Hill, Carol

From: Sent: To:

Cook, Jackie Friday, February 21, 2014 9:06 AM Hill, Carol; Murnahan, Colleen

Subject: Attachments:

FW: NRC Amendment Request 2014-01-29 2014-01-29 ncr commission-amendment request.PDF

Please set up this amendment request.

Thanks,

Jackie

From: NANCY LEE [mailto:N.LEE@kuakini.org) Sent: Thursday, February 20, 2014 7:49 PM To: Cook, Jackie Cc: Harry Palmer Subject: NRC Amendment Request 2014-01-29

Dear Ms. Cook

The attached is a copy of Kuakini Health System's letter to the US Nuclear Regu latory Commission dated 1/29/14 to request amendment of Kuakini's material license to remove from possession all Cesium-137 brachytherapy sources. It was mailed on 1/30/14, however, we realized that the address is incorrect and just received it back from the postal service.

Upon confirmation of the correct below address for re-mailing, the original letter and attachments will be mailed via usps (regular first class mail}:

U.S. Nuclear Regulatory Commission Region IV 1600 East Lamar Boulevard Arlington, TX 76011-4511 Attn: Ms. Jacqueline Cook

Please contact Harry Palmer, as stated in the letter, with any questions on concerns rega rding the amendment request.

Thank you,

Nancy Lee Administration Kuakini Health System 347 N. Kuakini Street Honolulu, Hawaii 96817 (808) 547-9231

1

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tr 583180

I~ A Health Care Organization Kuakini Health System

U.S. Nuclear Regulatory Commission Region IV Material Radiation Protection Section 612 E. Lamar Boulevard, Suite 400 Arl ington, TX 76011-4125 Attn: Ms. Jackie Cook

Re: Kuakini Medical Center Radioactive Materials License No. 53-17797-01 Docket Number 030-13337

Dear Ms. Cook:

January 29, 2014

This is to request amendment of our materials license to remove from possession all Cesium-137 brachytherapy sources, which were disposed of under the CRCPD program. Please also remove the brachytherapy storage area from areas of possession or use.

Attached are NCR forms 540- 542 that were sent to me documenting shipment for disposal by Environmental Management Consultants in Turlock, CA.

If you have any question, please contact Harry Palmer, M.C.E. at (808) 226-1961 or via email at saddhu808@hawaii.rr.com.

Sincerely,

KUAKINI MEDICAL CENTER

~ Gre IShi Sr. Vice President and Chief Operating Officer

Attachments: NCR Forms 540 - 542

cc: Harry Palmer, M.C .E.

347 NOnTH KUAKINI STREET • HONOLULU. HAWAII96817·9980 • TELEPHONE (808) 536-2236 • FAX (808) 547·9547 • www.kuakini.org

Kuakini Medical Center • Kuakini Geriatric Care. Inc. • Kuakini Support Services, Inc. • Kuakini Foundation

Caring is Our Tracliria11 tn 5 831 80

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6. SHIPPER • NAME NIO ,:~CIUTY SfW'f"ER fPA I O. IIULIOER 7. NRC FORU 540 AND $<KIA PAGE I 01' I PAOESISI 8. MANIFEST NUMBER Kuaklni Medical Center NRC fORM S<C t /\NO 541 I A PAGE I OF I PACES(SI -34 7 N Kuaklnl St COllECTOR NI•C f.OfV.t ~? ANO ~2A PAGE 1 OF I PACES(S) EB893 Honolulu, HI 96817 PROC~SSOR AOOiffONI\L INFORMATION PAGE 1 Of ""G~S!SI US~R PERMIT NUMBER I SHIVM~NT NU!.IIER X GeNERA fOR . t;UNSIUN::I:• ifJIWJ WII l'k."ffiif/ldl c.u CONTACT: G2198 TYPE ISPfoly) EMC Gaye Nelson CONTACT r:~r TEf.EPfiONE Nf.JMSCA. 3106 S Faith Home Road TELEPI~ NUMBER:

Harry Palmer 606-547-0546 Turlock, CA 95360 209-607-1102 • CJ\RHIER • N.ar'lll lllnd Ao"trfrfiJI EPA l.ll. NUMUEA

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11/25/13 tnartlod, on4 IO»tooltd .1¥111 ''"In propet cCf'lttlhon r« •anspot~-KCOtdlnQ to &ho nppli'Cablo ,.,uhtlh.lnl oliJw OetttH'"""'" of cm~rAcr· TF.I.~Pf lONE Nt.N!fUlYl TrolliPOr1::~~~ Olfto (tthl';:~:n m."lton<tl" ."Vo p3<,.a;td, 1118ttled. nM febOiod and .vo 11'1 t:topor conditlnn for ltantrtor

