS control number the NRC may not conduct or sponsor and a person is not required to respond to the information collection

INSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW

APPLICATION FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH

OFFICE OF FEDERAL amp STATE MATERIALS AND ENVIRONMENTAL MANAGEMENT PROGRAMS DIVISION OF MATERIALS SAFETY AND STATE AGREEMENTS US NUCLEAR REGULATORY COMMISSION WASHINGTON DC 20555-0001

ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS

IF YOU ARE LOCATED IN

ALABAMA CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA KENTUCKY MAINE MARYLAND MASSACHUSETTS NEW HAMPSHIRE NEW JERSEY NEW YORK NORTH CAROLINA PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH

ROU ~ ~J SEND APPUCATIONSTO (OlD - 31Lj K-C I

LICENSING ASSISTANCE TEAM DIVISION OF NUCLEAR MATERIALS SAFETY US NUCLEAR REGULATORY COMMISSION REGION I 2100 RENAISSANCE BOULEVARD SUITE 100 KING OF PRUSSIA PA 19406-2713

IF YOU ARE LOCATED IN

ILLINOIS INDIANA IOWA MICHIGAN MINNESOTA MISSOURI OHIO OR WISCONSIN SEND APPLICATIONS TO

MATERIALS LICENSING BRANCH US NUCLEAR REGULATORY COMMISSION REGION III 2443 WARRENVILLE ROAD SUITE 210 amp f LISLE IL 60532-4352

ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO HAWAII IDAHO KANSAS LOUISIANA MISSISSIPPI MONTANA NEBRASKA NEVADA NEW MEXICO NORTH DAKOTA OKLAHOMA OREGON PACIFIC TIRUST TERRITORIES SOUTH DAKOTA TEXAS UTAH WASHINGTON OR WYOMING LL 3fS1SEND APPLICATIONS TO

NUCLEAR MATERIALS LICENSING BRANCH US NUCLEAR REGULATORY COMMISSION REGION IV 1600 E LAMAR BOULEVARD AIltLlNGTON TX 76011-4511 03 03 ~S-82

PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE US NUCLEAR REGULATORY COMMISSION ONt+Jf THEY WISH TO POSSESS AND USE LICENSED MATERIAL IN STATES SUBJECT TO USNUCLEAR REGULATORY COMMISSION JURI~CTIONS

1 THIS IS AN APPLICATION FOR (Check appropriate Item) 2 NAME AND MAILING ADDRESS OF APPLICANT (Include ZIP code)

ITmiddot A NEW LICENSE ~J NovaMed Corporation

W B AMENDMENT TO LICENSE NUMBER 30 Nutmeg Drive 0 ~

Trumbull CT 06611 C RENEWAL OF LICENSE NUMBER 03LLfo ~~

3 ADDRESS WHERE LICENSED MATERIAL VVlLL BE USED OR POSSESSED 4 NAME OF PERSON TO BE CONTACTED ABOUT THIS APPLICATION -Robert M Constantine President _

CA

BUSINESS TELEPHONE NUMBER JBUSINESS CELLULAR TELE~E NUMBERPossession at temporary job sites only which are licensed

(203) 380-6682 (860) 944-3045 hospitals and blood banks requiring blood irradiator maintenance

BUSINESS EMAIL ADDRESS

rconstantinenovamedcorpcom SUBMIT ITEMS 5 THROUGH 11 ON 8-12 X 11 PAPER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED IN THE LICENSE APPLICATION GUIDE

5 RADIOACTIVE MATERIAL a Element and mass number b chemical andlor physical form and c maiximum amount 6 PURPOSE(S) FOR WHICH LICENSED MATERIAL VVlLL BE USED

which will be possessed at anyone time

7 INDIVIDUAL(S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR S TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREASTRAINING EXPERIENCE

9 FACILITIES AND EQUIPMENT 10 RADIATION SAFETY PROGRAM

12 LICENSE FEES (See 10 CFR 170 and Section 17031) 11 WASTE MANAGEMENT AMOUNT

FEE CATEGORY New Licence App $ 640000ENCLOSED

13 CERTIFICATION (Must be completed by applicant) THE APPLICANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENTATlONS MADE IN THIS APPLICATION ARE BINDING UPON THE APPLICANT

THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEHALF OF THE APPLICANT NAMED IN ITEM 2 CERTIFY THAT THIS APPLICATION is PREPARED IN CONFORMITY VVlTH TITLE 10 CODE OF FEDERAL REGULATIONS PARTS 30 32 33 34 353639 AND 40 AND THAT ALL INFORMATION CONTANED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF WARNiNG 18 USC SECTION 1001 ACT OF JUNE 25194862 STAT 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A VVlLLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER VVlTHIN ITS JURISDICTION ~~~~~~~~-~----------~~~ ~--~~---CERTIFYING OFFICER - TYPEDIPRINTED NAME AND TITLE IDATE

Robert M Constantine President ~c~~~- i lJ1l

FOR NRC USE ONLY TYPE OF FEE IFEE LOG IFEE IgtVIlt IMOUNT RECEIVED ICHECK NUMBER 1 vVMrv

i I APPROVED BY IDATE~~I

NRC FORM 313 (05-2012)

S7117shyNMSSAGN1 MATERIALS-002

i

NRC FORM 313 US NUCLEAR REGULATORY COMMISSION

APPLICATION FOR MATERIALS LICENCE

NovaMed Corporation

This is an application for a new license

Preface

NovaMed Corporation is purchasing the blood irradiator service business line from Pharmalucence Inc on or about October 15 2012 and seeks a new materials license to continue to operate the business line in the same manner as operated by Pharmalucence which is currently licensed by the NRC

llovaMed Corporation provides medical and research equipment maintenance service parts and sales After the purchase of the blood irradiator business line from Pharmalucence NovaMed will employ the two individuals currently trained and authorized to provide the service along with continuing to use the various radiation safety procedures currently in place

Thank you in advance for your consideration of this application

middot bull 1 lt

Appendix C

Suggested Format for Providing Information Requested in Items 5

through 11 of NRC Form 313

APPENDIXC

Suggested Format for Providing Information Requested in Items 5 through 11 of NRC Form 313

Appendix C is designed to be used for all types of applicants requesting a service license Because of the varied types of service applications it is necessary to make this appendix sufficiently broad in scope to handle most applications Services such as commercial nuclear laundries and waste management applicants may need to provide additional information once the necessary pre-licensing visit(s) are completed Maintaining close coordination during the early licensing phalte with the NRC licensing staff can be beneficial to both the NRC staff and applicant

Using this appendix successfully requires the applicant to do an initial review of the NUREG and preplan its answers We suggest that applicants read the entire appendix from beginning to end The next step is to select the individual elements that apply to the individual types of service(s) requested Highlight or circle Item Nos or in some other way identifY the areas that require specific information Provide the information on the specific elements that you identified as requiring input for obtaining authorization for the requested services

After selecting the applicable items that need to be addressed in Appendix C refer to the corresponding sections in the NUREG It is only necessary for applicants to provide the level of detail required for the individual types of service(s) requested in the application Note that providing information for very limited licenses eg leak test service provider requires less information than would be required for a commercial nuclear laundry or a waste management license Applicants for service licenses requiring authorization for types and quantities ofmaterial specific for broad scope licenses should refer to NUREG-1556 Vol 11 Consolidated Guidance About Material Licenses Program-Specific Guidance About Licenses of Broad Scope and NUREG-1556 Vol 7 Consolidated Guidance About Material Licenses Program-Specific Guidance About Academic Research and Development and Other Licenses of Limited Scope

Item Title and Criteria Use Description No Table(s) Attached

Below

C-I NUREG 1556 Vo1l8

5

APPENDIXC

RADIOACTIVE MATERIAL

Sealed Sources and Devices

bull Identify each radionuclide that will be used in each sealed sourcedevice

bull Identify the manufacturer or distributor and model number of each sealed sourcedevice

bull Confinn that each sealed sourcedevice combination is listed and approved in the SSD registIy for the purpose intended

bull Confinn that the activity per sourcemaximum activity per device specified in the SSD registration certificate will not be exceeded

Radioisotope

Cesium-137

o Depleted Uranium

o Uranium-238

o Thorium-232

o Other Specify

Radioisotope

Sealed Sources

Manufacturer Model No

CIS biointernational Model CSL-15 sealed source housed within Irradiator Model IBL-437C maximum 3 sources II

Quantity

Not to exceed the maximum activity per sourcedevice as specified in the Sealed Source and Device Registration Sheet



Source Material

Kilograms

Kilograms

_____ Kilograms

Kilograms

Special Nuclear Material

Manufacturer Quantity Model No

o

o

o

o

IYes INo

L2J 0

0 0

0 0

Yes No

NUREG 1556 Vol 18 C-2

APPENDIXC

0

0

0

Uranium-234

Uranium-235

Plutonium-238


0 0

0 Plutonium-239

0 Other SpecifY

C-3 NUREG 1556 Vo118

APPENDIXC

Unsealed or Uncontained Materials

Identify each individual isotope requested

Radioisotope Chemical or Physical Form Total Activity Requested

o Gas 0 Liquid o Solid o Other Specify


o Gas 0 Liquid 0 Solid o Other Specify


OR

Identify your request for Type B or Type C quantities of material by filling out the table below

Radioisotope IYes INo

bull Any radioisotope identified in 10 CFR 33100 Schedule A Column I (Type B o 0 License of Broad Scope)

OR o [] bull Any radioisotope identified in lO CFR 33lO0 Schedule A Column II - (Type C

License of Broad Scope)

AND IF APPLICABLE

Identify individual isotopes identified in 10 CFR 33100 Schedule A Column I or II that requested quantities exceeding amounts authorized in Column I or II


J Gas 0 Liquid o Solid o Other Specify

o Gas 0 Liquid 0 Sol1d [] Other Specify

o Gas J Liquid o Solid [] Other Speci ty


AND

NUREG - 1556 Vol 18 C-4

APPENDIXC

NUREG - 1556 Vo1l8 C-5

APPENDIXC

IdentifY any uncontained source or special nuclear materials that should be included in the license

Source Material

o Depleted Uranium Kilograms

o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams

Special Nuclear Material Less than Critical Mass Quantities

o Uranium-234 Grams

o Uranium-235 Grams

o Plutonium-238 Grams


For those individuals who will provide commercial services on sealed sourcesdevices and will be required to take possession ofmaterials incident to providing services

Sealed SourcesDevices Possessed Incident to Providing Services

Radioisotope Manufacturerl Quantity Yes No Model No

CIS Not to exceed the maximum activity per m 0Cesium-137 biointernational sourcedevice as specified in the Sealed Model CSL-15 Source and Device Registration Sheet sealed source

Not to exceed the maximum activity per 0 0housed within

sourcedevice as specified in the Sealed Irradiator Model Source and Device Registration Sheet bull - v

Surce Material

o Uranium-238 Kilograms

o Thorium-232 Grams

o Other Grams


NUREG - 1556 Vol 18 C-6

APPENDIXC


o Uranium-234 Grams

o Uranium-235 Grams



For those individuals who will provide commercial services involving unsealed or uncontained material and will be required to take possession of these materials incident to providing services


IdentifY each individual isotope requested


o Gas 0 Liquid o Solid o Other Speciry

o Gas 0 Liquid 0 Solid o Other Speciry



OR

IdentifY your request for Type B or Type C quantities of materials by filling out the table below

Radioisotope I Yes I No

bull Any radioisotope identified in 10 CFR 33100 Schedule A Column I - (Type B o o License of Broad Scope)

OR

bull Any radioisotope identified in 10 CFR 33100 Schedule A Column IT - (Type C o oLicense of Broad Scope)

C-7 NUREG - 1556 Vo118

APPENDIXC

AND IF APPLICABLE

IdentifY individual isotopes identified in 10 CFR 33100 Schedule A Column I or II that requested quantities exceeding amounts authorized in Column I or II


o Solid 0 Other Specify


o Solid 0 Other SpecifY


A~D

Identify any uncontained source or special nuclear materials that should be included in the license

Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams




APPENDIXC

Item No

Title and Criteria Yes No NA Description Attached

5 RADIOACTIVE MATERIAL

Financial Assurance and Recordkeeping For Decommissioning

bull Pursuant to 10 CFR 3035(g) we shaH maintain drawings and records important to decommissioning and transfer these records to a new licensee before licensed activities are transferred or assign the records to the appropriate NRC Regional Office before the license is terminated

121 D

Company does not possess radioactive material at any of its facilities A decommissioning plan is not required

OR

bull If financial assurance is required submit evidence D

C-9 NUREG - 1556 Voll8

APPENDlXC

Item Title and Criteria No

PURPOSE(S) FOR WHICH LICENSED MATERIAL WILL BE USED

6

bull Leak Test Analysis bull Environmental Sample Analysis bull InstrumentIDosimeter Calibration bull Instruction

Possession Incident to Performing the FoUowing Services on Sealed Sources and Devices

bull Installation bull Radiation Surveys bull Removal bull Disposal bull Relocation bull Repair bull Source Exchange bull Routine Maintenance bull Non-routine Maintenance bull Source Retrieval bull Transportation bull Packaging bull Leak Test Sample Acquisition bull Customer Training bull Other Services not identified above excluding activities

involving critical mass quantities ofspecial nuclear material Specity

Yes

I2J 0 0 0

IZI ~

0 0

(lJ 0 QJ

0 121 I2J I2J IZI CJ

No NA Description Attached

0 IZI I2J I2J

0

0 0 0 0 ~ 0

J 0 0 0 0 IZI 0 0 0 0 0 121 0 0 0 0 0 0 0 0 0 0 (]

NUREG - 1556 Vol 18 C-lO

APPENDIXC

Item No


6 PURPOSE(S) FOR WHICH LICENSED MATERIAL WILL BE USED (Contd)

Possession Incident to Performing Commercial Services Utilizing Unsealed or Uncontained Licensed Material

QJ

Nuclear Laundry 0 0

Waste Management Services

bull Commercial Incineration bull Commercial CompactionSuper Compaction bull Commercial SolidificationIVitrification bull Packaging Repackaging and Transportation of

Radioactive Waste bull Decontamination bull Decommissioning bull Site Characterization bull Radiation protection or health physics training and

instruction bull Other Services not identified above excluding activities

involving critical mass quantities of special nuclear material SpecifYshy

0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0

C-lI NUREG 1556 Vo1l8

7

APPENDIXC

Item Title and Criteria Yes No NA Description No Attached

INDIVIDUAL(S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR TRAINING EXPERIENCE

Radiation Safety Officer

bull The name of the QroQosed RSO IMichael Thomson I

AND EITHER

bull The specific training and experience of the RSO 0

OR

bull Alternative infonnation demonstrating that the proposed RSO is qualified by training and experience eg listed ~

by name as an authorized user or the RSO on an NRC or Agreement State license that requires a mdiation safety progmm of compamble size and scope

NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No


8 TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS

Authorized Users

bull Before using licensed material authorized users will receive the training described in Appendix H of NUREG-1556 Vol 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000

III 0

OR

bull A description of the training and experience for proposed authorized users

iii

Ancillary Personnel

bull Before using licensed materials ancillat) personnel will have successfully completed the classroom training portion of the training course described in Appendix H ofNlJREG-1556 Vol 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000

0 0

OR

bull A description of the radiation safety training program including topics covered groups ofworkers assessment oftraining qualifications of instl1lctors and the method and frequency oftraining

0

C-13 NUREG 1556 Voll8

APPENDIXC


9 FACILITIES A~D EQUIPMENT

Permanent Facilities Specifically Identified on the License

bull Leak Test and Environmental Sample Analysis Providers No response required for facilities (Equipment is discussed in Item 10 Radiation Safety Program)

bull Instrument Calibration If only sealed sources are possessed in registered devices designed to emit a collimated beam for the purpose of instrument calibration no response required (Equipment is discussed in Item 10 Radiation Safety Program)

bull Services that involve handling of sealed sources in a shielded container No response required (Equipment is discussed in Item 10 Radiation Safety Program)

bull Services that involve handling of sealed sources outside a shielded container

Submit a drawing or sketch of the proposed permanent facility identifYing areas where radioactive materials including radioactive wastes will be used or stored

- Show in the drawings the relationship and distance between restricted areas and adjacent unrestricted areas

- SpecifY in the drawings shielding materials (concrete lead etc) and means for securing radioactive materials from unauthorized removal

- Drawings sketches diagrams etc should indicate the scale or include dimensions on each drawing or sketch Describe engineered safety systems eg area monitors interlocks alarms etc

Yes No NA Description Attached

No Response is Necessary for this Section



0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC


9 FACILITIES MD EQUIPMENT (Contd)

Permanent Facilities Specifically Identified on the License Requesting the Use of Unsealed or Uncontained Material

bull Leak Test and Environmental Sample Analysis No Response is Necessary for Providers No response required for facilities this Section (Equipment is discussed in Item 10 Radiation Safety Program)

bull Other services that involve handling of unsealed 0 III radioactive material at pennanent facilities or field stations identified on the license - Describe the pennanent facilities and equipment to 0 0

be made available at each location where unsealed radioactive material will be used or handled

- Include a description of the area(s) assigned for the receipt storage security preparation handling 0 0 waste storage and measurement ofradioactive materials

- Submit a mcility diagram showing the proximity of licensed materials to unrestricted areas 0 0 0 0

- Drawings sketches diagrams etc should indicate the scale or include dimensions on each drawing or 0 sketch

- Submit a diagram sketch or drawing when applicable that identifies areas where radioactive 0 0 materials may become airborne The diagram should contain descriptions of the ventilation systems with pertinent airflow rates filtration equipment sample collection points and monitoring systems

- Submit a diagram of radioactive waste handling equipment that includes incinerators compactors 0 0 solidification equipment hold-up tanks sample collection points etc

C-15 NUREG 1556 Vo1l8

APPENDIXC


9 FACILITIES AND EQUIPMENT (Contd)

Permanent Facilities Specifically Identified on the License Requesting the Use of Unsealed or Uncontained Material (Contd)

- Describe proposed lalll1dry facilities if applicable 0 0 used for contaminated protective equipment and clothing SpecifY how the contaminated waste water from the lalll1dry machines or sinks is disposed Operating and emergency procedures should address decontamination ofthe laundry area and equipment Describe protective clothing (such as rubber gloves coveralls respirators and face shields) auxiliary 0 0 shielding absorbent materials secondary containers for waste water storage for decontamination purposes plastic bags for storing contaminated items etc that will be available

- IdentifY specialized handling tools facility interlocks designed to prevent operation of systems in the event that operation of the system could result in 0 0 accidental exposure or release ofmaterial (eg HEPA filters ventilation system etc) or equipment

Temporary Job Site Locations

bull No facility description is required for use of materials at Need Not Be Submitted With temporary job sites Application

Customers (hospitals and licensed blood banks eg Aml~rican Red Cross) are temporary job sites in IlirPI1ltpri friitip~

NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No


to RADIATION SAFETY PROGRAM

The applicant is required to establish and submit its radiation protection program Each item listed below should be addressed in the corresponding sections of this guide

bull Development and implementation of an ALARA QJ 0 0 0 program

bull Description of equipment and facilities adequate to protect personnel the public and the environment

bull Confmnation that licensed activities are conducted only by individuals qualified by training and experience

bull Development and maintenance ofwritten operating and emergency procedures

bull hnplementation of an audit program to ensure that at least annually the radiation safety program is reviewed

bull Description of organization structure and individuals responsible for ensuring day-to-day oversight of the radiation safety program

bull Establishment and management of a radiation safety and decommissioning records system

bull Methods or procedures for preventing the release of contaminated material and equipment

bull Methods or procedures for preventing personnel contamination Radiation safety procedures and the authorized users responsibilities unique to (ach type of service operation requested in the application

bull Radiation safety procedures bull Equipment techniques and corresponding radiation

safety procedures associated with providing services involving either sealed sources or unsealed materials

I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0

Audit Program Need Not Be Submitted With Application

C-17 NUREG - 1556 VoLl8

APPENDIXC

Item No


10 RADIATION SAFETY PROGRAM (Contd)

Radiation Monitoring Instruments

bull A description of the instrumentation described in Section 8102 ofNUREG-1556 Vo1 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000 that will be used to

perform required surveys We will use instruments that meet the radiation monitoring instrument specifications published in Appendix J of NUREGshy1556 VoL 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000 We reserve the right to upgrade our survey instruments as necessary

121 0 0

OR

bull A description of the instrumentation described in Section 8102 ofNUREG-1556 Vol 18 ConsoHdated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000 that will be ll)ed to perform required surveys We will use instrument) that meet the radiation monitoring instrument specifications published in Appendix J ofNUREGshy1556 Vol 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000 Additionally we will implement the model survey meter calibration program published in Appendix J of NUREG-1556 VoL 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000 We reserve the right to upgrade our survey instruments as necessary

0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No



Radiation Monitoring Instruments (Contd)

OR

bull A description of alternative equipment andor procedures for ensuring that appropriate radiation monitoring equipment will be used during licensed activities and that proper calibration and calibration frequency of survey equipment will be perfonned The statement We reserve the right to upgrade our survey instrument as necessary should be added to the response

0

Material Receipt and Accountability

bull Ordering licensed material and package receipt and opening will follow the model procedures in Appendix K ofNUREG-1556 VoL 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000

0 121

OR

bull Submit a description ofprocedure(s) for ordering licensed material and package receipt and opening

0

AND

bull For unsealed licensed material submit a description of procedure(s) for ensuring material accountability

0

C-19 NUREG - 1556 Vo1l8

APPENDIXC



Occupational Dosimetry

bull We will have a prospective evaluation and deteITIline QJ 0 that unmonitored individuals are not likely to receive in one year a radiation dose in excess of 10 of the allowable limits in 10 CFR Part 20 or we will monitor individuals in accordance with the criteria in the section entitled Occupational Dose in NUREG-1556 Vol 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000

OR

bull A description of an alternate method for demonstrating compliance with the referenced regulations 0

ANDOR

bull Provide a bioassay program when using unsealed radioactive materials If an applicant elects to provide a bioassay program that is less conservative than 0 recommended in Regulatory Guide 820 its rationale should be stated

AND

bull Bioassay programs must include what the applicant considers and acceptable interval or schedule for conducting bioassays identifY action levels or 0 guidelines and describe specific actions to be taken when action levels are exceeded Because of the complex nature ofbioassay and corresponding data analysis it is acceptable for applicants to make reference to the procedures in NRC guidance documents

NUREG - 1556 Vol 18 C-20

APPENDIXC



Occupational Dosimetry (Contd)

OR

bull Contract with an outside group for bioassay services 0 Provide a commitment that each vendor is licensed or otherwise authorized by NRC or Agreement State to provide required bioassay services

Public Dose Need Not Be Submitted With Application

The applicant is not required to and should not submit a response to the public dose section during the licensing phase This matter will be addressed during an inspection

Operating and Emergency Procedures

bull Procedure for obtaining an agreement with customers I2J 0 0 0 outlining the responsibilities of both the customer and service provider when performing service operations at a customers facility

bull Instructions for handling and using licensed materials liZ 0 0 0 bull Instructions for maintaining security during storage and

transportation I2J 0 0 0 bull Instructions to keep licensed material under control and

immediate surveillance during use IZI 0 0 bull Steps to take to keep radiation exposures ALARA bull Steps to maintain accountability during use 0 0 (2J 0 bull Steps to control access to work sites 0 0 IZl 0 bull Steps to take and whom to contact when an emergency 13 0 0 0

occurs 0 0 0 0 bull Instructions for using remote handling tools when

handling sealed sources except low-activity calibration 0 0 liZ 0 sources

bull Methods and occasions for conducting radiation surveys including surveys for detecting contamination aJ 0 0 0

C-21 NUREG - 1556 Vol 18

APPENDIXC


to RADIATION SAFETY PROGRAM (Contd)

Operating and Emergency Procedures (Contd)

bull Procedures to minimize personnel exposure during ~

routine use and in the event of an incident including exposures from inhalation and ingestion of licensed unsealed materials

bull Methods and occasions for locking and securing stored 0 licensed materiallt

bull Procedures for the implementation and adherence to good health physics practices while performing service operations

Minimization ofdistance to areas to the extent ~

practicable where licensed materials are used and stored Maximization of survey frequency within reason to I2J enhance detection of contamination Segregation of radioactive material in waltte storage 0 areas Segregation of sealed sources and tracer materials 0 to prevent cross-contamination Separation of radioactive material from explosives Separation of potentially contaminated areas from clean areas by barriers or other controls I2J

bull Personnel monitoring including bioassays and the use I2J ofpersonnel monitoring equipment

bull Transportation of licensed materials to temporary job I2J sites packaging of licensed materials for transport in vehicles placarding ofvehicles when needed and physically securing licensed materials in transport vehicles during transportation to prevent accidental loss tampering or unauthorized removal

bull Procedures for picking up receiving and opening III packages containing licensed materials in accordance with 10 CFR 201906

bull Instructions for maintaining records in accordance with I2J the regulations and the license conditions

NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0

Description Attached

0

0

Good health physics practices are 0 observed during service

0 provision irradiators

0 featu re fixed sealed sources

0 within high capacity

0 shielding system

0

0

0 Note Further research required

0

0

NlJREG -1556 Vol 18 C-22

APPENDIXC

Item No




bull Procedures for identifYing and reporting to NRC defects and noncompliance as required by 10 CFR 2121(a) of this chapter

bull Procedures and actions to be taken if a sealed source is ruptured including actions to prevent the spread of contamination and minimize inhalation and ingestion of licensed materials and actions to obtain suitable radiation survey instruments

bull Instructions for the proper storage and disposal of radioactive waste

bull Procedures to be followed in the event of uncontrolled release of radioactive unsealed licensed material to the environment including notification ofthe RSO NRC and other Federal and state agencies

bull Procedures for identifying and reporting to ~C defects and noncompliance See Table 84 which describes the typical incident notifications required by NRC regulations

m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys

bull We will survey our facility and maintain contamination levels in accordance with the survey frequencies and contamination levels published in NUREG-1556 Vol 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000

(2J 0

OR

bull Submit description of alternative method for demonstrating how to evaluate a radiological hazard 0

Leak Tests

bull Leak tests when required by the license will be performed at intervals approved by NRC or an Agreement State and specified in the Sealed Source and Device Registration Sheet Leak tests will be performed by an organization authorized by NRC or an Agreement State to provide leak testing services to other licensees or using a leak test kit supplied by an organization authorized by NRC or an Agreement State to provide leak test kits to other licensees and according to the kit suppliers instructions

0 0 0

OR

middot Leak testing will follow the model procedures in Appendix 0 ofNUREG-1556 Vol 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000

IJ 0

NUREG l556 Vol 18 C-24

APPENDIXC

Item No


10 RADIATION SAFETY PROGRAlf (Contd)

Leak Tests (Contd)

OR

bull Leak testing procedures and analysis will be done by the applicant Provide the infonnation in supporting a request to perfonn leak testing Appendix 0 of NUREG-1556 Vol 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000 may serve as guidance

III LJ 0 121

OR

bull We will provide commercial leak test kits as described in the model leak test kit description in Section 898 of NUREG-1556 Vol 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000

0 0 0

AND

bull We will provide leak test kits as described in the model leak test kit description in Section 898 of NUREG-1556 Vol 18

bull Provided is a sample of the leak test kits that will be distributed commercially for each type of sealed sourcedevice combination we plan to provide

0 0 0

0


APPENDIXC


10 RADIATION SAFETY PROGRAlVI (Contd)

Maintenance

bull We will implement and maintain procedures for conducting routine maintenance ofour device according to each manufacturers (or distributors) written recommendations and instructions

OR

bull Alternative procedures are provided for NRCs review bull We will have the device manufacturer (or distributor)

or other person authorized by NRC or an Agreement State to perform non-routine maintenance on our devices

OR

bull Information requested in Appendix P of NUREG-1556 Vol 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000 is provided to support requests to conduct non-routine maintenance procedures

Minimization of Contamination

middot NRC will consider that the criteria for minimization of contamination has been met if the applicants responses satisfY the criteria in the following sections Radioactive Material Unsealed andor Sealed Sources Facilities and Equipment Radiation Safety Program - Safe Use of Radioisotopes and Emergency Procedures Radiation Safety Program - Surveys and Radiation Safety Program - Waste Management


I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC



Transportation No Response is Necessary for this Section

No response is needed from applicants during the licensing phase

Waste Management

bull We will use the model waste procedures published in 0 0 ~

Appendix N ofNUREG-1556 Vol 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000

bull If the applicant wishes to use only selected model 0 0 121 procedures provide a statement that We will use the (specify either (1) Decay-In-Storage or (2) Disposal ofLiquids Into Sanitary Sewerage) model waste procedures that are published in Appendix N of NUREG-1556 VoL 18 Consolidated Guidance About Materials Licenses Program-Specific Guidance About Service Provider Licenses dated November 2000

OR

bull Provided are procedures for waste collection storage 0 and disposal by any of the authorized methods described in this section

OR

bull If access to a radioactive waste burial site is 0 0 I2J 0 unavailable the applicant should request authorization for extended interim storage ofwaste Applicant should refer to NRC IN 90-09 Extended Interim Storage of Low-Level Radioactive Waste by Fuel Cycle and Materials Licensees dated February 1990 for guidance if extended storage is required



APPIICATION FOR MATERIALS LICENCE

NovaMed Corporation

Section 5 RADIOACTIVE MATERIAL

A Radioisotope - Cesium-137

B Chemical andor physical form - Sealed Source Manufacturer - CIS bio international Gif-sur-Yvette Saclay France Model- CSL-15

C Possession Limit - Not to exceed 1870 Ci692 TBq per source 11220 ci4151 TBq total

From one to three Model CSL-15 sources are permanently installed in a Model IBL 437C Irradiator Possession limits are defined to allow temporary possession of two (2) IBL 437C irradiators at a temporary job site requiring irradiator replacement (existing irradiator removal and replacement irradiator installation) The IBL 437C is a category I (self-contained dry source-storage) gamma irradiator See ANSI N4331-1977

Section 6 PURPOSES FOR WHICH LICENSED MATERIAL WILL BE USED

Possession of irradiators at temporary job sites only for possession incident to maintenance repair relocation (packaging and transportation at licensed site) and leak testing of Model IBL 437C irradiators Sealed radioactive sources wi not be installed replaced or disposed of The source shield will not be breached disassembled or modified at any time except for modification to secondary shielding for enhancement of ModellBL 437C irradiators consistent with designs established by Sandia National Laboratories and as described by US NRC regulatory Issue Summary 2008-17 Voluntary Security Enhancements for Self-Contained Irradiators Containing Cesium Chloride Sources



NovaMed Corporation

Section 7 INDIVIDUAL RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR TRAINING EXPERIENCE

See attached NovaMed Organization Chart for RSO reporting

Michael M Thomson Field Service Engineer and Radiation Safety Officer

Michael Thomson has been authorized to use licensed material in the provision of commercial service to Part 36 irradiators since June 1995 under NRC license 20-20973shy04 (terminated 82702) and Massachusetts Radiation Control Program license number 20-9734 currently in effect

Michael Thomson has held the role of Radiation Safety Officer under the MRCP license 20-9734 since 2008 and is qualified in this role per NUREG -1556 Vol 5 Appendix G Consolidated Guidance about Materials Licenses Program Specific Guidance about Self-shielded Irradiator Licenses dated June 1998 (See attached training record)

--

--------

Robert MJZiL~U~~-- Constantine

NovaMed President

I John JaKer

Joan Hall Melissa Bauer C Joseph Carbone Sue E Stanley Regional Director of

Human Resources Customer Support Director of ServiceVP amp CFO Service Ops

Manager Operations Mgr Operrlions(MidAtlantic)

Joseph McGillicuddyI r--shyTimothy Franklin Director of

Sr Imaging I- Business Dev Engineer Shurland Fields Paul Grammer MtdAtanttt SupervisorSupervisor )--

BlOffied SeflIlCe Ops RobertBIOmedIcal Service Ops Bndgeport DeFrancesco

Sales Account Theodore Kosinski Richard Klaff I-----shy

Equipment BMETIIIp0J-ICtr - David Green I-

Specialist ILabl 8ndgaport ~ecu~ rd George Mason U BMETIII I-- -f V Rozovsky J

MasonlCare 8 FTE Site Manager Flteld Svc 2 FTE Jeffrey Dlmitt

lawrence (NY) Thomas

esney Kevin Richir Hostetler Sales Account f-shySite Manager ExecutiveBMETIIIoord I-shyUVA Ma~ PA

---- Tushar Mitra I-- 4Dhr~iman Das J 1~~r~ortESite Manager 8MET t

Hackettstown (NJ) lawrence (NY) i Carol Koumbaros J Drew Sheppard David Reihl Sales amp MktingBMETII f-shy

UVA Philip Perdion EqUipment I- Ad~ni~tSpecialist

M~i~~Repair I-- BndoeportH Ks~drew poniro~w~K~n Tech Anthony COPPOlaJ Fernando Sr Imaging Eng Baystate ~MA SrteMgr Bridgeportin 2FTE Eastem Long I$ (NY) Abrego

BMET IIIIFS r (~L~l - Bridgeport amp SateiliteBMETHI FWilIQServlCe (lAAj Frulhlres vnares gl Field Service

Peabody(pm lFTE yScott Comenzo j H

EngmeerRSO

f---

ITmiddot-Site Mgr Sr Iagirt Eng (MAl Southampion (NY) Jamil Thomas

BMETII f--shy------ Ernie Rau Bridgeport Ronald McCoy H HyunLee ~~aUI cOIi1~~jltopengt Sr Imaging Eng Field Service FS BMETIII FSBMETIII f--- (FS-MA)Field Service t-- iVents AnesthesIa) (Upstate New York) Engineer

Technician tNH ) BaySlale (MA) Marcus J-

ChapmanKeith Golmk MankusGeorge True 8METI AnarewI l~ FSBMET Bndgeport Sr Imagi~ Eng

Intem FS BMETIII f--shy~Mlford 4 ns 6)[-- y

ByIMAI t-- Special~

ii DePina I Robert Morin I ltopengt BMETI Imaging EngllValentin Boyo - I-shy

I MIlitary Leave I (Mway-LOA) ~ FS BMET- Biomed Tech ell Eng Inlem FS BMETIII thru OcU NOli(Sterlhzersl (FS-CT)BaystateMAj 2012

Tell1Pi~e~I11i1 PtT

y --

pharmalucence t ~ 1 ~ -bullbullbullbullbullbull shy

CERTIFICATE OF TRAINING

RADIATION SAFETY AND

REGULATORY COMPLIANCE

Has completed AUGMENTED ANNUAL TRAINING per Section 120753 Code ofMassachusetts Regulation lOS Applicable to Activities and responsibility authorized in

Massachusetts Material License No 20-9734 to INSTALL amp SERVICE GAMMA IRRADIATORS

Training Venue Pharmalucence -Reviewed and updated Field Service Engineers Compliance Book Reviewed and updated NRC and Agreement State notification procedures and forms and covered safety and

security procedures for irradiators Discussed CRCPD documentation (Radiological Dispersive Device Guide to First responders and handout) on radiation incidents Discussed FDA dose requirements and how to

address FDA questions with customers 175 Hours

Attest Dated November 120]]liJJ 1n~ Michael M Thomson Radiation Safety Officer

CIS-USInc 10 DeAngelo Drive BedfordMA01730 (781)275-7120 bull Fax (781) 275-5191

wwwcisusinccom

alucencemiddot p~~r11 ~

lSI bullbullbullbullbull




II II

Has completed AUGMENTED ANNUAL TRAINING per Section 120753 Code ofMassachusetts Regulation 105

Applicable to Activities and responsibilities authorized ill Massachusetts Material License No 20-9734 to

INSTALL amp SERVICE GAMMA IRRADIATORS

Training Venue DL Flight 0441-middotReviewed and updated Operating Procedure Tcmporary Job Site Field Service Operating Procedure Temporary Job Site Installation Emergency I Precautionary Procedures shy

Temporary Job Site and Reviewed Sealed Source Leak Test Procedure Also reviewed pertinent NRC Incident Reports

Attest-LriwJJ~middot Dated November 7 2010 ~~7n~~~~--==shyMichael M Thomson Radiation Safety Officer

CIS-US Inc 10 De Angelo Drive Bedford MA 01730 (781) 275-7120 Fax (781) 275-5191

wwwcisusinccom

pharmalucence ~t 3 J 4l t

I bull-bullbullbullbullbullbull shyCERTIFICATE OF TRAINING



Has completed AUGMENTED ANNUAL TRAINING per S~tion 120753 Code ofMassachusetts Regulation 105 Applicable to Activities and responsibilitie authorized in


Training Venue ill Hotel Richmond VA - Surveys leak testing and new jig associated with Voluntary Security Enhancement Reviewed and updated Field service Engineers Field Book Reviewed Voluntary

Security Enhancement paperwork and security procedures

Attest Dated November 30 20092tid-L 17 ---shyMichael M Thomson Radiation Safety Officer

CIS-US Inc lODe Angelo Drive bull BedfordMA01730 bull (781)275-7120 bull Fax (781) 275-5191

wwwcisusinccom

tr ph~rmaLucence - bullbullbullbullbullbullbullbullshy




I I Has completed AUGMENTED ANNUAL TRAINING per Section 120753 Code of Massachusetts Regulation 105 Applicable to Activities and responsibilitie authorized in


Training Venue Memorial Sloan Cancer Center New York New York by Sandia National Laboratories Subject Hardening of Irradiators

Attest--21i-LI~~=----1J~~~~--===-_ Dated September 18 2008 Michael M Thomson Radiation Safety Officer

CIS-USInc 10 DeAngelo Drive bull BedfordMAOl730 bull 78l)275-7120 bull Fax781)275-5191

wwwcisusinccom

CISmiddotUS Inc ~ ----~




Has completed AUGMENTED ANNUAL TRAINING per Section 120753 Code ofMassachusetts Regulation 105 Applicable to Activities and responsibilitie authorized in


Training Venue Manufacturers Meetings Sandia National Laboratories Albequerque NM

Attest--~7~~-----17---=--~----=--=------=--_ Dated Marcb amp November 2007 Michael M Thomson Reciiation Safety Officer

CIS-US Inc bull 10 De Angelo Drive bull Bedford MA 01730 (781) 275-7120 Pax (781) 275-5191

wwwcisusinccom

pharmalucence -== -- =~-shy- RADIOLOGICAL TRAINING AND EXPERIENCE

Michael M Thomson Field Service Engineer

FORMAL TRAINING IN RADIATION SAFETY Field ofTrainin

a Radiation Physics amp Instrumentation

b Principles amp Practices of Radiation Protection

c Mathematics Pertaining to Use and Measurement of Radioactivity

Biological Effects of Ionizing Radiation ampRisks of Occupational Exposure

e Safety amp Regulatory Issues for IBL 437C Field Service

CIS-US Radiation Safety Course (695)

CIS-US Radiation Safety Training Course (695) 4 4

CIS-US Radiation Safety Training Course (6195)



USNRC Rgn IV Protective Measures Workshop 61504 NRC Increased RM Access ControlsMampD Orders CY2006 Auamented Annual Trainina Sessions (Last 3107 amp 1107)

2

8 8

60

EXPERIENCE WITH RADIATION (Actual use of Radionuclides or Equivalent Experience)

y

Guy Turqwt de Beauregard General Manager Emsll gturquetclsbocom

Mr Glenn ALTO CIS-US Inc 10 DeAngelo Drive

Bedford Ma 01730 USA

QLBf OJ07-361CDIID Saelay September 411gt 2007

Dear Mr AIIo

In response to the recent divestiture by CIS blo international of its company CIS-US Inc to the CISshyUS manapment team we hereby acknowledges that

bull CIS-US Ine 10 DeAngelo Drive Bedford MA 01730 continues tobe the xelus~ field service provider for the CIS bio international Modellel 437C blood irradiator systems WithIn the respective jurisdictions of the US NRC and its Agreement States

bull fltOllald G McCoy and Michael M Thomson employaea of CIS-US Inc have 8IlCIUed many years of field service experience since lheir factory-training at CIS blo International faeilltles in belay [FRANce in 1991 and 1996 NSpectively They have beensuceessfully evaluatecl and authorized through US NRC-ordered security cearences to rJeId-service the ModetlBl 437C Irradiators

CIS bIo international is pleased to support CIS-US Inc in its continuing commitment to maintain and operate under the guidance of NRC and Agreement state security polioy

Sincerely

4~ Guy TUAaUET de BEAUREGARD Ganeral Manager CIS bio international

CiS blo ifltemaWtull ~ SAS u Gapllwl tie 311)00 000 EU()$ 5111 Saelov(E bullbullOI1oe)middot RN 306 bull BP 32 - 911Q2 GlfmiddoturYWlI Cedex - __ - T 33 (0)1 1185 70 70 _ F -33 (0)1 698510 71 bull WWWClbiointe lioolfr

Res evry B 312 261 894 - N klOfIIIflcUon TVA PR ltl312 261 8114

UNITED STATES NUCLEAR REGULATORY COMMISSION

WASHINGTON DC 20555middot0001

OFFICIAL USE ONLY

November 25 2003

Paul M Tyree CIS-US Inc 10 Deangelo Drive Bedford MA 01730

SUBJECT INITIAL AUTHORIZATION FOR ACCESS TO SAFEGUARDS INFORMATION AND ISSUANCE OF ORDER IMPOSING REQUIREMENTS FOR PROTECTING CERTAIN SAFEGUARDS INFORMATION

Dear Mr Tyree

In order to facilitate enhancement of security at your facility in Bedford MA I am granting initial authorization for the following personnel to view discuss and receive material designated as Safeguards Information (SGI) This authorization is based on the information provided in the transmittal of November 19 2003 from Paul M Tyree Corporate Radiation Safety Officer regarding the trustworthiness and reliability of the named individuals

PositionfTitle

1 Michael M Thomson Field Service Engineer 2 Ronald G McCoy Field Service Engineer 3 Paul M Tyree Corporate Radiation Safety Officer

Safeguards Information must be protected from unauthorized disclosure in accordance with Section 147 Atomic Energy Act of 1954 as amended and handled in accordance with specific requirements that the Commission may impose The enclosed Regulatory Issue Summary (RIS) 2003-08 issued on AprH 3D 2003 provided additional information conceming the importance of protecting SGI

OFFICIAL USE ONLY May be exempt from public release under the Freedom 01 Inlom1ation Act (5 USC 552)

Exemption number __2_ Nuclear Regulatol) Commission review required before public release

M 0 Layton NSIRIONSIMTWS Name and organization 01 person making determination

Oata of Determination ___1w112~512003=-___

OFFICIAL USE ONLY

-2shyOFFICIAL USE ONLY

The US Nuclear Regulatory Commission (NRC) will maintain these individuals as your points of contact for receiving SGI that may be included in any future correspondence Please notify the Office of Nuclear Security and Incident Response (at the contact listed below) when any of these individuals are no longer authorized to receive SGI If you authorize a new point of contact as a replacement please provide the basis for your determination that the new individual has an established need to know and is trustworthy and reliable If you subsequently authorize other individuals to have access to SGI you do not have to notify NRC We request that you keep at least one individual on this list as your pOint of contact for receiving SG

If you have any questions about this letter you can contact Fritz Sturz Office of Nuclear Security and Incident Response at the phone number 301-415-6678 or bye-mall at fcsnrcgov

Sincerely

~-4J~-k- Thomas H Essig Chief

Materials Safety and Inspeotion Branch Division of Industrial and Medical

Nudear Safety Office of Nuclear Material Safety

and Safeguards

Enclosure RIS 2003-08

MA License No 20-9734

OFFICIAL USE ONLY

10 DeAngelo Drive Bedford Massachusetts 01730 7812757125 (F) 7812755191

November 72003

US Nuclear Regulatory Commission Director Division of Nuclear Security Office of Nuclear Security and Incident Response Mail Stop T-4D8 Washington DC 20555

Sub Registration to receive information re enhanced security of radioactive material in response to USNRC letter dated 31-0CT-03

Dear SirMadam

CIS-US Inc hereby designates and vouches for the following key individuals to receive NRC authorized access to certain Safeguards Information

Michael M Thomson Field Service Engineer been authorized by the current MAlRCP and precedent USNRC since 23-JUN-9S

Ronald G McCoy Field Service Engineer authorized by the current MAlRCP and 29-APR-98

Ron has been licenses since

been the RS 0 for all of and Manages reciprocity arrangements for irradiator field service in other Agreement States and in NRC jurisdictions

CISmiddotUS Inc affirms that all measures prescribed in Enclosure 2 of the subject NRC letter will be implemented to protect Safeguards Information that it may possess or control

Thank you for your consideration and timely confirmation of our actions in this matter Please fee free to contact me immediately with any questions or concerns

Sincerely Paul M Tyree Radiation Safety Officer X 3020 ptyrcccisusinccom

PERSONAL INFORMATION WAS REMOVED ~y NRC NO COpy OF THIS INFORMATION VAS RETAINED BY THE NRC

phlilrmalucence ~~~~~i~~jl

PHARMALUCENCE COMPETENCY EVALUATION

Employee Name Mike Thomson

Date 2012

Title Field Service Engineer

Signed

~n~ Employee

Date

29 Duntmm itnCld bull Hill Mf 01R2 bull Phon 71l1~15721J Fax nn2iSH1 WIiliphllrlllaluccllcecon



Date 112011

Review Period 2010


x

x No installationsRelocations

x

x

We no longer attend trade Attend trade shows and specific training programs as needed X shows Looking to attend

RSO soon

Performs duties of Radiation Safety Officer and works with office staff to obtain reciprocity and make appropriate X

)Z7L~ Employee Date I

-~----Date

Fcommonhrcompetency evaluationyour title



Date 112010

Review Period 2009 shy 2010


and appropriate spare parts inventory C0l1~j1ermQ availability lead time from equipment

Monitor service contract administration develop correspondence and reports as needed for customers or other V

Abo() Employee Date (

f7--Iu---__ Date




Date 112010

Review Period 2009 -2010


nn~ventltie maintenance and service for equipment CIS-US in the United States

Assist development projects related to equipment sold or specific after-sale services offered by the

iill and provide training classes

Maintain and appropriate spare parts inventory considering availability lead time from equipment manufacturer Monitor service contract administration develop correspondence and reports as needed for customers or other More work needs 10 be done in this area

Sign~7L Employee

SUP~~S3 Date


CIS-US COMPETENCY EVALUATION Employee Name Michael 1110mson Date 12709 Review Period 2108-13109 Title Field Service Engineer

PerfOffil preventative maintenance and service for equipment sold and serviced by CIS-US in the United States Assist In technical development projects related to equipment sold or specific after-sale services offered by Ithe

trammg classes Maintain adequate and appropriate spare parts inventory considering availability lead time from equipment manufacturer JVIpound1nmr service contract develop correspondence and reports as needed for customers or other cIr111mfmt~

programs as

Signed

~d~ Employee Date

Date

Fcommonhtcompetency evaluation your title



NovaMed Corporation

SECTION 8 TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS



Ronald G McCoy Field Service Engineer

Ronald McCoy has been authorized to use licensed material in the provision of commercial service to Part 36 irradiators since May 1998 under NRC license 20-20973shy04 (terminated 82702) and Massachusetts Radiation Control Program license number 20-9734 currently in effect (See attached training record)

No Ancillary Personnel are associated with the purposes for which the licensed material will be used

pharmaLucenceI J 10 ~ bull bullbullbullbullbullbullbull shy




Has completed AUGMENTED ANNUAL TRAINING per Section 120753 Code ofMassachusetts Regulation 105 Applicable to Activities and responsibility authorized in

Massachusetts Material License No 20middot9734 to INSTALL amp SERVICE GAMMA IRRADIATORS

Training Venue Pharmaluoenee-Reviewed and updated Field Service Engineers Compliance Book Reviewed and updated NRC and Agreement State notification procedures and forms and covered safety and



Dated November I 2011 Michael M Thomson Radiation Safety Officer

Attest~~-6middot~--11~~~~~_

CISmiddotUSInc 10 De Angelo Drive BedfordMAOl730 (781)275middot7120 Fax(781)275middot5191

wwwcisusinccom

bullbullbullbullbullbullbullbullbullbullbull bullbullbullbull bull lt pharmaLucence

bullbullbullbullbullbull~ it




I I Has completed AUGMENTED ANNUAL TRAINING per Section 120753 Code of Massachusetts Regulation 105 Applicable to Activities and responsibilities authorized in


Training Venue DL Flight 044I-Reviewed and updated Operating Procedure Temporary Job Site Field Service Operating Procedure Temporary Job Site Installation Emergency Precautionary Proceduresshy


Attest~ 11 ~-c--c-- Dated November 7 20W Michael M Thomson Radiation Safety Officer

CISmiddotUSInc lODe Angelo Drive BedfordMAOl730 (781)275middot7120 Fax(781)27S-5191

wwwcisusinccom

pharmaLucence l J it ~ bull to bull bullbullbullbullbullbull shy




Has completed AUGMENTED ANNUAL TRAINING per Section 120753 Code of Massachusetts Regulation 105 Applicable to Activities and responsibilitie authorized in


Training Venue HI Hotel Richmond VA - Surveys leak testing and new jig associated with Voluntary Security Enhancement Reviewed and updated Field Service Engineers Field Book Reviewed Voluntary


Altest--olJiJJ~middotlt===-_11----~~=-=--middot=--_ Dated November 30 2009 Michael M Thomson Radiation Safety Officer

CIS-US Inc 10 De Angelo Drive Bedford MA 01730 (781) 275-7120 bull Fax (781) 275middot5191

wwwcisusinccom

pharmalucence III bull II I gt bull bullbullbullbull






Training Venue Memorial Sloan Cancer Center New York New York by Sandia National Laboratories Subject Hardening ofllTadiators

Dated September 18 2008 Michael M Thomson Radiation Safety Officer

Attest~ tJJtL--shy

CIS-USlnc bull 10 De Angelo Drive BedfurdMAOI730 (781)275-7120 Fax(781)275-5191

wwwcisusinccom





Has completed AUGMENTED ANNUAL TRAINING per Section 120753 Code ofMlssachusetts Regulation lOS Applicable to Activities and responsibilitie authorized in


Training Venue Manufacturers Meetings Sandia National Laboratories Alblquerque NM

Dated March amp November 2007 Attest~~7~~---J17~~~7+~~Michael M TIlomson Radiation Safety Officer

crs-us Inc 10 De Angelo Drive Bedford 11-1A 01730 bull (781) 275-7120 Fax (781) 275middot5191

wwwcisusinccom

CIS-US Inc

CERTIFICATE TRAININGOF



Ronald G McCoy

Has completed AUGMENTED ANNUAL TRAINING per

Section 120753 Code of Massachusetts Regulation 105

Applicable to activities and responsibilities authorized in

Massachusetts Materials License No 20-9734 to

INSTALL amp SERVICE GAMMA IRRADIATORS [SC-DSSj

Dated November 28 2006Attest----~~__----___--shyPaul M Tyree Corporate RSO

ClS-USIHCbullbull 10 De Ango Drive bull Bedloro MA 01730 bull (781) 275-7120 bull Fall F8i) 275-5191 Wyvyi cisuSViccom

RADIOLOGICAL TRAINING AND E PERIENCE

Rna1I G McC Field Service Engineer

FORMAL TRAINING IN RADIATION SAFETY

I Field of Training I Localion(s) and Dales) ofTraining Type amp Len1ilh ofTraining lecture amp SuDetVised

Trainill(l~~ a Radiation Physics amp CISmiddotUS Radiation Safety Training Course (3198) 6 2

Instrumentallon

b Principles amp Practices CIS-US Radiation Safety Training Course (3198) 4 4 of RadiatiOn Protectlon

c MathematiCS Pertaining CISmiddotUS Radiation Safety Training Course (3198) 1 to Use and Measurement of Radioactivity

d Biological Effects of Ionizing CISmiddotUS Radiation Safety Training Course (3198) 1 Radiation amp RIsks of Occupational Exposures

e Safety amp Regulatory Issues CIS-US Radiation Safety Training Course (3198) 2 for Irradiator Field Service Augmented Annual Training Sessions (last 11(6) 36

CY 2006middotgt NRC Increased RM Access Controls Mamp 0 Orders 8

E PERIENCE IT RADIATION (Actual Use of Radionuclides or Equivalent Experience) Type I Source($ I Where Experience was Gained I Duratlon I Scope of Use

r Csmiddot137 Irradiators CISmiddotUS Inc Irradiator Field Service 519apresent 3 f Cs-137 irradiators CISmiddotUS amp CBI factory training SaClay FRANCE middot4198 12

Xmiddotray Xmiddotray machines medical General Electric 71 middot74 4

Ii~ 9f 11Ii -~~X 1 Field service trainee for installation and maintenance of se-oss Gamma Irraol8tors 2 Manufacturers service trainee for installation and maintenance of SCooSS Gamma irradiators 3 Ucenseauthorized Field Service Engineer 4 Installation amp Maintenance of medical X-rav equipment

R11106 - PMT

Guy Turquet de Beauregard General Manager Email gturquetcisblocom



2lBIf DJ07middot361CDIID Saclay September 4111 2007

Dear Mr Alto

In response to the recent divestiture by CIS bio International of Its company CIS-US Inc to the CISshyUS management team we hereby acknowledges that

bull CISmiddotUS Inc 10 DeAngelo DrIve Bedford MA 01730 continues to be the exelusive field service provider for the CIS bIo international MedallBL 437C blood Imldlator systems within the respective jurisdictions of the US NRC anlt its Agreement Stetes

bull Ronald G McCoy and Michael M Thomson employees of CIS-US loc have accrued many years of field service experience since their factory-training at CIS blo Intematlonal facilities In Sadey [FRANCE] in 1998 and 1995 respectively They have been successfully evaluated and authorized through US NRCordered security clearances to fleld-servlce the Medel IBL 437C irradiators

CIS blo International Is pleased to support CIS-US Inc In its continuing commitment to maintain and operate under the guidance of NRC and Ag~ment State security policy

Sincerely

~~ Guy TURQUET de BEAUREGARD General Manager CIS blo International


WASHINGTON DC 20555-0001

OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle


Safeguards Information must be protected from unauthorized disclosure in accordance with Section 147 Atomic Energy Act of 1954 as amended and handled in accordance with specific requirements that the Commission may impose The enclosed Regulatory Issue Summary (RIS) 2003-08 issued on April 30 2003 provided additional information concerning the importance of protecting SGI

OFFICIAL USE ONLY May be exempt from publlo mlease under the Freedom of Information Act (5 USC 552)

Exemption number __2 _ Nuclear Regulatory Commission review required before public release

M C Laylon NSIRIDNSlMTWS Name and organization of person making determination

Date of Determination 1112512003

OFFICIAL USE ONLY


November 7 2003

US Nuclear Regulatory Commission Director Division of Nuclear Security Office of Nuclear Security and Incident Response Mail Stop T -4D8 Washington DC 20555

Sub Registration to receive information fe enhanced security of radioactive material in response to USN RC letter dated 31-0CT-03

Dear SirMadam

CISmiddotUS Inc hereby designates and vouches for the following key individuals to receive NRC authorized access to certain Safeguards Information

Michael M Thomson Field Service En ineer ike has been authorized by the current MNRCP and prece ent USNRC irradiator service licenses since 23middotJUNmiddot95

I~~ has been II licenses since


Thank you for your consideration and timely confirmation of our actions in this matter Please feel free to contact me immediately with any questions or concerns

Sincerely Paul M Tyree Radiation Safety Officer X 3020 ptyreecisusinccom

PERSONAL INFORMATION WAS REMOVED BY NRC NO COPY OF THIS INFORMATION VAS RETAINED BY THE NRC

middot2shyOFFICIAL USE ONLY

The US Nuclear Regulatory Commission (NRC) will maintain these individuals as your points of contact for receiving S61 that may be Included in any future correspondence Please notify the Office of Nuclear Security and Incident Response (at the contact listed below) when any of these individuals are no longer authorized to receive S6 If you authorize a new point of contact as a replacement please provide the basis for your determination that the new individual has an established need to know and is trustworthy and reliable If you subsequently authorize other individuals to have access to S61 you do not have to notify NRC We request that you keep at least one individual on this list as your paint of contact for receiving S6

If you have any questions about this letter you can contact Fritz Sturz Office of Nuclear Security and Incident Response at the phone number 301-415-6678 or bye-mail at fcsnrcgov

Sincerely

~ltJ~or Thomas H Essig Chief

Materials Safety and Inspection Branch Division of Industrial and Medical

Nuclear Safety Office of Nuclear Material Safety

and Safeguards



OFFICIAL USE ONLY

_C~IS_-U_S_I_nc_______________________-lt~ Subsidiary of CIS bio intematlonal ~

o TRAINING CERTIFICATION FOR CIS-US FIELD ENGINEERS

IBL 437C PRODUCT IRRADIATOR

FUNCTION DATE LOCATION INSTRUCTORS SIGNATURE

IIntroduction of the operation and 112798 Hackensack Med CII aid ~~ component location ofthe IBL

2 Observation of a PM on the ISL 128198 Hackell$ack Med CII tZJ~tJN~according to the attached PM checklist

3 Perform a P M on the IBL model H 112998 Stamford Hospital ~ under the instructors guidance according to the attached checklist

4 Perform a PM on the IBL model G 3111198 Hudson Valley Blood Clr ~~~ o under the instructors guidance according to the attached checklist

5 Perform a PM on the IBL H without 112998 Stamford Hospital ~wcSbtc~direct instructors supervision according to the attached checklist

6 Observe and assist with an lBL 112198 Hackensack Moo Ctr ~M~ installation performed by the instructor according to the attached checklist

This is to certifY that Ronald G McCoy has completed the necessary training course and authorizes Ronald G McCoy to conduct PMs and emergency service on CIS-US IBL 437C

~QMC~ CSusInc authorized signature

Eie-(U S~4 elfpound Title

r Date

Cl8-USINC bull 100eAngeloDrive bull 8eofordMA 01730 bull (781)275-7120 bull Fax(781)27SmiddotS191 mail()is-usccmaiicompuservecom

c

o CIS bio international

We certifY the successful participation of

RONMCCOY CIS-US

to our technical training course From Feb 23th to Feb 26th 1998 in Sac1ay FRANCE

He is able to provide installation technical service preventive maintenance of the

IBL 437 C

He is able to loadunload IBL 437 C intofrom the transport container CC30

shy__ ~X-tifA

~~ Michel DEZANDEE - Yves LACROIX Course Instructor International Service Manager

o CIS bio international GloLJpeORIS

BP 32 91192 GIF-$UR-YVETT EDEX - ~ANCE - Telephone (1) 69857280 et 7281

pharmaLucence -~ii-~)

PHARMALUCENCE COMPETENCY EVAIUATION

Employee Name Ron McCoy

Date 2012

Tide Field Service Engineer

Date

29 Dunham Road Billerica MA 01821 bull Phone 7812757120 Fax 7812755191 wwwpharmalucencecom

PHARMALDCENCE COMPETENCY EVAIDATION


Date 112011

Review Period 2010


AssIst in technical development projects X equipment sold or specific after-sale services offered by the

eqluplnellt and provide training X

iVUll adequate and appropriate spare parts mvemorv considering availability lead time from equipment manufacturer Monitor service contract administration develop X correspondence and reports as needed for customers or other

Date

w4 Date

Fcommonhrcompetency evaluationyour tide


Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010


Has employee demonsttated competence in the following position responsibilities Perform preventative maintenance and service for equipment sold and serviced by CIS-US in the United States IAssist in technical development projects related to equipment sold or specific after-sale services offered by the

companraquo Perform installations of equipment and provide training classes on equipment operation Maintain adequate and appropriate spare parts inventory considering availability lead time from equipment manufacturer Monitor service contract administration develop correspondence and reports as needed for custcmers or other departments Attend trade shows and specific training programs as needed Additional Conmetlt11~~

gA1)O~3 0+

Yes No

1 y V y I

y I

YES=Optional NOzRecuires a comment

I

I

I

i

Date

Date


NRC FORM 313 us NUCLEAR REGULATORY COMMISSION


NovaMed Corporation

SECTION 9 FACILITIES AND EQUIPMENT

Per Appendix C NUREG - 1566 vol 18 no response is required for facilities defined as temporary job sites All activities under the requested license are performed at temporary job sites (licensed hospitals and blood banks) and are activities performed on sealed sources in a sealed container (irradiator)

SECTION 10 RADIATION SAFETY PROGRAM

See attached policies and procedures

SECTION 11 WASTE MANAGEMENT

No radioactive waste is generated in the provision of IBL 437C irradiator services

~~ NovaMed

Radiation Safety Program Manual Appendix A

EMPLOYEE RADIATION SAFETY TRAINING PROGRAM

10 General

11 Company employee radiation safety training program is at a minimum composed of a lecturedemonstration written information retention survey and on-the-job training These shall be conducted by the Radiation Safety Officer or his designee and the employees training supervisor

12 Individuals will be assigned to act in the capacity of an occupational worker when such individual has satisfactorily completed the appropriate training and qualification program described in this section

20 Occupational Worker Training and Qualification

21 An individual assigned as an Occupational Worker must complete the following training program Upon completion a written information retention survey shall be administered to monitor training effectiveness

22 On-the-job training shall be provided by the individuals training supervisor and the Radiation Safety Officer or his designee who are jointly responsible to ensure the effectiveness of initial and ongoing training

23 The subjects given in table 1 shall as a minimum be included in the occupational worker training program

T bl 1 (T t 0a e rammg or ccupatlOna I W k )or ers Classroom time (hr Olerational time Subject

[hrJ 4 0 Introduction

Course Requirements Fundamentals of Radiation

3 1 Biological Effects from Radiation Risks from Radiation Exposure Sources of Radiation Exposure ALARA Radiation Protection Personnel Dosimetry

Table 1 (continued)

IRadiation Detection

wwwnovamedcmmiddotpcom

~~ NovaMed

Survey Instruments Radiation Counting Systems Radiation Measurements Using Radiation Quantities Using Radiation Units

3 1 Radiation Protection Standards and Regulations Regulatory Compliance Issues Emergencies amp Accidents Information Retention Survey

30 Annual Refresher and Update Training

31 Each Occupational Worker must attend a minimum of one periodic training session each year These sessions shall be conducted by the Radiation Safety Officer or his designee The purpose and scope of this training may include one or all of the subjects listed in table 2

T ble 2 (A e res h JPC ate Tmiddotmiddota nnua1 R f erandUd rammg)

Classroom time Olerational time Subject (hrJ (hrJ

10 10 Radiation amp Radioactivity Survey Methods Specific Radioactivity Measurement Procedures

20 10 Radiation Protection- Problems and Methods ALARA Goals and Methods Review of Emergency Plans amp Procedures Review of LaboratoryArea Safety Instructions

20 00 RadiationlRadioactivity Units and Uses Statistics in radioactivity Measurements Shielding amp Distance Exposure Factors

10 00 New Regulatory Issues

I

wwwnonunedcorpcom 2

Radiation Safety Procedure ~~ Safe Use of Radionuclides NovaMed of 3RSP-0011

Safe Use of Radionuclides

Approved by Date

Michael M Thomson RSO 01Aug2012

Issued by Date

NovaMed Corporation Trumbull CT 01Aug2012

Supersedes updates Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2

40 Radioactive Material Storage 2

50 Personnel Monitoring 2

60 Surveys 3

70 Radiation Safety Equipment and Protective Apparel 3

80 General Instructions 3

wwwnovamedcorpcom

Radiation Safety Procedure ~~ Safe Use of Radionuclides NovaMed Page 2 of 3RSP-0011

10 Purpose

The purpose of this procedure is to ensure the safe use of radioactive materials and to ensure exposure to radioactive material (RAM) is minimized during performance of service on the IBL 437 C irradiator

20 Responsibility

It is the responsibility of all employees to adhere to this policy and to maintain safety in handling radioactive material

30 General

31 Only trained and authorized personnel are permitted to perform service activities on the IBL 437 C irradiator - Authorized Users (AUs)

32 Any untrained personnel who need to perform service as part of company training or for any reason must be accompanied by the RSOARSO or designee at all times while performing IBL 437 C service

33 Personnel working on the IBL 437 C and the area in which it is installed shall practice good hygiene Hands shall be thoroughly washed prior to leaving the area and prior to eating drinking or smoking

34 Eating drinking smoking or storing food in the laboratory or any area that contains radioactive material is strictly prohibited

35 Gloves must be worn as appropriate when performing IBL 437 C service to protect against any residual biohazard associated with blood handling Follow the same procedures as the facility personnel when working with the device

40 Radioactive Material Storage

Radioactive material possession or storage is not permitted under our license

50 Personnel Monitoring

51 All individuals approved and consenting to work or frequent restricted areas per sect 120226 criteria are assigned personal dosimeters (DOE SDE Landauer Type P1 Luxeltm OSL bimonthly reporting Visitor badges are issued to public members for RSO-approved temporary access Individuals who work in areas adjacent to those in which radioactive material is used may also receive a dosimeter to ensure that their annual exposure is lt100 millirem

wwwnovamedcorJlcom


52 See RSP-005 - Personnel Monitoring for further information and instruction

60 Surveys

61 See RSP-006 - Surveys for further information and instruction

70 Radiation Safety Equipment and Protective Apparel

71 Safety equipment and materials are to be available to facilitate safe use and to keep personnel exposures ALARA

To include

bull Survey Meters and Laboratory Monitors

72 Protective apparel includes lab coat disposable gloves shoe covers and safety glasses

80 General Instructions

81 A list of general instructions is contained in the Field Service Compliance Manual carried by every Field Service Engineer posted in restricted areas to supplement training by reminding trained personnel to use safety equipment and protective apparel and to practice monitoring and housekeeping procedures that have been demonstrated to be cardinal in safe handling of radioactive materials

82 See Form RSP-001-FR

11

wwwnovamedcorpcom

Radiation Safety Program

~~ Procedure RSP-0021 NovaMed Radiological Emergency Procedures

Radiological Emergency Procedures

Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background

40 Radioactive Material Leakage

50 Decontamination of Personnel

60 Documentation

70 Emergency Response Personnel

80 Theft or Loss of Radioactive Material

Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom


~~ Procedure RSP-0021 Page 2 of 6 NovaMed Radiological Emergency Procedures

10 Purpose

The purpose of this procedure is to outline the steps to be taken in the event of an emergency involving radioactive material derived from the IBL 437C irradiator

20 Responsibility

It is the responsibility of all personnel that service the IBL 437C irradiator to adhere to this procedure

30 Background

The company provides field service restricted to the purposes authorized under either NRC or Agreement State licensure All services provided are performed at temporary job sites which hold an NRC or Agreement State license All service operations are performed with recognition of the operational requirements of the temporary job sites license

The IBL 437C irradiator may contain between one to three sealed sources containing Cs-137 chloride within double stainless steel capsules Each source may contain activity up to 1870 Ci (761) The sealed sources are fixed in position and are fully shielded in all directions These sources are inaccessible to operators and field service personnel and may only be accessed by dismantling of the irradiator shielding using specialized equipment within a hot cell

The companys emergency procedures are designed to address the event of escape of radioactive Cs-137 chloride from a sealed source There are no other radioactive materials associated with the IBL 437C

There are a significant number of IBL 437C Blood Irradiators installed within the United States There has never been any incident of measurable quantities of Cs-137 chloride coming from an IBL 437C sealed source The company views its safety program within the context of Risk which is defined

Risk = Hazard X Exposure where

Hazard =the potential for adverse health effect

Exposure = frequency of contact with the hazardous material

Historical exposure events associated with Cs-137 escaping the doubly encapsulated fixed sealed sources in the IBL 437C Blood Irradiator is zero

wwwnovamedcorpcom



When determining risk of radiation exposure we can calculate in retrospect that it is zero

Risk = High Hazard X 0 Exposures = Zero (0)

However due to the high hazard associated with high concentration Cs-137 chloride exposure we have implemented the following safety program

The principles of Time Distance and Shielding will form the basis of our response to any radiological event

40 Radioactive material leakage

41 Prior to performing IBL 437C irradiator field service the Field Service Engineer (FSE) will perform a radiation survey per RSP- 0061 If any reading is greater than historically expected for the number of sources in the device or greater than 25 mRh the facility RSO will be contacted immediately and informed of the readings

A reading below 01 rem (1 mSv) in 1 hour at 30 cm from the device (High Radiation Area) - No evacuation further study to determine the source using safe practices and PPE as appropriate

Above 01 rem(1 mSv) in 1 hour at 30 cm from the device (High Radiation Area) - Immediately evacuate all personnel to a safe distance and define the (High radiation Area) with postings and exclusion tape Note that depending on the level of contamination there may be a Very High radiation area contained within the (High Radiation Area)

Definitions

High radiation area means an area accessible to individuals in which radiation levels from radiation sources external to the body could result in an individual receiving a dose equivalent in excess of 01 rem (1 mSv) in 1 hour at 30 centimeters from the radiation source or 30 centimeters from any surface that the radiation penetrates

Very high radiation area means an area accessible to individuals in

which radiation levels from radiation sources external to the body

could result in an individual receiving an absorbed dose in excess of

wwwnovamedcorpcom


Procedure RSP-0021 Page 4 of 6 ~fampJNovaMed Radiological Emergency Procedures

500 rads (5 grays) in 1 hour at 1 meter from a radiation source or 1

meter from any surface that the radiation penetrates

(Note At very high doses received at high dose rates units of

absorbed dose (eg rads and grays) are appropriate rather than

units of dose equivalent (eg rems and sieverts))

42 Notify all personnel in the area Carefully move all personnel out of the area using a survey meter to ascertain contamination Assure that no contamination is being brought out of the restricted area on clothing or shoe covers

43 Notify the RSO (Facility and NovaMed) and Supervision immediately Further management of the radioactive contamination event is to be addressed by the RSO of the licensed site Company FSE personnel will consult for and collaborate with the site RSO The facility RSO shall be responsible for timely notification of the appropriate regulatory authorities

44 Only a minimum crew of experienced qualified personnel necessary to deal with a radioactive contamination event should enterremain in the area Carefully monitor skin clothing shoes etc of all personnel leaving the contaminated area

45 Control and decontaminate the area as follows

451 Put on proper Personal Protective Equipment (PPE) as instructed by site RSO

452 Isolate the IBL 437 C irradiator with supplemental shielding material to limit exposure A Plastic barrier taped to the floor may be appropriate to prevent further dispersal of leaking source material

453 Mark off contaminated area and restrict traffic to that area

454 Do not allow anyone to leave the area of the leak without first being monitored for contamination

455 Begin decontamination procedures as soon as possible but not without direction of the RSO and Supervision Cs-137 chloride is a salt and is water soluble Aqueous cleaning agents should be used Begin at the outer most edge of the contaminated area and work inward reducing the contaminated area Personnel

wwwnovamedcOImiddotpcom



specifically trained and qualified to address radioactive contamination should be employed to address decontamination

456 Isolate all contaminated cleaning materials and PPE into properly labeled plastic bags for transfer to radioactive waste Cs-137 has a half-life of -30 years and must be disposed as radioactive waste and not held for decay

457 Survey the area with a calibrated survey meter to monitor the effectiveness of the decontamination procedure and to ensure there is no spread of the contamination beyond the spill area Perform contamination surveys and count the wipes using an appropriate counter and continue decontamination until the removable contamination is below the limits set by the RSO If the spill is high in radiation field or extent the RSO may specify area closure

458 Repeat the spill area cleaning until the contamination is removed as evidenced by wipe testing

Note Areas may be covered with appropriate shielding in the event that non-removable contamination exists The RSO may opt to prohibit further work in the area until a decontamination strategy is in place


51 Notify the RSO and Supervision

52 Identify the contaminated area(s) with a calibrated survey meter

53 Remove any contaminated clothing and place in a properly labeled plastic bag for disposal as long-lived radioactive waste

wwwnovamedcorpcom



54 Decontamination of the skin should be attempted with the mildest methods first progressing to more harsh methods if necessary and under direction of the RSO and Supervision Cleansing methods in order of harshness are as follows

bull Using RadiacWash towelettes

bull Lifting off with sticky tape

bull Washing with soap and warm water

bull Washing with a mildly abrasive soap a soft brush and water

bull Washing with detergent

bull Using a mild organic acid (citric acid)

bull Using an exfoliating cream to gently remove the outer layer of skin

If contamination is in the area of a wound a physician should supervise the decontamination operation

Cleaning should be from the periphery of the contaminated area towards the center to avoid spreading the contamination

Repeat cleaning procedure several times continuously monitoring to determine effectiveness

Note All personnel contamination shall be documented The need to construct a dose equivalent exposure record will be determined by the RSO

If the above methods are unable to remove all contamination from the skin then the area must be covered with gloves andor tape to prevent the spread of contamination due to contact or skin sloughing off until the contaminated area(s) are below background

60 Documentation

61 The RSO and affectedinvolved individuals will document the incident including any corrective measures and other improvements identified to prevent a similar occurrence

62 Documentation of radiological emergency incidents (spills etc) shall be maintained for review at NRC inspections Incidents involving work

wwwnovamedcorpcom



related injury or illness of employees must be reported in OSHA records maintained by the EHSHR Dept


Immediately notify the RSO (both NovaMed and Facility) a listed Emergency Coordinator andor Supervision emergency response personnel (police fire etc) if radioactive materials are involved in a fireexplosion or other release-event Be prepared to notify and inform arriving emergency response personnel of the nuclides activities and forms involved Assist the facility RSO with contacting the appropriate USNRC or Agreement State authorities in an appropriate and timely manner Emergency Notification numbers are posted near devices as well as in our Reciprocity Field Service Manual under the appropriate authority


Any missing radioactive material must be immediately reported to the RSO as soon as its absence becomes apparent

wwwnovamedcorpcom

Radiation Safety Procedure ~~ Material Receipt amp ShipmentNovaMed Page 1 of 2 RSP-0031

Material Receipt amp Shipment

Approved by

Michael M Thomson Radiation Safety Officer

Issued by

NovaMed Corporation Trumbull CT


Table of Contents

10 Purpose

20 Responsibility

30 No Material Received

Date

01A~g2012

Date 01Aug2012

2

2

2

Radiation Safety Procedure ~~ Material Receipt amp Shipment

NovaMed Page 2 of 2 RSP-0031

10 Purpose

The purpose of this procedure is to ensure all incoming radioactive material is properly received and accounted for and all outgoing radioactive material is properly shipped

20 Responsibility

All authorized users and all personnel that may receive or ship radioactive material must comply with this procedure

30 NovaMed does not purchase or receive radioactive material with the exception of exempt calibrated sealed sources (approximately 1 microcurie CS-137) for the purposes of instrument checks and leak testing reference standards

Radiation Safety Procedure~~ Radiation Safety Audit ProgramNovaMed Page 1 of 5 RSP-00401

R dO f S f t Auda la Ion a e[y Ot ProgramI Approved by Date

Michael M Thomson RSO 01JULY2012

Issued by Dale

NovaMed Corporation Trumbull CT 01JULY2012

~ul2ersedei1 uodales Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2

40 Audit Procedures 3

50 Documentation 4

60 Enforcement of RAD Safety 4

wwwnovamedcorpcom

Radiation Safety Procedure ~~ Radiation Safety Audit ProgramNovaMed Page 2 of 5 RSP-0041

10 Purpose

This procedure is to outline the requirements of the Radiation Safety Audit Program The audit will ensure that compliance is maintained with the requirements of the USNRC regulations and the terms and conditions of the USNRC license The audit will also ensure that occupational doses and doses to the public are 8s bOw 8s is Reasonably 8chievable (ALARA)

20 Responsibility

It is the responsibility of the RSOARSO or qualified designee or outside contractor to perform the audit The radiation safety program will be evaluated and audited on an annual basis

30 General

31 During daily activities authorized users (AU) shall be aware of any nonshycompliance with the USNRC standards or the terms and conditions of the USNRC license Non-compliance shall be corrected immediately and reported to the RSOARSO

32 The RSOARSO or designee will perform audits of procedures where radioactive materials are used The audit will ascertain compliance levels with respect to the radiation safety program Non-compliance will be described and a corrective action plan implemented

33 Audit records will be maintained on file for a period of not less than three years from the date of the record Audit records shall include the following

bull Date of the audit bull Name of the person(s) conducting the audit bull Persons contacted by the auditor(s) bull Areas audited bull Audit findings bull Corrective actions and bull Follow-up

wwwnov~lmedcorpcom


40 Audit Procedures

The audit shall consist of the following

41 Audit history - date of the last audit deficiencies identified and corrective actions taken

42 Organization and Scope of the Program - brief description of organizational structure noting any personnel changes Description of the scope of the licensed activities at the location Ensure RSO is identified

43 Training Retraining and Instructions to Personnel- ensure that personnel working with radioactive material have received the required training Ensure that each AU has a copy of the procedures and that heshe can implement these procedures

44 Audits - verify audits fulfill the requirements of the USNRC and that they are properly conducted and properly documented

45 Materials - Not applicable The company does not possess radioactive material

46 Leak Tests - verify that leak testing is performed calculated and reported correctly by reviewing the results of leak tests performed at customer sites

47 Inventories - the company does not possess radioactive material except exempt quantities in calibrated check sources

48 Radiation Surveys - verify that surveys are performed according to standard operating procedure and operator training and that appropriate operable and calibrated survey instruments are available

49 Transportation - if transporting materials (Le relocation of the IBL 437C within or to another licensed site) determine compliance with DOT requirements Verify packages are prepared marked and labeled in accordance with DOT requirements and that proper shipping papers are prepared in accordance with requirements

410 Personnel Radiation Protection - determine that unmonitored personnel are not likely to receive more than 10 of allowable limits Review personnel monitoring records compare exposures of individuals doing similar work determine reasons for significant differences in exposure If any AU declares pregnancy in writing evaluate compliance with 10 CFR 201208 Check maintenance of records

wwwnovamcdcorpcom

Radiation Safety Procedure ~~ Radiation Safety Audit Program NovaMed Page 4 of 5 RSP-0041

411 Notification and Reports - ensure compliance with the notification and reporting requirements of the USNRC (10 CFR 19 Notices Instructions and Reports to Workers Inspection and Investigation and 10 CFR 21 Reporting of Defects and Non-compliance) Ensure the telephone number of the USNRCs Emergency Telephone (301-816-51 00) is known

412 Posting and Labeling - verify compliance with the posting and labeling requirements of USIIRC and DOT for cases of IBL 437C relocation

413 Bulletins and Information Notices - verify that bulletins information notices and other correspondence from the USNRC are being received Verify that appropriate action is taken in response to US NRC mailings

414 Special License Conditions or Issues - verify compliance with any special conditions on the USNRC license

415 Problems or Deficiencies and Recommendations - note any problems or deficiencies with the program or any non-compliance with USNRC requirements Indicate the recommended corrective actions to correct these deficiencies

416 Evaluation of Other Factors - evaluate managements involvement with the radiation safety program and whether the RSO has sufficient resources to perform required duties to maintain compliance with regulatory requirements

50 Documentation

51 Annual audits are to be recorded The audits will detail the findings if any and the necessary corrective actions to be taken

52 Follow-up reports detailing corrective action(s) taken in response to an audit shall be provided to the RSOARSO

53 Records of audits shall be maintained for a minimum of three years

60 Enforcement of RAD Safety

61 During the audits of compliance with the safety program violations will result in the following

bull Verbal- verbal warning from the RSOARSO describing the infraction corrective action(s) and completion date for corrective action(s)

Wlwnovamcdcorpcom


bull Written - if the response to the first infraction is not satisfactory or the same violation is repeated within one year the RSOARSO will provide the warning in writing

bull Suspension - if the response continues to be unsatisfactory or if the violation is repeated within one year the user shall be prohibited from activities involving radioactive materials until the user demonstrates to the RSOARSO an understanding of the applicable procedures andor regulations The suspension remains in force during all appeals (to the RSO)

62 Retraining may also be provided to ensure there is an understanding of the RAD safety program

63 All warnings will be documented

wwwuovamcdcorpcom

Radiation Safety Procedure ~~ Personnel Monitoring

NovaMed Page 1 of 5 RSP-OOS1

personne1Momtorlng Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2

40 Minimization of Exposure 3

50 Personnel Contamination 45

wwwnovamedcorpcom

Radiation Safety Procedure ~~ Personnel MonitoringNovaMed Page 2 of 5 RSP-0051

10 Purpose

The purpose of this procedure is to ensure all personnel working with radioactive material (RAM) are properly monitored for exposure to radiation and to ensure that the dose rates specified by the USNRC are not exceeded

20 Responsibility

It is the responsibility of the Authorized Users (AUs) of RAM and others handling RAM to abide by this procedure

30 General

31 All individuals that come in contact with RAM must wear appropriate dosimeters (monitor badge)

32 Dosimeters used to monitor dose to workers will be evaluated through a NVLAP-accredited facility

33 If an exposure in excess of the regulatory limits is suspected at any time it must be reported immediately to the RSOARSO and the badge will be processed immediately

34 Whole Body Dosimeters should be worn and handled as follows

bull Wear on the outside of the outer garment bull Do not place the badges in pockets or under protective clothing bull Wear the badge on the area of the body that would potentially receive

the greatest exposure to radiation bull Do not place badges on contaminated surfaces or store near sources

of radiation bull Store badges away from sunlight and sources of heat keep dry bull Leave badges at work

35 Personal monitoring shall be performed upon suspicion of a leaking source using a proper calibrated survey instrument

36 Dosimeters will consist of a whole body monitor to be worn as described in 34

wwwnovamcdcorpcom

Radiation Safety Procedure ~~ Personnel MonitoringNovaMed Page 3 of 5 RSP-OOS1

37 Doses to embryolfetus are to be controlled by limiting the doses to declared pregnant women to 05 rem during the gestation period and ensuring that the dose is distributed uniformly during the gestation period See RSP-009 for more information

38 Any individual who receives more than 10 of the annual limit in one quarter shall be investigated by the RSOARSO

39 The RSOARSO shall advise users of their dose on a quarterly basis or when requested in writing pursuant to USNRC regulation Some Agreement States require quarterly results as a part of their conditions for granting reciprocity

310 Non-users who are not likely to receive 10 of their applicable annual limits may accompany an AU with a Visitors Badge

311 Doses in unrestricted areas will be limited such that no individual will receive gt2 mrem in anyone hour or 100 mrem in a given year from operations This shall be demonstrated by area monitoring andlor routine operating surveys

40 Minimization of Exposure

41 It is the policy of the company to maintain exposure to radioactive materials to 8s bOW 8s Reasonably 8chievable (ALARA) levels through proper handling of materials and through adherence to the rules and regulations of the USNRC and the requirements of the facility Radiation Safety Program The NovaMed guideline is to limit exposure to radioactive material to 10 of the dose limits specified by the USNRC in Regulatory Guide 813 as follows

05 reml r 15 reml r 50 reml r 50 reml r 50 reml r 01 reml estation eriod

Suggested in NRC Regulatory Guide 813

wwwIlovamedcorpcom

Radiation Safety Procedure ~famp Personnel Monitoring NovaMed Page 4 of 5 RSP-OOS1

50 Personnel Contamination

51 Notify the RSOARSO



54 Decontamination of the skin should be attempted with the mildest methods first progressing to more harsh methods if necessary Cleansing methods in order of harshness are as follows

bull Using RadiacWash Towelettes bull Lifting off with sticky tape bull Washing with soap and warm water bull Washing with a mildly abrasive soap a soft brush and water bull Washing with detergent bull Using a mild organic acid (citric aCid)

Note Skin decontamination procedures should not increase penetration of the radioactivity into the body by excessive abrasion of the skin If contamination is in the area of a wound a physician should supervise the decontamination operation

55 Cleaning should be from the periphery of the contaminated area towards the center to avoid spreading the contamination

56 Repeat cleaning procedure several times continuously monitoring to determine effectiveness

Note All personnel contamination shall be documented The need to assign a shallow dose equivalent due to skin contamination will be determined on an individual basis by the RSOARSO

57 If the above methods are unable to remove all contamination from the skin then the area must be covered with gloves andor tape to prevent the spread of contamination due to contact or skin sloughing off until the contaminated area(s) are below background

58 The RSOARSO in conjunction with the individuals involved shall document the incident including any measures identified to prevent a similar occurrence

510 Documentation of incidents (spills etc) shall be maintained on file for the life of the US NRC license in compliance with the USNRC regulation

wwwllovamedcorpcom


wwruovamedcorpcom

Radiation Safety Procedure ~~ Surveys NovaMed RSP-0061 Page 1 of 3

s Approved by


Issued by

NovalVled Corporation Trumbull CT


Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys

50 Wipe Test Surveys

60 Contamination

urveys Date 01Jufy2012

Date 01July2012

2

2

2

3

3

3

Radiation Safety Procedure ~~ Surveys

Page20f3NovaMed RSP-0061

10 Purpose

The purpose of this procedure is to ensure areas where the IBL 437 C irradiator is used are properly and adequately surveyed prior to the performance of services to determine if there is presence of radioactive contamination

20 Responsibility

It is the responsibility of the Authorized Users (AUs) of RAM and others in the process of servicing the devices to perform appropriate surveys to maintain ALARA dosages

30 General

31 Surveys are to be performed on the device to be serviced at the beginning of the service event so as ascertain the presence of radioactive contamination if it were to be present A simple survey of all surfaces of the device is conducted and the highest reading is recorded Prior to turning the device over to a subcontractor for any relocation a more detailed survey is performed and recorded After placement of a relocated device and prior to retuning the device to service a detailed survey is performed and documented

311 Wipe tests are conducted using an appropriate solventabsorbent combination to wipe a 100 cm2 area The absorbent component is counted in a sufficiently sensitive and calibrated radioactivity measurement device to allow quantitation of the presence of any radioactive material (Cs-137)

32 The RSOARSO or designee on at least a quarterly basis will review results of these surveys

33 Documented surveys will be retained for a minimum of three years

40 Device Surveys

41 Device surveys are to be surveyed using an appropriate calibrated survey meter

42 If a reading of 25 mRlhr or greater is discovered notify RSOARSO immediately to assist in locating the source of the radioactive field

43 Surveys shall be documented and retained for a minimum of three years


44 Jote JovaMed does not possess materials nor have restricted areas Surveys are performed at licensed customer sites on the IBL-437C Blood Irradiator


51 Wipe the internal and external surfaces of the device as appropriate

52 Use an appropriate solventabsorbent combination to wipe a 100 cm2

area and count the sample in a calibrated well counter

53 If a wipe measures 185 Bq (0005 microcuries) over background the device is contaminated Immediately notify the site licensee RSO and department management Engage procedures associated with radioactive materials contamination (RSP-0061)

54 Wipe test surveys shall be documented and retained for a minimum of three years per 10 CFR 202103(a)

60 Contamination

61 Contamination on surfaces must be addressed with respect to the site license procedures and coordinated with the site RSO and department management

Radiation Safety Procedure ~~ Radioactive Waste Management NovaMed Page 1 of 2 RSP-0071

Approved by a loac Ive as e R d r w t Management

Date

Michael M Thomson Radiation Safety 01AUG2012

Officer Issued by

NovaMed Corporation Trumbull CT 06611 Sugersedes ugdates Original Document

Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2

30 Radioactive Waste 2


10 Purpose

The purpose of this procedure is to outline the proper waste management practices for the storage and disposal of radioactive waste material

20 Responsibility

It is the responsibility of all authorized users (AUs) of RAM to adhere to this procedure and to properly manage radioactive waste material

30 Radioactive Waste - NovaMed does not generate store accept for storage or disposal any radioactive waste at its faCilities

wwwnovamedcorpcom

Radiation Safety Procedure ~~ Personnel Training NovaMed RSP~0081

personneITraining I Approved by Date

Michael M Thomson Radiation Safety 01Aug2012 Officer

Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3

Radiation Safety Procedure ~~ Personnel TrainingNovaMed Page 2 of 4RSP-OOS1

10 Purpose

The purpose of this procedure is to outline the training requirements for Field Service Engineers (FSE) performing service on the IBL 437 C irradiator

20 Responsibility

It is the responsibility of the RSOARSO to ensure all FSE receive the proper training prior to performing service on the IBL 437 C irradiator

It is the responsibility of the RSOARSO to ensure that all employees are notified of the potential risks to the embryofetus of exposure to radiation

30 General

31 All personnel that are to work with radioactive materials (Authorized Users) must undergo proper training prior to working with any radioactive material Topics included in the training are as follows

a) Radiation Safety i) Background Levels of Radiation ii) Radiation Exposure - Internal amp External iii) Radiation ampContamination iv) ALARA Concept v) Biological Effects of Radiation vi) Radiation Risks vii) Prenatal Radiation Exposure Risks

b) Regulatory Requirements i) Company license ii) US NRC Regulations iii) RSO iv) Material Control amp Accountability v) Personnel Dosimetry vi) Radiation Safety Program Audits vii) Transportation viii) Recordkeeping ix) Surveys x) Posting amp Labeling xi) Reporting Incidents xii) US NRC Licensing amp Inspections xiii) Employee Protection xiv) Deliberate Misconduct

32 IBL 437 C irradiator service may only be performed by trained and authorized personnel

Radiation Safety Procedure ~~ Personnel Training NovaMed Page 3 of 4 RSP-OOS1

33 All FSE must complete the company training curriculum prior to performing independent IBL 437 C service

34 Annual refresher training will also be provided

35 Retraining will take place when the need arises as evidenced by procedural or policy deficiencies or when new procedures are put in place

40 Radiation Safety Officer Training

10 The Radiation Safety Officer (RSO) shall be trained in the following topics Training may be in the form of lecture videotape hands-on or self-study and emphasizes practical subjects important to the safe use of the self-shielded irradiator

Radiation Safety

Radiation vs contamination Internal vs external exposure Biological effects of radiation Types and relative hazards of radioactive material possessed ALARA concept Use of time distance and shielding to minimize exposure Use of radiation detection instruments

Regulatory Requirements

Locations of use and storage of radioactive materials Material control and accountability Annual audit of radiation safety program License conditions amendments renewals Transfer and disposal Recordkeeping Handling incidents Licensing and inspection by regulatory agency Need for complete and accurate information Employee protection Deliberate misconduct

Practical Explanation of the Theory and Operation for Each Irradiator Possessed by the Licensee

Routine vs non-routine maintenance Operating and emergency procedures Prior events involving self-shielded irradiators


Instructors Qualifications The individual preparing and conducting training is qualified as RSO or AU on a self-shielded irradiator license before giving training

Training Assessment Management will ensure that potential RSOs and authorized users are qualified to work independently with each type of the licensees irradiators This may be demonstrated by written or oral examination or by observation

50 Documentation

All training will be documented in accordance with the companys Radiation Safety Training Documentation

Radiation Safety Procedure ~~ Pregnant EmployeelFetal Dose

Page 1 of 6 NovaMed RSP-0091

pregnant EmployeeIFeta10ose Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2

40 Declared Pregnancy 3

50 Fetal Dose Control 3

60 Confidentiality 4

70 NRC Regulatory Guide 813 4

80 Rescinding Pregnancy 4

Pregnancy Declaration 5

ReSCinding Pregnancy Declaration 6

Radiation Safety Procedure Pregnant EmployeeFetal Dose~rampJ Page 2 of 6 NovaMecI RSP-0091

10 Purpose

The purpose of this procedure is to provide a means for controlling occupational dose to an embryofetus

20 Responsibility

21 It is the responsibility of the pregnant radiation worker to declare her pregnancy so that adequate precautions to prevent or minimize radiation exposure can be taken and so that the employee can be fully informed of potential risks

30 Policy

31 A pregnant female who chooses to declare pregnancy must notify the RSOARSO of her pregnancy in writing on the form provided (attached)

32 Meetings to discuss fetal dose will be scheduled with each radiation worker who declares her actual suspected or planned pregnancy These meetings are also available to any other employee upon request

33 The meeting will be with the RSOARSO or designee the employee and the employees supervisor

34 Safety aspects of the employees work will be reviewed There will also be a discussion of the following

bull risks of fetal exposure bull exposure limits bull methods to minimize exposure and bull company policy regarding declared pregnant females

35 An opportunity for questions will be provided The employees monitoring records as well as the current potential for radiation exposure will be reviewed

Radiation Safety Procedure ~~ Pregnant EmployeeFetal Dose


36 The company has no responsibility in accordance with NRC regulations to provide specific fetal radiation dose precautions until a radiation employee openly declares in writing her pregnancy status to the RSOARSO

40 Declared Pregnancy

41 When a radiation employee wishes the company to be involved in the protection of her fetus under the 05 rem and the 01 rem ALARA dose guideline (10 CFR 201208) she must declare her pregnancy to the RSOARSO This declaration must be in writing on the form provided by the RSOARSO A meeting will be sCheduled with the employee the RSOARSO and her supervisor

42 The radiation employee will be required to sign a training document in accordance with the company Radiation Safety Training Documentation confirming safety information was presented and understood

50 Fetal Dose Control

51 The radiation employee will be assigned a monthly radiation-monitoring badge if one is not currently assigned

52 The Companys responsibility to protect the embryofetus under the US NRC 05 rem limit and the ALARA 01 rem guideline begins only when the employee declares her pregnancy in writing to the RSOARSO Any dose must be evenly distributed over the course of the pregnancy

53 Control of fetal dose will be attained with the full cooperation of the employee and the employees supervisor without economic penalty or loss of job opportunity Work assignment changes consistent with company Human Resources Policies may be initiated if necessary

54 When the occupational radiation dose of a declared pregnant woman exceeds 01 rem since conception the radiation employee may request adjustments in work assignment that will mitigate further occupational radiation dose

The supervisor may elect to

a) change the employees work assignment b) select one of the available leave options until the

employee becomes eligible for or requests maternity leave

55 In conjunction with the 05 rem fetal dose limit the ALARA philosophy will be applied to maintain dose as low as practicable



56 Pregnant radiation workers should not participate in any task that may result in higher exposures as determined by the RSOARSO

60 Confidentiality

Radiation employees may wish to keep their pregnancy status confidential for a period of time Any employee may still obtain fetal dose and related radiation safety information at any time through the RSOARSO without officially declaring her pregnancy status

70 NRC Regulatory Guide

The NRC Regulatory Guide 813 -Instruction Concerning Prenatal Radiation Exposure - provides information regarding the expectations of the licensee when handling declared pregnant women This guide has been and will be consulted when handling issues concerning declared pregnant women

80 Rescinding Pregnancy

When the declared worker is no longer pregnant she will notify the RSOARSO of this in writing on the form provided (attached) This completed form will be placed in her records to show that she is able to resume unrestricted work



Pregnancy Declaration

Date _____ Department__________

I voluntarily declare that I am (or may be)

pregnant The estimated month and year of conception is The expected delivery date is _______

I understand the radiation dose to my embryofetus during my entire pregnancy will not be allowed to exceed 05 rem (5 millisieverts) (unless that dose has already been exceeded between the time of conception and submitting this letter) I also understand that meeting the lower dose limit may require a change in job or job responsibilities during my pregnancy

Signature

Supervisor Signature

ASOARSO Signature



Rescinding Pregnancy Declaration


I voluntarily declare that I am no longer pregnant I

am now able to resume unrestricted work in the RAM Lab

Signature


RSOARSO Signature

Radiation Safety Procedure ~~ Survey Instrumentation


Survey Instrumentation

I Approved by Date

Michael M Thomson Radiation Safety 01AUg2012 Officer

Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Instrument Calibration 2

40 Instrument Use 2

50 Specific Instrumentation 3


Page 2 of 3NovaMed RSP-00101

10 Purpose

The purpose of this procedure is to ensure all radioactive material (RAM) survey instrumentation is properly used and calibrated in accordance with manufacturers instructions and NRC or Agreement State regulations

20 Responsibility

21 It is the responsibility of the RSOARSO to maintain RAM survey instrumentation and to ensure its proper calibration at specified intervals

22 It is the responsibility of the Authorized Users (AUs) to properly use RAM survey instruments

30 Instrument Calibration

31 All RAM survey instrumentation must be calibrated on at least an annual basis

311 Special calibrations may be performed at any time there is reason to believe that the operating characteristics of an instrument have been changed by repair or alteration or whenever system performance is observed to have changed

32 Calibration must be performed by a qualified outside RAM instrument calibration service licensed by the NRC or agreement state to perform such services

33 Instruments must be calibrated in accordance with ANSI 323(a) -1999 Radiation Protection Instrumentation Test and Calibration standards and must be calibrated using NIST-traceable radioactive sources Note We only work with Cs-137therefore we have the instruments calibrated specifically for that radioactive material

34 Records of calibration must be maintained per 10 CFR 2021 03(a)

40 Instrument Use

41 Prior to using RAM survey instrumentation ensure the type of instrument is appropriate for the source to be measured and that the proper and appropriate probes are installed

42 Ensure the proper batteries are installed and perform a battery check

421 If the unit needs batteries install fresh batteries of the proper size and in the proper configuration

Radiation Safety Procedure Survey Instrumentation ~DampNovaMed RSP-00101 Page 3 of 3

43 If applicable check the response of the unit with a known radioactive source material

44 Check all cables for proper and tight connection

45 If the survey instrument does not properly respond to the instrument checks and a cause for unresponsiveness can not be found and corrected do not use the unit and mark it as inoperable and return the unit to the supplier for service

50 Specific Instrumentation

51 Instruments that meet the radiation monitoring instrument specifications published in Appendix J to NUREG-1556 vol 18 Consolidated Guidance about Materials Licenses Program-Specific Guidance about Service Provider Licenses dated November 2000 are used We reserve the right to upgrade our survey instruments as necessary

52 RAM survey instrumentation

521 SE International Modellnspector+ with Wipe Test Plate for use in surveys and to perform wipe test analysis (See attached Specifications sheet and User Manual)

522 The Inspector is a small handheld microprocessor-based instrument which offers excellent sensitivity to low levels of alpha beta gamma and x-rays The digital readout is displayed with a red count light and a beeper sounds with each count detected Other features include an adjustable timer external calibration controls and adjustable alert Note The adjustable alert will be set to alarm at a maximum of 25 mRh which is the maximum allowable dose at the device surface

523 All Field Service Engineers are equipped with a meter The company maintains a backup inventory of meters to allow substitution in case of failure at calibration end dates and to provide a second meter in jurisdictions (Maryland) which require two meters to be present on site

Radiation Safety Procedure ~~ Sealed Sources


Sealed Sources Approved by


Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose

The purpose of this procedure is to ensure sealed radioactive sources contained in the IBL 437 C irradiator are properly maintained inventoried and tested for leakage

20 Responsibility

21 It is the responsibility of the Licensed Facility to properly maintain the IBL 437 C irradiator and to ensure its sealed sources are not compromised in any way that would cause the release of radioactivity The company provides IBL 437 C irradiator services at temporary job sites under a US NRC license and is only in possession of the irradiator as part of maintaining servicing relocating or upgrading (as defined in US NRC RIS 2008-17 Voluntary Security enhancements)

22 It is the responsibility of the Licensed Facility RSOARSO to maintain the sealed source inventory and to ensure that sealed sources are leak tested in accordance with US NRC regulatory requirements and requirements outlined in the facility radioactive materials license The company may assist the Licensed Facility RSO in compliance with National Source Tracking System (NSTS) and other regulatory issues

30 General

31 Only those sealed sources licensed or exempt by the US NRC may be possessed onsite

32 Sealed sources installed in the IBL 437 C are permanently fixed and inaccessible to irradiator users and service personnel No operation shall be performed on the IBL 437 C by any company field service engineer that could compromise the irradiator shielding or create access to the sealed sources

33 Sealed sources must be tested for leakage at a minimum of 6-month intervals Leak testing must be documented and records must be maintained on file On each visit to a Licensed facility by a company Field Service Engineer the engineer will verify that a leak test has been performed within the last 6 months If the interval is greater than 6-months the engineer shall immediately contact the Licensed facility RSO and will either have the RSO perform the leak test or perform a leak test prior to beginning work

34 An appropriate solventabsorbent combination to wipe the sealed source must be used

35 Leak tests of sealed sources may only be analyzed by organizations licensed by the NRC or agreement state to perform such services

36 The company license indicates that the company can be in posseSSion of a maximum of 6 sealed sources in a maximum of 2 devices This posseSSion is incident to performing work at temporary job site No inventory of sources is required



37 The sealed source leak test must be capable of detecting the presence of 185 Bq (0005 microcuries) of radioactive material on the test sample

38 If the test reveals the presence of 185 Ba (0005 microcuries) or more of removable contamination a report must be filed with the US NRC in accordance with US NRC regulation Immediate notification of the site RSO shall be made and procedures engaged in conformance with the sites radioactive contamination mitigation policies The IBL 437 C irradiator should be immediately removed from service and decontaminated repaired or disposed of in accordance with US NRC requirements

39 The RSO will be responsible for the filing of any report if necessary with the US NRC

Radiation Safety Procedure ~~ Radiation Safety Organization

ResponsibilitiesNovaMed RSP-0121

Radiation Safety Organization Responsibilities

Approved by Date

Michael M Thomson Radiation Safety 01Aug2012 Officer Issued by Date


Supersedes updates

Original document

Table of Contents

10 Purpose

20 RSOIARSO Designation

30 RSOIARSO Responsibilities

40 Radiation Worker Responsibilities

50 Requirements for Handlers of Radioactive Materials

Page 1 of 5

2

2

2

3

4


Page 2 of 5 ResponsibilitiesNovaMed RSP-0121

Purpose

11 To describe radiation safety responsibilities within the organization to ensure the best practices of the safe handling and use of radioactive sources are used

12 Oversee site radiation safety activities

20 RSOARSO Designation

21 The RSO is appointed by the officer of the company responsible for the facility (herein after referred to as the Chief Officer or CO) The RSO shall have experience in the handling of radioisotopes and practice of radiation protection The RSO shall have training consistent with the requirements of NRC or Agreement State regulations and reflective of the purpose of the companys license

22 The RSO reports directly to the CO and may be overruled only by that position

23 Changing the RSO requires an amendment to the existing Radioactive Material License

24 RSO may have other duties however sufficient time must be devoted to fulfillment of RSO responsibilities and license conditions

25 In the absence of the RSO the Assistant RSO shall assume the responsibilities of the RSO The ARSO should have the same training as the RSO described in Section 21 above

30 RSOARSO Responsibilities

The RSOs duties and responsibilities include ensuring radiological safety and compliance with NRC Agreement State and DOT regulations and the conditions of the license see Figure 81 Typically these duties and responsibilities include ensuring the following

31 Activities involving licensed material that the RSO considers unsafe are

stopped

32 Radiation exposures are ALARA

33 Posting of required documents or a notice where the following documents

can be found


Page 3 of 5ResponsibilitiesNovaMed RSP-0121

34 Development distribution implementation and maintenance of up-to-date

operating and emergency procedures

35 Possession installation relocation use storage repair and maintenance of

self-shielded irradiators are consistent with the limitations in the license the

SSD Registration Certificate(s) and manufacturers written recommendations

and instructions

36 Safety consequences are analyzed before conducting any activities involving

repair use maintenance installation or relocation of IBL 437 C irradiators

37 Individuals installing relocating using maintaining or repairing self-shielded

irradiators are trained and authorized (as described in the license application)

38 Prospective evaluations are performed demonstrating that individuals are not

likely to receive in one year a radiation dose in excess of 10 of the allowable

limits or personnel monitoring devices are provided

39 When necessary personnel monitoring devices are used and exchanged at the

proper intervals and records of the results of such monitoring are maintained

310 Self-shielded irradiators are properly secured

311 Documentation is maintained to demonstrate by measurement or calculation

that the radioactive dose to an individual member of the public likely to receive

the highest dose from the licensed operation does not exceed the annual limit

in 10 CFR 201301

312 Proper authorities are notified of incidents such as damage to or malfunction of

self-shielded irradiators fire or theft

313 Unusual occurrences involving the self-shielded irradiators (eg malfunctions

or damage) are investigated cause(s) and appropriate corrective action(s) are

identified and timely corrective action(s) are taken

314 Radiation safety program audits are performed at least annually and

documented



315 When the licensee identifies violations of regulations or license conditions or

program weaknesses the licensee develops implements and documents

corrective actions

316 Licensed material is transported in accordance with all applicable DOT

requirements

317 Licensed material is disposed of properly

318 Appropriate records are maintained

319 Up-to-date license is maintained and amendment and renewal requests are

submitted in a timely manner


41 Government Regulations - all persons who receive possess use or transfer radioactive materials on site are subject to regulations issued by the US NRC

42 Company Policies

421 Employees must comply with company procedures for safe handling of radioactive materials (RSP-001) and practice ALARA concepts

422 Procedures must be adequately planned to ensure necessary safety precautions are taken

423 Employees must wear personal monitoring devices (supplied by the RSO) while in restricted areas as stated in RSP-OOS

424 Employees must maintain logs and perform surveys as required by the RSO as stated in RSP-006 and RSP-OO

425 Survey hands shoes body and clothing for radioactive contamination before leaving the restricted area If contamination is discovered follow RSP-OOS for decontamination procedures


51 A prospective Authorized User must



511 Be over 18 years of age and provide RSO with prior exposure documentation and radioactive material use history

512 Receive training from RSOARSO on applicable US NRC and State regulations and Corporate Radiation Safety Procedures prior to being allowed to work with radioactive material This training will be documented in accordance with company Radiation Safety Program Training

513 Work in the field under the direct supervision of the RSOARSO When the Authorized Users techniques and knowledge of radiation safety procedures are deemed sufficient by the RSOARSO then the Authorized user may work unsupervised in the field

Radiation Safety Procedure ~~ Leak Test Procedure

Page 1 of 7 NovaMed

Sealed Sources Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2

50 Leak Test Materials 4

60 Leak Test Procedure 4

70 Documentation 5

80 Record Retention 5

Example A (Leak test record 6

Radiation Safety Procedure ~~ leak Test Procedure NovaMed Page 2 of 7

10 Purpose

The purpose of this document is to ensure the procedure for testing sealed radioactive sources contained in the IBL 437 C is properly defined and understood by those performing the testing

20 Responsibility

21 It is the responsibility of the RSO to define review and update the procedure and to review the procedure with Authorized Users (AU) to verify it is being properly performed

22 It is the responsibility of the Authorized Users (AU) to perform the procedure as described and to report any errors or other issues to the RSO

30 Discussion

31 NovaMed performs leak testing as a part of relocation projects We do not solicit nor accept wipe smears sent in from customers and do not perform as commercial leak test service providers

32 The IBL-437C Blood Irradiator is a self-shielded device with the sealed sources inaccessible to our field engineers Thus evidence of radioactive contamination is not expected on a wipe test smear Results are categorized as either not contaminated or contaminated A minimum level of acceptable radioactive contamination is not defined In the event a wipe test provides results that are statistically above background the company will notify the facility RSO The presence of 185 Bq (0005 ~Ci) or more of removable contamination on any test sample shall be considered evidence that a sealed source is leaking

33 Our instrumentation efficiencies are capable of detecting a Minimal Discernable Activity (MDA) of 185 Bq (0005 microcuries) at a 95 confidence

40 Formulas

41 The calibrated check source must be decayed from its initial value

At =Aoemiddot693 () I tmiddothalf

Given At = Activity (current) Ao =Initial activity of the source 102 microcurie on 1211974 (example)

t-half for Cs-137 = 3015 years t = time years of decay of source

Example

If calculation made on 72712

~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)

Radiation Safety Procedure Leak Test Procedure

Page 3 of 7

=(102 IJCi) (emiddot693(3767 yrs) 1(3015 years)

Cmiddot) ( -693(123)=(102 IJ I e

=(102 IJCi) (e-middot866)

= (102 pCi) (4206)

=429 IJCi (1588 KBq)

42 The efficiency of the instrument is calculated

[(cpm from standard) - (cpm from bkgl] = efficiency in cpmBq Activity of std in Bq

Where

cpm = counts per minute std = standard bkg =background Bq = Becquerel

Example

Standard cpm = 64000 Countsmin Background = 42 Countsmin Standard Activity = 1588 KBq (04292 IJCi)

EFF = 64000 cpm(std) - 42 cpm(bkg) = 4027 cpmBq 15880 Bq

43 The Minimal Discernable Activity (MDA) also call Lower Limit of Detection (LLD) is calculated and must be at least 185 Bq (0005 microcuries)

The formula we use is the one for determining a measurement at the 95 confidence level The formula for this level is

Where

MDA = Minimum Discernable Activity in disintegrationsmin B =Background count (42 cpm) EFF =Efficiency in cpmBq (4027 cpmBq) T = Count time (1 minute)

Radiation Safety Procedure ~~ Leak Test Procedure NovaMed Page 4 of 7

271+465 vBt MDA= EFFt

MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027

MDA =7482 dpm =01247 8q (337E-6 microcuries)

43 The sample counting time and background counting time must be equal The counting efficiency must be determined by using a standard source of known activity that emits photons of approximately the same energy as the contaminant to be detected The counting rate for the standard is divided by the standard activity to determine the counting efficiency When dividing the two values must be in compatible units For example a standard activity in lCi must be converted to dpm by multiplying by a factor of 22E+6

45 For a copy of the full discussion of the theory and limitations of this test refer to pages 307-311 in NCRP Report No 58 A Handbook of Radioactivity Measurement Procedures issued Februaryl 1985 by the National Council on Radiation Protection and Measurements 7910 Woodmont Avenue Bethesda MD 20814

46 Leak testing formulas are part of a Microsoft Excel spreadsheet which is verified and protected to prevent corruption

50 Leak Test Materials

51 DEFENSAP leak test wipes or alcohol swabs or suitable substitutes

60 Leak Test Procedure

6 t Samples will be collected at appropriate locations and the date time locationidentification as well as the individual collecting the sample will be recorded on the package The data for the check source in use is confirmed in the spreadsheet as accurate which includes the original actual activity and date of measurement

62 The sample swab is checked with a survey meter to determine presence of any contamination

63 A suitable location to perform the analysis will be selected which is away from the device and other sources of radiation The sample tray will be used to

Radiation Safety Procedure Leak Test Procedure~fampNovaMed Page 5 of 7

position the samples to be counted as well as the calibrated check source assuring proper symmetry to the detector

64 The Inspector will be turned on and the calibration number displayed during POST (Power On Self-Test) will be viewed to confirm the meter is operating An instrument check with the appropriate check source will be performed to confirm proper instrument operation If the check source does not read within 20 of the expected value after calibration the meter will not be used

65 The meter will be placed into the Totalrrimer mode with the timer switch (on top) placed to the Set position The Set + and - buttons are used to set the count time to 1 minute

66 A background count will be performed with no check source and no wipe test in the sample tray in order to determine the background count The Timer switch is moved to the On position the meter beeps 3 times and an hourglass turns indicating that the 1 minute count has started while the count rises At the end of the 1 minute time the beeper again beeps in a pattern of 3 beeps a delay 3 beeps a delay and a final 3 beeps The hourglass is no longer moving and the display is steady The background count is entered into the spreadsheet

67 A source count is performed by placing the calibrated check source into the sample tray with the calibration sticker down (The window for the check source is on the back If the check source is placed incorrectly the count will not be sufficient to produce an acceptable MDA) The meter is again set for one minute per the above instructions and the count is performed for the one minute timed period The results are entered into the appropriate field in the spreadsheet The spreadsheet automatically calculates the decay of the cesium check source based on the original activity and date of measurement

68 The wipe test sample(s) are measured in the same manner for one minute and the results are recorded in the appropriately labeled gross count section for each wipe test performed

69 The spreadsheet is designed to calculate the MDA as well as the results of each wipe test If the results are appropriate and acceptable the fields will have a green background and if inappropriate or exceeding limits the cell backgrounds will be red

70 Documentation

71 The results of all leak testing will be recorded on the Leak Test Analysis form see attached example A

72 Review the data and sign and date the record


80 Record Retention

81 Retain records for 3 years (10 CPR 202103(araquo


EXAMPLE A

(See attached pdf file)

h rm lucence

Facility Name Facility Address

City State Zip Code

LEAK TEST ANALYSIS for SERIAL NUMBER 90middot323

Date of Test 27-Jul-12 Background 42

Date of Analysis 27Jul-12 Source Count 64000 Originsillei I 1020

Counter Inseector Efficiency 7 Cal date I 1-0ec-74

Serial 19974 Current Ci I 04292

Set-up (1) Standard MDA(3) 203E-04 Ci 753 Bq

Results

Gross Count 45 Sample Net CPM 3IBL Internal- Pre-Move Results Test Activity 201E-05 jJCi

Acceptable laquo0005 Ci) 074 Bq

Gross Count 750 Sample Net CPM --_708----IBL External- Pre-Move Results Test Activity

Acceptable laquo0005 Ci)

Gross Count 787 Sample Net CPM --_745----IBL Internal - Post-Move Results Test Activity 500E-03 jJCi


Gross Count 788 Sample Net CPM --_746----IBL External - Post-Move Results Test Activity

Failed

(1) Sample geometrycounter set-up as appropriate to reproduce measurement (2) NIST traceable source used to derive measurement efficiency (3) Minimum Detectable Activity 95 confidence level (4) Minimum Detectable Activity when sample net CPM-Iower detection level (Ld) CPM

The Irradiator was found to be free of contamination andor leakage of Cs-137 at the above test sensitivity (MDA) The maximum level for acceptance of the Irradiator is 5E-03 jJCi [185 Bq]

Prepared by

Michael M Thomson Field Service Engineer Date

NovaMed Corporation - Drive bull TrumbulL GT vwvwpharmaucence com

M14-1-004A Effective 308 Rev 1

This is to acknowledge the receipt of your letteeuroplicatio~ated

g- 7 - h and to inform you that the initial processing which includes an administrative review has been performed

~erewe~ OsiOS ~o9a~i~i~W~~gned to a technical reviewer Please note that the technical review may identify additional omissions or require additional information

o Please provide to this office within 30 days of your receipt of this card

A copy of your action has been forwarded to our License Fee amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved

Your action has been assigned Mail Control Number S 7 Cflll When calling to inquire about this action please refer to this control number You may call us on (610) 337-5398 or 337-5260

NRC FORM 532 (RI) Sincerely (6-96) Licensing Assistance Team Leader



NovaMed Corporation

This is an application for a new license

Preface

NovaMed Corporation is purchasing the blood irradiator service business line from Pharmalucence Inc on or about October 15 2012 and seeks a new materials license to continue to operate the business line in the same manner as operated by Pharmalucence which is currently licensed by the NRC

llovaMed Corporation provides medical and research equipment maintenance service parts and sales After the purchase of the blood irradiator business line from Pharmalucence NovaMed will employ the two individuals currently trained and authorized to provide the service along with continuing to use the various radiation safety procedures currently in place

Thank you in advance for your consideration of this application

middot bull 1 lt

Appendix C



APPENDIXC






Below


5

APPENDIXC







Radioisotope

Cesium-137

o Depleted Uranium

o Uranium-238

o Thorium-232

o Other Specify

Radioisotope

Sealed Sources



Quantity




Source Material

Kilograms

Kilograms

_____ Kilograms

Kilograms



o

o

o

o

IYes INo

L2J 0

0 0

0 0

Yes No


APPENDIXC

0

0

0

Uranium-234

Uranium-235

Plutonium-238


0 0

0 Plutonium-239

0 Other SpecifY


APPENDIXC








OR






AND IF APPLICABLE







AND

NUREG - 1556 Vol 18 C-4

APPENDIXC


APPENDIXC


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams









Surce Material


o Thorium-232 Grams

o Other Grams


NUREG - 1556 Vol 18 C-6

APPENDIXC


o Uranium-234 Grams

o Uranium-235 Grams











OR




OR


C-7 NUREG - 1556 Vo118

APPENDIXC

AND IF APPLICABLE







A~D


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams




APPENDIXC

Item No





121 D


OR



APPENDlXC



6





Yes

I2J 0 0 0

IZI ~

0 0

(lJ 0 QJ



0 IZI I2J I2J

0

0 0 0 0 ~ 0

J 0 0 0 0 IZI 0 0 0 0 0 121 0 0 0 0 0 0 0 0 0 0 (]


APPENDIXC

Item No




QJ

Nuclear Laundry 0 0






0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0


7

APPENDIXC





AND EITHER


OR



NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No



Authorized Users


III 0

OR


iii

Ancillary Personnel


0 0

OR


0


APPENDIXC
















0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC













APPENDIXC









NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No















I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0



APPENDIXC

Item No






121 0 0

OR


0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No




OR


0



0 121

OR


0

AND


0

C-19 NUREG - 1556 Vo1l8

APPENDIXC





OR


ANDOR


AND


NUREG - 1556 Vol 18 C-20

APPENDIXC




OR












C-21 NUREG - 1556 Vol 18

APPENDIXC














NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0


0

0





0 shielding system

0

0


0

0


APPENDIXC

Item No









m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys


(2J 0

OR


Leak Tests


0 0 0

OR


IJ 0


APPENDIXC

Item No



Leak Tests (Contd)

OR


III LJ 0 121

OR


0 0 0

AND



0 0 0

0


APPENDIXC



Maintenance


OR



OR





I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC





Waste Management




OR


OR





NovaMed Corporation










NovaMed Corporation






--

--------


NovaMed President

I John JaKer



















EngmeerRSO

f---






ByIMAI t-- Special~



Tell1Pi~e~I11i1 PtT

y --












wwwcisusinccom






II II








wwwcisusinccom











wwwcisusinccom










wwwcisusinccom










wwwcisusinccom















2

8 8

60


y





Dear Mr AIIo





Sincerely






OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositionfTitle







OFFICIAL USE ONLY




Sincerely




and Safeguards



OFFICIAL USE ONLY


November 72003



Dear SirMadam













Date 2012


Signed

~n~ Employee

Date




Date 112011

Review Period 2010


x


x

x


RSO soon



-~----Date




Date 112010






f7--Iu---__ Date




Date 112010







Sign~7L Employee

SUP~~S3 Date





programs as

Signed

~d~ Employee Date

Date




NovaMed Corporation



















wwwcisusinccom












wwwcisusinccom











wwwcisusinccom









Attest~ tJJtL--shy


wwwcisusinccom










wwwcisusinccom

CIS-US Inc




Ronald G McCoy













Instrumentallon










R11106 - PMT





Dear Mr Alto





Sincerely




OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle







OFFICIAL USE ONLY


November 7 2003



Dear SirMadam











Sincerely




and Safeguards



OFFICIAL USE ONLY














r Date


c



RONMCCOY CIS-US



IBL 437 C


shy__ ~X-tifA







Date 2012


Date




Date 112011

Review Period 2010





Date

w4 Date



Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010




gA1)O~3 0+

Yes No

1 y V y I

y I


I

I

I

i

Date

Date




NovaMed Corporation







~~ NovaMed



10 General











Table 1 (continued)



~~ NovaMed











I

wwwnonunedcorpcom 2



Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



60 Surveys 3



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamedcorJlcom



60 Surveys




To include






11

wwwnovamedcorpcom




Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background



60 Documentation



Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom



10 Purpose


20 Responsibility


30 Background









wwwnovamedcorpcom











Definitions





wwwnovamedcorpcom





























wwwnovamedcorpcom
















60 Documentation



wwwnovamedcorpcom








wwwnovamedcorpcom



Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility


Date

01A~g2012

Date 01Aug2012

2

2

2



10 Purpose


20 Responsibility






Issued by Dale



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2


50 Documentation 4


wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General





wwwnov~lmedcorpcom


40 Audit Procedures












wwwnovamcdcorpcom








50 Documentation







Wlwnovamcdcorpcom






wwwuovamcdcorpcom





Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamcdcorpcom











wwwIlovamedcorpcom















wwwllovamedcorpcom


wwruovamedcorpcom


s Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys


60 Contamination


Date 01July2012

2

2

2

3

3

3



10 Purpose


20 Responsibility


30 General





40 Device Surveys












60 Contamination




Date


Officer Issued by


Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2



10 Purpose


20 Responsibility



wwwnovamedcorpcom




Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3


10 Purpose


20 Responsibility



30 General











Radiation Safety









50 Documentation






Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2









10 Purpose


20 Responsibility


30 Policy

























60 Confidentiality













Signature


ASOARSO Signature







Signature


RSOARSO Signature




I Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2


40 Instrument Use 2




10 Purpose


20 Responsibility









40 Instrument Use


















Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose


20 Responsibility



30 General















Approved by Date



Supersedes updates

Original document

Table of Contents

10 Purpose





Page 1 of 5

2

2

2

3

4



Purpose












stopped



can be found








and instructions














in 10 CFR 201301







documented





corrective actions


requirements







42 Company Policies














Page 1 of 7 NovaMed



Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2



70 Documentation 5




10 Purpose


20 Responsibility



30 Discussion




40 Formulas





Example


~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)


Page 3 of 7


Cmiddot) ( -693(123)=(102 IJ I e


= (102 pCi) (4206)

=429 IJCi (1588 KBq)



Where


Example





Where




MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027



















70 Documentation




80 Record Retention



EXAMPLE A


h rm lucence


City State Zip Code







Results








Failed



Prepared by











middot bull 1 lt

Appendix C



APPENDIXC






Below


5

APPENDIXC







Radioisotope

Cesium-137

o Depleted Uranium

o Uranium-238

o Thorium-232

o Other Specify

Radioisotope

Sealed Sources



Quantity




Source Material

Kilograms

Kilograms

_____ Kilograms

Kilograms



o

o

o

o

IYes INo

L2J 0

0 0

0 0

Yes No


APPENDIXC

0

0

0

Uranium-234

Uranium-235

Plutonium-238


0 0

0 Plutonium-239

0 Other SpecifY


APPENDIXC








OR






AND IF APPLICABLE







AND

NUREG - 1556 Vol 18 C-4

APPENDIXC


APPENDIXC


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams









Surce Material


o Thorium-232 Grams

o Other Grams


NUREG - 1556 Vol 18 C-6

APPENDIXC


o Uranium-234 Grams

o Uranium-235 Grams











OR




OR


C-7 NUREG - 1556 Vo118

APPENDIXC

AND IF APPLICABLE







A~D


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams




APPENDIXC

Item No





121 D


OR



APPENDlXC



6





Yes

I2J 0 0 0

IZI ~

0 0

(lJ 0 QJ



0 IZI I2J I2J

0

0 0 0 0 ~ 0

J 0 0 0 0 IZI 0 0 0 0 0 121 0 0 0 0 0 0 0 0 0 0 (]


APPENDIXC

Item No




QJ

Nuclear Laundry 0 0






0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0


7

APPENDIXC





AND EITHER


OR



NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No



Authorized Users


III 0

OR


iii

Ancillary Personnel


0 0

OR


0


APPENDIXC
















0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC













APPENDIXC









NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No















I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0



APPENDIXC

Item No






121 0 0

OR


0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No




OR


0



0 121

OR


0

AND


0

C-19 NUREG - 1556 Vo1l8

APPENDIXC





OR


ANDOR


AND


NUREG - 1556 Vol 18 C-20

APPENDIXC




OR












C-21 NUREG - 1556 Vol 18

APPENDIXC














NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0


0

0





0 shielding system

0

0


0

0


APPENDIXC

Item No









m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys


(2J 0

OR


Leak Tests


0 0 0

OR


IJ 0


APPENDIXC

Item No



Leak Tests (Contd)

OR


III LJ 0 121

OR


0 0 0

AND



0 0 0

0


APPENDIXC



Maintenance


OR



OR





I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC





Waste Management




OR


OR





NovaMed Corporation










NovaMed Corporation






--

--------


NovaMed President

I John JaKer



















EngmeerRSO

f---






ByIMAI t-- Special~



Tell1Pi~e~I11i1 PtT

y --












wwwcisusinccom






II II








wwwcisusinccom











wwwcisusinccom










wwwcisusinccom










wwwcisusinccom















2

8 8

60


y





Dear Mr AIIo





Sincerely






OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositionfTitle







OFFICIAL USE ONLY




Sincerely




and Safeguards



OFFICIAL USE ONLY


November 72003



Dear SirMadam













Date 2012


Signed

~n~ Employee

Date




Date 112011

Review Period 2010


x


x

x


RSO soon



-~----Date




Date 112010






f7--Iu---__ Date




Date 112010







Sign~7L Employee

SUP~~S3 Date





programs as

Signed

~d~ Employee Date

Date




NovaMed Corporation



















wwwcisusinccom












wwwcisusinccom











wwwcisusinccom









Attest~ tJJtL--shy


wwwcisusinccom










wwwcisusinccom

CIS-US Inc




Ronald G McCoy













Instrumentallon










R11106 - PMT





Dear Mr Alto





Sincerely




OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle







OFFICIAL USE ONLY


November 7 2003



Dear SirMadam











Sincerely




and Safeguards



OFFICIAL USE ONLY














r Date


c



RONMCCOY CIS-US



IBL 437 C


shy__ ~X-tifA







Date 2012


Date




Date 112011

Review Period 2010





Date

w4 Date



Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010




gA1)O~3 0+

Yes No

1 y V y I

y I


I

I

I

i

Date

Date




NovaMed Corporation







~~ NovaMed



10 General











Table 1 (continued)



~~ NovaMed











I

wwwnonunedcorpcom 2



Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



60 Surveys 3



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamedcorJlcom



60 Surveys




To include






11

wwwnovamedcorpcom




Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background



60 Documentation



Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom



10 Purpose


20 Responsibility


30 Background









wwwnovamedcorpcom











Definitions





wwwnovamedcorpcom





























wwwnovamedcorpcom
















60 Documentation



wwwnovamedcorpcom








wwwnovamedcorpcom



Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility


Date

01A~g2012

Date 01Aug2012

2

2

2



10 Purpose


20 Responsibility






Issued by Dale



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2


50 Documentation 4


wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General





wwwnov~lmedcorpcom


40 Audit Procedures












wwwnovamcdcorpcom








50 Documentation







Wlwnovamcdcorpcom






wwwuovamcdcorpcom





Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamcdcorpcom











wwwIlovamedcorpcom















wwwllovamedcorpcom


wwruovamedcorpcom


s Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys


60 Contamination


Date 01July2012

2

2

2

3

3

3



10 Purpose


20 Responsibility


30 General





40 Device Surveys












60 Contamination




Date


Officer Issued by


Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2



10 Purpose


20 Responsibility



wwwnovamedcorpcom




Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3


10 Purpose


20 Responsibility



30 General











Radiation Safety









50 Documentation






Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2









10 Purpose


20 Responsibility


30 Policy

























60 Confidentiality













Signature


ASOARSO Signature







Signature


RSOARSO Signature




I Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2


40 Instrument Use 2




10 Purpose


20 Responsibility









40 Instrument Use


















Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose


20 Responsibility



30 General















Approved by Date



Supersedes updates

Original document

Table of Contents

10 Purpose





Page 1 of 5

2

2

2

3

4



Purpose












stopped



can be found








and instructions














in 10 CFR 201301







documented





corrective actions


requirements







42 Company Policies














Page 1 of 7 NovaMed



Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2



70 Documentation 5




10 Purpose


20 Responsibility



30 Discussion




40 Formulas





Example


~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)


Page 3 of 7


Cmiddot) ( -693(123)=(102 IJ I e


= (102 pCi) (4206)

=429 IJCi (1588 KBq)



Where


Example





Where




MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027



















70 Documentation




80 Record Retention



EXAMPLE A


h rm lucence


City State Zip Code







Results








Failed



Prepared by











APPENDIXC






Below


5

APPENDIXC







Radioisotope

Cesium-137

o Depleted Uranium

o Uranium-238

o Thorium-232

o Other Specify

Radioisotope

Sealed Sources



Quantity




Source Material

Kilograms

Kilograms

_____ Kilograms

Kilograms



o

o

o

o

IYes INo

L2J 0

0 0

0 0

Yes No


APPENDIXC

0

0

0

Uranium-234

Uranium-235

Plutonium-238


0 0

0 Plutonium-239

0 Other SpecifY


APPENDIXC








OR






AND IF APPLICABLE







AND

NUREG - 1556 Vol 18 C-4

APPENDIXC


APPENDIXC


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams









Surce Material


o Thorium-232 Grams

o Other Grams


NUREG - 1556 Vol 18 C-6

APPENDIXC


o Uranium-234 Grams

o Uranium-235 Grams











OR




OR


C-7 NUREG - 1556 Vo118

APPENDIXC

AND IF APPLICABLE







A~D


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams




APPENDIXC

Item No





121 D


OR



APPENDlXC



6





Yes

I2J 0 0 0

IZI ~

0 0

(lJ 0 QJ



0 IZI I2J I2J

0

0 0 0 0 ~ 0

J 0 0 0 0 IZI 0 0 0 0 0 121 0 0 0 0 0 0 0 0 0 0 (]


APPENDIXC

Item No




QJ

Nuclear Laundry 0 0






0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0


7

APPENDIXC





AND EITHER


OR



NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No



Authorized Users


III 0

OR


iii

Ancillary Personnel


0 0

OR


0


APPENDIXC
















0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC













APPENDIXC









NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No















I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0



APPENDIXC

Item No






121 0 0

OR


0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No




OR


0



0 121

OR


0

AND


0

C-19 NUREG - 1556 Vo1l8

APPENDIXC





OR


ANDOR


AND


NUREG - 1556 Vol 18 C-20

APPENDIXC




OR












C-21 NUREG - 1556 Vol 18

APPENDIXC














NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0


0

0





0 shielding system

0

0


0

0


APPENDIXC

Item No









m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys


(2J 0

OR


Leak Tests


0 0 0

OR


IJ 0


APPENDIXC

Item No



Leak Tests (Contd)

OR


III LJ 0 121

OR


0 0 0

AND



0 0 0

0


APPENDIXC



Maintenance


OR



OR





I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC





Waste Management




OR


OR





NovaMed Corporation










NovaMed Corporation






--

--------


NovaMed President

I John JaKer



















EngmeerRSO

f---






ByIMAI t-- Special~



Tell1Pi~e~I11i1 PtT

y --












wwwcisusinccom






II II








wwwcisusinccom











wwwcisusinccom










wwwcisusinccom










wwwcisusinccom















2

8 8

60


y





Dear Mr AIIo





Sincerely






OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositionfTitle







OFFICIAL USE ONLY




Sincerely




and Safeguards



OFFICIAL USE ONLY


November 72003



Dear SirMadam













Date 2012


Signed

~n~ Employee

Date




Date 112011

Review Period 2010


x


x

x


RSO soon



-~----Date




Date 112010






f7--Iu---__ Date




Date 112010







Sign~7L Employee

SUP~~S3 Date





programs as

Signed

~d~ Employee Date

Date




NovaMed Corporation



















wwwcisusinccom












wwwcisusinccom











wwwcisusinccom









Attest~ tJJtL--shy


wwwcisusinccom










wwwcisusinccom

CIS-US Inc




Ronald G McCoy













Instrumentallon










R11106 - PMT





Dear Mr Alto





Sincerely




OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle







OFFICIAL USE ONLY


November 7 2003



Dear SirMadam











Sincerely




and Safeguards



OFFICIAL USE ONLY














r Date


c



RONMCCOY CIS-US



IBL 437 C


shy__ ~X-tifA







Date 2012


Date




Date 112011

Review Period 2010





Date

w4 Date



Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010




gA1)O~3 0+

Yes No

1 y V y I

y I


I

I

I

i

Date

Date




NovaMed Corporation







~~ NovaMed



10 General











Table 1 (continued)



~~ NovaMed











I

wwwnonunedcorpcom 2



Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



60 Surveys 3



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamedcorJlcom



60 Surveys




To include






11

wwwnovamedcorpcom




Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background



60 Documentation



Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom



10 Purpose


20 Responsibility


30 Background









wwwnovamedcorpcom











Definitions





wwwnovamedcorpcom


Procedure RSP-0021 of 6 ~fampJNovaMed Radiological Emergency Procedures



























wwwnovamedcorpcom
















60 Documentation



wwwnovamedcorpcom








wwwnovamedcorpcom



Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility


Date

01A~g2012

Date 01Aug2012

2

2

2



10 Purpose


20 Responsibility






Issued by Dale



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2


50 Documentation 4


wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General





wwwnov~lmedcorpcom


40 Audit Procedures












wwwnovamcdcorpcom








50 Documentation







Wlwnovamcdcorpcom






wwwuovamcdcorpcom





Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamcdcorpcom











wwwIlovamedcorpcom















wwwllovamedcorpcom


wwruovamedcorpcom


s Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys


60 Contamination


Date 01July2012

2

2

2

3

3

3



10 Purpose


20 Responsibility


30 General





40 Device Surveys












60 Contamination




Date


Officer Issued by


Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2



10 Purpose


20 Responsibility



wwwnovamedcorpcom




Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3


10 Purpose


20 Responsibility



30 General











Radiation Safety









50 Documentation






Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2









10 Purpose


20 Responsibility


30 Policy

























60 Confidentiality













Signature


ASOARSO Signature







Signature


RSOARSO Signature




I Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2


40 Instrument Use 2




10 Purpose


20 Responsibility









40 Instrument Use


















Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose


20 Responsibility



30 General















Approved by Date



Supersedes updates

Original document

Table of Contents

10 Purpose





Page 1 of 5

2

2

2

3

4



Purpose












stopped



can be found








and instructions














in 10 CFR 201301







documented





corrective actions


requirements







42 Company Policies














Page 1 of 7 NovaMed



Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2



70 Documentation 5




10 Purpose


20 Responsibility



30 Discussion




40 Formulas





Example


~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)


Page 3 of 7


Cmiddot) ( -693(123)=(102 IJ I e


= (102 pCi) (4206)

=429 IJCi (1588 KBq)



Where


Example





Where




MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027



















70 Documentation




80 Record Retention



EXAMPLE A


h rm lucence


City State Zip Code







Results








Failed



Prepared by











5

APPENDIXC







Radioisotope

Cesium-137

o Depleted Uranium

o Uranium-238

o Thorium-232

o Other Specify

Radioisotope

Sealed Sources



Quantity




Source Material

Kilograms

Kilograms

_____ Kilograms

Kilograms



o

o

o

o

IYes INo

L2J 0

0 0

0 0

Yes No


APPENDIXC

0

0

0

Uranium-234

Uranium-235

Plutonium-238


0 0

0 Plutonium-239

0 Other SpecifY


APPENDIXC








OR






AND IF APPLICABLE







AND

NUREG - 1556 Vol 18 C-4

APPENDIXC


APPENDIXC


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams









Surce Material


o Thorium-232 Grams

o Other Grams


NUREG - 1556 Vol 18 C-6

APPENDIXC


o Uranium-234 Grams

o Uranium-235 Grams











OR




OR


C-7 NUREG - 1556 Vo118

APPENDIXC

AND IF APPLICABLE







A~D


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams




APPENDIXC

Item No





121 D


OR



APPENDlXC



6





Yes

I2J 0 0 0

IZI ~

0 0

(lJ 0 QJ



0 IZI I2J I2J

0

0 0 0 0 ~ 0

J 0 0 0 0 IZI 0 0 0 0 0 121 0 0 0 0 0 0 0 0 0 0 (]


APPENDIXC

Item No




QJ

Nuclear Laundry 0 0






0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0


7

APPENDIXC





AND EITHER


OR



NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No



Authorized Users


III 0

OR


iii

Ancillary Personnel


0 0

OR


0


APPENDIXC
















0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC













APPENDIXC









NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No















I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0



APPENDIXC

Item No






121 0 0

OR


0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No




OR


0



0 121

OR


0

AND


0

C-19 NUREG - 1556 Vo1l8

APPENDIXC





OR


ANDOR


AND


NUREG - 1556 Vol 18 C-20

APPENDIXC




OR












C-21 NUREG - 1556 Vol 18

APPENDIXC














NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0


0

0





0 shielding system

0

0


0

0


APPENDIXC

Item No









m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys


(2J 0

OR


Leak Tests


0 0 0

OR


IJ 0


APPENDIXC

Item No



Leak Tests (Contd)

OR


III LJ 0 121

OR


0 0 0

AND



0 0 0

0


APPENDIXC



Maintenance


OR



OR





I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC





Waste Management




OR


OR





NovaMed Corporation










NovaMed Corporation






--

--------


NovaMed President

I John JaKer



















EngmeerRSO

f---






ByIMAI t-- Special~



Tell1Pi~e~I11i1 PtT

y --












wwwcisusinccom






II II








wwwcisusinccom











wwwcisusinccom










wwwcisusinccom










wwwcisusinccom















2

8 8

60


y





Dear Mr AIIo





Sincerely






OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositionfTitle







OFFICIAL USE ONLY




Sincerely




and Safeguards



OFFICIAL USE ONLY


November 72003



Dear SirMadam













Date 2012


Signed

~n~ Employee

Date




Date 112011

Review Period 2010


x


x

x


RSO soon



-~----Date




Date 112010






f7--Iu---__ Date




Date 112010







Sign~7L Employee

SUP~~S3 Date





programs as

Signed

~d~ Employee Date

Date




NovaMed Corporation



















wwwcisusinccom












wwwcisusinccom











wwwcisusinccom









Attest~ tJJtL--shy


wwwcisusinccom










wwwcisusinccom

CIS-US Inc




Ronald G McCoy













Instrumentallon










R11106 - PMT





Dear Mr Alto





Sincerely




OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle







OFFICIAL USE ONLY


November 7 2003



Dear SirMadam











Sincerely




and Safeguards



OFFICIAL USE ONLY














r Date


c



RONMCCOY CIS-US



IBL 437 C


shy__ ~X-tifA







Date 2012


Date




Date 112011

Review Period 2010





Date

w4 Date



Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010




gA1)O~3 0+

Yes No

1 y V y I

y I


I

I

I

i

Date

Date




NovaMed Corporation







~~ NovaMed



10 General











Table 1 (continued)



~~ NovaMed











I

wwwnonunedcorpcom 2



Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



60 Surveys 3



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamedcorJlcom



60 Surveys




To include






11

wwwnovamedcorpcom




Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background



60 Documentation



Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom



10 Purpose


20 Responsibility


30 Background









wwwnovamedcorpcom











Definitions





wwwnovamedcorpcom



















~~ Procedure RSP-0021 of 6 NovaMed Radiological Emergency Procedures










wwwnovamedcorpcom
















60 Documentation



wwwnovamedcorpcom








wwwnovamedcorpcom



Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility


Date

01A~g2012

Date 01Aug2012

2

2

2



10 Purpose


20 Responsibility






Issued by Dale



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2


50 Documentation 4


wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General





wwwnov~lmedcorpcom


40 Audit Procedures












wwwnovamcdcorpcom








50 Documentation







Wlwnovamcdcorpcom






wwwuovamcdcorpcom





Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamcdcorpcom











wwwIlovamedcorpcom















wwwllovamedcorpcom


wwruovamedcorpcom


s Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys


60 Contamination


Date 01July2012

2

2

2

3

3

3



10 Purpose


20 Responsibility


30 General





40 Device Surveys












60 Contamination




Date


Officer Issued by


Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2



10 Purpose


20 Responsibility



wwwnovamedcorpcom




Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3


10 Purpose


20 Responsibility



30 General











Radiation Safety









50 Documentation






Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2









10 Purpose


20 Responsibility


30 Policy

























60 Confidentiality













Signature


ASOARSO Signature







Signature


RSOARSO Signature




I Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2


40 Instrument Use 2




10 Purpose


20 Responsibility









40 Instrument Use


















Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose


20 Responsibility



30 General















Approved by Date



Supersedes updates

Original document

Table of Contents

10 Purpose





Page 1 of 5

2

2

2

3

4



Purpose












stopped



can be found








and instructions














in 10 CFR 201301







documented





corrective actions


requirements







42 Company Policies














Page 1 of 7 NovaMed



Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2



70 Documentation 5




10 Purpose


20 Responsibility



30 Discussion




40 Formulas





Example


~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)


Page 3 of 7


Cmiddot) ( -693(123)=(102 IJ I e


= (102 pCi) (4206)

=429 IJCi (1588 KBq)



Where


Example





Where




MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027



















70 Documentation




80 Record Retention



EXAMPLE A


h rm lucence


City State Zip Code







Results








Failed



Prepared by











APPENDIXC

0

0

0

Uranium-234

Uranium-235

Plutonium-238


0 0

0 Plutonium-239

0 Other SpecifY


APPENDIXC








OR






AND IF APPLICABLE







AND

NUREG - 1556 Vol 18 C-4

APPENDIXC


APPENDIXC


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams









Surce Material


o Thorium-232 Grams

o Other Grams


NUREG - 1556 Vol 18 C-6

APPENDIXC


o Uranium-234 Grams

o Uranium-235 Grams











OR




OR


C-7 NUREG - 1556 Vo118

APPENDIXC

AND IF APPLICABLE







A~D


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams




APPENDIXC

Item No





121 D


OR



APPENDlXC



6





Yes

I2J 0 0 0

IZI ~

0 0

(lJ 0 QJ



0 IZI I2J I2J

0

0 0 0 0 ~ 0

J 0 0 0 0 IZI 0 0 0 0 0 121 0 0 0 0 0 0 0 0 0 0 (]


APPENDIXC

Item No




QJ

Nuclear Laundry 0 0






0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0


7

APPENDIXC





AND EITHER


OR



NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No



Authorized Users


III 0

OR


iii

Ancillary Personnel


0 0

OR


0


APPENDIXC
















0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC













APPENDIXC









NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No















I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0



APPENDIXC

Item No






121 0 0

OR


0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No




OR


0



0 121

OR


0

AND


0

C-19 NUREG - 1556 Vo1l8

APPENDIXC





OR


ANDOR


AND


NUREG - 1556 Vol 18 C-20

APPENDIXC




OR












C-21 NUREG - 1556 Vol 18

APPENDIXC














NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0


0

0





0 shielding system

0

0


0

0


APPENDIXC

Item No









m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys


(2J 0

OR


Leak Tests


0 0 0

OR


IJ 0


APPENDIXC

Item No



Leak Tests (Contd)

OR


III LJ 0 121

OR


0 0 0

AND



0 0 0

0


APPENDIXC



Maintenance


OR



OR





I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC





Waste Management




OR


OR





NovaMed Corporation










NovaMed Corporation






--

--------


NovaMed President

I John JaKer



















EngmeerRSO

f---






ByIMAI t-- Special~



Tell1Pi~e~I11i1 PtT

y --












wwwcisusinccom






II II








wwwcisusinccom











wwwcisusinccom










wwwcisusinccom










wwwcisusinccom















2

8 8

60


y





Dear Mr AIIo





Sincerely






OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositionfTitle







OFFICIAL USE ONLY




Sincerely




and Safeguards



OFFICIAL USE ONLY


November 72003



Dear SirMadam













Date 2012


Signed

~n~ Employee

Date




Date 112011

Review Period 2010


x


x

x


RSO soon



-~----Date




Date 112010






f7--Iu---__ Date




Date 112010







Sign~7L Employee

SUP~~S3 Date





programs as

Signed

~d~ Employee Date

Date




NovaMed Corporation



















wwwcisusinccom












wwwcisusinccom











wwwcisusinccom









Attest~ tJJtL--shy


wwwcisusinccom










wwwcisusinccom

CIS-US Inc




Ronald G McCoy













Instrumentallon










R11106 - PMT





Dear Mr Alto





Sincerely




OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle







OFFICIAL USE ONLY


November 7 2003



Dear SirMadam











Sincerely




and Safeguards



OFFICIAL USE ONLY














r Date


c



RONMCCOY CIS-US



IBL 437 C


shy__ ~X-tifA







Date 2012


Date




Date 112011

Review Period 2010





Date

w4 Date



Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010




gA1)O~3 0+

Yes No

1 y V y I

y I


I

I

I

i

Date

Date




NovaMed Corporation







~~ NovaMed



10 General











Table 1 (continued)



