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'jRC FORM 374 U.S. NUCLEAR REGULATORV COMMISSION PAGE OF PAGES9,

9* Amendment No. 23M ATERIAI S 1.lCENSE -GPursuant to the Atomic Energy Act of 1954, as amended. the Energy Reorganization Act of 1974 (Public Law 93-438). and Title 10, Code of |

$f Federal Regulations, Chapter 1. Parts 30,31,32,33,34,35,36,39,40. and 70. and in reliance on statements and representanons heretofore made |

L(i by the licensee. a license is hereby iwued authorizing the licensee to receive. acquire. possew, and tran fer byproduct, source. and special nuclear,

!'

I j material designated below; to use such material for the purpose (s) and at the place (s) designated below: to deliser or transfer such material to,

|"| persons authori/ed to receive it in accordance with the regulations of the appheable Part(st This license shall be deemed to contain the conditions|3 pecified in Section 183 of the Atomic Energy Act of 1954, as amended, and is subject to all applicable rules, regulations, and orders of the

Nuclear Regulatory Commission now or hereafter m effect and to any conditions specified below. I

N bD/VY $||2 Licensee In accordance with letter dated / 5'October 1, 1996 s

l |t Michael Lala, M.D., P.C. 3. License Number 21-24380-01 is amended E i| South Allen Radiology in its entirety to read as follows: 412

|5 -, 5518 Allen Road iIg Allen Park, MI 48101 4. Expiration Date August 31, 2005 g'is ;;$ 5. Docket or 030-18558 2

Reference No. ga 6. Byproduct, Source, and/or 7. Chemical and/or Physical 8. Maximum Amount that Licensee s$ Special Nuclear Material Form May Possess at Any One Time jt Under This License's -L t|8 .A . Any byproduct A. Any A. As needed gf material identified radiopharmaceutical 3gf in 10 CFR 35.100 identified in 10 CFR $$, 35.100 t

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B. Any. byproduct B. Any B. As needed g3 material identified radiopharmaceutical (|h in 10 CFR 35.200 identified in 10 CFR s

G@|35.200 (excluding 5'Xenon-133) s

: 2$ C. Any byproduct C. Any C. 1 Curie 5?| material identified radiopharmaceutical 52{| in 10 CFR 35.300 identified in 10 CFR R,

| 35.300 (excluding" *

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. Medical use described in 10 CFR 35.300 (excluding Iodine-131 for thyroidOh !

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%|fi NRC FORM 374A U.Sf" CLEAR RECULATCRY COMMISSION ,^'3 PAGE 2 OF 3 PAGES h['h j License NurntQf !hj

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|3 21-24380-01 I5||3 MATERIALS LICENSE (!Docket or Reference Numberg SUPPLEMENTARY SHEET 030-18558 E||s* E',i Amendment No. 23 E|!} E*|El

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E|>|G! CONDITIONS E|

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|S! i!|E' 10. Locations of Use:|3! i|3a Rin|5! Farmington Medical Arts X-Ray Dr. Pai

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lsl 23800 Orchard Lake Road 2450 Walton Blvd.j Farmington Hills, MI 48024 Rochester, MI 48309 gg

35300 Nankin, Suite 601 6033 Middle Belt Roadj Westland, MI 48185 Garden City, MI 48135 ga5 Internal Medical Associates W. J. Ringold, M.D., P.C. fg 1611 Monroe Avenue 2200 Monroe ;j Dearborn, MI 48124 Dearborn, MI 48167

g5 A. Herrero, M.D. Northville Medical Center $5 317 Ecorse Road, Suite 11 308 South Main Street E

Ypsilanti, MI 48197 Northville, MI 481803 Taylor Nuclear and Ultrasound 15520 Garfield E3 23265 Eureka Road Allen Park, MI 48101 E5 Taylor, MI 48180

.E3E! V. Goburdhun, M.D., P.C. Metro Medical Center E

5 14555 Levan Road Suite 403 12701 S. Telegraph Road E3 Livonia, Michigan Taylor, MI 48180 E3| E3 Livonia Internal Medicine Ei 3|

20311 Farmington RoadEs Livonia, MI 48152Eiis

I EI3 11. Radiation Safety Officer: Michael Lala, M.D. EIhE

|3 12. Licensed material listed in Item 6 above is only authorized for use by, or under the $|3 supervision of, the following individuals for the materials and uses indicated: Eii

E|3 Authorized Users Material and Use E|3 E|3 A. Sallem Azad, M.D. 10 CFR 35.100 and 35.200 (excluding y) Xenon-133). Ei

|3 E3 B. Adelfo Melicor, M.D. 10 CFR 35.100 and 35.200 (excluding E|d|UI Xenon-133). $i

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|f NR FORM 374A U.S. NUCLEAR REGULATORY CpMMISSIONg PAGE 3 OF 3 PAGES*

License Num5 } gs 21-24380-01${|3 MATERIALS LICENSE Docket or Reference Number$|j SUPPLEMENTARY SHEET 030-18558 EBE!s Amendment No. 23 ;E|

9%9 '

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sE 12. Authorized Users (Continued)

@ {b Nh Authorized Users Material and Useai C. Michael Lala, M.D. 10 CFR 35.100 and 35.200 (excluding js

4

i Xenon-133) and 35.300 (excluding Iodine-131 gj for thyroid carcinoma therapy). gD. Maria Antionetta Crumes, M.D. 10 CFR 35,100 and 35.200 (excluding

y Xenon-133). ,13. Except as specifically provided otherwise in this license, the licensee shall

| |g . conduct its program in accordance with the statements, rep'resentations, andprocedures contained in the documents, including any enclosures, listed below, E

| except for minor changes in the medical use radiation safety procedures as provided E ',in 10 CFR 35.31. The Nuclear- Regulatory Commission's regulations shall govern NNunless the statements, representations, and procedures in the licensee's application Iand correspondence are more restrictive than the regulations.

|5 A. Application dated October 25, 1994; EN

NLetters dated JanuarN 30,1995, April 17,1995, July 10,1995,N B. October 1, 1996; E

N and NN

NN C. Only facility sketches in: EN

93 1. Applications dated August 29, 1984, August 14, 1989 and May 17, 1991, and i3

N,N 2. Letters dated December 23, 1991, December 14, 1993, May 23, 1994, and EN November 5, 1993, and ~

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EN 3. Letter received November 5, 1993.

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o O*- .~ -, . .1 (FOR LFMS USE): INFORMATION FROM LTSEETWEEN: Q--------------------

License Fee Management Branch, ARM : Program Code: 02200and : Status Code: 0Regional Licensing Sections : Fee Category: 7C

: Exp. Date: 20050831: Fee Comments:: Decom Fin Assu~~Re::::::::::::::::::::q3T~R~~~~~~~~~~~~:::::::::::::::::

LICENSE FEE TRANSMITTAL

A. REGION

1. APPLICATION ATTACHEDApplicant / Licensee: MICHAEL LALA, M.D., P.C.Received Date* 961009Docket No: 3018558Control No.: 301934License No.: 21-24380-01Action Type: Amendment

2. FEE ATTACHEDAmount

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Check No.:__ ]

3. COMMENTS MM" ---Silned .

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cB. LICENSE FEE MANAGEMENT BRANCH (Check when milestone 03 is n ered / /) Z1. Fee Category and Amount _h_____________________,,______________2. Correct Fee Paid. Application may be processed for: CO

Amendment V~~~~~~~~~~~~~~Renewal~~

License __[_"_[_~ ::_~ :_~3. OTHER

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LICENSE FEE AND DEST COLLECTION BRANCHDIVISION OF ACCOUNTING AND FINANCE

LICENSE FEE REQUIREMENTS OFFICE OF THE CONTROLLERU.S. NUCLEAR REGULATORY COMMISSIONWASHINGTON, DC 20586 0001

,

!TYPE OF ACTION -|

NEW LICENSE !;e'

RENEWAL OF LICENSE ,

SOUTH ALLEN RADIOLOGY IAMENDMENT TO UCENSE 1i. ATTN; DR. MICHAEL LALA

5518 ALLEN ROAD REQUESTED DATE

j ALLEN PARK, MICH'GAN 48101 10-1-96

| LICENSE NUMBER

1 21-24380-01I CONTROL NUMBER

3019341

1. APPLICATION FEE DUE li. FEE NOT REQUIRED4

Your request for a licensing action is subject to the fee (s) in the category (ies) ]i noted below in accordance with Section 170.31 of the enclosed Federal Enclosed is Check No. which accompanied your! Register notice. Payment of the fee is required prior to the issuance of the request. The fee is not required because:

license, renewel, or amendment.