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IIOII!K P~SK".AI AHOCI!CMICAl.F~I ltlllf'VtOUAL RAOt0NIJCU nt!8 tOrN.. r...o<ACt:: AtlMf V tSII ClASS tll.otth) ..,._...R U.6 SOIIOIOXI08S 1~s1at 5313.2 Mt:IQ nla 20.0 106693-00 '

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(143.6) mCI +1.0 0.8 solid/oXIdes ll-5137 5036.7 -Meq n/a 20.0 E6693-DO:

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WASTE RECEIPT ACKNOWLEDGEMENT PREFERENCE (please check a box and add Information If necessary)

D FAX

0 EMAIL

RWIOACTIVE WASTE SIDPMENT CERTIFICATION FOR SHIPMENTS TO THE RADIOACTIVE WASTE DISPOSAL FACILITY

OR RADIOACTIVE WASTE PROCESSOR

The following certific:~tion. completed as applicable. is made to the state of Washington:

CO.MlV.lERCIAL

Certifie<~tion is hereby made to the state ofWashin~;~on lhat the radioactive waste described on manifest'billoflading E8893 has been inspected and it has been d~tcnnined that the materials ore properly classified. described. packll!;!d. marked. and labeled. and arc in proper condition for trnnsportntion according to the applicable federal and slate TC!,'Uiations. laws. rules. and licenses.

The unde.signed shall indemnitY and l1old hannle~s the State of Washington !Tom any and oil claims. suits. losses. charges. and expenses on account of injuries to any and all pe.sons whomsoever. and any and all property damage arising or growing out of or in any manner connected with this shipment to the extent that the claims. suits. losses. charges.

or expenses arc caused in whole or in part by negligent acts or omissions of the undersigned.

E.~cept tor any violation of applicable state or t~deral statute or re~ulotion or license condition respecting packaging and shipment, inspection and acceptance or any item or container or material covered by this certification ty the State of Washington or a duly authorized contractor shall relcasc the party who executed this certificate from any and ~II requirements ofindemnifia.tion and hold harmless from injury or loss.

SECTION A:

GENERATOR: Kuakini Medical Center (Company or Agency Name)

PERMIT NUMBER: G219S

VOLUME OF WASTE IN THIS SHIPMENT: 4.02 ft3

BY:

(Company Name)

PERMIT NUMBER:

VOLUME OF WASTE IN THIS SHIPMENT:

BY: (Printed Kame)

SECTJO.NC: CARRIER:

(Company Name)

VOLUME OF WASTE IN THIS SH!Ptv ft3

TITLE: _______ _ DRIVER: _ _________________ _

DATED=------------------===--=========--========--==--==========--=====--========--===--====================---=--===============================--====: DOH R.HF-:11 D

Updated 3/01

1 Federal government agencies entering inlo this certification arc subjecrto all applicable federal law including. but not limited to. the Feder:~ I Tort

Claims Act and the Anti-Deficiency Act.

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• RC FORM 541 2. MANIFEST NUMBER Pllll!S 11:~/13 1. MANIFEST TOTALS E8893 . HIM8lf4ut ,.M'MUE .. ftf!. tWA.Ill! M:t WASJ' SPECIAl NUCLEAR MATERW. (grams) 3.PAGE 1 OF 1 PAGE(S)

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WASTE MANIFEST 3

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CON I /liNER AND WASTE DESCRIPTION ALL NUCLIDES I TRITIUM Cl~ Tc·99 I 1129 SOURCE (~g) SHIPPER 10 NUMBER PERMIT NUMBER

15662.1 MBq 0 0 0 0 0 G2198 423.3 mCI

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tC FORIWI 542 U.S. NUCLEAR REGULATORY COMMISSION 1. WASTE COLLECTOR/PROCESSOR '*RES 11fl0t/13 . UNIFORM LOW-LEVEL RADIOACTIVE NAME SHIPPER USE OHL Y

WASTE MANIFEST Environmental Management & Controls OEHTFICATIOH HUMBER PEA.Mfl NtJir.RJER

MANIFEST INDEX AND REGIONAL COMPACT TABU~ATION

"' OJ ()) .... CD

0

OENEF1AIOU IO£NTI!"' !CATION

HUMBER

Ustal original "PROCESS EO WASTE' gonerators (II any) SH«PPlHG DATE before "COLLECTEO WASTE" generetou 11/25/2013

