.n, L.rt. Rutland Regional Medical Center Diagnostic Imaging …09/2~/2011 10:27 P.002/014 .n, L.rt....
14
10:27 P.002/014 .n, Rutland Regional Medical Center L.rt. Diagnostic Imaging 160 Allen Streel Rutland, VT 05701 802.747.1755 802.747.6200 fax br. J September 20,2011 Janice Nguyen Nuclear Regulatory Commission Region 1 475 Allendale Road King of Prussia, PA 19406 Dear Janice Nguyen. This is a request to remove the licensees facilities located at 1 Commons and 6 Commons from license 44-14121-01. Find enclosed a copy of all close-out surveys and wipes for those facilities. All sealed sources and waste from 1 Commons and 6 Commons were transferred to the facility at 12 Commons. Find enclosed a copy of the last sealed source inventories and leak tests from 1 Commons and 6 Commons. Also enclosed is a copy of the sealed source inventory for 12 Commons. Please let us know if any further information is needed. Leah Denton, Director Diagnostic Imaging NMSSlRGN1 MATERIALS-002 www.ft.mc.org
Transcript of .n, L.rt. Rutland Regional Medical Center Diagnostic Imaging …09/2~/2011 10:27 P.002/014 .n, L.rt....
092~2011 1027 P002014
n Rutland Regional Medical CenterLrt Diagnostic Imaging
160 Allen Streel Rutland VT 05701
8027471755 8027476200 fax br J
September 202011
Janice Nguyen Nuclear Regulatory Commission Region 1 475 Allendale Road King ofPrussia PA 19406
Dear Janice Nguyen ~30J15~1
This is a request to remove the licensees facilities located at 1 Commons and 6 Commons from license 44-14121-01 Find enclosed a copy of all close-out surveys and wipes for those facilities
All sealed sources and waste from 1Commons and 6 Commons were transferred to the facility at 12 Commons Find enclosed a copy ofthe last sealed source inventories and leak tests from 1 Commons and 6 Commons Also enclosed is a copy ofthe sealed source inventory for 12 Commons
Please let us know ifany further information is needed
Leah Denton Director Diagnostic Imaging
~7amp()17 NMSSlRGN1 MATERIALS-002
wwwftmcorg
---
Rutland Regional Medical Center II Nuclear Medicine Department o- 160 Allen Street Rutland Vennont crJ g ~ Lic 44-14121-01 0 September 22 2011
Area Monitoring Report
Group Name 1 COMMONS RUTLAND HEART CENTER Date Range 091012011 To 0913012011
In CkSrc Bkq Area 1 Area 2 Area 3
DateTime Tich st Batt mRhr IIIRIhr DRhI mRhr mRhr ~----- --_--shy09-08-11 0245 PW 1 p 300middot 002 002 002 002~
b
Note Areas Underlined are Olver tr~r limit
QC Readwgs markecf with (astHisk)T iDdicates tfampat QC wu Dot prt of the Area MOIIitM test
Battery Check P = Pass F == Fail
Test Not performed or Not Required - Trigga Limit 500 mRlhr
Comments 09-08-2011 0245- CLOSE OOT SURVEY
Curreat Area Trigger Limits (mRllr) HOT LAB AREA 500 NOCLEAR CAMERA - 005 NUCLEAR STRESS - a bull 05
IastrumeDt JaformsDoD II Name Manufacturer Next Cal Serial Number Efficiency
--~-------- shy
1 LUDLOM 3 Ludlum 06-08-2012 29537 NA
OrigiDal area names ~ Generic Name Actual Area Name Generic Name Actual Area Name Generic Name Actua~ Area Name o ------------------------------shy Area 1 BOl LAB AREA Area 2 NUCLEAR CAMERA AREA Area J NUCLEAR STRESS TEST AREA
shy o N N t ~ Page 102
Rutfand Regional Medical Center
-II J~ Nucfear Medicine Department o
160 Alten Street RutJand r Vermont ~ 0 lie 44-14121-01
Area Wipe Report
Group NaJlle~COMMONS RUTLAND HEART CENTER
In CkSrc Bkg Area 1 ALea 2 Area 3 DateTime Tech st Batt em CPM CPM DPM em DPK CPM DPM
09-08-11 0245 PW 4 446 44 0 o o a o o ~
Note Areas Ulldertilled are ovlaquo tJiaIer limit IbtDwy Cbedc T =PlIlIII P Fail Test Not performed or Not Required - CIiedi souloo readiDg wu dODe today itut ItOt as part ofGis luneywipe test
Wipe Area 10000 Sq CM Trigger Limit lOOOOO DPM
Comments 09-08-2011 024$ - croSB 0lI IiIFES
Current Ara Trialaquo Limits (DPM) lOOOOO
lostnlleat Details J Instrument Manufactuzer Next Cal Date Serial No lfficiency
4 ATOOI LAB 950 Biodex ()1-31-2012 4259608 10000
OrigiDai Ua Dames Generic Name Actual area name G1neric Name Actual area name Generic Name
~ Area 1 ROT LAB AREA Area 2 NOCLEAa CAMERA AREA Area 3 o
Ted lDfonruatioll Tech TecbName PW PAUL WAITE
S o
~ ~
Sergtlember 22 2011
Date Range 091012011 To 0913012011
Actual area name --------------shy
NUCLEAR STRESS TEST AREA
Page 1 of2
Rutland Regional Medical Center ~ Nuclear Medicine Department o ~ Area Wipe Report Group Name 1 COMMONS RUltAND HEART CENTER Date Range 090112011 To 0913012011 a
t4-ftiI(At
~ iO IVshy
I lt HIH
~ o
o N N ~ ~
-C-f
L~~
Hirt-UK-j
U w~ -7
2xA-vshy
26C--shy
5-t0 r-G L
r~)((GZ IJt2c ~) lJr-~ I
i
i J
~ l i ~ I
1
I
~ 0 $C4+-f
Page2ot2
Rutland Regional Medical Center II Nudear Medicine Department
o ~ 160 Allen Street Rutland Vermont ~ a Lic44-14121-01
Area Wipe Report
Group Name 6 COMMONS RUTlAND HEART CENTER
In CkSrc Bkq Area 1 Area 2 Area 3 Datelime Tech st Batt CIM CPM CPM DPM CPM DPK CPM DIK
09-14-11 1030 PW 4 -- 456~ 456 0 a o a o a ~
Neill Areas Uaderliaed ue over tricger limit
BattEry Chedc 1m = Pass T = Fail
Tnt Not performed or Not Required - ClllilCk lOIlnlli reading wu dOlle today bat Ret as part Qt tills surveylwipe test
Wipe Area 10000 Sq CII Trigcc Limit= 200000 DPM
COIICIlt Area Trigger Limits (DPM) 100000
InsUumeDt Details I Inst~ument Manufacturer Next Cal Date seziaI Ito Efficiency
A1oo LAB 950 Biodex 01-31-2012 4259608 IOOflO
OriginaJ rea DllllllfS
Generic Name Actual area name Generic blame Actual area name Generic Name----- ------------ shy~ Area 1 HOT LAB AREA Area 2 CAMERA AREA Area J o Tecb rmOll
Tocb TecllName PW PAUL WAITE sectNshyN
~
September 22 2011
Date Range 0910112011 To 093012011
Actual areltl name --- - _---shy
NUCLEAR SlRESS LAB AREA
Page1of2
Rutland Regional Medical Center Nociear Medicine Department Q ~ 160 Allen Street Rutland Vennont
~ Lie 44-14121-01 D ~ernber222011
Area Monitoring Report
Group Name 6 COMMONS RUTLAND HEART CENTER Date Range 0910112011 To 0913012011
In CkSrc Bkg Area 1 Area 2 Area 3 I)ateTime Tech st Batt mRht mRhr mRhr mRht mRhr
09-14-11 1030 PW 1 P 300 002 002 002 002 ~
Notlaquo AreIIJ UIlderlined are over trigxer limit
QC ReadiDgs marbd witIl II (asterisk) iadicates tbat QC wu not pari of the Area Moaitor test
Battery Check P = Pus F = FaU 11_11Test Not performed orNot Required
Trigger Limit 500 ~r
COlDlDena 09-14-2011 1030- CLOSE OUT SORVEYS
CUlTeDt Area Triger Limits (Rlllr) HOT LAB AREA 500 ClIMampRA AREA OGS NUCLEAR STRESS - 005
Iostrwnent lIIformation bull Name Manufacturer Next Cal Serial Number Efficiency
1 LODLOM 3 LudlUl11 06-08-2012 29537 NIA
Origirud area DaDles ~ Generic Name Actual Area Name Generic Name Actual Area Name Generic Name Actual Area Name Q ~~~~~~~------------------~----- Area 1 HOT LAB AREA Area 2 CUlERA ABEA Area 3 NUCLEAR SlRESS LAB AREA
~ tv N-en Q Page 1 of2
Rutland Regional Medical Center o- Nudear Medicine Department g
Area Wipe Report Group Name 6 COMMONS RUTLAND HEART CENTER Date Range 090112011 To 09302011 0
lt- I-IJI-u w ~~J --~
I No ~ fA r r
COUll nOll rxltt -z
y- ~ lt eatI ~ f ~ lt tP rV~
V) ~ UA-Mft t4l tJ
fS6i 70 5cPLL en (i o
o
~ C Page 20f2 ~
CL
QJRL ~fDIoaf 4pound f-~ -r t~Jrtto-en Nuclear Medicine Department
6 Common S1reet RuUand VelTJlOnt$ ~ I shy
lic II aall1Q1 --itt - ilt I Z 1-0 I L-[pound~ 1e--gtr April 04 2011
04-04-2Q11 1417Tat Ibk Time TeclmaJlldJlt SUSAN SCHNEIDER bsfru_ M6de1 ell Maudu1tIrcr Capiec
Strial iii 001414 hanEft 84)00
Bsckp-ocwl 000 CPM Triaw L~d OOOS uCi
IutnIDL UIliIJt 2
~ Cm_Qt
bull CbnWalN_ Mw SGIaJ (11 0 -IIoId Ad Wipo c BIf Oorr F Ibmltwed Ad t ll6(42-9 U-ltlI-2BIB l490SmCi 2l CPM 000 100 aGOOQI3 aCi yCo-17
IOl4-2Q21 Il-ltlI-21lO3 UllOM I uCi CJ CIII 000 100 0000000 aCi y2 C-131
7111lQ-l 11(11-2003 4213419 aCi 107 OM 0110 100 COOOO6O aCi y3 Cs-137
4 0 14Ill~91 12(11-2009 LI09mCi 4) CPM 000 100 0000000 aCi y
ThD RcpJri iadieatts mat alillDove sealed SODIUS ban PASSE)) a LakTest Removed Acttrity ltIt soarCH-1S ~ ooos -alRClSTATE Trigpr Limit
IlSO SigcaItle lt 113 TeclmologistSignature ~
en N o o C N N Page 1 of 1g
(utland Heart Center - 6 Commons Nudear Medicine DepartmentS o ~NniS- -~~ 6 Commons Street Rutland Vermont o -- shy0 Lic 44 se881 8~ l-i - 11 J -z 1- 0 I --N ltxI) f0 i -j
July 01 2011 Tesl Date a Time 87-01-2011 1416 Teehllologist PAUL WAITE
II Cftemical NQIe MaoufadlJrer Model SeriaJtI Localioo CaLDak CaLAdivitv Carrot Act Prtsent iIN
Co-Y7 Eckm aud Ziegler- 1366-42-9 HOT LAB 12-01middot2009 52140 mCi 11949 lOCi Y
2 CS-U7 LPL 1014-20-21 HOT LAB 1l-01-1C03 1730000 uCi 1492S61 uCi Y
3 Cs -1l7 LPL 78~3 HOT LAB 12-01-2003 5000000 j 4200SIl nCi Y~ ~
4 Co-S7 EclIIrt and Ziegfa 1402-091 HOT LAB 12-01-2009 U()OO mCi 11UI8 mCi Y
S (() - S7 Eckm aIId Ziegllaquo 1500-160 HOT LAB O1-O1middotl() It 100000 lnCi 1002515 mCi Y
~- ~- ~- ---~ -_ _ - - - - ~
The Above Report iodicates all of the Sea
RSO Sigoature TeclmoJogist Signature 1
~ 0 shy
shy ~ N
sect N
Page 1 of 1
- bull rutland Heart Center -1 Commons bull NucfearMedicine Departmente 1 Commons Street Rutland Vennont ---o ~
Lic1I 14181-amp1 lilt- -II L i -0 ( J r)Cf)nz -gt------Jyty01 2011 - ___-- ---- shy
Test Date Time O7o1-ltIll D58 Tedmologlst PAlIL W AITJ
I 0HaIImlN_ MaWlllEi MaCJa smI8 LoaIIrm OdnIe Cd~ cmut Ad lnIaItYIN
05-137 LPL 114--3l-3 HOT LAB 03-01middot2006 2OO~OOO uCi l77374Q uct Y
1 Co- 57 ECKERT ZIEGLER 1366-3-12 HOTLAB 03-(11middot2009 547SO mCi 06210 mCi Y
3 Qsmiddot137 LP1 Ull-3-7 HafLAB 03-01middot2006 OQ909 uCi 00804 uCi y
~ 4 Co- 57 LP1 1436-l22 HOT LAB 06-01middot2010 100000 mCi 36504 mCi Y
The AlKwe Reportin bave beeo aaouated for Technologist Signature ~
~-Ilt 71nlll
o ~ o o pound Nmiddot N
~ Page 1 of
3
_c~ J-kliz1 Q~pounde oor Nuclear Medicine Departmento N 1 Common StJeet Rutland Vermont q ---shyQ We 44 jjBa1J~ i-t-l_ -I 1-- cJ I Lf A-lt c _APriL01 2011
Sealed Sources Leak Test Report
late Range 04-01middot2011 thN 04-01-2011 DIID Madel swt Camp DIIdI 01 Ad PnIIIcIM A4 Ad 111- TId- ClluliallName
1no11 01middot137 1145-31-3 03-01-2006 2OOlOuCi 118j8 aCi zaOOCPM 0000000 uCi Y PW
~ CA-YI 1366-3-12 03-01-2009 S47mCi O78mCi Z700CPM OOQQOOO ua y PW
01 - 137 O08UCi 2900CPW 0000001 uCi Y PW1I31-3-7 03-01-2006 Oll9uCi
Co-7 4 59mCi zaooCPM 0000000 uCi Y PW1436-121 06-014010 lOOOmCi
fiutrmIIfIIt DetaiII
Instrument Manufacturer Next Cal Date Serial NQ Efficiency CPPRAC Caplnt~ 001715 10000
bis Report indicates that all above sealed SIlIIIOCS bave PASSED aLeakTest emovecI Adivity1Qr SOOItlfS was below the 0005 uCi NRClSTATE TriggerLimit
redllafonatiia
TedllDitbls OmpJete Name
PW PAULWAlTE
o ~~~ eclmo1ogist Siguatun
N
f~ j(5Jo t Nmiddot
~ Page 1 of1
09222011 1030 (f~) P013014
Rutland Heart Center 8 Commons Nuclear Medicine Department
~R6Ple8t~~ftWnd Vermont ~ Cc)rfft1GN5 Lic~ 1--1- Id-o (
vf Source Co~S7 ManuflSupp Eckert and Ziegler Cal Dote 1210112009 Cal Act S2140mCi Is Souroe In Use Yes Tech TK
f1Comment
Source ClImiddot 137 M811uflSUpp TPL Cal Date 030112006 Cal Act 2005000 uCi Is $OU1ce [n Use No Teoh PW
J3comment
Source Co- 57 ManuflSupp Eckert and Ziegler Cal Date 030112009 Cal Act 540 mCi Is Source In Use No Tech PW
Comment
Soutee Cs shy 137 ManuflSupp lPL Cal Date 031212006 Cal Act 00909 uCi Is Souree In Use Yes Tech PW
~omment 5 Souree Co - 57 MmtuflSupp IPL Cal Date 06012010 Cal Act lOOOOOmCi Is Source In Use No Tech PW CCllnmcnt
vfi Source Cs - 137 ManufSupp IPL Cal Date 110112003 Cal Act t7S0000 uCi Is SOluce In Use Yes fech TK Comment
September 21 2011 -~--- ~
Sealed Sources Database File t~ tXI)rceJ
Name VIAL REFERENCE SOURCE SerlD 1366-429 Model Put Dille LocatIon HOT LAB Current 09654 mCi HL 27100 days
Name VIAL REFERENCE SOURCE SerID 1 1145-31middot3 Model II Pur Date Loation HOT LAB Current 1764453 uCi HL 1101200 days
Name VIAL REFERENCE SOURCE ScrJlD 1366312 Model Pur Date Location HOT LAB Cunent 05017 mCi HL 27100 days
Name ROD SOURCE ScrID 11313-7 Model Pur Date Location HOT LAB Current 00800 uCi HL 1101200 days
Name FrLOOD SOURCE SerID 1436122 ModelN Pur Date Location HOT LAB Current 29492 mCi HL 27100 days
Name VIAL REFERENCE SOURCE ScrID 1014-20-21 Model It Pur Date Location HOT LAB Current middot484747 uCi HL 1101200 days
Page 1 of2
09222011 1031 (f~ P014014
Rutland Heart Center bull ~ I) c()II) tJ 5 Nuclear Medicine Department
Sealed Sources Database File -~_M__
J Source CS - 137 Nanle ROD SOURCE MMUflSupp IPL SerID 780w68w3 Model Cal Date 120112003 Pur Date Lotlltlon HOT LAB Cal Act SOOOOOO nCi CUII-ent 4178520 nCi HL 1101200 days Is Source In Use No Tech TK Comment
viS SOUICO Co-57 Name FLOOD SOURCE ManuUSupp Eckert and Ziegler SerID II 1402-091 Model Cal Dato 120112009 Pur Datc Location HOT LAB Cal Act 7S000mCi Current 13887 mCi HL 27100 days Is Source In Usc Yes rcch MJS
comment 9 Source Co- 57 Name FLOOD SOURCE ManuflSupp Eckert and Ziegler SarID Ii 1500middot160 ModeJ Cal Date 0710112011 Pur Date Location HOT LAB Cal Act 100000 mCi Currenl 80998 mCi HL 27100 days Is Source In Use Yes Tech SLS Comment
Note Allterisk() indicates that there is a Memo for that Sealed Source
Page 2of2
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
---
Rutland Regional Medical Center II Nuclear Medicine Department o- 160 Allen Street Rutland Vennont crJ g ~ Lic 44-14121-01 0 September 22 2011
Area Monitoring Report
Group Name 1 COMMONS RUTLAND HEART CENTER Date Range 091012011 To 0913012011
In CkSrc Bkq Area 1 Area 2 Area 3
DateTime Tich st Batt mRhr IIIRIhr DRhI mRhr mRhr ~----- --_--shy09-08-11 0245 PW 1 p 300middot 002 002 002 002~
b
Note Areas Underlined are Olver tr~r limit
QC Readwgs markecf with (astHisk)T iDdicates tfampat QC wu Dot prt of the Area MOIIitM test
Battery Check P = Pass F == Fail
Test Not performed or Not Required - Trigga Limit 500 mRlhr
Comments 09-08-2011 0245- CLOSE OOT SURVEY
Curreat Area Trigger Limits (mRllr) HOT LAB AREA 500 NOCLEAR CAMERA - 005 NUCLEAR STRESS - a bull 05
IastrumeDt JaformsDoD II Name Manufacturer Next Cal Serial Number Efficiency
--~-------- shy
1 LUDLOM 3 Ludlum 06-08-2012 29537 NA
OrigiDal area names ~ Generic Name Actual Area Name Generic Name Actual Area Name Generic Name Actua~ Area Name o ------------------------------shy Area 1 BOl LAB AREA Area 2 NUCLEAR CAMERA AREA Area J NUCLEAR STRESS TEST AREA
shy o N N t ~ Page 102
Rutfand Regional Medical Center
-II J~ Nucfear Medicine Department o
160 Alten Street RutJand r Vermont ~ 0 lie 44-14121-01
Area Wipe Report
Group NaJlle~COMMONS RUTLAND HEART CENTER
In CkSrc Bkg Area 1 ALea 2 Area 3 DateTime Tech st Batt em CPM CPM DPM em DPK CPM DPM
09-08-11 0245 PW 4 446 44 0 o o a o o ~
Note Areas Ulldertilled are ovlaquo tJiaIer limit IbtDwy Cbedc T =PlIlIII P Fail Test Not performed or Not Required - CIiedi souloo readiDg wu dODe today itut ItOt as part ofGis luneywipe test
Wipe Area 10000 Sq CM Trigger Limit lOOOOO DPM
Comments 09-08-2011 024$ - croSB 0lI IiIFES
Current Ara Trialaquo Limits (DPM) lOOOOO
lostnlleat Details J Instrument Manufactuzer Next Cal Date Serial No lfficiency
4 ATOOI LAB 950 Biodex ()1-31-2012 4259608 10000
OrigiDai Ua Dames Generic Name Actual area name G1neric Name Actual area name Generic Name
~ Area 1 ROT LAB AREA Area 2 NOCLEAa CAMERA AREA Area 3 o
Ted lDfonruatioll Tech TecbName PW PAUL WAITE
S o
~ ~
Sergtlember 22 2011
Date Range 091012011 To 0913012011
Actual area name --------------shy
NUCLEAR STRESS TEST AREA
Page 1 of2
Rutland Regional Medical Center ~ Nuclear Medicine Department o ~ Area Wipe Report Group Name 1 COMMONS RUltAND HEART CENTER Date Range 090112011 To 0913012011 a
t4-ftiI(At
~ iO IVshy
I lt HIH
~ o
o N N ~ ~
-C-f
L~~
Hirt-UK-j
U w~ -7
2xA-vshy
26C--shy
5-t0 r-G L
r~)((GZ IJt2c ~) lJr-~ I
i
i J
~ l i ~ I
1
I
~ 0 $C4+-f
Page2ot2
Rutland Regional Medical Center II Nudear Medicine Department
o ~ 160 Allen Street Rutland Vermont ~ a Lic44-14121-01
Area Wipe Report
Group Name 6 COMMONS RUTlAND HEART CENTER
In CkSrc Bkq Area 1 Area 2 Area 3 Datelime Tech st Batt CIM CPM CPM DPM CPM DPK CPM DIK
09-14-11 1030 PW 4 -- 456~ 456 0 a o a o a ~
Neill Areas Uaderliaed ue over tricger limit
BattEry Chedc 1m = Pass T = Fail
Tnt Not performed or Not Required - ClllilCk lOIlnlli reading wu dOlle today bat Ret as part Qt tills surveylwipe test
Wipe Area 10000 Sq CII Trigcc Limit= 200000 DPM
COIICIlt Area Trigger Limits (DPM) 100000
InsUumeDt Details I Inst~ument Manufacturer Next Cal Date seziaI Ito Efficiency
A1oo LAB 950 Biodex 01-31-2012 4259608 IOOflO
OriginaJ rea DllllllfS
Generic Name Actual area name Generic blame Actual area name Generic Name----- ------------ shy~ Area 1 HOT LAB AREA Area 2 CAMERA AREA Area J o Tecb rmOll
Tocb TecllName PW PAUL WAITE sectNshyN
~
September 22 2011
Date Range 0910112011 To 093012011
Actual areltl name --- - _---shy
NUCLEAR SlRESS LAB AREA
Page1of2
Rutland Regional Medical Center Nociear Medicine Department Q ~ 160 Allen Street Rutland Vennont
~ Lie 44-14121-01 D ~ernber222011
Area Monitoring Report
Group Name 6 COMMONS RUTLAND HEART CENTER Date Range 0910112011 To 0913012011
In CkSrc Bkg Area 1 Area 2 Area 3 I)ateTime Tech st Batt mRht mRhr mRhr mRht mRhr
09-14-11 1030 PW 1 P 300 002 002 002 002 ~
Notlaquo AreIIJ UIlderlined are over trigxer limit
QC ReadiDgs marbd witIl II (asterisk) iadicates tbat QC wu not pari of the Area Moaitor test
Battery Check P = Pus F = FaU 11_11Test Not performed orNot Required
Trigger Limit 500 ~r
COlDlDena 09-14-2011 1030- CLOSE OUT SORVEYS
CUlTeDt Area Triger Limits (Rlllr) HOT LAB AREA 500 ClIMampRA AREA OGS NUCLEAR STRESS - 005
Iostrwnent lIIformation bull Name Manufacturer Next Cal Serial Number Efficiency
1 LODLOM 3 LudlUl11 06-08-2012 29537 NIA
Origirud area DaDles ~ Generic Name Actual Area Name Generic Name Actual Area Name Generic Name Actual Area Name Q ~~~~~~~------------------~----- Area 1 HOT LAB AREA Area 2 CUlERA ABEA Area 3 NUCLEAR SlRESS LAB AREA
~ tv N-en Q Page 1 of2
Rutland Regional Medical Center o- Nudear Medicine Department g
Area Wipe Report Group Name 6 COMMONS RUTLAND HEART CENTER Date Range 090112011 To 09302011 0
lt- I-IJI-u w ~~J --~
I No ~ fA r r
COUll nOll rxltt -z
y- ~ lt eatI ~ f ~ lt tP rV~
V) ~ UA-Mft t4l tJ
fS6i 70 5cPLL en (i o
o
~ C Page 20f2 ~
CL
QJRL ~fDIoaf 4pound f-~ -r t~Jrtto-en Nuclear Medicine Department
6 Common S1reet RuUand VelTJlOnt$ ~ I shy
lic II aall1Q1 --itt - ilt I Z 1-0 I L-[pound~ 1e--gtr April 04 2011
04-04-2Q11 1417Tat Ibk Time TeclmaJlldJlt SUSAN SCHNEIDER bsfru_ M6de1 ell Maudu1tIrcr Capiec
Strial iii 001414 hanEft 84)00
Bsckp-ocwl 000 CPM Triaw L~d OOOS uCi
IutnIDL UIliIJt 2
~ Cm_Qt
bull CbnWalN_ Mw SGIaJ (11 0 -IIoId Ad Wipo c BIf Oorr F Ibmltwed Ad t ll6(42-9 U-ltlI-2BIB l490SmCi 2l CPM 000 100 aGOOQI3 aCi yCo-17
IOl4-2Q21 Il-ltlI-21lO3 UllOM I uCi CJ CIII 000 100 0000000 aCi y2 C-131
7111lQ-l 11(11-2003 4213419 aCi 107 OM 0110 100 COOOO6O aCi y3 Cs-137
4 0 14Ill~91 12(11-2009 LI09mCi 4) CPM 000 100 0000000 aCi y
ThD RcpJri iadieatts mat alillDove sealed SODIUS ban PASSE)) a LakTest Removed Acttrity ltIt soarCH-1S ~ ooos -alRClSTATE Trigpr Limit
IlSO SigcaItle lt 113 TeclmologistSignature ~
en N o o C N N Page 1 of 1g
(utland Heart Center - 6 Commons Nudear Medicine DepartmentS o ~NniS- -~~ 6 Commons Street Rutland Vermont o -- shy0 Lic 44 se881 8~ l-i - 11 J -z 1- 0 I --N ltxI) f0 i -j
July 01 2011 Tesl Date a Time 87-01-2011 1416 Teehllologist PAUL WAITE
II Cftemical NQIe MaoufadlJrer Model SeriaJtI Localioo CaLDak CaLAdivitv Carrot Act Prtsent iIN
Co-Y7 Eckm aud Ziegler- 1366-42-9 HOT LAB 12-01middot2009 52140 mCi 11949 lOCi Y
2 CS-U7 LPL 1014-20-21 HOT LAB 1l-01-1C03 1730000 uCi 1492S61 uCi Y
3 Cs -1l7 LPL 78~3 HOT LAB 12-01-2003 5000000 j 4200SIl nCi Y~ ~
4 Co-S7 EclIIrt and Ziegfa 1402-091 HOT LAB 12-01-2009 U()OO mCi 11UI8 mCi Y
S (() - S7 Eckm aIId Ziegllaquo 1500-160 HOT LAB O1-O1middotl() It 100000 lnCi 1002515 mCi Y
~- ~- ~- ---~ -_ _ - - - - ~
The Above Report iodicates all of the Sea
RSO Sigoature TeclmoJogist Signature 1
~ 0 shy
shy ~ N
sect N
Page 1 of 1
- bull rutland Heart Center -1 Commons bull NucfearMedicine Departmente 1 Commons Street Rutland Vennont ---o ~
Lic1I 14181-amp1 lilt- -II L i -0 ( J r)Cf)nz -gt------Jyty01 2011 - ___-- ---- shy
Test Date Time O7o1-ltIll D58 Tedmologlst PAlIL W AITJ
I 0HaIImlN_ MaWlllEi MaCJa smI8 LoaIIrm OdnIe Cd~ cmut Ad lnIaItYIN
05-137 LPL 114--3l-3 HOT LAB 03-01middot2006 2OO~OOO uCi l77374Q uct Y
1 Co- 57 ECKERT ZIEGLER 1366-3-12 HOTLAB 03-(11middot2009 547SO mCi 06210 mCi Y
3 Qsmiddot137 LP1 Ull-3-7 HafLAB 03-01middot2006 OQ909 uCi 00804 uCi y
~ 4 Co- 57 LP1 1436-l22 HOT LAB 06-01middot2010 100000 mCi 36504 mCi Y
The AlKwe Reportin bave beeo aaouated for Technologist Signature ~
~-Ilt 71nlll
o ~ o o pound Nmiddot N
~ Page 1 of
3
_c~ J-kliz1 Q~pounde oor Nuclear Medicine Departmento N 1 Common StJeet Rutland Vermont q ---shyQ We 44 jjBa1J~ i-t-l_ -I 1-- cJ I Lf A-lt c _APriL01 2011
Sealed Sources Leak Test Report
late Range 04-01middot2011 thN 04-01-2011 DIID Madel swt Camp DIIdI 01 Ad PnIIIcIM A4 Ad 111- TId- ClluliallName
1no11 01middot137 1145-31-3 03-01-2006 2OOlOuCi 118j8 aCi zaOOCPM 0000000 uCi Y PW
~ CA-YI 1366-3-12 03-01-2009 S47mCi O78mCi Z700CPM OOQQOOO ua y PW
01 - 137 O08UCi 2900CPW 0000001 uCi Y PW1I31-3-7 03-01-2006 Oll9uCi
Co-7 4 59mCi zaooCPM 0000000 uCi Y PW1436-121 06-014010 lOOOmCi
fiutrmIIfIIt DetaiII
Instrument Manufacturer Next Cal Date Serial NQ Efficiency CPPRAC Caplnt~ 001715 10000
bis Report indicates that all above sealed SIlIIIOCS bave PASSED aLeakTest emovecI Adivity1Qr SOOItlfS was below the 0005 uCi NRClSTATE TriggerLimit
redllafonatiia
TedllDitbls OmpJete Name
PW PAULWAlTE
o ~~~ eclmo1ogist Siguatun
N
f~ j(5Jo t Nmiddot
~ Page 1 of1
09222011 1030 (f~) P013014
Rutland Heart Center 8 Commons Nuclear Medicine Department