Jd. ' APPLICATION RENEWAL AMENDMENT f We received your Check No. In payment of,7C s s s 440.00 l the fee.

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$ $ $

s s s The Licensir'g staff has informed us that your request is to beg g g considered as a continuation of your request dated

Oj 8 $ $ , Control No.

$ $ $

8 8 ';Your request was combined, prior to review, with your '-

S $ $

s s s request, Control No ., ,

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lit. CHECK RETURNED

FEE (s) DUE s 440.00'

i PAYMENT RECEIVED s 430.00 Enclosed is Check No. ~ which was retumed to us |< W N h* fw:'

AMOUNT DUE s 10.00

Your request was received without the prescribed applicationfee. ACCOUNT CLOSED

We received your Check No. 9622 in the amount of I*

;- 3 430.00 Payment of the additional fee notedabove is required.

MAIL TH$ REPLACEMENT CHECK TO THE ADDRESS LISTED AT THEYour request willincrease the scope of your license program. . TOP OF THIS FORM AND REFERENCE THE ABOVE CONTROL,Therefore, your request is subject to the application fee (s) noted above. NUMBER.,Refer to Section 170.31 and Footnote 1(d)(2).

N. LICENSE ISSUED WITHOUT THE REQUIRED FEEfYour license expired prior to the receipt of your application for renewel. O License No. . Amendment No. * issued onTherefore, your request is subject to the application fee (s) noted above..

| Refer to Section 170.31 and Footnote 1(a). was issued without the required fee beingcollected. The fee required is noted in Section I of this form.,

'

MAKE PAYMENT OF THE FEE (S) TO THE U.S. NUCLEAR The scope of your licensed program was increased. Therefore, yourREGULATORY COMMISSION AND MAIL THE PAYMENT TO THE request is subject to the application fee (s) noted in Section 1 of this form.ADDRESS LISTED AT THE TOP OF THIS FORM. IF WE DO NOT Refer to Section 170.31 and Footnote 1(d)(2).

'

RECEIVE A REPLY FROM YOU WITHIN 30 CALENDAR DAYS FROM*i THE DATE LISTED BELOW, WE SHALL ASSUME THAT YOU DO NOT ] remittanceofBecause of t urgency of your request, the license was issued withoutj WISH TO PURSUE YOUR APPUCATION AND WILL VOlD THIS prescribed fee noted in Section 1 of this form.! ACTION, A s

S - UCE [E T. ILpCB LFDCB Distnbution: \/ g DATE.k Pending Fee File s( 3.2.7)~ 0/23/96 LFARB R/F (2) Regio h. cd3,[k1

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NRc FORM $77 M195) TNs form was electromcully produced by Elite Federd Forms, Inc.'

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N* {/ $0'' [[[ 0',-'ADOLPHO MELICOR. M.D. M. LALA, M.D.xMARIA CRUMES, M.D. 5518 ALLEN ROAD o,DMw"%YM7d

ALLEN PARK, MI 48101(313) 388-1930

RADIOLOGY, MAMMOGRAPHY, NUCLEAR MEDICINE, ULTRASOUND, ECHOCARDIOGRAPHY AND VASCULAR STUDIES

October 1,1996

Nuclear Regulatory CmunissionPegion IIIMaterials Licensing Eranch801 Warrenville PoadLisle, IL 60532-4351

Dear Sir:

Please amend byproduct material license 21-24390-01 for the following changes:

1. Add Livonia Internal Medicine20311 Parmington RoadLivonia, MI 48153

attached is a diagram ard equirunent list.

7. Delete the following locations of uset

Praned Ragal,10 - Jackson Northwest Clinic, TC24651 Collidge Highway 2200 Springport PoadOak Park, MI 49237 Jac1' son, MI 49?O2

No materials were ever received or used at these locatiors.

3. Delete Farmington Medical Arts & Xray23900 Orchard Lake RoadFarmington Hills, MI 48024

6033 Middlebelt RoadGarden City, MI 48135

Copies of the close-out surveys will be sent as soon as the close-out isccmplete.

Enclosed is a check for $430.00 for the amendment fee.

If there are any auestions, please contact Pay A. Carlson, M.S. at (113)455-4710._ _ -

Sincerely, ,

g1 ' g / - N[:- RECEIVED,

m 09 MMichael Lala, .REGION III

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EQUIPMENT LIST FOR: Livonia Internal Metlicine|

1. Siemens Gamma Camera.2. Capintec CRC-10 dos, calibrator.3. Bicron 2000, GM survey meter,4. Capintec Caprac well counter.5. Lead bricks.6. Lead-glass siscid.7. Syringe shields.8. Lead shicided waste container. ,.

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DEC 0 91996

Michael Lala, M.D., P.C.South Allen Radiology5518 Allen RoadAllen Park, MI 48101

Dear Dr. Lala:

Enclosed is Amendment No. 23 to your NRC Material License No. 21-24380-01 in |accordance with your request.

;

1

Please review the enclosed document carefully and be sure that you understand allconditions. If there are any errors or questions, please notify the U.S. Nuclear Regulatory

|Cr.,mmission, Region 111 office at (630) 829-9887 so that we can provide appropriate Icorrections and answers.

Please note: we have added five years to the expiration date listed on your license. You |will be receiving official notification from our headquarters office explaining the cause forthe five year extension in a few weeks. In the meantime, if you have any questions,please call me. I

Please be advised that we cannot authorize you to release your old nuclear medicine spacefor unrestricted use (even by other members of your staff) until we have received andreviewed a copy d the results of your close-out survey. This includes facilities at both6033 Middlebelt Road, Parden City, Michigan and at Farmington Medical Arts and X-Ray,23800 Orchard Lake Road, Farmington Hills, Michigan. The survey should consist ofexposure rate measurements to show that all sources of radioactive material have beenremoved, and contamination checks of areas where radioactive n sterials were used orstored. Average radiation levels associated with surface contamination and removablecontamination should not exceed those specified in the enclosed decontamination guide.Please submit the following information with your close-out survey:

a. A diagram of your old facilities with survey and wipe test results keyed to specificlocations.

b. The name of the person performing the surveys.

c. I he date the survey was performed.

d. The instrument (s) used for exposure rate measurements and for analysis of thewipes.

80AM__

,. _. _. _. -__ _ _ _ _ _ . __. . _ _ _ _ _

M. Lala -2-:

!

i

; e. Background readings. .;

j f. The date that the survey instrument was last calibrated.

Please be advised that your license expires at the end of the day, in the month, and yearstated in the license. Unless your license has been terminated, you must conduct your

;

program involving byproduct materials in accordance with the conditions of your NRC '

license, representations made in your license application, and NRC regulations. In.particular, note that you must: !,

,

} 1. Operate in accordance with NRC regulations 10 CFR Part 19, " Notices, Instructionsand Reports to Workers; inspections," 10 CFR Part 20, " Standards for ProtectionAgainst Radiation," and other applicable regulations.

2. Notify NRC, in writing, within 30 dayc:.

a. When an authorized user or Radiation Safety Officer permanently idiscontinues performance of duties under the license or has a name change; ior

b. When the licensee's mailing address changes (no fee is required if thelocation of byproduct material remair's the same).

3. In accordance with 10 CFR 30.36(b) and/or license condition, notify NRC,promptly, in writing, and request termination of the license when you decide toterminate all activities involving materials authorized under the license.

4. Request and obtain a license amendment before you:

a. Receive or use byproduct material for a clinical procedure permitted underPart 35 but not permitted by your license issued pursuant to this Part;

b. Permit anyone, except individuals described in 10 CFR 35.13(b), to work asan authorized user under the license;

c. Change Radiation Safety Officers;

d. Order byproduct materialin excess of the amount, or radionuclide, or formdifferent than authorized on the license;

e. Add or change the areas of use or address or addresses of use identified inthe license application or on the license; or

f. Change ownership of your organization.

_

_ _ _ . _ _ _ . _ . . _ _ _ _ . . _ .- _ . _ _ - - _ _ _ . _ - - _ _ _ . _

'

! M. Lala -3-

5. Submit a complete renewal application with proper fee or termination request atleast 30 days before the expiration date of your license. You will receive areminder notice approximately 90 days before the expiration date. Possession ofbyproduct material after your license expires is a violation of NRC regulations. Alicense will not normally be renewed, except on a case-by-case basis, in instanceswhere licensed material has never been possessed or used.

In addition, please note that NRC Form 313 requires the applicant, by his/her signature, toverify that the applicant understands that all statements contained in the application arutrue and correct to the best of the applicant's knowledge. The signatory for.theapplication should be the licensee or certifying official rather than a consultant.

,

)

You will be periodically inspected by NRC. Failure to conduct your program in accordancewith NRC regulations, license conditions, and representations made in your licenseapplication and supplemental correspondence with NRC will result in enforcement actionagainst you. This could include issuance of a notice of violation, or imposition of a civilpenalty, or an order suspending, modifying or revoking your license as specified in theGeneral Policy and Procedures for NRC Enforcement Actions. Since serious consequencesto employees and the public can result from failure to comply with NRC requirements, iprompt and vigorous enfcrcement action will be taken when dealing with licensees who do |not achieve the necessary meticulous attention to detail and the high standard of 1compliance which NRP spects of its licensees.

Sincerely,

|

!Original Signed By '

Loren J. HueterNuclear Materials Licensing Branch

License No. 21-24380-01 ;Docket No. 030-18558 1

Enclosures:1. Amendment No. 23 12. NRC Form 313 j

;

DOCUMENT NAME: M:\03018558.CL6 !To receive a copy of this document, indicate in the box: "C" = Copy without attachment / enclosure "E" = ;Copy with attachment / enclosure "N" = No copy )

OFFICE DNMS/ Rill f/ |NAME LJHueter:brtgj// |DATE 12/p[, /96 ~ C/ '

OFFICIAL RECORD COPY

_ __ _ _ - . _ _ _ . .. __ _ _ __ .~. . . . _ . . _ _ _ _ - . . - _ . _

** % UNITED STATESk NUCLEAR REGULATORY COMMISSION*

REGION tilU E 801 WARRENVILLE ROAD

i

/ USLE. ILUNOIS 60532-4351'

***** October 9, 1996

Michael Lala. M.D.Radiation Safety Officer5518 Allen RoadAllen Park, MI 48101

SUBJECT: ACKNOWLEDGEMENT OF CORRESPONDENCE(Letter Dated 10/01/96)

1

Dear Licensee:1

In response to your request, we have completed the initial processing. which isan administrative review of your application for a(n):

i1

New License X Amendment RenewalTermination Auth User (Amendment not required)Other

No administrative deficiencies were identified during this initial review.~ However, it should be noted that a technical review may identify omissions in thesubmitted information.

It appears that your request is routine (see 1-3 below, as applicable).

1. New and amendment actions are normally processed within 90 days, unless wefind major deficiencies. or policy issues requiring central program officeassistance.

2. Renewal actions are normally processed within 180 days, however, undertimely filing (before expiration). you may continue to operate under yourexisting license.

3. _ Termination actions are normally processed within 90 days. unlessconfirmatory surveys following decontamination / decommissioning activitiesare involved.

A copy of your correspondence has been forwarded to our Licensing Fee andDebt Collection Branch (301/415-6097) for approval of the fee category andamount, if required.

If you have a compelling safety or business-related reason for requestingexpedited review, please contact the Materials Licensing Branch at (630)829-9887 We will try to complete your request as soon as practicable.Any correspondence about this request should reference the control number.

Nuclear Materials Support Branch

Mail Control No. 301934License No. 21-24380-01