5. 6. GENEMTOR NAME GENERATOR

PERMIT N\JI.18ER (F APPUCA8lE) FACit.ITY

AN0 TElEPl«JHE I«JNBER AOO/IESS

IKuaklnl Medical Center ,nr N Kuaklnt st Honolulu, HI 96817

G2196 608-547-9548 Harrv Palmer

- - - -~~-~~-------~~-

7. 8. 9. 10. PAS'ROCESSEO MIII(IFEST HUI.Ifi£At5) ur<ot!R WASTE COO£ OfUG~ATINO

W~lE 'MilCH WI\IITE (OR MATERII\L) P •l't«JCESSEO COMPACT

(OR MATEitW. RECEIVED AH0 DATE C • COllECTED REGION OR

VOlU!.lE(m'J Of RECEIPT STAT~

U.11JU464 ci:IUIIJ c HI

11/25/2013

TOTALS ON ALL PAGES (NRC FORMS 542 & 542A)

--~--- ~~- -

2. MANIFEST NUMBER

-E8893

l .

PAGE 1 of 1

11. AS PROCnSEDICOllECTED TOTI\I.

A. SOURCE 8 . SN!.l C. ACTMTY O.VOlULi!

IMTERJI\l

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423.3 4 .02

0 0 15602.1 0 .11 3646 423.3 4.02

NRC FORM 532 (1-2012)

U.S. NUCLEAR REGULATORY COMMISSION

DATE

02/25/2014

NAME AND ADDRESS OF APPLICANT AND/OR LICENSEE LICENSE NUMBER

53-17797-01 Kuakini Medical Center ATTN: Harry Palmer MAIL CONTROL NUMBER

583180 Radiation Safety Officer

347 North Kuakini Street Honolulu, HI 96817-9980 LICENSING AND/OR TECHNICAL REVIEWER

ch

This is to acknowledge the receipt of your:

[Z] LETTER and/or D APPLICATION DATED: 01 /29/2014

The initial processing, which included an administrative review, has been performed.

0 AMENDMENT D TERMINATION D NEW LICENSE D RENEWAL

D There were no administrative omissions identified during our initial review.

D This is to acknowledge receipt of your application for renewal of the material(s) license identified above. Your application is deemed timely filed, and accordingly, the license will not expire until final action has been taken by this office.

D Your application for a new NRC license did not include your taxpayer identification number. Please fill out NRC Form 531 , located at the following link:

http://www. nrc.gov/reading-rm/doc-collections/forms/n rc531 .pdf

Send the completed NRC Form 531, by facsimile, to the following number: (301) 415-5387

A copy of your action has been em ailed to our License Fee and Accounts Receivable Branch, in our Headquarters office in Rockville, MD. You will be contacted separately if there is a fee issue involved.

Your application has been assigned the above listed MAIL CONTROL NUMBER. When calling to inquire about this action, please refer to this control number. Your application has been forwarded to a technical reviewer. Please note that the technical review, which is normally completed within 180 days for a renewal application (90 days for all other requests}, may identify additional omissions or require additional information. If you have any questions concerning the processing of your application, our contact information is listed below:

NRC FORM 532 (1-2012)

V'/;sJi

Region IV U. S. Nuclear Regulatory Commission DNMS/NMSB - B 1600 E. Lamar Boulevard Arlington, TX 76011-4511 (817) 200-1103 or (817) 200-1140

BETWEEN:

Accounts Receivable/Payable and

Regional Licensing Branches

[ FOR ARPB USE ]

INFORMATION FROM WBL . .

Program Code: 02120 Status Code: Pending Amendment

Fee Category: 7C Exp. Date: 08/3112014

Fee Comments:

Decom Fin Assur Reqd: N

License Fee Worksheet - License Fee Transmittal

A. REGION

1. APPLICATION ATTACHED ApplicanVLicensee: KUAKINI MEDICAL CTR.

Received Date: 02/21 /2014

Docket Number: 3013337

Mail Control Number: 583180 License Number: 53-17797-01

Action Type: Amendment

2. FEE ATTACHED

Amount:

Check No.:

3. COMMENTS

Signed:

Date:

B. LICENSE FEE MANAGEMENT BRANCH (Check when milestone 03 Is entered

1. Fee Category and Amount:

2. Correct Fee Paid. Application may be processed for:

Amendment:

Renewal:

License:

3. OTHER - - ------- ------

Signed:

Date: