Feb-14-03 16:50; Page 24106652074;

3 Krueger-Gilbert Health Physics, Inc. 3601 EAST JOP1A ROAD B3ALTIMORE, MARYLAND 21234 (410) 665.KGHP (.5447) FAX (410) 665.2074

February 14, 2003

Ms. Sheryl Villar U.S. Nuulcar Regulatory Commission, Region I

475 Allendale Road King of Prussia, PA 19406-141'5

Dcar Ms. Villar:

The following location has been added to Attachment A:

Molecular Imaging Services 613 High Street Seaford, DE 19973

The following location has golic from monthly visits to quarterly visit. See Attachment A.

Greater Southeast Community Hospital

1310 Southern Avenue, S.E. Washington, DC 20032

If you have any questions, please do rnot hesitate to contact me at (410) 665-5447.

Sincerely,

Suzanne F. Krueger-Schrnidt PresidentiRSO

Sent By: K;

Sent By: K; 4106652074: Feb-14-03 16:50; Page 3

Sent By: K; 4106652074; Feb-14-03 16:57;

Pace 15/16

NRC FORM241 U.S. NUCLEAR REGULATORY COMM=IifON APPROVED BY ClAD: NO. 3115040`13 EXPOME: 07)31==0 (7-1 DR0 Extinsm buxidenver.- lase to comply. wltn this fmadoyaEtn request: 15 minvutg. Thin nalfcatflcon is required sto tb07Nt`QC my

zdeuaInwploction of &mt aativltl to verure timt they am vonuWI accordance writh requirements for proieetibn of the publiv heafth and

REPORT OF PROPOSED ACTIVITIES IN eafnty. Send commntsnni regarding burden anfirrada to tos Records Man *mmBa .S ula eguiatory Commeiiaon,

NON-AGREEMENT STATES, AREAS OF EXCLUIS lyE Wos-hign orDC 2t~-0i " or nterand Regulato b~@rtg FEDERAL JURISDICTION, OR OFFSHORE WATERS NECOB10202, C7150-O01l¶ Office of Manaement and Budet,

ooOielofi do~eg not dieplay a currently valid 01.4 comrol nuni or. thn (?iuoise read ýhe Instruclions before comploting this fomr) NRC may noat conduct or sponsor, anid a person is not roquired tol

_________________________________________________________ rapen to, tbe Intformation collection,

1. N AM E O F U C E N S E E ~M arsn a fr i A w 'rm v oA W 1 o d a O evg /6 * d v c e bsOow ) 2 , T Y P E 0O F R E PO IJ I T Krueger-Gilbert Health Physics, Inc INITIAL 0 REV)SION CLARIFICATION

3. ADDRESSOF UCENSMO rdft wdaru0 o c5lIr bonwtie'U IX mary 6 locaedi 4. UCENS6E COrJTACT AND TihE

3601 E. Joppa Road ,., ., Physicist Baltimidre, Maryland 21234 5. TEGIENME .FACSIMLE NUMBER

I,,oh-. At Code) M1WA~.~J Ar- Cod.

410-665.-5447 1410-665-2074 7. ACTIVITES TO BF, CONDUCTED UNDER THE GENIERAL4LIENSE GIVEN IN 1D CFR 150.20

WELL LOGGING LEAK TESTI NG AND/OR CALIBRATIONS TE=LETERAPY/IRRADIATOR SERVICE

PORTABLE GAUGES OTHER (Specify) __________________________

D RADOGRAPY 4> RrS)STC0 AS USIM OF~ PACI(AGMN tCOiICATES Or- COMP.IPUNCS NUMBERS) B. CL19NT NAME, ACORESS. CrTY(CCUNITY. STATE, ZP CODE P1. ACTUAL PHYNSJCAL ADDRCSS OF WORK LOCATION

Greater Southea t' Commun"Ity Hospit~alsae s8 1310 Southern Avenue, SE 'Washington, DC 20032LOAONW.PCEU0

10, ONMTTEL13>HON1 NUJMBER 1.WR OAOTLIM UBR lMelude A," 00d) Opcvde Arse Codqi 202-574-6684 202-574-6684

1.DTSSHDLD13. NUMRER OF 14. 15g1. LOCATION 12 DTE SWEOLRKpj DAYS ADD DEET REFERENCE NUMBER TOO NUAMBERTO fir

ASSrONED BY NRO

_1 jOt LV ..*

I~TAD~TIOAL ORK hIE N£PARATE SHEET(S) TO INCLUE ALL INFORMTO COTAINED IN ITEMS 8-IS ABOVE 17, LIST MID4OACTIv9 MATIENRAL. WHIcH WILL BE POSS tS!LID. USED., INBTALLED. SVOMMM, opt yr. ATF

Cs-137 ICN MLD-01#30938.9, 25OuCi (11/23/87) Cs-137 NAS MED 3550 #A7380, 182.5 -aCi (11/1/97)

¶ BAO¶EJ.ENTSTTEaP~jF~ CE~EH!rH AUTHORIZES TH~ JRSCNog Cc*mucr LICENSE NUM8ERt STATE EYPIRATXW4 DATE AA~fVE W9tC ARE TE ME. t F~POR LOCATION OF 5o ;r rB 6/0/00

ABO. fFou oploates Oap1)GIIIIMicn" must fl te MMI&I NR C r-m 24M)D.-05-101-01 MD 119. CERTIFICATION (MUST BE COMPLETED BYA4PPUCANT

1, THE UNDER310NED, HEREBY CERTIFY THAT:

Q. All Informaltion In this repott is tre and complate.

b.I have read and understand the provision of the generni l cenrj 10 OFR 150.20 reprnteud on the Inmtuction. of thin form; and I understand that I amt required to comply with these provinioria as to all byproduct, source, or "pclal nuclear material wtfich I possess. antd use in nan-Agreement zireihs or oflehor water3 under the general license for which this i-aport Im flied with the U.S. Nuclear Regulatory Commisaion.

0,Iudrtn htat~tertcu~~soee, conductied In non-Agreement States under general license 10 CFR 15C.20 are limited to a tortal of 180 dyaM

in calendar ypnr. With the iexctpfton of work conducted In oft-ehore watefs. which is authoriZad for an undlmited period or time In the calandar year.

d. I understand thatt I mnay be InL?*dted by NRC at the abovek listed work site locations and at thre Licensee harms office address for activities performed In non-Agreem~ot Staes or offshore Waters.

c.I understand that conduct of any activittea not decrjibed above. Including conduct of actlvytde3 on datez or locations different trorn those dwscribed above or without NRC authoriztion, MAYay sbirct mre to enforcemnteu action, Inclut~ig Civil orcrmnlpuf .I

C D 1 Y N G O F F IC E R - RS O o r M a n s il a m a ke p r a s e n u t t (P ra ff m a n d 7 ; &) ) 1 I I.ri r cD 7 , C nn= riiPc,~r-9rhmidt.Pret fiYŽ

WARNING: False statemnent in this cirtilficalle mouY beIut ctt c Vnd~or criminat pana Ms. NR eutosrquitre thatsuwtilSo the NRC ke comtplete and accurate In all matileril i -eets 13 US -i~ilo i0O mksf' iinloense to mfake a willfulIly false

ý t t - ~ . en.#, onton o tt¶rt or aneincv of the United States as to any matter within Its lurlacdlctlon.-I

FOR NRC R~~N O"0A MP vid Nmw .vn IP) .A1JED TOTAL USAaF - DAYS TO DATE USE ONLY T_ NZ7_ *AS -.NRC FORM 241 (7-1 W9) U

e� ;Afi/63PRNIED ON Rel-TiAkv rý

4106652074;Sent By: K; Feb-14-03 16:57; Pace 15/16

Sent By: K; 4106652074; Feb-14-03 16:51;

NRC FORM 241 U.S. NUCLEAR REGULATORY COMMISSION APPROVED w ee- N -e .. =o/.with V& ,da 005afNR r.'uet:m " 15 minutl. This not~tlmuqn is requmid an out NRC may eahdut boeotmi cin s"Mte mmisure ht they era oorslced in

accordance Wi4th reqUlremests for Prot Otln of the pulchatli mad REPORT OF PROPOSED ACTIVITIES IN U2mm--ts . Nuclear b Rden -tto mmissien-e u~la R~• •~mStU5l310n Ndeer0 IRegurrtor Commiasi-W n, DC 206-.0901, or by Inturnol e-mai Ialt t G.1OV. NONAGREEMENT STATES, AREAS OF EXCLUSIVE jw' ose Densrk CIrnd IoBudge.to.y •,

9E08-10202 p150-0013)1 crfice of Management a]n udngt,

FEDERAL JURISDICTION, OR OFFSHORE WATERS Waghng-on, -c 20503. It a mean to Impose an InfoI col-iteeln doe" not d-ieay a curfuntfy valid OMB control number, the NRC ay ot ondct o spnso, ad Aa person is not required to (Please read the instructions before completing th•s form) NRC msy not conduct or sponsor, an (Peser a=n 0, the Inf

Sent By: K, 4106652074; Feo-14-03 16:51;Page

5

ITKE uNORsIc;N.5D, HEREMY CERTIFY THAT:

~.All Inftirmation In 1hIs: report Is Olie nard complete. bI have read and untlertxuri thle PfOVISI Off the gaeflmn lIcense 10 cmR 1502 reiptirtnti on tVie ntiructIons

of ThlIs formi; and I undestand Meat I ant

raqlutrad to comply wilth thtese pToV-ltiont as to all byproduct, source, or special nucistr metewia whilch' I posseas and urn. In nen-AgreemTelnt S~tfls or

offshore wvaters under thle general license for WhIich thL% Mtpor* Is flied With the U.S. Nuclear Regulatory Commission.