~~ NovaMed











I

wwwnonunedcorpcom 2



Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



60 Surveys 3



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamedcorJlcom



60 Surveys




To include






11

wwwnovamedcorpcom




Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background



60 Documentation



Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom



10 Purpose


20 Responsibility


30 Background









wwwnovamedcorpcom











Definitions





wwwnovamedcorpcom





























wwwnovamedcorpcom
















60 Documentation



wwwnovamedcorpcom








wwwnovamedcorpcom



Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility


Date

01A~g2012

Date 01Aug2012

2

2

2



10 Purpose


20 Responsibility






Issued by Dale



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2


50 Documentation 4


wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General





wwwnov~lmedcorpcom


40 Audit Procedures












wwwnovamcdcorpcom








50 Documentation







Wlwnovamcdcorpcom






wwwuovamcdcorpcom





Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamcdcorpcom











wwwIlovamedcorpcom















wwwllovamedcorpcom


wwruovamedcorpcom


s Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys


60 Contamination


Date 01July2012

2

2

2

3

3

3



10 Purpose


20 Responsibility


30 General





40 Device Surveys












60 Contamination




Date


Officer Issued by


Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2



10 Purpose


20 Responsibility



wwwnovamedcorpcom




Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3


10 Purpose


20 Responsibility



30 General











Radiation Safety









50 Documentation






Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2









10 Purpose


20 Responsibility


30 Policy

























60 Confidentiality













Signature


ASOARSO Signature







Signature


RSOARSO Signature




I Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2


40 Instrument Use 2




10 Purpose


20 Responsibility









40 Instrument Use


















Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose


20 Responsibility



30 General















Approved by Date



Supersedes updates

Original document

Table of Contents

10 Purpose





Page 1 of 5

2

2

2

3

4



Purpose












stopped



can be found








and instructions














in 10 CFR 201301







documented





corrective actions


requirements







42 Company Policies














Page 1 of 7 NovaMed



Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2



70 Documentation 5




10 Purpose


20 Responsibility



30 Discussion




40 Formulas





Example


~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)


Page 3 of 7


Cmiddot) ( -693(123)=(102 IJ I e


= (102 pCi) (4206)

=429 IJCi (1588 KBq)



Where


Example





Where




MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027



















70 Documentation




80 Record Retention



EXAMPLE A


h rm lucence


City State Zip Code







Results








Failed



Prepared by











APPENDIXC








OR






AND IF APPLICABLE







AND

NUREG - 1556 Vol 18 C-4

APPENDIXC


APPENDIXC


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams









Surce Material


o Thorium-232 Grams

o Other Grams


NUREG - 1556 Vol 18 C-6

APPENDIXC


o Uranium-234 Grams

o Uranium-235 Grams











OR




OR


C-7 NUREG - 1556 Vo118

APPENDIXC

AND IF APPLICABLE







A~D


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams




APPENDIXC

Item No





121 D


OR



APPENDlXC



6





Yes

I2J 0 0 0

IZI ~

0 0

(lJ 0 QJ



0 IZI I2J I2J

0

0 0 0 0 ~ 0

J 0 0 0 0 IZI 0 0 0 0 0 121 0 0 0 0 0 0 0 0 0 0 (]


APPENDIXC

Item No




QJ

Nuclear Laundry 0 0






0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0


7

APPENDIXC





AND EITHER


OR



NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No



Authorized Users


III 0

OR


iii

Ancillary Personnel


0 0

OR


0


APPENDIXC
















0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC













APPENDIXC









NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No















I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0



APPENDIXC

Item No






121 0 0

OR


0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No




OR


0



0 121

OR


0

AND


0

C-19 NUREG - 1556 Vo1l8

APPENDIXC





OR


ANDOR


AND


NUREG - 1556 Vol 18 C-20

APPENDIXC




OR












C-21 NUREG - 1556 Vol 18

APPENDIXC














NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0


0

0





0 shielding system

0

0


0

0


APPENDIXC

Item No









m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys


(2J 0

OR


Leak Tests


0 0 0

OR


IJ 0


APPENDIXC

Item No



Leak Tests (Contd)

OR


III LJ 0 121

OR


0 0 0

AND



0 0 0

0


APPENDIXC



Maintenance


OR



OR





I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC





Waste Management




OR


OR





NovaMed Corporation










NovaMed Corporation






--

--------


NovaMed President

I John JaKer



















EngmeerRSO

f---






ByIMAI t-- Special~



Tell1Pi~e~I11i1 PtT

y --












wwwcisusinccom






II II








wwwcisusinccom











wwwcisusinccom










wwwcisusinccom










wwwcisusinccom















2

8 8

60


y





Dear Mr AIIo





Sincerely






OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositionfTitle







OFFICIAL USE ONLY




Sincerely




and Safeguards



OFFICIAL USE ONLY


November 72003



Dear SirMadam













Date 2012


Signed

~n~ Employee

Date




Date 112011

Review Period 2010


x


x

x


RSO soon



-~----Date




Date 112010






f7--Iu---__ Date




Date 112010







Sign~7L Employee

SUP~~S3 Date





programs as

Signed

~d~ Employee Date

Date




NovaMed Corporation



















wwwcisusinccom












wwwcisusinccom











wwwcisusinccom









Attest~ tJJtL--shy


wwwcisusinccom










wwwcisusinccom

CIS-US Inc




Ronald G McCoy













Instrumentallon










R11106 - PMT





Dear Mr Alto





Sincerely




OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle







OFFICIAL USE ONLY


November 7 2003



Dear SirMadam











Sincerely




and Safeguards



OFFICIAL USE ONLY














r Date


c



RONMCCOY CIS-US



IBL 437 C


shy__ ~X-tifA







Date 2012


Date




Date 112011

Review Period 2010





Date

w4 Date



Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010




gA1)O~3 0+

Yes No

1 y V y I

y I


I

I

I

i

Date

Date




NovaMed Corporation







~~ NovaMed



10 General











Table 1 (continued)



~~ NovaMed











I

wwwnonunedcorpcom 2



Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



60 Surveys 3



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamedcorJlcom



60 Surveys




To include






11

wwwnovamedcorpcom




Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background



60 Documentation



Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom



10 Purpose


20 Responsibility


30 Background









wwwnovamedcorpcom











Definitions





wwwnovamedcorpcom





























wwwnovamedcorpcom
















60 Documentation



wwwnovamedcorpcom








wwwnovamedcorpcom



Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility


Date

01A~g2012

Date 01Aug2012

2

2

2



10 Purpose


20 Responsibility






Issued by Dale



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2


50 Documentation 4


wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General





wwwnov~lmedcorpcom


40 Audit Procedures












wwwnovamcdcorpcom








50 Documentation







Wlwnovamcdcorpcom






wwwuovamcdcorpcom





Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamcdcorpcom











wwwIlovamedcorpcom















wwwllovamedcorpcom


wwruovamedcorpcom


s Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys


60 Contamination


Date 01July2012

2

2

2

3

3

3



10 Purpose


20 Responsibility


30 General





40 Device Surveys












60 Contamination




Date


Officer Issued by


Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2



10 Purpose


20 Responsibility



wwwnovamedcorpcom




Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3


10 Purpose


20 Responsibility



30 General











Radiation Safety









50 Documentation






Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2









10 Purpose


20 Responsibility


30 Policy

























60 Confidentiality













Signature


ASOARSO Signature







Signature


RSOARSO Signature




I Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2


40 Instrument Use 2




10 Purpose


20 Responsibility









40 Instrument Use


















Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose


20 Responsibility



30 General















Approved by Date



Supersedes updates

Original document

Table of Contents

10 Purpose





Page 1 of 5

2

2

2

3

4



Purpose












stopped



can be found








and instructions














in 10 CFR 201301







documented





corrective actions


requirements







42 Company Policies














Page 1 of 7 NovaMed



Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2



70 Documentation 5




10 Purpose


20 Responsibility



30 Discussion




40 Formulas





Example


~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)


Page 3 of 7


Cmiddot) ( -693(123)=(102 IJ I e


= (102 pCi) (4206)

=429 IJCi (1588 KBq)



Where


Example





Where




MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027



















70 Documentation




80 Record Retention



EXAMPLE A


h rm lucence


City State Zip Code







Results








Failed



Prepared by











APPENDIXC


APPENDIXC


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams









Surce Material


o Thorium-232 Grams

o Other Grams


NUREG - 1556 Vol 18 C-6

APPENDIXC


o Uranium-234 Grams

o Uranium-235 Grams











OR




OR


C-7 NUREG - 1556 Vo118

APPENDIXC

AND IF APPLICABLE







A~D


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams




APPENDIXC

Item No





121 D


OR



APPENDlXC



6





Yes

I2J 0 0 0

IZI ~

0 0

(lJ 0 QJ



0 IZI I2J I2J

0

0 0 0 0 ~ 0

J 0 0 0 0 IZI 0 0 0 0 0 121 0 0 0 0 0 0 0 0 0 0 (]


APPENDIXC

Item No




QJ

Nuclear Laundry 0 0






0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0


7

APPENDIXC





AND EITHER


OR



NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No



Authorized Users


III 0

OR


iii

Ancillary Personnel


0 0

OR


0


APPENDIXC
















0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC













APPENDIXC









NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No















I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0



APPENDIXC

Item No






121 0 0

OR


0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No




OR


0



0 121

OR


0

AND


0

C-19 NUREG - 1556 Vo1l8

APPENDIXC





OR


ANDOR


AND


NUREG - 1556 Vol 18 C-20

APPENDIXC




OR












C-21 NUREG - 1556 Vol 18

APPENDIXC














NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0


0

0





0 shielding system

0

0


0

0


APPENDIXC

Item No









m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys


(2J 0

OR


Leak Tests


0 0 0

OR


IJ 0


APPENDIXC

Item No



Leak Tests (Contd)

OR


III LJ 0 121

OR


0 0 0

AND



0 0 0

0


APPENDIXC



Maintenance


OR



OR





I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC





Waste Management




OR


OR





NovaMed Corporation










NovaMed Corporation






--

--------


NovaMed President

I John JaKer



















EngmeerRSO

f---






ByIMAI t-- Special~



Tell1Pi~e~I11i1 PtT

y --












wwwcisusinccom






II II








wwwcisusinccom











wwwcisusinccom










wwwcisusinccom










wwwcisusinccom















2

8 8

60


y





Dear Mr AIIo





Sincerely






OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositionfTitle







OFFICIAL USE ONLY




Sincerely




and Safeguards



OFFICIAL USE ONLY


November 72003



Dear SirMadam













Date 2012


Signed

~n~ Employee

Date




Date 112011

Review Period 2010


x


x

x


RSO soon



-~----Date




Date 112010






f7--Iu---__ Date




Date 112010







Sign~7L Employee

SUP~~S3 Date





programs as

Signed

~d~ Employee Date

Date




NovaMed Corporation



















wwwcisusinccom












wwwcisusinccom











wwwcisusinccom









Attest~ tJJtL--shy


wwwcisusinccom










wwwcisusinccom

CIS-US Inc




Ronald G McCoy













Instrumentallon










R11106 - PMT





Dear Mr Alto





Sincerely




OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle







OFFICIAL USE ONLY


November 7 2003



Dear SirMadam











Sincerely




and Safeguards



OFFICIAL USE ONLY














r Date


c



RONMCCOY CIS-US



IBL 437 C


shy__ ~X-tifA







Date 2012


Date




Date 112011

Review Period 2010





Date

w4 Date



Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010




gA1)O~3 0+

Yes No

1 y V y I

y I


I

I

I

i

Date

Date




NovaMed Corporation







~~ NovaMed



10 General











Table 1 (continued)



~~ NovaMed











I

wwwnonunedcorpcom 2



Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



60 Surveys 3



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamedcorJlcom



60 Surveys




To include






11

wwwnovamedcorpcom




Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background



60 Documentation



Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom



10 Purpose


20 Responsibility


30 Background









wwwnovamedcorpcom











Definitions





wwwnovamedcorpcom





























wwwnovamedcorpcom
















60 Documentation



wwwnovamedcorpcom








wwwnovamedcorpcom



Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility


Date

01A~g2012

Date 01Aug2012

2

2

2



10 Purpose


20 Responsibility






Issued by Dale



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2


50 Documentation 4


wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General





wwwnov~lmedcorpcom


40 Audit Procedures












wwwnovamcdcorpcom








50 Documentation







Wlwnovamcdcorpcom






wwwuovamcdcorpcom





Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamcdcorpcom











wwwIlovamedcorpcom















wwwllovamedcorpcom


wwruovamedcorpcom


s Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys


60 Contamination


Date 01July2012

2

2

2

3

3

3



10 Purpose


20 Responsibility


30 General





40 Device Surveys












60 Contamination




Date


Officer Issued by


Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2



10 Purpose


20 Responsibility



wwwnovamedcorpcom




Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3


10 Purpose


20 Responsibility



30 General











Radiation Safety









50 Documentation






Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2









10 Purpose


20 Responsibility


30 Policy

























60 Confidentiality













Signature


ASOARSO Signature







Signature


RSOARSO Signature




I Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2


40 Instrument Use 2




10 Purpose


20 Responsibility









40 Instrument Use


















Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose


20 Responsibility



30 General















Approved by Date



Supersedes updates

Original document

Table of Contents

10 Purpose





Page 1 of 5

2

2

2

3

4



Purpose












stopped



can be found








and instructions














in 10 CFR 201301







documented





corrective actions


requirements







42 Company Policies














Page 1 of 7 NovaMed



Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2



70 Documentation 5




10 Purpose


20 Responsibility



30 Discussion




40 Formulas





Example


~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)


Page 3 of 7


Cmiddot) ( -693(123)=(102 IJ I e


= (102 pCi) (4206)

=429 IJCi (1588 KBq)



Where


Example





Where




MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027



















70 Documentation




80 Record Retention



EXAMPLE A


h rm lucence


City State Zip Code







Results








Failed



Prepared by











APPENDIXC


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams









Surce Material


o Thorium-232 Grams

o Other Grams


NUREG - 1556 Vol 18 C-6

APPENDIXC


o Uranium-234 Grams

o Uranium-235 Grams











OR




OR


C-7 NUREG - 1556 Vo118

APPENDIXC

AND IF APPLICABLE







A~D


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams




APPENDIXC

Item No





121 D


OR



APPENDlXC



6





Yes

I2J 0 0 0

IZI ~

0 0

(lJ 0 QJ



0 IZI I2J I2J

0

0 0 0 0 ~ 0

J 0 0 0 0 IZI 0 0 0 0 0 121 0 0 0 0 0 0 0 0 0 0 (]


APPENDIXC

Item No




QJ

Nuclear Laundry 0 0






0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0


7

APPENDIXC





AND EITHER


OR



NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No



Authorized Users


III 0

OR


iii

Ancillary Personnel


0 0

OR


0


APPENDIXC
















0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC













APPENDIXC









NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No















I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0



APPENDIXC

Item No






121 0 0

OR


0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No




OR


0



0 121

OR


0

AND


0

C-19 NUREG - 1556 Vo1l8

APPENDIXC





OR


ANDOR


AND


NUREG - 1556 Vol 18 C-20

APPENDIXC




OR












C-21 NUREG - 1556 Vol 18

APPENDIXC














NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0


0

0





0 shielding system

0

0


0

0


APPENDIXC

Item No









m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys


(2J 0

OR


Leak Tests


0 0 0

OR


IJ 0


APPENDIXC

Item No



Leak Tests (Contd)

OR


III LJ 0 121

OR


0 0 0

AND



0 0 0

0


APPENDIXC



Maintenance


OR



OR





I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC





Waste Management




OR


OR





NovaMed Corporation










NovaMed Corporation






--

--------


NovaMed President

I John JaKer



















EngmeerRSO

f---






ByIMAI t-- Special~



Tell1Pi~e~I11i1 PtT

y --












wwwcisusinccom






II II








wwwcisusinccom











wwwcisusinccom










wwwcisusinccom










wwwcisusinccom















2

8 8

60


y





Dear Mr AIIo





Sincerely






OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositionfTitle







OFFICIAL USE ONLY




Sincerely




and Safeguards



OFFICIAL USE ONLY


November 72003



Dear SirMadam













Date 2012


Signed

~n~ Employee

Date




Date 112011

Review Period 2010


x


x

x


RSO soon



-~----Date




Date 112010






f7--Iu---__ Date




Date 112010







Sign~7L Employee

SUP~~S3 Date





programs as

Signed

~d~ Employee Date

Date




NovaMed Corporation



















wwwcisusinccom












wwwcisusinccom











wwwcisusinccom









Attest~ tJJtL--shy


wwwcisusinccom










wwwcisusinccom

CIS-US Inc




Ronald G McCoy













Instrumentallon










R11106 - PMT





Dear Mr Alto





Sincerely




OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle







OFFICIAL USE ONLY


November 7 2003



Dear SirMadam











Sincerely




and Safeguards



OFFICIAL USE ONLY














r Date


c



RONMCCOY CIS-US



IBL 437 C


shy__ ~X-tifA







Date 2012


Date




Date 112011

Review Period 2010





Date

w4 Date



Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010




gA1)O~3 0+

Yes No

1 y V y I

y I


I

I

I

i

Date

Date




NovaMed Corporation







~~ NovaMed



10 General











Table 1 (continued)



~~ NovaMed











I

wwwnonunedcorpcom 2



Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



60 Surveys 3



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamedcorJlcom



60 Surveys




To include






11

wwwnovamedcorpcom




Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background



60 Documentation



Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom



10 Purpose


20 Responsibility


30 Background









wwwnovamedcorpcom











Definitions





wwwnovamedcorpcom





























wwwnovamedcorpcom
















60 Documentation



wwwnovamedcorpcom








wwwnovamedcorpcom



Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility


Date

01A~g2012

Date 01Aug2012

2

2

2



10 Purpose


20 Responsibility






Issued by Dale



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2


50 Documentation 4


wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General





wwwnov~lmedcorpcom


40 Audit Procedures












wwwnovamcdcorpcom








50 Documentation







Wlwnovamcdcorpcom






wwwuovamcdcorpcom





Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamcdcorpcom











wwwIlovamedcorpcom















wwwllovamedcorpcom


wwruovamedcorpcom


s Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys


60 Contamination


Date 01July2012

2

2

2

3

3

3



10 Purpose


20 Responsibility


30 General





40 Device Surveys












60 Contamination




Date


Officer Issued by


Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2



10 Purpose


20 Responsibility



wwwnovamedcorpcom




Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3


10 Purpose


20 Responsibility



30 General











Radiation Safety









50 Documentation






Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2









10 Purpose


20 Responsibility


30 Policy

























60 Confidentiality













Signature


ASOARSO Signature







Signature


RSOARSO Signature




I Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2


40 Instrument Use 2




10 Purpose


20 Responsibility









40 Instrument Use


















Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose


20 Responsibility



30 General















Approved by Date



Supersedes updates

Original document

Table of Contents

10 Purpose





Page 1 of 5

2

2

2

3

4



Purpose












stopped



can be found








and instructions














in 10 CFR 201301







documented





corrective actions


requirements







42 Company Policies














Page 1 of 7 NovaMed



Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2



70 Documentation 5




10 Purpose


20 Responsibility



30 Discussion




40 Formulas





Example


~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)


Page 3 of 7


Cmiddot) ( -693(123)=(102 IJ I e


= (102 pCi) (4206)

=429 IJCi (1588 KBq)



Where


Example





Where




MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027



















70 Documentation




80 Record Retention



EXAMPLE A


h rm lucence


City State Zip Code







Results








Failed



Prepared by











APPENDIXC


o Uranium-234 Grams

o Uranium-235 Grams











OR




OR


C-7 NUREG - 1556 Vo118

APPENDIXC

AND IF APPLICABLE







A~D


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams




APPENDIXC

Item No





121 D


OR



APPENDlXC



6





Yes

I2J 0 0 0

IZI ~

0 0

(lJ 0 QJ



0 IZI I2J I2J

0

0 0 0 0 ~ 0

J 0 0 0 0 IZI 0 0 0 0 0 121 0 0 0 0 0 0 0 0 0 0 (]


APPENDIXC

Item No




QJ

Nuclear Laundry 0 0






0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0


7

APPENDIXC





AND EITHER


OR



NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No



Authorized Users


III 0

OR


iii

Ancillary Personnel


0 0

OR


0


APPENDIXC
















0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC













APPENDIXC









NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No















I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0



APPENDIXC

Item No






121 0 0

OR


0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No




OR


0



0 121

OR


0

AND


0

C-19 NUREG - 1556 Vo1l8

APPENDIXC





OR


ANDOR


AND


NUREG - 1556 Vol 18 C-20

APPENDIXC




OR












C-21 NUREG - 1556 Vol 18

APPENDIXC














NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0


0

0





0 shielding system

0

0


0

0


APPENDIXC

Item No









m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys


(2J 0

OR


Leak Tests


0 0 0

OR


IJ 0


APPENDIXC

Item No



Leak Tests (Contd)

OR


III LJ 0 121

OR


0 0 0

AND



0 0 0

0


APPENDIXC



Maintenance


OR



OR





I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC





Waste Management




OR


OR





NovaMed Corporation










NovaMed Corporation






--

--------


NovaMed President

I John JaKer



















EngmeerRSO

f---






ByIMAI t-- Special~



Tell1Pi~e~I11i1 PtT

y --












wwwcisusinccom






II II








wwwcisusinccom











wwwcisusinccom










wwwcisusinccom










wwwcisusinccom















2

8 8

60


y





Dear Mr AIIo





Sincerely






OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositionfTitle







OFFICIAL USE ONLY




Sincerely




and Safeguards



OFFICIAL USE ONLY


November 72003



Dear SirMadam













Date 2012


Signed

~n~ Employee

Date




Date 112011

Review Period 2010


x


x

x


RSO soon



-~----Date




Date 112010






f7--Iu---__ Date




Date 112010







Sign~7L Employee

SUP~~S3 Date





programs as

Signed

~d~ Employee Date

Date




NovaMed Corporation



















wwwcisusinccom












wwwcisusinccom











wwwcisusinccom









Attest~ tJJtL--shy


wwwcisusinccom










wwwcisusinccom

CIS-US Inc




Ronald G McCoy













Instrumentallon










R11106 - PMT





Dear Mr Alto





Sincerely




OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle







OFFICIAL USE ONLY


November 7 2003



Dear SirMadam











Sincerely




and Safeguards



OFFICIAL USE ONLY














r Date


c



RONMCCOY CIS-US



IBL 437 C


shy__ ~X-tifA







Date 2012


Date




Date 112011

Review Period 2010





Date

w4 Date



Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010




gA1)O~3 0+

Yes No

1 y V y I

y I


I

I

I

i

Date

Date




NovaMed Corporation







~~ NovaMed



10 General











Table 1 (continued)



~~ NovaMed











I

wwwnonunedcorpcom 2



Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



60 Surveys 3



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamedcorJlcom



60 Surveys




To include






11

wwwnovamedcorpcom




Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background



60 Documentation



Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom



10 Purpose


20 Responsibility


30 Background









wwwnovamedcorpcom











Definitions





wwwnovamedcorpcom





























wwwnovamedcorpcom
















60 Documentation



wwwnovamedcorpcom








wwwnovamedcorpcom



Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility


Date

01A~g2012

Date 01Aug2012

2

2

2



10 Purpose


20 Responsibility






Issued by Dale



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2


50 Documentation 4


wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General





wwwnov~lmedcorpcom


40 Audit Procedures












wwwnovamcdcorpcom








50 Documentation







Wlwnovamcdcorpcom






wwwuovamcdcorpcom





Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamcdcorpcom











wwwIlovamedcorpcom















wwwllovamedcorpcom


wwruovamedcorpcom


s Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys


60 Contamination


Date 01July2012

2

2

2

3

3

3



10 Purpose


20 Responsibility


30 General





40 Device Surveys












60 Contamination




Date


Officer Issued by


Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2



10 Purpose


20 Responsibility



wwwnovamedcorpcom




Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3


10 Purpose


20 Responsibility



30 General











Radiation Safety









50 Documentation






Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2









10 Purpose


20 Responsibility


30 Policy

























60 Confidentiality













Signature


ASOARSO Signature







Signature


RSOARSO Signature




I Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2


40 Instrument Use 2




10 Purpose


20 Responsibility









40 Instrument Use


















Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose


20 Responsibility



30 General















Approved by Date



Supersedes updates

Original document

Table of Contents

10 Purpose





Page 1 of 5

2

2

2

3

4



Purpose












stopped



can be found








and instructions














in 10 CFR 201301







documented





corrective actions


requirements







42 Company Policies














Page 1 of 7 NovaMed



Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2



70 Documentation 5




10 Purpose


20 Responsibility



30 Discussion




40 Formulas





Example


~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)


Page 3 of 7


Cmiddot) ( -693(123)=(102 IJ I e


= (102 pCi) (4206)

=429 IJCi (1588 KBq)



Where


Example





Where




MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027



















70 Documentation




80 Record Retention



EXAMPLE A


h rm lucence


City State Zip Code







Results








Failed



Prepared by











APPENDIXC

AND IF APPLICABLE







A~D


Source Material


o Uranium-238 Grams

o Thorium-232 Grams

o Other Grams


o Uranium-234 Grams

o Uranium-235 Grams




APPENDIXC

Item No





121 D


OR



APPENDlXC



6





Yes

I2J 0 0 0

IZI ~

0 0

(lJ 0 QJ



0 IZI I2J I2J

0

0 0 0 0 ~ 0

J 0 0 0 0 IZI 0 0 0 0 0 121 0 0 0 0 0 0 0 0 0 0 (]


APPENDIXC

Item No




QJ

Nuclear Laundry 0 0






0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0


7

APPENDIXC





AND EITHER


OR



NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No



Authorized Users


III 0

OR


iii

Ancillary Personnel


0 0

OR


0


APPENDIXC
















0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC













APPENDIXC









NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No















I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0



APPENDIXC

Item No






121 0 0

OR


0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No




OR


0



0 121

OR


0

AND


0

C-19 NUREG - 1556 Vo1l8

APPENDIXC





OR


ANDOR


AND


NUREG - 1556 Vol 18 C-20

APPENDIXC




OR












C-21 NUREG - 1556 Vol 18

APPENDIXC














NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0


0

0





0 shielding system

0

0


0

0


APPENDIXC

Item No









m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys


(2J 0

OR


Leak Tests


0 0 0

OR


IJ 0


APPENDIXC

Item No



Leak Tests (Contd)

OR


III LJ 0 121

OR


0 0 0

AND



0 0 0

0


APPENDIXC



Maintenance


OR



OR





I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC





Waste Management




OR


OR





NovaMed Corporation










NovaMed Corporation






--

--------


NovaMed President

I John JaKer



















EngmeerRSO

f---






ByIMAI t-- Special~



Tell1Pi~e~I11i1 PtT

y --












wwwcisusinccom






II II








wwwcisusinccom











wwwcisusinccom










wwwcisusinccom










wwwcisusinccom















2

8 8

60


y





Dear Mr AIIo





Sincerely






OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositionfTitle







OFFICIAL USE ONLY




Sincerely




and Safeguards



OFFICIAL USE ONLY


November 72003



Dear SirMadam













Date 2012


Signed

~n~ Employee

Date




Date 112011

Review Period 2010


x


x

x


RSO soon



-~----Date




Date 112010






f7--Iu---__ Date




Date 112010







Sign~7L Employee

SUP~~S3 Date





programs as

Signed

~d~ Employee Date

Date




NovaMed Corporation



















wwwcisusinccom












wwwcisusinccom











wwwcisusinccom









Attest~ tJJtL--shy


wwwcisusinccom










wwwcisusinccom

CIS-US Inc




Ronald G McCoy













Instrumentallon










R11106 - PMT





Dear Mr Alto





Sincerely




OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle







OFFICIAL USE ONLY


November 7 2003



Dear SirMadam











Sincerely




and Safeguards



OFFICIAL USE ONLY














r Date


c



RONMCCOY CIS-US



IBL 437 C


shy__ ~X-tifA







Date 2012


Date




Date 112011

Review Period 2010





Date

w4 Date



Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010




gA1)O~3 0+

Yes No

1 y V y I

y I


I

I

I

i

Date

Date




NovaMed Corporation







~~ NovaMed



10 General











Table 1 (continued)



~~ NovaMed











I

wwwnonunedcorpcom 2



Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



60 Surveys 3



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamedcorJlcom



60 Surveys




To include






11

wwwnovamedcorpcom




Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background



60 Documentation



Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom



10 Purpose


20 Responsibility


30 Background









wwwnovamedcorpcom











Definitions





wwwnovamedcorpcom





























wwwnovamedcorpcom
















60 Documentation



wwwnovamedcorpcom








wwwnovamedcorpcom



Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility


Date

01A~g2012

Date 01Aug2012

2

2

2



10 Purpose


20 Responsibility






Issued by Dale



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2


50 Documentation 4


wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General





wwwnov~lmedcorpcom


40 Audit Procedures












wwwnovamcdcorpcom








50 Documentation







Wlwnovamcdcorpcom






wwwuovamcdcorpcom





Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamcdcorpcom











wwwIlovamedcorpcom















wwwllovamedcorpcom


wwruovamedcorpcom


s Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys


60 Contamination


Date 01July2012

2

2

2

3

3

3



10 Purpose


20 Responsibility


30 General





40 Device Surveys












60 Contamination




Date


Officer Issued by


Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2



10 Purpose


20 Responsibility



wwwnovamedcorpcom




Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3


10 Purpose


20 Responsibility



30 General











Radiation Safety









50 Documentation






Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2









10 Purpose


20 Responsibility


30 Policy

























60 Confidentiality













Signature


ASOARSO Signature







Signature


RSOARSO Signature




I Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2


40 Instrument Use 2




10 Purpose


20 Responsibility









40 Instrument Use


















Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose


20 Responsibility



30 General















Approved by Date



Supersedes updates

Original document

Table of Contents

10 Purpose





Page 1 of 5

2

2

2

3

4



Purpose












stopped



can be found








and instructions














in 10 CFR 201301







documented





corrective actions


requirements







42 Company Policies














Page 1 of 7 NovaMed



Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2



70 Documentation 5




10 Purpose


20 Responsibility



30 Discussion




40 Formulas





Example


~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)


Page 3 of 7


Cmiddot) ( -693(123)=(102 IJ I e


= (102 pCi) (4206)

=429 IJCi (1588 KBq)



Where


Example





Where




MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027



















70 Documentation




80 Record Retention



EXAMPLE A


h rm lucence


City State Zip Code







Results








Failed



Prepared by











APPENDIXC

Item No





121 D


OR



APPENDlXC



6





Yes

I2J 0 0 0

IZI ~

0 0

(lJ 0 QJ



0 IZI I2J I2J

0

0 0 0 0 ~ 0

J 0 0 0 0 IZI 0 0 0 0 0 121 0 0 0 0 0 0 0 0 0 0 (]


APPENDIXC

Item No




QJ

Nuclear Laundry 0 0






0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0


7

APPENDIXC





AND EITHER


OR



NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No



Authorized Users


III 0

OR


iii

Ancillary Personnel


0 0

OR


0


APPENDIXC
















0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC













APPENDIXC









NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No















I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0



APPENDIXC

Item No






121 0 0

OR


0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No




OR


0



0 121

OR


0

AND


0

C-19 NUREG - 1556 Vo1l8

APPENDIXC





OR


ANDOR


AND


NUREG - 1556 Vol 18 C-20

APPENDIXC




OR












C-21 NUREG - 1556 Vol 18

APPENDIXC














NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0


0

0





0 shielding system

0

0


0

0


APPENDIXC

Item No









m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys


(2J 0

OR


Leak Tests


0 0 0

OR


IJ 0


APPENDIXC

Item No



Leak Tests (Contd)

OR


III LJ 0 121

OR


0 0 0

AND



0 0 0

0


APPENDIXC



Maintenance


OR



OR





I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC





Waste Management




OR


OR





NovaMed Corporation










NovaMed Corporation






--

--------


NovaMed President

I John JaKer



















EngmeerRSO

f---






ByIMAI t-- Special~



Tell1Pi~e~I11i1 PtT

y --












wwwcisusinccom






II II








wwwcisusinccom











wwwcisusinccom










wwwcisusinccom










wwwcisusinccom















2

8 8

60


y





Dear Mr AIIo





Sincerely






OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositionfTitle







OFFICIAL USE ONLY




Sincerely




and Safeguards



OFFICIAL USE ONLY


November 72003



Dear SirMadam













Date 2012


Signed

~n~ Employee

Date




Date 112011

Review Period 2010


x


x

x


RSO soon



-~----Date




Date 112010






f7--Iu---__ Date




Date 112010







Sign~7L Employee

SUP~~S3 Date





programs as

Signed

~d~ Employee Date

Date




NovaMed Corporation



















wwwcisusinccom












wwwcisusinccom











wwwcisusinccom









Attest~ tJJtL--shy


wwwcisusinccom










wwwcisusinccom

CIS-US Inc




Ronald G McCoy













Instrumentallon










R11106 - PMT





Dear Mr Alto





Sincerely




OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle







OFFICIAL USE ONLY


November 7 2003



Dear SirMadam











Sincerely




and Safeguards



OFFICIAL USE ONLY














r Date


c



RONMCCOY CIS-US



IBL 437 C


shy__ ~X-tifA







Date 2012


Date




Date 112011

Review Period 2010





Date

w4 Date



Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010




gA1)O~3 0+

Yes No

1 y V y I

y I


I

I

I

i

Date

Date




NovaMed Corporation







~~ NovaMed



10 General











Table 1 (continued)



~~ NovaMed











I

wwwnonunedcorpcom 2



Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



60 Surveys 3



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamedcorJlcom



60 Surveys




To include






11

wwwnovamedcorpcom




Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background



60 Documentation



Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom



10 Purpose


20 Responsibility


30 Background









wwwnovamedcorpcom











Definitions





wwwnovamedcorpcom





























wwwnovamedcorpcom
















60 Documentation



wwwnovamedcorpcom








wwwnovamedcorpcom



Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility


Date

01A~g2012

Date 01Aug2012

2

2

2



10 Purpose


20 Responsibility






Issued by Dale



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2


50 Documentation 4


wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General





wwwnov~lmedcorpcom


40 Audit Procedures












wwwnovamcdcorpcom








50 Documentation







Wlwnovamcdcorpcom






wwwuovamcdcorpcom





Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamcdcorpcom











wwwIlovamedcorpcom















wwwllovamedcorpcom


wwruovamedcorpcom


s Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys


60 Contamination


Date 01July2012

2

2

2

3

3

3



10 Purpose


20 Responsibility


30 General





40 Device Surveys












60 Contamination




Date


Officer Issued by


Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2



10 Purpose


20 Responsibility



wwwnovamedcorpcom




Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3


10 Purpose


20 Responsibility



30 General











Radiation Safety









50 Documentation






Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2









10 Purpose


20 Responsibility


30 Policy

























60 Confidentiality













Signature


ASOARSO Signature







Signature


RSOARSO Signature




I Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2


40 Instrument Use 2




10 Purpose


20 Responsibility









40 Instrument Use


















Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose


20 Responsibility



30 General















Approved by Date



Supersedes updates

Original document

Table of Contents

10 Purpose





Page 1 of 5

2

2

2

3

4



Purpose












stopped



can be found








and instructions














in 10 CFR 201301







documented





corrective actions


requirements







42 Company Policies














Page 1 of 7 NovaMed



Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2



70 Documentation 5




10 Purpose


20 Responsibility



30 Discussion




40 Formulas





Example


~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)


Page 3 of 7


Cmiddot) ( -693(123)=(102 IJ I e


= (102 pCi) (4206)

=429 IJCi (1588 KBq)



Where


Example





Where




MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027



















70 Documentation




80 Record Retention



EXAMPLE A


h rm lucence


City State Zip Code







Results








Failed



Prepared by











APPENDlXC



6





Yes

I2J 0 0 0

IZI ~

0 0

(lJ 0 QJ



0 IZI I2J I2J

0

0 0 0 0 ~ 0

J 0 0 0 0 IZI 0 0 0 0 0 121 0 0 0 0 0 0 0 0 0 0 (]


APPENDIXC

Item No




QJ

Nuclear Laundry 0 0






0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0


7

APPENDIXC





AND EITHER


OR



NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No



Authorized Users


III 0

OR


iii

Ancillary Personnel


0 0

OR


0


APPENDIXC
















0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC













APPENDIXC









NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No















I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0



APPENDIXC

Item No






121 0 0

OR


0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No




OR


0



0 121

OR


0

AND


0

C-19 NUREG - 1556 Vo1l8

APPENDIXC





OR


ANDOR


AND


NUREG - 1556 Vol 18 C-20

APPENDIXC




OR












C-21 NUREG - 1556 Vol 18

APPENDIXC














NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0


0

0





0 shielding system

0

0


0

0


APPENDIXC

Item No









m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys


(2J 0

OR


Leak Tests


0 0 0

OR


IJ 0


APPENDIXC

Item No



Leak Tests (Contd)

OR


III LJ 0 121

OR


0 0 0

AND



0 0 0

0


APPENDIXC



Maintenance


OR



OR





I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC





Waste Management




OR


OR





NovaMed Corporation










NovaMed Corporation






--

--------


NovaMed President

I John JaKer



















EngmeerRSO

f---






ByIMAI t-- Special~



Tell1Pi~e~I11i1 PtT

y --












wwwcisusinccom






II II








wwwcisusinccom











wwwcisusinccom










wwwcisusinccom










wwwcisusinccom















2

8 8

60


y





Dear Mr AIIo





Sincerely






OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositionfTitle







OFFICIAL USE ONLY




Sincerely




and Safeguards



OFFICIAL USE ONLY


November 72003



Dear SirMadam













Date 2012


Signed

~n~ Employee

Date




Date 112011

Review Period 2010


x


x

x


RSO soon



-~----Date




Date 112010






f7--Iu---__ Date




Date 112010







Sign~7L Employee

SUP~~S3 Date





programs as

Signed

~d~ Employee Date

Date




NovaMed Corporation



















wwwcisusinccom












wwwcisusinccom











wwwcisusinccom









Attest~ tJJtL--shy


wwwcisusinccom










wwwcisusinccom

CIS-US Inc




Ronald G McCoy













Instrumentallon










R11106 - PMT





Dear Mr Alto





Sincerely




OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle







OFFICIAL USE ONLY


November 7 2003



Dear SirMadam











Sincerely




and Safeguards



OFFICIAL USE ONLY














r Date


c



RONMCCOY CIS-US



IBL 437 C


shy__ ~X-tifA







Date 2012


Date




Date 112011

Review Period 2010





Date

w4 Date



Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010




gA1)O~3 0+

Yes No

1 y V y I

y I


I

I

I

i

Date

Date




NovaMed Corporation







~~ NovaMed



10 General











Table 1 (continued)



~~ NovaMed











I

wwwnonunedcorpcom 2



Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



60 Surveys 3



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamedcorJlcom



60 Surveys




To include






11

wwwnovamedcorpcom




Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background



60 Documentation



Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom



10 Purpose


20 Responsibility


30 Background









wwwnovamedcorpcom











Definitions





wwwnovamedcorpcom





























wwwnovamedcorpcom
















60 Documentation



wwwnovamedcorpcom








wwwnovamedcorpcom



Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility


Date

01A~g2012

Date 01Aug2012

2

2

2



10 Purpose


20 Responsibility






Issued by Dale



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2


50 Documentation 4


wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General





wwwnov~lmedcorpcom


40 Audit Procedures












wwwnovamcdcorpcom








50 Documentation







Wlwnovamcdcorpcom






wwwuovamcdcorpcom





Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamcdcorpcom











wwwIlovamedcorpcom















wwwllovamedcorpcom


wwruovamedcorpcom


s Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys


60 Contamination


Date 01July2012

2

2

2

3

3

3



10 Purpose


20 Responsibility


30 General





40 Device Surveys












60 Contamination




Date


Officer Issued by


Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2



10 Purpose


20 Responsibility



wwwnovamedcorpcom




Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3


10 Purpose


20 Responsibility



30 General











Radiation Safety









50 Documentation






Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2









10 Purpose


20 Responsibility


30 Policy

























60 Confidentiality













Signature


ASOARSO Signature







Signature


RSOARSO Signature




I Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2


40 Instrument Use 2




10 Purpose


20 Responsibility









40 Instrument Use


















Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose


20 Responsibility



30 General















Approved by Date



Supersedes updates

Original document

Table of Contents

10 Purpose





Page 1 of 5

2

2

2

3

4



Purpose












stopped



can be found








and instructions














in 10 CFR 201301







documented





corrective actions


requirements







42 Company Policies














Page 1 of 7 NovaMed



Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2



70 Documentation 5




10 Purpose


20 Responsibility



30 Discussion




40 Formulas





Example


~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)


Page 3 of 7


Cmiddot) ( -693(123)=(102 IJ I e


= (102 pCi) (4206)

=429 IJCi (1588 KBq)



Where


Example





Where




MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027



















70 Documentation




80 Record Retention



EXAMPLE A


h rm lucence


City State Zip Code







Results








Failed



Prepared by











APPENDIXC

Item No




QJ

Nuclear Laundry 0 0






0 0 0 0

0 0 0 0

0 0 0 0

1 0 1 0

0


7

APPENDIXC





AND EITHER


OR



NUREG - 1556 Vol 18 C-12

APPENDIXC

Item No



Authorized Users


III 0

OR


iii

Ancillary Personnel


0 0

OR


0


APPENDIXC
















0 [)

0

0

0

0

0

I

NUREG - 1556 Vol 18 C-14

APPENDIXC













APPENDIXC









NUREG - 1556 VoL 18 C-16

19

APPENDIXC

Item No















I2J

121

I2J

121

121

I2J

I2J

121

WJ

I2J

0

0

0

0

0

0

0

0

0 0

0

0

0

0

0

0

0

0

0 0

0

0

1

0

0

0

0

0

0 0



APPENDIXC

Item No






121 0 0

OR


0

NUREG - 1556 Vol 18 C-8

APPENDIXC

Item No




OR


0



0 121

OR


0

AND


0

C-19 NUREG - 1556 Vo1l8

APPENDIXC





OR


ANDOR


AND


NUREG - 1556 Vol 18 C-20

APPENDIXC




OR












C-21 NUREG - 1556 Vol 18

APPENDIXC














NA

0 0

0 121

0 0

0 0

0 I2J

0 II2J

0 0

0 0

0 0

0 0

0 0

0 0


0

0





0 shielding system

0

0


0

0


APPENDIXC

Item No









m

rlI

IZJ

rlI

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

C-23 NUREG - 1556 Vo1l8

APPENDIXC

Item No



Surveys


(2J 0

OR


Leak Tests


0 0 0

OR


IJ 0


APPENDIXC

Item No



Leak Tests (Contd)

OR


III LJ 0 121

OR


0 0 0

AND



0 0 0

0


APPENDIXC



Maintenance


OR



OR





I2J 0 0

0 0 0

0


NUREG - 1556 Vol 18 C-26

APPENDIXC





Waste Management




OR


OR





NovaMed Corporation










NovaMed Corporation






--

--------


NovaMed President

I John JaKer



















EngmeerRSO

f---






ByIMAI t-- Special~



Tell1Pi~e~I11i1 PtT

y --












wwwcisusinccom






II II








wwwcisusinccom











wwwcisusinccom










wwwcisusinccom










wwwcisusinccom















2

8 8

60


y





Dear Mr AIIo





Sincerely






OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositionfTitle







OFFICIAL USE ONLY




Sincerely




and Safeguards



OFFICIAL USE ONLY


November 72003



Dear SirMadam













Date 2012


Signed

~n~ Employee

Date




Date 112011

Review Period 2010


x


x

x


RSO soon



-~----Date




Date 112010






f7--Iu---__ Date




Date 112010







Sign~7L Employee

SUP~~S3 Date





programs as

Signed

~d~ Employee Date

Date




NovaMed Corporation



















wwwcisusinccom












wwwcisusinccom











wwwcisusinccom









Attest~ tJJtL--shy


wwwcisusinccom










wwwcisusinccom

CIS-US Inc




Ronald G McCoy













Instrumentallon










R11106 - PMT





Dear Mr Alto





Sincerely




OFFICIAL USE ONLY

November 25 2003



Dear Mr Tyree


PositioniTitle







OFFICIAL USE ONLY


November 7 2003



Dear SirMadam











Sincerely




and Safeguards



OFFICIAL USE ONLY














r Date


c



RONMCCOY CIS-US



IBL 437 C


shy__ ~X-tifA







Date 2012


Date




Date 112011

Review Period 2010





Date

w4 Date



Employee Name

Date

Review Period

Ron McCoy

112010

2009 -2010




gA1)O~3 0+

Yes No

1 y V y I

y I


I

I

I

i

Date

Date




NovaMed Corporation







~~ NovaMed



10 General











Table 1 (continued)



~~ NovaMed











I

wwwnonunedcorpcom 2



Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



60 Surveys 3



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamedcorJlcom



60 Surveys




To include






11

wwwnovamedcorpcom




Approved by Date


Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose

20 Responsibility

30 Background



60 Documentation



Page 1 of 6

2

2

2

3

5

6

7

7

i

wwwnovamedcorpcom



10 Purpose


20 Responsibility


30 Background









wwwnovamedcorpcom











Definitions





wwwnovamedcorpcom





























wwwnovamedcorpcom
















60 Documentation



wwwnovamedcorpcom








wwwnovamedcorpcom



Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility


Date

01A~g2012

Date 01Aug2012

2

2

2



10 Purpose


20 Responsibility






Issued by Dale



Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2


50 Documentation 4


wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General





wwwnov~lmedcorpcom


40 Audit Procedures












wwwnovamcdcorpcom








50 Documentation







Wlwnovamcdcorpcom






wwwuovamcdcorpcom





Issued by Date


Supersedes updates

Original Document

Table of Contents

10 Purpose 2

20 Responsibility 2

30 General 2



wwwnovamedcorpcom


10 Purpose


20 Responsibility


30 General










wwwnovamcdcorpcom











wwwIlovamedcorpcom















wwwllovamedcorpcom


wwruovamedcorpcom


s Approved by


Issued by



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Area Surveys


60 Contamination


Date 01July2012

2

2

2

3

3

3



10 Purpose


20 Responsibility


30 General





40 Device Surveys












60 Contamination




Date


Officer Issued by


Date 01AUG2012

Table of Contents

10 Purpose 2

20 Responsibility 2



10 Purpose


20 Responsibility



wwwnovamedcorpcom




Issued by Date



Table of Contents

10 Purpose

20 Responsibility

30 General

40 Documentation

Page 1 of 4

2

2

2

3


10 Purpose


20 Responsibility



30 General











Radiation Safety









50 Documentation






Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Policy 2









10 Purpose


20 Responsibility


30 Policy

























60 Confidentiality













Signature


ASOARSO Signature







Signature


RSOARSO Signature




I Approved by Date


Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2


40 Instrument Use 2




10 Purpose


20 Responsibility









40 Instrument Use


















Issued by


Date 01AUG2012

Date

01AUG2012

Supersedesl updates

Original Document

Table of Contents

10

20

30

Purpose

Responsibility

General

2

2

2



10 Purpose


20 Responsibility



30 General















Approved by Date



Supersedes updates

Original document

Table of Contents

10 Purpose





Page 1 of 5

2

2

2

3

4



Purpose












stopped



can be found








and instructions














in 10 CFR 201301







documented





corrective actions


requirements







42 Company Policies














Page 1 of 7 NovaMed



Issued by Date



Table of Contents

10 Purpose 2

20 Responsibility 2

30 Discussion 2

40 Formulas 2



70 Documentation 5




10 Purpose


20 Responsibility



30 Discussion




40 Formulas





Example


~~ NovaMed

A(8142003)

A(842003)

A(842003)

A(842003)

A(842003)


Page 3 of 7


Cmiddot) ( -693(123)=(102 IJ I e


= (102 pCi) (4206)

=429 IJCi (1588 KBq)



Where


Example





Where




MDA = 271 + 465 v42 1 = 271 + 465 6480 1 = 30132 7482 dpm 40271 4027 4027



















70 Documentation




80 Record Retention



EXAMPLE A


h rm lucence


City State Zip Code







Results








Failed



Prepared by











novamed corporation, new license application dated …

Documents