~.I undearsnd that actlvitles, IncludIng mtragE, cranducrd in n orý-rqesnisnl $6&ai u'War general Ilicane 10 CPR 190.20 are limited to a 0Il of 180 days

In caelndar year, With thle exception of vmrk1 condUcfed in affahor nt#,Watr, whlciN Lga uthortzed tar an u nflmhtied period orf tIme In the calendar year.

d.I uftdehlthld that 1 may be Inspected by NRC at the above dIated wovX site lovztliofl and at the Liceniaea home office addres . for adItIvbS aperlormadlin*

non-Agrearrent Statm or offshoreS watefs.

I Understand th~at conduct of any metMIltes not described above, including conduct of.cttvltles; onm datet or locations dltfrefit IToMt those daiicribed

nbov orwitoutNRCaiihorlktofl ma suject me to anlcomben Ct octlicr laudll'p cMI or criminal pnaftt.

CCG7TlF'yNG OFFICM1 - R30 ow Wmerugffiffl Rexried fl ft" as~ TIE.'i DAý1

WIARMNONG Fixkba statimerntiis hn this cartifknato pwny be sub)Ac- to c1,ir erintan Pena es. NRC reg ulatlorm require ftat zuhrnls~lortS to

thle NRC be complain and accurate In all "nuieal respects. Is U.5st Aciro- 1001 MaRe V crimInal offense to miake a willfully %Inse

gstirtervnt or ropiriamatr'atioli to any department or agency of ii~ie United Staes aslto any mattitr within Its jurisdiction.

FORNR I EVEWIG Pkfff Ntv'ee M I~ TO6~J1gt AETAL UISAGE - DAYS TO DATE

USE ONLY 17-L- k' /2'/l I

PRW1IM ON RECYCLED PAPR

Li .2 2//,g 5?~

NRC FORM 241 U.S. NUCLEAR REGULATORY COMSINAPpptOVIMED BY 0: No. 3150-00`13 EXp[IRE: o7131120

COMISSONEa~muted burdenprreo ncml wit am mandatory aOLVOOM retquest: 16 minu to."This nottfiotlo, that NRC mnay

schedule Impaction or RBins ctlvlsa to ansure tint they aer e~ndiwtd in acceirdenoe with requirenmeffM 10T prouti-b of the public humilth en

REPORT OF PROPOSED ACTIVITIES IN iwfety. &nd comments, ret ardtn burden esIlmall. to the Racoirldr

MmnaarnnI ranh ~ U2. Nuclea P-Mulatoay Caommissio FYI'~~II?~IVD gln C 0 0, or by Internet G-rmal? to blatiliil MoV.

NON-AGREEMENT STATES, AR.EAS OF ECUIEdýj fieo nor'unadRglg FEDERAL JUR1SDICTION, OR OFFSHORE WATERS (315O-dBC20013. ra er luse oimposean1 inn But colinetfian doem norl display a ourrurrly volld 01VI =rnrl nuimbr, the

(Plase eadrhoInarucfon befra ompefig tisfrm) NRtC mary not conduct or mponflaf, and la person Is not toinqird to

(PM~ rad hoInsruci~n bfor coplein ths frm to in irom~ir Lollaion.

17 N-AME OF UCENNSt. ipwxon a-ikn" Pm~rieni to oucl MRJ sc10'vIi aitwm) 2. TYPE OF REPO T

Krueqer-Gilbe~rt Heal.th Physics, inC INITAL REVISION CLARIFICATION

3. DDIESSOF C~tSS~(Me~h~eddna5or ftwjegon imw i~~nA mabe ioesj4. UCENSEE CONTACr AND M~r

3601 E. Joppa Road Wendy Chari.ton/Health Physic

Baltirndre, Maryland 21234 AC- A.NE

7. ACTIVITIES TO BE CONIOUCTiE.0 uwDER THE GENIERAL. LICENSE GIVEN IN 10 CFR 180-20

D WELL LOGGING LEAK TES-iNG AND/OR CALIBRATIONS D TELETHERAPY/IRRADIATOR SERVICE D PORTABLE, GAIJGES OTHER (Specify) 4 _______________________

D RADIOGRAPKY VS LIS OF PACKA0ONQ [COR7WCATIM OF COM011JANCE UER &. Q~ENT NAMr. ADDRESS, CrnYrCDUNW. STATF,,ZIP COc 9. ACTUAL PhYiwCAL AcoRmS

OFwoRK LOCCATION4 rMV0( mild Kbrlbe? Cr 0010 fxawai,. GAM s a ýmt i en addrms ar drociati av poeetlJm

Genispher~e/PolYprobe same a s 4170 City Avenu~e Philadelphia, PA 19131-1*604

'10.. CURN(FIL.UIONS Numgelk 11. WO~~I~lNmE~oEUB

12 LTSSHDLD13 NUMBE1 OF 14. I 1~.15. LOCATION

12.WOR DAE CEULDD~jAY3 D DELETE REFIERENCE NUMBER

FRM-Or NUMBER To or! / I/ASIZINEDUY Nitc

LIST ADDITIONA L WORK SITES ON SEPARATE SHE-IET(S1 TO0 INC LUIDE ALL INFORMATION CONTAINED0 IN rTEMS 8.18, ABOVE,

17ý LIST RA=OACTrIVE MATE~IRAI.. WHICH WILL. SC P S0=ES61M, U=,n INIFTALLED, rVr~CEZ, OR mx-rao

CS-137 ICN MLD-01#30938 5, 250uCi (11/23/87)

Cs-137 NAS MED 3550 #A7380, 182.5.uCi (11/1/97)

18. ~ ~ ~ ~ ~ ~ ~ - L C )NO~UEA SEIII CENSF NUMBER STATZ OCtR1N DATE

A&A n, UES WHICH AVfG~c~T CN~~

AaoVE. (Four =#"e offi VSPOCNi-fic lcnSE; iuf& acotirnflyh emlhiNC ~ 2414 ~ tl0.11-1 /020 1i LijII.u1 fILA

_C DV-.~JD 6 / 3 0Z LOO

Pace 5

Lst

Sent By: K; 44106652074;

U.S. NUCLEAR REGlULATORYT LCur-MIO'QQLJINRC FORML 241 (7-1 M)

REPORT OF PROPOSED ACTIVITIES IN NON-AGREEMENT STATES, AREAS OF EXCLUSIVE FEDERAL JURISDICTION, OR OFFSHORE WATERS

-. ~~~ I--- " ~ ,, - nnn'r ishi form)(t')avae reada the ,Ij~rIUL;AWJIG V'~~~ -* respond 1b. tuIii-o

1.r~imE OF UCENCEE P3-w-n orne prowcohos oru h Wf~dcnwbdW 2. TYPE OF REPO 7

Krueaer-Gilbert- Health physics, Inc INMlAL REVISION XCLARIFICATION

I 3 ADRES OFLIENOE (atig dd~aa eV~edL~i w~~u ~.f8~.nnbe ce~d)4. uceESE CONTACT AND~TITLE

3601E. Jppa oadWendy Charlton/Health Physicist

B altimnbr5 Maryl-and 21234 6,&MPHON NS a. FACSIMILE NUMBER

I _______________________________410-665-5447 141 0-665-2 07 4 7,. ACTIVITIES TO BE CONDUC-TED UNDER THE GENERAL LICENSE GIVEN IN 10 CF.R 160-20

EWE LL LOGGING LEAK7ESTING ANDIOR CALIBRATIONS DTELETHERAPY11IRRADIATJOR SERVICE

DPORTABLE GAUGES D OTHER" (SPeClf)~__________________________ D RADIOGRAPHY -~RQS~ , ERO AKAGN ,CR~iAE I ~AUNENMES

a, CLIENT NAmE. ADDFEss, crryJ~uNTy, STATE. ZP COCE 9. AjLP1Y~I ADORES OF WORKt LOCAtION oroew umeLL Give at OOVaWvio on isd so dfloiIOI &a

Genishpiere / olyprobe 2'801*St~rling Drive Hatfield, PA 19440 same as #8

U T D~mOAL WRK ITESON SPARTE 1EET0) T INCLUDWiXPOE AL NFOMBA 1O WORK LANED N ITEMSON 9-GBVSE.

C1-13 NAS15 OFD 3550 Is,80 18. ui (11/1/97

STATRWORK DAY ADD D P~

ABom T HEoro

otoaefctaiama ctn l i natNCFr .- - -3 - ~ ~ ~ ~ ~ ~ ~ ~ ~ A OE BY .. ... N.. rrn. a,*a

1, THL- UNDERSIGNED, HERESBY CERTIPY THAT. All information intylThs report in true and coMplete

In I have read an6 underta*nd the provision of the generaIl rtflese 10 CFR IC n2tpito dan the InStrctiong of tiLt form; and I Understand thatI IMt

required to Comply, with thiAa Provisionls all t. all byproduct, source, or special nuclear maleflel which I possew and use In non-Agreamontl 3ttAs or

Offshtore waertei uncler the general license for which this reponIs fialed wilth the U.S. Nuclear Regulatory Comobeitzon

I. underanttd Thai activitito, InCluding storaqs. conducted kri norl.Agrevaetlfnt Smaes under general flcense 10 CFR 190.20 are limited to a total of 180 days

In) calendar yter. Wtt the maception of worX conducted In off-ahom waters, which Inaumithorized for an unlimited period o1 t~me lr thne calendcar yWi.

d. I unclarstand that I may be Insptetad by NRC st thit obove Iliftad woric aftn locatlantr and at the Licenses honme oflce scidrez for activlves peftirmed In

nort-Agrammn nt States or oftahors wtatem

I undersftnd that conduct af any activities not described above, Intcluding tonduct of activMtls on dates or ocatloft5 d~ffrant from those dacitufbed

above or withouit NRC authorization, mna subject me to enforcemnten acton, Inctuog clvii or crimlinal nItl.s

cE-R¶FYH04 OFFItCER - PSO, Of MWWWVntef ROPRPiteairtlftom n h)/..Qx'c4v~~PiI

WVARNING: False saermetft In this cartificate may be subject to C ri dior crwn makeG as R eu~~fsrqe tiliff ubmkin tals the NRC he comnplete antl accurate in all mfaterial r1pcs .. ato 1001 Tnakes a ciriminal

offense tomaea it Tle

statwrnIdl or ruproestaitioit to any clepartrnenrt or Sagency of the LUtteid Staes as to any mnattr within its jurisdictiont.¶Th jAFneOD7

FOR NRC EEiN UJSE ONLY 77-f\IJOC FORM 241 (7-1995)

/ I

Feb-14-03 16:52; Paae 6

APPOVERD BY OMB: No, 3160-M3l EXPIRiUS: 07M=0~D2 Extimeit; btnas" o r rweraeo to comply with thies ndtwwlcl raguget- IS minutot. T Lz ncitalf~lon 'i: roquied at trista NRC Maly e.tr:duje inaecatlon of the adivtas no armura they are cwiduftwi In acoordance With r~qulrsmnofts for protection of the public henIil and uafery. Send comments r" airding burdenl estimate to the Records

3 C05B 0 , or by Interest 8-mAll to ~je1Slai.gov. Wi;*A;'60 Officer~j, Office of Intomrnlan and Rag crly Affalte.

NEOD-10202 (3160-1001a), 0Mfce of Management and Budawt. Womhington, i3C 20503. I a moons used to Impocse antkIform-Ot)~ ocileleton does nol display Q DurTofitly valid 0MB control number. Ira NRC may not conduct or sponsor, and a person is not requ~ired to

Sent By: K;

(Tesnso read the insfrZCtiofls before camPletfng thIsfrm

I. NIAME O XLC~SE (pwr~e o-r &_ pmpaeiV I, fItect I V ~CWN deo bod be W)

Krueger- Gilbert Health ýPhysics, Inc

3- ADOii;6 OPF UCE. E (t4.A'i ad~l,5 orw ed.Joma~on WAWs how,.- efAy be Iaeufrm

Fe�-14-03 16:52; Page 7/16

4106652074:

U.S. NUCLEAR REGUL.ATORY COMMIS=IN

RT OF PROPOSED ACTIVITIES IN

-i4ENT STATES, AREAS OF EXCLUSIVE

-,-,L jURISDICTION, OR OFFSHORE WATERS

3601E. Jppa oadWendy Charlton/Health Physicist

Baltimo~re, Mayan 1245 TEUEPHOrNE u~aim e1 FACSIMI8LE NUMBER

410-665-5447 410-665-2074

7. ACTIVITIES To BE CONOUCTMD UNDER THE GENERAL LICENSE GWVEN IN 10 CFR 150.20

D WELL LOGGING R7 PORTABLE GAUGES

I LEAK TESTING AND/OR CAUIBRATM0NSDTE-LETHERAPYJ1RPADIATOR SER\ACE

O7T0HER (SpeclfY) *> _________________________

D RADOGRAHY4> RECISTM'ED AS JEER OF PAC).GINO rc~wnpiFCATES Cr- COMPUAN'CE NUMBIESI a. cuIw't NAMEC, A DESZ, YCrrIOUT STATF. ZI COOS T21

ACTUAL PIMYCAL ADDRESS OF WORK LOCATION

Riddle Memorial Hospital 1068 W. Baltimore Pike Media, PA 19063

D2 A1Z3 SCHEDULED

I- ----- I. -%. _.~

a n v d m o r d f r e a t a n e U

same as 8

0.CLIVplTRTJHONE- NUMBER t.WORK LOCATION TELE4ONE NMBMSE

I. ~-N M E NUMBER" OF14 a.L0A1o

WORKf DAYS ADD DEEER~EMENCE NUM13ER

NUMVER TO BE -ASSIGNED 5Y NRC

-~ ~~rm rnt~St IINFOMATONCOhTAINED IN ITEMS 9-16 ABOE- LIST ADDITIONAL WORK SITES ON SEPAKA I r- Q-Q I I.)" ..

IT. LIST RADiOAcliVe MIAT1'RIAJ. WNICH WILL Or- POSSESSED. USED. INSTALLED, SEVIACED. OR TrSTED

rfncIIW d4acrtodof oOfe MAnd qu~rFMa~itY esdtmova moiere zeawad maim", or deifres to be used,;

Cs-137 ICN N.LD-01#3O93 8 9 , 25ouci (11/23/87)

qFT -,rn 350A7380, 182.5 uCi (11/11197)

GSWIOONW Ar7HnjG6RLE M --V TO CONDUCT L:ZN NUMBERI ST.ATE RfO DAT

1& ACIREEMENT STATE SP4ECIF ETS :$2OE

INA~O WEM 9.TN0

ACTrvmEs wIcA-TUCN' EARGRO , n 0

AwsOV f~our copleSof V-'A ccoCn3&msfm6ccom Ympny ip 10N~~7 -R -1

3 2003)

-M. CEFCTIFICAT'RON (M9UST BE COMPLETE.D BY APPLiCANT)

1, THE UNDEMIiGNED, ttEREBY CERIPrY THAT:

a. All Information~ In tlhla report Ir tnJ0 and cornplkrt

bI have read and underntahd ith ptmvi~Iof al'tbe general IJcUimie 10 CF~t 160.2 reprinfted an the

Inatfuebans af thal laTin; and I understanld that Iam

required to comply WftIh these proviolohis as to all byproduct, ma~urc, or aeoeclal nuclear material Which I poffa"e and

use In non-AgTre1Wmnt States Of

affshore waetrs under the general Ic~ne fl~ or which this report 13 flied *4hi the U.S. Nuclear Ragulatory Commissiion

C_ understand fthat activItles, including storage, contducted Itn non-Agreement State* undel genornl

license 10 CFR 150a20 are Ilmited to a total of 180 days

in czla,,der year. With the exaceptionl of work conducted In off-shore waterZ. Which i3 outhraiS-ed! far an

uiLllmlttd period of time In the cs~endar year.

SI undertanhid that I masy be inapected by .NRC St the 3boVe Iiittd Work rite locationls and at the Ucenseaft

home office address for activitIles performe~d Int

non.Agreemtflt States or offlnOre wUICI)1

a~I undersiand t~hat coniduct of "n sacvit1*S not descrlbt-d abovel, Including contauct of activitlea

an date or locations diftrent from those deatcibed

above cT without NR.C authorttEtlohi. may sub ect me to WVorcerlefll action, Includkg ci vii

or crimninal Deralues.

CETIFYWNC OFRCEA - RSO ar Mw~xvoel¶amt Rv (IT1wn and ThwI SN / (2 £1

WARNING. False statarrwrnts in this cartif1t2t* may bo su~bjec1to n :r' oingn peru

eS. RCeuatofls require that Submnissions to

theNR b cmpet ad scuat i al nset~i esecS.IiUS aon1001 makes crn~aI offense to aea Ztll In

Sttement or rpreSen~taion to any dopartrllaflt o~r $gency of the United Stattes as to any matter

within Its lufiedidlion.

anR NRCW 90! StA IEDATE T .OTAL USAGE- DAYS TO DATE

USE ONLY '%- k- 'ýJk('3

NAC PCSAM 241 (1.100) 4 PINTM ON RECVYCl. pP;;E

APPROVED By DM& No- a'50-0012 EXPIRES. 07)31Z=0

E.Iiinnla =utLr pierecmm to comily with 11'" mnunWTIF~ 02ooudii

raqieftlE inras. Te actificalion 'aveu~ an that NRtc may tscheduiv InMmpoaic" Of the 20*Arl1e3 to 'elafur, he are ood~db sceordoIoa Mbt requlromeflbi for pralgotlor,

of the public beeith end

sault. Sand m omnnto rdi b irden ealirnite to the Records

nap Stn . .tie]r ReUi~i Commsioniif,

NUOB-10202 3 `160- 0131 , fftoo of Manspemani and Bud gat.

Whlngfn, ~C 20 a meni 3a to I~geU min olnf.A IDh cocI an dos o dieplay a Ou 7fty

mnld0Bgnil numbe.r, the

NRC may not coiut or uponor,. ancl a person It not reqummad to

reod to, the I fratlom Coliec nf.

2.. TYPE OF REP elT

INITIAL REVISION CLARIFICATION

A. LCIrEriE CONTACT AND TMTE

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SentL By: K; 41 06652,074; Feb-14-03 16:54; Page 9/16

NRC FPWR~ 241 U.&. NUCLEAP REGU-A7rory comm =sioN APPRoA7I ay oMB: No. 3150-001 EXPIP.O3 07)312= 1 * ~Ealnrietd burden re$ renorwto comply with Iesmandaitay colitoý

request: 1! Mtn=te. Thli5 nolfflotrtionbis aquld so that NRC may uclindaii inspectioni of the eazMiaso 10r thsart they are consducb in ancadanes wvith requitmenis fo r praontioon of Ihe public health *Ad REPORT OF PROPOSED ACliVIlES IN\ valely. Send comments re ordl. burden estimaite to Ikie Record&

Manaemet Branh VlT- U tO. Nuclear Ragulaory Ooimlatlo. Wahigon, DC 201 0001, or by injarrMf Onel to blat ejzito'am. NON-AGREEMENT STATES, AdREAS OF'EXCLUSIVE I andto heDes OfcarOffice afi Ifnatlin and RequIinfr AilOti.

FIEDERAL JURISICTION, OR OF~FSHORE WATERS NED122(11-t1) Ofic of ai M unapma n Bdgt coiiaoton does not dinplay oufruoitaW=cnt rolumeyh

(?M')gs& rnad lb. 1ns=vCffOnS before completing this form) NRC may fiot conduct or aponsor, ad apersonm Is not required to __________________________________________________________ M= o, the. Information collection.

1,NM F UCE45M pwm mor &MwlgV b comau em sctlvibwdwO t ~bobhw, 2. TYPE OF REPPOqT

Krtie er:-Gilbert Health Physics, Inc INITIAL REVISION CLARIFICATION 5.A1DRESS OF UCENMM (W~ftti 0-1 --W,-i k*ciaf wA- wa .mm moy Do movW0o 14 UCR40~C0NTA'rKQTM.

3601 E. Joppa Road f, eat Phsc t ~atmrMaryland 21234 S AShL=NJAý

410-665--5447 T410-665-2074 7. ACTIVITES TO BE CONDUCTED UNDER THE GENMRAL ~LJSE GVEN IN 10 CFr- 150.2

D WELL LOGGING LEAK TESTING AND/OR CALIBRATIONS TELETHERAPY/iRRADLATOR SERVIC-E D PORTA13LE GAUGES OTHER (SpeclfM um ________________________

REMSTOM AS U30t CFPACKAOING M (FiaA7Fz or- C0MPAatLACE NUMOCMlS

mm& OMtTHAS 5 YRX, rnUNT. ETAMtE. ~PCOWE ~ ~ - ~ot~owmoi~

Habib ~Oluxchi, MD sm 4'503 XHigrhwAy one... Rehoboth, D.E. 19-971.

F C10. Q FTS .8 D K ON E NUM BER I 11, W O RK LOCA 71ON T61.9 "M ON rJ`UM JM 2 30.2-645-7671 30-645-7671

12.OA~S SH~UED12. NUMBIER1 OF 14. 16. 1.OCTION 1.Cn CEUM WORK DAYS A1DOLFTRFRIC NUMBER

UjsT AbrmOA WORK 5lTES ON SEPARATE 6 MET(S) TO INCL.UDE L INFORIVITO cOTIED IN ITEMS B-16 ABOVE, 17. LIST l~AMAtWCTWMATl!RAL. WrKCH WLL.59 PDOSSESSM UB5M, INSTAL.LEfl 8171?C, 0o T!8T

otmne~y dafft or"*~o efNwand0awtv of efr*Wava uW&MA1 sawtos vokeas of davicrso" baa mad

Ct-137* ICN MLD-01#309389ý, 25OuCi (11/23/87) CS-1.37 NAS MIED 3550 #073.80, 182.5 uCi. (11 /11/97)

VAt. AUHOZ LXN=N% Dif ENSE NUMBER STATZ eXPiRATION DATE

ASOVFE =Y~pa WM If#W Wt 1ýt1fJR om2I Mr)- 05-1 01 -01 ID 1I 6/30/200319. CERTIFICATION OWL'STaE COMPLM~DD~YAPP1JCANf7)

1, THE UNDFUR-rIONIC, HOUBRY CEKIIPY THAT:

All Inftrmation In thin report Wtr ue and camplete.SI hav& red and understnd the provIsion of thle general license 10 CIR ISO.20reprledvont ierInauuctions ofthIilform, and IunderabnthltW I n

rezulrcd to comply with theme provialorts as to all bayproduct source, or dSpecia nluclear Material Which I poemsws and use LIn non.Agreurnent States or offshore waters under the general license for wh]Cil thIS report it] tIld WIth the IJ.Z. Nuclear Rtegulatory Commission.

I unde zuid vw czahkk.1 Including storagje, conducted in rion-Agrftment Stalve undergeMoral license 10D CFRI115.21) we limited to e atft~l or 180 days Iin calendlar year. With the mitceptton af Wolf COldUcted In oft-4nore Waters, which Is authorfzed for on unlimited Period of time In thle calenmdar year.

d.I understtand Ihaft I may be b1nzcmacd by NRC at the above ltiotd work *ite locations and at the I-Icensee home office address for actIvIllas p411 Onfned Mi nan-Agreaenuff State or offshiore wxatrs.

SI understand tunt conduct of aiiy adhutvtles not describod obove, Includhing conduct of mcitivttes on dates or locations ctturant from these deacrthed above or without NRC nuttiorLzftkn, may subjct rat to enforcement esthoni Incluiliig civil ofcimimnal penaiies. I____i

CEFftGO F -RM o m~mn ,nm, ~..dTu v/ L .. DII ATN4hI~~ ~ -irv vt i-YffY-PjJ /J~(kAoL/'O

wARNING: False staernent Ini this cinrtltlcatB ffY Joe subject to cr4Mdior crbtnaju rena);6z. NRC regulations require thu sb-si o:~ to the NRC be complete and accurtat In all maiteilal respe -s I -1 USv.Cv ection 1001 me es lWe oriminal offense to fmohe in wilfully false st~tumnit or representationl to any 6.eparlrnent or agency of the Unitekd States ag to any matter vWthn Its Jurisdiction, ___

rJn�ref� p-inep� I I,* Pnn� OH � PAPER

FOR NRC I wAL"" 7c"=jý4 rrpf* T0TA- UBAO A AT - DAYS 70 WE~ USE ONLY I - --4,- kALý2-\N=FDW24i (7-ioW al-a- 5

f f, PFWM ON ASCYCLED PAID=

Sent By: K; 4106652074; Feb-14-03 16:54; Page 10/16

[NRC FORK~ 241 U.S. NUCLEAR REGULATORY COMMISSION APRV BY OM13: NO. ZI4120Cf expl~IAE: 071211=0 etnadburdqiprraos oomt4htl adtr Ielo (7-1Da~~~ requesat: lBmntso a lh~oaIfo,*I~fs requireds lA R ay

schedule Inspection of t1e 201Wt~ies to enurem they "r SMCondm00d In REPORT OF PROPOSED ACTIVf TiES IN saey Sedonmns rh udnetmt oteRMd

Minis~~~~~ erotBac V~ J. Nuotear Regulatory. Commicacit.

NON-AGREEMENT STATES, AREAS OF EXCLUSIVE ort to.1-11 DInl 11 dee IfaOfieR~ alo00ry.Afu~

FEDERAL JURISDICTION, OR OFFSHORE WATERS 053 If al3 mean~s 1medtoimoe on inaferrn.71 9olecIo990n2tio.nt dislaply a curwrll7y ~valid 0MB control mbste

(P'iosse read the Instruccions beforr completing this frirn) NCmyndo. codc rS.sradapmr s o eurd "PC the Informaiion collection. 1, NAME OF LICENSEE 0Pison cw &m pmopoing to ow~idct Me eatMiv~ d~w arfrd A*Aowj 2. TYPE OF REPOI T

Krueger-Gilbert Health.Physics, Inc INITIAL REVISION ~CLARIFICATION S. ADDRESS OF LLCENSEE -hem~n .dmw 0 CtoodA¶ 1f5 kedy 4: UCIENSE CONTACT AND TITLE

3601 B. Joppa Road Doflfl Thim '.Health Physicist Baltimdre, Maryland 212.34 S. OEPBENWM0 F.ACSCL UMSMý

(Indud. Alga Cdod) Paciue. A-u co".)

L4'10-665-5447 1410 -665 -2074 7. ACTIVITIES TO BE CONDUCTED UNDER THE GENERAL LICENSE GIVEN IN 10 GFR 150.20

D WELL. LOGGING W LEAKTESTING AN/RCALIBRATIONS TELETH ERAPYIR RADIATOR SERVICE PORTABLE GAUGES D OTHER (Specify).~

E ADOG AP Y 4* REOQ TRED AS US89OF PACKtAOINO(caT1cA7E9OF COMPLIANCE ?4LMBERSI

A. CLISN'T NAMr. A~oioRsI. CfYJCOUNI sTATF. zip coE 0. ACTIAL PfMCAL ADDPlEZB OF WORK LOCATION M5~iaJ ad NWmWarCVlomjlon. Gres as compf@etean ed&uaW 8f~a~ 8psS

Milford Memorial Hospital same as #8 21 W. Clark Avenue Milford, DE 19963

10. CugT'Te.MIPONI! NUMBER 11. WORK LOCATION TMlSPION. NUMGEh fwu" Arw Coda Onakie Aroe Cc*.

302-422-3311 302-422-3311 12. NUMBER Of 14. 16. IQ. LOCATIlON

12. DATES SCHEDULED WORK DAYS ADD) DELET12 REFERENCE NUMBER

FROM To NUMBER TO 09

3/2 /3/f/j//o ASSOONEO BY 1RC

LIST ADDM~ONAL WORI( SITES ON SEPARATE SHEET(S) TO INCLUDE ALL INFORMATION CONTAINED IN ITEMS 8-16 ABOVE.

17. LIST I1ADIOAC11VE MATERIAL. WHICH WILL BE POS~SWED, USED. INSTALLED. MWWvcoo, DR TESTED

finctude de.c4ripdn of Wra Aly pqintr' u juroic vhnriia vowed sourtog, ar daytoa to be taoc

Cs-137' ICN MLD-01#309389, 250UCi. (11/23/87)

C5-1317 NAS MED 3550 #A7380, 182.5 uCi (11/1 /97)

18 (ACUCNEWAIYMORLZES THE VNO~~L To C2NDP1XT LIOCt8E NUhASER TTE O(PIRATION DATE

1A. IEU NSW~hRLATION OFUSE ASscliN SPD 0510-0 15/30/2003 ASoyc. fPotir copies ofifie, .pecc license ItNIS MD-I~e~ 05-e 10 1 NR0 Non 41V

19. CERTIFICATION (MUST BE COMPLETED BYAPF'1lJA~I) 1, THE UNDERSIGNED, HEREBY CERTIFY THAT:

~.All Information In this report 13 true and complete.b. I have road and undaratAnd the provimon of the general license 10 CFR 10~.20 reprinted on the Instruetlons of this form; and I understand that I am

required to comply will, theme provisions as to all byproduct, source, or s-pecial nuclear material which I poton arid uoa. in non-Agreement iStats or offxhore water& under ths general licenme for which this report It filed with the U.S. Nuclear Regulatory Comimleaton.

c. I undeirstand that actIvIties, including saorage, conducted In noet-Agremierrk States under general Ik1enee 10 CM1' 150.30 are lmimted to a total of 190 days In calendar year. Wfth the exemption of work conducted In, off-altore waterx, which Is authorized for ain un~lImted period of time In the calendar yeas.

d. I uincerstaand that I may be Inmpected by NitC at the above listed woti amit locations and at the Licensee home CfMCe addreous for activities performed In

nor-Agreement states or offshore watera.

I. uncdarstand that conduct of any aCt"Vdtie not described above, Including conduct of activities on dates or locatins different fronm those described aboe o wthot RC uthriatinmay aublact me toenforcement action, Inclu!pI civtt or criminal penalties.

CERIFY'NQ OFFICER. - ISO or Mwagoard Reftpr eriadw P-km. and 771*1)

CZ1,7ntnl-IP xhrulelpWARNING: False statements In thIs certificate! may be subject to cAI~~nd!ior cirtimni the NRC be complete and accurata In all material re-spects. 18 U.S.ZleediWr 19Ml n statement or representation to .ny departrnent or agency of Mhe United Slates uis to

ýFOR NRC REv1EWwNQ OFMIAJ. (Typ""Nmt*4d TAY") lUSE ONLY 1 3- 7ý-~ S- f-i H,NRC PORM 241 (7-1=9)

Page 11/16

Selit By: K;s 4166204 Feb-14-0 16:55;rPJ NRC FORM 241 U.S. NUCLEAR REGULATORY COMMISSION APPROVED. buYe per: mO. xIw.01 toIRS 1= iht iaddr olla

=Iuet a1 m~nutes. Me. "noificationl to rilqured so that NRC ff*Y Ingdte~pe~jon orthe aslNIas Io *mum dud they w" ouuwdb

anoortlance witi requirumanic for protection of the putillo health and REPRT F POPOEDACTVITES N afety. Sand commenits reading burden matirnetfi to the Rocordin

h~nalonDC 2 )SO{orb internet e.4naUl to bi 16rncoo.gr NON-AGREEMENT STATES, AREAS OF EXCLUSIVE darmOfc f noroii n ReagD1t ""NE'-020 p5o-oo:13 Oftio. of hisnageern~n end Bud wt.

FEDERAL JURISD)CTION, OR OFFSHORE WATERS WE o53 a a wzue oips nifr (Plenee read Mhe Instructions before completing this fo~rm) NRC may not conduc or ponfo, and a person Is riot required

in respond bo, he n1form~lion =Orllel.

i. IxAM EO F LICEN SEE fp &*5 ornpfirm prop ng t o w it d o athe W d u d a f b v 2. T Y P E O F R E P T

Krueger-Gilbert Health:Physics, Inc INITIAL ~JREVISION PjCLARIFICATION 3. ADORESS OF LICENSEE (MailNg addiwi 6 00We xUoh Wh" cm# ab k~nI/tWy .IC0,1 &COISECONTACT AND iTITLE

360 E.Jopa RadDonna thin ./Health Physici

Baltimflre, Maryland 21234 5 rSHN5Nwe ýFCIIENME 410-665-5447 1410-665-2074

7. ACTIVITIES TO BE CONDUCTED UNDER THE GENERAL LICENSE GIVEN IN 10 CFR 150220

D WELL LOGGING LEAK TESTING ANDIOR CALIBRATIONS TELETH ERAPYA'R RADIATOR SEPMCE D PORTABLE GAUGES F7OTHER (SpecJfy) ~~ ________________________

D RADOGRAPY ~> RcEOSji1D As L)sER OF PACKAcING (CeNT ICA-TESOF COMPLIANCE NUM88tetS) a.CLIENT NAME. ADORESZ, CrTYJCOUNIY. STAITE, ZIP CODE 1. ACTUAL Pi.4vrAL ADOhESM COP WORK LOCATION (Street and HMWna w o~1aw, Ase .~~* a ~~&~d'~tw.spcal.

Bayh'ealth Medical center same as #8 Kent General Hospiital 640 South-State Street. Dover, Delaware 19901 IQ. CU 14UMBER 11 WOAKL OCNO IEU*>NUMSCR

1302-674-4700 302-674-4700 18. NUMBER~ OF JA4. Is, 16. LOCATION

12. DATES SCHEDUL.ED WORK DAYS ADD DELMT PRWDS!tCE NUMBER

FROMT NUMBERl TO BE TO AS=NED tY NREC

LIS ADITINALWOR SIES N EPARATE SHEET(S) TO INCUIDE IN-O.MATION CONTAINEDI ITEMS 8-16 AOE

17. LIST JtADIOACTrWS MATERIAL. WHICHONWILL BEMOSsZSKSf, u9111. iN reTLLED. IERVICIEDlot -rari

flnuhid desorfpnn of es~ and qumnio' frof .oactfe vistarti seciadirawcae, or dfewkst to a. uxed.3

,Cs-137 ICNI MLD-01# 309189, 250uCi ('11/23/87)

Cs-137 DIAS MED 3550 #A7380,. 182.5 uCi (11/1/97)

I& AOREM'I STATE SPE CIIC U~NEWHICCNAJTh4ORIZES TNE UWNCCRSINEQ To CONDUC CES NUMBER TAEXDPUZATION DATE

AOT)VTT1SWNHICH-A0I HE .SgrA, Dg FOR LOCATION OF USE. AS SPECIFIED V4 TEM F&~ ~ r MAt~w ForcyEso t pct tkw 9 SO?$8ptOV ompffy the AWNRC 7t'P241ý

M- - - n' 613 00

1, ThE U NDERSIGNED, HEREBY CE1ITWY ThAY:

111 All Information In this report is true anm ccmplate.

b. I have read end understand the prvvialon of the ganwad licanse 10 C M 150.M2 reprinted on the Instructlona of thin form; and I uniderstand that I am

required to Comply WIS. theme PCVIIiion$ AS to ail byproduct, source, Ci special nuclemr nuttariai which I poissess and uae Sn non-Agiraterntrst Sates or oflshore wartnrm under the general tlcenise for which thin report In filied with' the U.S. Nuclear Rtegulatory Commassion.

c, I underistand that activtides, Including slorige, conlductetd In non-Agreaement States under general licnsea 10 CM~ 110.20 are limiated be total of 180 days

in calendar year. With tho exception of workc conducted In aff-ihore waters, which Is authoflzad for an unlmited period of time In the calender yeaf.

d. I understiand that I may be Inspected by NRC at the abovet l0ted work sitte locticflE and at the L~censvif home office addturA for activitles performed In

non-Agreement S~tat of offshore Waters.

*.I understand that conduct of any activItles not described abpove, Including conduct orf ectilvfties on dates or locations different frome those described

above or without NRC authorixatlon, may mubjlict me to onforcemnont action, htclutfng ctlvior crlnalrupennafltez.

tTjirr'r qrhmr1 rfh. Pr

WARNING: False statements In this certificate may be subjeect too ccIiv4s Alidlr tvr~mninapena es. NRC regulationis requiret that submIssions to

the NRC be completie and accurate In all mnaterial respects. 16 U.S.EXection 1001 mukes A --- in~n' offense to makes a whlinly [alse

statemrent or repraz~entationto any deparlment or agency oi thil Unhed Slates as to any matter within Its Jurisdictionl.

FOR NRC WM O~F 1OAL MpftPline kl and nib)CA1J~E ~ (N- DATIE TOAL USAGE - DAYS TO DATE

USE ONLY I a ,ajv~ ~ -1 ~g/.�RC FORM � c�*, G�'I ~'Q

DA

I I - . I

4106652074; Feb-14-03 16:55;Sent By: K;

LLS, NUCLEAR1 REGULATORY COM MISSIONJ ePROVE BY Oua. iso NO-1So1 EPIREN: =3l141

gLI nr otlednI squired so thatNRC me 21COrdanon Wfth reqlulremetil for prceetOn o Urll public health and

REPORT OF PROPOSED ACTIVTIES IN safety. Send camnvrelprding burden aiilbT~sie to the Fmds: NON-AGREEMENT STATES, AREAS OF EXCLUSIVE o-reh c Dua~lC~ Of26-010 forlyIntrne *and) toReiQnmrvN~,

FEDERAL JURISDICTION, OR OFFSHORE WATERS NE013 02.02, 1500131 ,. Office ofafnalloment and Budget, "c"icondesnt dkeplay a cumrrenly valid 0MB control number,% (Piawsa rand rho Iristrucdions before comlpletJfg this form) NRC maynt conduct or aosr n eo~I o eurdt

I.NAME OF LICOX.E F-.~ 0Th lc" tVloWI coLct : M&e Icfrllb- d-6b beOw) 2. TYPE OF REPOI}T

Krueger-Gilbert Health: Physics, Inc INITIAL [] RE\IISION ~CLARIFICAT'ION ~.AWMOIE ~UCENSEE td, edus 01 eaOlVWIc,.*m-hieI1)4. LleS CONTACr AXDTM

3601 E. Joppa Road Donna thirn ./Health Physici Baltimdre,* Maryland 21234 8. T12.HONB.NUMS 0,FACSLE NM6RZ

410-665-5447 1410-665-2074 7. ACTIVITES TO BE CONDUCTED UNDER THE GENERAL ULCEJSE GIVEN IN ID CF:R 18C1.21)

WELL LOGGING LEAK TESTING AND/OR CALIBRA71ONS EjTELETHERAPrYJRRADiATOR SER=IE PORTABLE GAUGES OTHER (SpecVf~ =4 ________________________

RADOGRPHYREOI5TE1Ef As USIM 0 1 PAC1KAGiNa (cnOi~Es5O COMPUANCE NUMBGV

B.CLJ?(r NAME. ADDRESS, Ofl'OUNTY, STATE. Z.jP C006 9. ACTAL PWMlCAL ADOSMO ORK CTO esnwfwd Iwnbior vowroa . ro~m as cvmpif w adarmn or drua~a mw posote)

Bay~malth m'edical center sm s# Kent Gelie'ral -Canct~r' Cehter 7913 *S. Queen Street Dover, Delaware 19904 1CLCE.NrTTEL~rKENVMMB11 WOR LOATO~N TWHNENUBE

(302) 674- (401 302) 674r-4411 %NUMa!R 014. is. III. LOCATION

-2. DATE$ SCIC8ULED WORKI DAYS AD EOTE REFIE71MICE NUMBER FROM ~~~TO NME OB

~TADDITIONAL WORK( S OS PARLATE SHEET 7r. TO INCLUMEA~l- IN ORUMATN CONTAINED IN FrEms 97I ABOVE. 17. LIST? WAfOAOTWE/ MATSUAL, WHIC14 WIU. 80 POSSESSED. USED. INSTALLED, SE91CS. Oft TWT=

.Cs-137 ICN MALD-01#309389, 25OuCi- (11/23/87) Cs-137 NAS MED 3550 #A7380,. 182.5 uCi (11/1/97)

iL AA ý 606W~gSZWAurX W1. UWpNoU UCOISENUMEER ITATE 10"CATONJDATE M C 5A CCsEýrý IM

In

ASOaF-(FOU cPaOfthfe4c~WCCem'emuStnfcOMWrY~u1kiltaINRCPorm241.) MD- 0 c-101-Q1 'MD 6/30/2003

1. THE UINOMSIONED. HMUY CERTIFY THAT.sAM Informantion Inthi. report Is true and ecomplete.

b. I hav% reAd and UnderstAnd the Pravtsin tit the Peneral licenst 10 CFX 150.20 re~rtntfA on the InmWettOna OltltLalOiyn and I understand that I emi required to comply wfth theme provislOnN as t all byproduct1 mourcr, or npeade nudgew material Wakhd I possess and usce In nan.Agreament BMW1. or afflhhfe wta~rn uder the general license for which thls report tar tile w~th ime U.s. Nuclear Regulstory Commissilon.

I, undeystand that actMIGi~S, Including sftrange, conducted In mof.-Agruamentsttefllldergeneral Icenee 10 CirR 1IS.2 are lnimledtn a total of 150 dayr

in calendiar year. With the exception Of WOMl conlductd In off -ahore wxtsrz, which Is authartuZd for an nIlimita period of time in the calendar year.

d.Iunderstand thst I may be inspected by NRC at li-i above listedvvork site locationx and at the U.cenatc home oltice addruza for actvivties eiorid In non-Aproeement Sbiee or offtlhOoe wftera.

I understand that conduct of any eCM18lie not described 2bave, intluding c~onduct of adcvtlves on dates or locations diferefl from thtose described, nbove or wtthout NRC amithortzAtton. Iiafy subJect me to "norcament actior, lncld,ýq Jgcivil of crimtinal =Me& Itas

cgT~'rN O RFc1 R&O or emsagnz R&puWi-m- ~Nemn. ad nh D UE 1 AY= /

WOARNING:, Uase stnatements In this CertifiCat.s may be SUNjo a~'761cil n/ri e"Imunal pet s. NRC regulations raquirn that pomtsslafl to the NRC be Domplete and accuratet In all nwtetila respects. 18 U.S.C.ectionl10 aO aarCs ofnet make a willfully fallatUAwnont or relprsentetlon to any departrnort or agency of the Unitad Stvtas as to any miatter within fts jurlsdlctlon.

FOR NRC D-1" ~~-fw ~ ~ A- -oTOTAL UeAGE - DAyS10DT USE ONLY I~ -~\-- ~ - ~ ŽNRC FOtW 241 (7-1WP

�,'

rrum 10W %An 1W. 1 6-6ý

Pacle 12/164106652074; Feb-14-03 16:55;Sent By: K;

t

4106652074;

U.S. NUCLEAR REGULATORY CO)MMISRSIO.NNRc FORM 241

REPORT OF PROPOSED ACTIVITIES IN

NON-AGREEMENT STATES, AREAS OF EXCLUSIVE

FEDERAL JURISDICTIO.N, OR OFFSHORE WATERS--- --- 5 AL.. � h.�#rrO t�nuein/ntfiiti 11,/s form)

Sent By: K;

(Pleass reau we* 11M044------------1-~ -W tri in " n W I I4I~

1. uAmE OF L1CENSEE F-onwh -&m Vc0- to 10 -W;; WVVV4' 4937- b-. 2,- TYEOF '

Krueger-Giibert Health Physies,_Inc INITAL ~REVISION ~CLARIFICATION

3. ADOOF55 OF UCNN8EE faitk4~' edm w a~w ti"o W "'Y Lt.0 m eJ 4. UCW9i5EECONTCT ANO TtLE

MoqTLrt iIO,4 /Health Physicist 3601 E. Joppa Road

Baltimdre, Maryl.and 21234 M.T3"OCNMBRPCY.ENUMAM

7. ACTIVITIES TO BE CONDUCTED UNDER THE GENE~RAL LICENSE OWVEN IN 10 CFR 150-207

D WELL. LOGGING LEAK TES71NG ANDJOR CAUBRA71ONS .TELMTERAPYI'RRADIATOR SERVICE PORTABLE GAUGES OTHER (Specify) __________________________

D RAD OGRAP Y ~ , REGM-ER M:IAS URER OF PACKAZ2IN (CMTFIMATE S OF COMPUAiNCE HU M90W~ a. CURNT NAME. ADDRESS. CiIYCUI41Y STATE. ZP Coot 9. ACTUAL. PWSCAL ADDROM

OF WORK OAII /SkeuI~ ~ ~~~~Tl: 64 ~b d ~e. W aonpaes ad""a or *WdM 1119,00W61.).

Amrerican. -MedicaI Laboratories, Inc. same as 8 14225 Newbrook Drive P-0O. Box 10841

Chantilly, VA 20.153-0841 10 11.W~rNME0k ii WORK LQCATIwTPHC~.NEUMBER

703--02-72-- 1703-80-72 13. NUMBER OF 14. 1& . %0 LOCATION

12. DATES SCHEDULUD WORK DAYS ADD DELETE RUERENCE NUMBER

AS=NED 9YNRC

- .. ~4, .. ,., ~r,,, esiiee ~u~w~air~nAIMED IN TVMS -IS ABDVEL

17. UST pADIoACTiVE MATM414L. WHICH WILL BE PO5SSIMIED, us8D. YNaTALL-SD, SURVICMD, Olt TaZTm

pinop&~ dagcflotJ f yi* Ot n quante Of adloecWl ftIhWWin cnr45WU, dGVkce ton Do imdt)

Ct-137 ICN MLID-D11#30938 9 r 250uCi (11/23/87)

Cs-1 37 NAS MED 3550 #A7380, 182.5 uCi (11/1/97)

CJý HCND N M1Nfr7ucwm NIJmuE STATE EXPIRA¶ON

DT 1a, ME Or -, -e0

0

Ill. CERTIFICATION rMUSTBZ COMPL1;TED EyAPPLJ 0AN7J

1, TrHE INDMMIGNED, HEMEY COMTWy THAT!

1 have read and unceaiand the poovailon of, the genraetl licensel t0OCFR 190.20 f@repflted on thte inairCliOng ft~ om fdIudftidta n

required to comply with thes provisions at to all byproductsoaurce, or zpadal nuclear melaerial which I pososaw and use in non.AgrmCI-ft Sltate of

offshore watmers under the gurm1 rot lcanza for which Ihis report Lx filed wtth 'the U.S. N ucear Regulatory CommnInatiofl

c. I underiftand that activities, including Itaort5i, conducted In non-Agraeenoit Stxatt under gener.' 1mange 10 CMR 1190.20 are limited to a total of 180 days

in calendar yma~r. With the excitptlon of worb conducted In olT-Chom' wittz, which is stuthorized for an unlimited ploid ot time in fthe calendar year.

d.1 understand thad I may be Instpected by NRC at the iabove Ilirtd work site locationsa and at the L.1cenizee home oftiee nddr~ss for act~vities performed In

non-Agrearritut "tats or offetior watens.

I underiftrid that conduct of any octIVItIeS not desacribed above, Isicitrdtng conduct of actIvitits an dates or locations d~frilrantfrorn thosw darcrile

itbova or wtthout NRC 2utht'rtxatton, maty xliject me to etofremmeri actIon, Incltzdlip civil or crtmlnal pensast .5

-~ ~~ n~T~ J ~O ~ l ~A'M~

OR N RC EW4 PA pnadm U-03E_0 OLY T

Feb-14-03 16:56; Facie 13/16

APPROVWE 91 OMIB: NO. 3140.0010 WCIPRE: 07/1=11202 Ei~~~M~~ksdt buoomp"~n ~ wlJy Withtis lrandatarY CO1QOtlU

raquae 15 lnu= "W. 1,"mcaffluionlis requled oothat NRC may aoki~du, ireitW1 f th adde* ~ eeur tho ~r umuctad I woourimnoe w~ith requirantiiltt for priataotion of the public health and

saoy eand Omnea rgardtna burden' asitmrate io the Ratootds s¶met n~hiO _a~ U.S. tNucJr Relokilory CoMIisstion,

DC 20 5400 or by Intartenwi mall to bosIonre~gov, S officer Offic of lnforriatkmoi gild Regu sory AffaiMe

Nt!CD.10202. CS5- 3, Offloe of Management and budget,

Woahtn to, DC 2060, itL means used to Imports an informu on,

luI~litic domecs not dhiuPly a curtTUitly valid 0MS conimal number, the NRC t may ioenduct or =pnsr, and an person is not required to

WARNING, False salatanwts In this certiicua rismay bs subject to c~vllhndlor criminall enal'Ves. NNIR reg

the NRC be complete and ac~rate In alil moateial respects. 19 U.S.Cý$eSctlon 1001 makes Wa' crimialnaJ ff'

zistenient or rapreir~mtfftion to any deparit~liaf or agency of the United States as to any mautte withiin fts J

NRC FORM 241 (7-10W

I

'UST ADDITIONAALL YWOO K SITIES ON 'SEPARA I a SHEE 5 ISI 1 0 INM

19. CERTIFICATION tMLJSTBE COMPLETED fiYAPPIJCAN7J 1. THE UNDEMI3GNEfl, HER~EBY CRTIF-Y TMAT:

An Ifrornation In thtt report ls.trlje and complats.

bI have reatd and mnde6titnfd IMe pro'MiOrl Of th! general IIOc1I.6 10 C~lR 10=.2 raptintnd on¶ the Iat~ruotlonz of thismform; and I understmnd thjil arm raqukrad to comply wtth~ tha- l1toviUflos as to an byprodUct, source, or "prWm nueclrwismatrial wnlcil 1 po---- and use In nan-Agreuttem Stitee or offshore water5 underth a gnrank ilcanne for Which thLs rmpofl it I'llad wltth the U.S. Nuclear Rcgulatoty Conimia-Mon.

c. I undw~n dtiztate~Vtfla, Including StoraVI. conductedl In not rvw enS ot utswt ganefa IkI wel 0CF LMMam WNW ft~to A tal 0o1"9 day3 in calendar year. With the exception of vrork ccnductud In off-eliom- wsterf4 whkic Is autkiortzatd for an unilmited pariod of time In the calenclaryear.

I vnderstand that I may ba Itrpsactd by NRC tit the above Hasted wrwk she locaflons and atthe Licerwra homne offie asddrewa for act~v~ttei pefforred In norb.Acrearcant Staes or offshore watilte.

c. undemtand Sthat conduct uf anly mctkvitMJ "iit described abavia, Incknong conducted1 actIvIties on dates or locirtiona difwvrnt fromt thuxe described above or wkIhout NRC eutliortzalior, may LOIbjct nre to enfortement metion, knft a WWlIi or criminal perwiti. 0

CopFnlNQ OFP1ER Rwt or mmlWmV- Rporaersd"kv 04nw re d The)

WARNING: Fits shrtteiments in this certfficate mawy be subject to %y4 ¶dior orimin the NRC het evmnlet. find asemvita in all maturial resPects.. IR U44 a tton 1001 n xt~ilamant or representation to any depattnefli Or agency of the Unite States as to

IFOR NRC j"~ USE ONLY I-v~NKC FORM 241 (7-19WO

Qiizarinp E.

I

4106652074; Feo-14-03 16:56; Pace 14/16Sent By: K;SenROVED B; 410 652 74 NO. 814-0316: 6 EPI E:ace 14 160:

ýNRC FORM 241I u.s. NUCLEAR RrzoULA'TORY COMM=SION EwhaPcROV burYo per: n"O.r t1o comly w tf'iRE HumimbIr colld ,~qa~qza 15 minute. This rwifft1oetion is roquk rad am IMt NFZCay sotI~dUgI m~pmton of thes actbivmto amt n tha they am =ondLuced Goounrma= With mquiOramrnit; for potao~btio of thle publt hoalth eMw

REPORT OF PROPOSED ACTIVITIES IN saafty. .Sand 13omrnet" r' rdIn budo ailrou toIaReo NON-AGREEMENT STATES, AREAS OF EXCLUSIVE WMiufr~n POC 20K-0004 , rby Intornat e-fnfll t l~ h1nt.poy, end lath Desk Oflear. ffc ef nfornnatton smd Rg dvfory Afbt~rz,

S .i31-0202 Were-O1~ 01u Mnaan& fi n~d Budget, FEDERAL JUrvSDICuT.IOi,~ OR OF=FSHORE WATERS Wahntn l 00.ammr s* oIpo nIlfnb OaCH"Lion dove not dia toy 0 c~Urrry valid OMB control Rurnbu, the (2'i azse imad the Jnsftafoflns befb orecrp~iwng ibis formn) NRC;t nmot conductor apoozar, and it person is not requirad t6

o.te anrfmtion covitofigon. 1. MA4 F~ tua1 PW~SI ~M1~i~ho)2. TYPE OF REPO~

Er-ueger-Gilbert H~eal]th Phy-sics, Inc INMTAL REVISION ~CLARIFICATION aAnoRmS or UcEEs t'I dt omkwwr*iwwny9 -W . LUC~ENGI CONTfACTAND TITLE

3601 E. Joppa Road f4T.eltHa-hPhysicisl Baltimore, Maryland 21234 NMMN)41

7. ACTIVTTIES TO BE CONDUC-TED UNDER THE GENERAL LICENSE GIVEN IN ID CFR 160-20

D WELL LOGGING LEAKTESTING ANID/OR CALIBRATIONS D.TELETHERAPYJIRRADIA.TOR SERVICE D PORTABLE. GAUG.ES D OTHE R (Specify) 4i>__ ___________________

REMS0TE11M AS USERt OP PIA0CAG[Nr (CalFICATES Or CboVu4nCe NWjM~jMWI

U RADIOGRAPHY ~~ _____________________ 8.ELT ADD. CRESS. CflYJ=YJN. STATZ. 7JP ECOE- .A1A.FNCLAOESO WORK LOCAiO

o~'~ ~Nmu tr Jwketh%,. C i. -. wmP)Vf add-~ wa .1m w-- &%. The Cardi~ovascular-GtrOUPe PC same as8 130 Pa~rk&Str~eet, .S..E, Sui~te 100 Vienna, Virginia 2.2180

UST~~~~~~~~ ~~ AITOAWOKSTSOSERAESET)TONCLUD L INWORATO CO. AINED ICN ITEMSPHO-16 ABOVE. 17. ET RflIOOT1V MATRIAL WhIH Wil. 5 POSIi~fl~ U.~D.INSTLLED RERIAitl, OTECW

One1'J ~ ~ ~ ~ ~ 7-3-8112e 703-281-1265~ or1ocW ,~i~i~mLrg r ataa~

17 DTMSICDL 13.t O~NUM151 CI 14.~ 16.8 STT R~LOCATIO ABV, f 1 o~C~weniz ~7Wy to WfoJ RC Piym 41 ADD-0- 0101I DI /3/

Sent By: K; 4106652074; Peb-14-03 16:57;

Page 16/16

NRC FORM 241 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO.'at 0.oo013 EXPIR.: 0713112002 bulnaoed burden .- r rem.+.,'s to comply. with this mandatory ",'lI'aiozn '"quest: 16 ml=ulaB. This notification Is required so thet NRC tony schedule Inspection oa tha e lWvks to ensure that they arc vonduod in accordance with requirements for protection of the public h•alth arnd

REPORT OF PROPOSED ACTIVITIES IN vaety. Send oommenin rta rdnl burden estimale to the Recorts. NON rn-erdn Brnoeh IT-G E±). U. Nuclear Regulatory Commission, NON-AGREEMENT STATES, AREAS OF EXCLUSIVE wand ton. De Offiero- or My Inalene a••m , Regltor Affairs, end Et10 a 310-0 0.31r. Ofice or Iformaton aend Ralnlatoyf., Burg, FEDERAL JURISDICTION, OR OFFSHORE WATERS NEut-i0go, DO 200. a•ameans used I•toIpoo an Information

collection dos; rnt dispksy a currently valid 0MB oontrol number, the

PieaGse read the insrucations before completing this form) NRC may not conduct or sponsor. and a person is not requirad to

r"fP0nd •,the nfor at liar, Ieton,

. INAME OF I.CENSEE (P*20A c0171 pvpOakg locldua ev svli aaadoo *Odbelow) 2. TYPE OF REPORT

Krueger-Gilbert Health Physics, Inc INITIAL [ REVISION CLARIFICATION 3.OUS OucNs (a.ng.•,13o, ,owiow'. ,n.m.wA ) A iCB4SSOSPECONT.ACT^AN'D:f He al. th

3601 E. Joppa Road 1., ,• Baltim~re, Maryland 21234 5. TELEPHONE N. FACSMIL•.NUMBER

• 410-665-5447 1410-665-2074 7. ACTIVITIES TO BE CONDUCTED UNDER THE GENERAL LICENSE GIVEN IN 10 CFR 160.20

D WELL LOGGING LEAK TESTING AND/OR CALIBRATIONS D TELETHERAPY/IRRADIATOR SERVICE P6RTABLE GAUGES OTHER (Specify) w_0

REGISTE•".D AS UGMR OF PACKAGING (C.RTiFICAT.ES OF COMP'JANCE NUMBERS) L RADIOGRAPHY SCLIENT NAME. ADDRESS, CTY(COUNTY, STATE. ZIP COD 0. ACTUAL PHYS•.AL ADDRESS OF WORK LOCATION

(5~w andNumw oritiulocticr. Gcn compleof,1 an odmv~ or dkeetftma poasoi-j

Delaware Diagnostic Service, Inc same as #8 Community Imaging Center 1941 Limestone Road, Suite 214 Wilmington ,. Delaware 19.808 %D. CLINTT'LEP "ON .UM R , W ORK c A'noNTELP NNUNB

PdtAM*a Cod$) PncI-Y.d Atse Cod*) 302-892-6200 302-892-6200

13. NUMBER OF 14. 16. 16. LOCATION 12. DATES SCHEDULED WORK DAYS ADD DELETE REFERENCE NUMBER

FROM. TO NUMSERT0912 ] / ASSIGNED By NRC LIST ADDITIONAL WORK SITES ON SEPARATE SHEET(Sj TO INCLUDE ALL INFORMATION CONTAINED IN ITEMS 9-16 ABOVE.

17. LisT IR•IOAZlVE 14ATIERIAL. WHICH WILL BE POSSSS•li It. USED. INSTAL.LED, ERVICED, OR TESTED ,7rEjud& docaieflpao of iryp and quanrly of a70800rve inrwriat seelsd scurces. ordu,~cas Ds bv used.)

Cs-137 ICN MLD-01#309389, 250uCi (11/23/87) Cs-137 NAS MED 3550 #A7380, 182.5 uCi (11/1/97)

1i8 AOREMNIT SýTATIE SpecIF IC UC-S WHIXAUTHlOcE THE UNDQRSQNEC TO CONDUCT FL IEC EN SE N U MB6ER STATýEEXPIRAMON DATE A;f1EW&TNNiOIARET ftEA%5 EXETFRO NOFU E, AS SPIECIFIDI fi . ABOVE (Fourp-•o .. ,,offt spe6c 1ka acompyt'i'alA"M" "-5INrCr2i1.) D- _ V,-1 0 1 0_ 6/30/2003

Ia. CERTIFICATION (MUST BE COMPLETED BY APPLJCAN7) 1, THE .NDERSIGNEM, HMWBY CERTIFY THAT:

. All Information In this report Is true and complete.

b. I have read and understand the provIsion of the general license 10 CF'. 150.20 reprinted on the Instructions of th•s form; and I understand that I am

required to comply with these provislons al to all byproduct, ,outca, or special nuclear mteriali which I possems and uie In non-A~gratment States or

oflfhore wotera under the general Ilcenst for which thl3 report Is filtd with the U.S. Nuclear o tegulatofry Comm|is.Ion.

0. I undrm-tand that actIvitIJs, Including storage, conducted in non-Jgran•nt States under general Icense 10 CFR 160.20 are limited to a total of 180 dayS

In czlendar year. Wth the excapdton of worit conducted In off-&lors watws, which in euthortzed for an unlimited piriocd of aime In the calendar year.

d. I understand tiat I muay be Inspectd by NRC at the above listed worK she location arnd at tThe Licanset home office address for activltlen pwrfonmed In

non-Agreement States or offshore waters,

e, I undetaortnd that conduct or any ac:ivlUns Pot described above, Including conduct of activities on dotes or locations ditfrtnt Itrom hose demcirlbed

above or wfthout NRC authorizationr may sUbject me to enforcement action, lncIUO.Wij cMI or criminal pmnetles.

CoklIyN OFFICER - R60 or mainageme~nt RaprsenItz" va (1m. vnd Tr".) Is 4 AT

C ~ 'V r-i r h M i d t .Pre a

WARNING: False statements in this cerificato may be subject to ii nd/or cnninal unPes. NRC regulatioin require thattUbmlssono the NRC be complete and accurate In all material respects. 19 U..C.'Sec|tlon 1001 rina es a crlimirnal offense to make a Wilhl'Uly false

staterment or reprenentatlon to any department or ageney of the UnIted Statie ai to any matter within Its jurisdiction.

FOR NRC I REVIEWING OPFICIAL Ir a Name and Two) ONAJRED

USE ONLY \,, W -p __ _ _ _ _NRC ,fRM 241 (T.1 •K t, PRLTED ON RECYCLED PAPER

45&/00I

Sent By: K; 4106652074; Feb-14-03 16:57; Page 16/16