~R6Ple8t~~ftWnd Vermont ~ Cc)rfft1GN5 Lic~ 1--1- Id-o (
vf Source Co~S7 ManuflSupp Eckert and Ziegler Cal Dote 1210112009 Cal Act S2140mCi Is Souroe In Use Yes Tech TK
f1Comment
Source ClImiddot 137 M811uflSUpp TPL Cal Date 030112006 Cal Act 2005000 uCi Is $OU1ce [n Use No Teoh PW
J3comment
Source Co- 57 ManuflSupp Eckert and Ziegler Cal Date 030112009 Cal Act 540 mCi Is Source In Use No Tech PW
Comment
Soutee Cs shy 137 ManuflSupp lPL Cal Date 031212006 Cal Act 00909 uCi Is Souree In Use Yes Tech PW
~omment 5 Souree Co - 57 MmtuflSupp IPL Cal Date 06012010 Cal Act lOOOOOmCi Is Source In Use No Tech PW CCllnmcnt
vfi Source Cs - 137 ManufSupp IPL Cal Date 110112003 Cal Act t7S0000 uCi Is SOluce In Use Yes fech TK Comment
September 21 2011 -~--- ~
Sealed Sources Database File t~ tXI)rceJ
Name VIAL REFERENCE SOURCE SerlD 1366-429 Model Put Dille LocatIon HOT LAB Current 09654 mCi HL 27100 days
Name VIAL REFERENCE SOURCE SerID 1 1145-31middot3 Model II Pur Date Loation HOT LAB Current 1764453 uCi HL 1101200 days
Name VIAL REFERENCE SOURCE ScrJlD 1366312 Model Pur Date Location HOT LAB Cunent 05017 mCi HL 27100 days
Name ROD SOURCE ScrID 11313-7 Model Pur Date Location HOT LAB Current 00800 uCi HL 1101200 days
Name FrLOOD SOURCE SerID 1436122 ModelN Pur Date Location HOT LAB Current 29492 mCi HL 27100 days
Name VIAL REFERENCE SOURCE ScrID 1014-20-21 Model It Pur Date Location HOT LAB Current middot484747 uCi HL 1101200 days
Page 1 of2
09222011 1031 (f~ P014014
Rutland Heart Center bull ~ I) c()II) tJ 5 Nuclear Medicine Department
Sealed Sources Database File -~_M__
J Source CS - 137 Nanle ROD SOURCE MMUflSupp IPL SerID 780w68w3 Model Cal Date 120112003 Pur Date Lotlltlon HOT LAB Cal Act SOOOOOO nCi CUII-ent 4178520 nCi HL 1101200 days Is Source In Use No Tech TK Comment
viS SOUICO Co-57 Name FLOOD SOURCE ManuUSupp Eckert and Ziegler SerID II 1402-091 Model Cal Dato 120112009 Pur Datc Location HOT LAB Cal Act 7S000mCi Current 13887 mCi HL 27100 days Is Source In Usc Yes rcch MJS
comment 9 Source Co- 57 Name FLOOD SOURCE ManuflSupp Eckert and Ziegler SarID Ii 1500middot160 ModeJ Cal Date 0710112011 Pur Date Location HOT LAB Cal Act 100000 mCi Currenl 80998 mCi HL 27100 days Is Source In Use Yes Tech SLS Comment
Note Allterisk() indicates that there is a Memo for that Sealed Source
Page 2of2
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
Rutfand Regional Medical Center
-II J~ Nucfear Medicine Department o
160 Alten Street RutJand r Vermont ~ 0 lie 44-14121-01
Area Wipe Report
Group NaJlle~COMMONS RUTLAND HEART CENTER
In CkSrc Bkg Area 1 ALea 2 Area 3 DateTime Tech st Batt em CPM CPM DPM em DPK CPM DPM
09-08-11 0245 PW 4 446 44 0 o o a o o ~
Note Areas Ulldertilled are ovlaquo tJiaIer limit IbtDwy Cbedc T =PlIlIII P Fail Test Not performed or Not Required - CIiedi souloo readiDg wu dODe today itut ItOt as part ofGis luneywipe test
Wipe Area 10000 Sq CM Trigger Limit lOOOOO DPM
Comments 09-08-2011 024$ - croSB 0lI IiIFES
Current Ara Trialaquo Limits (DPM) lOOOOO
lostnlleat Details J Instrument Manufactuzer Next Cal Date Serial No lfficiency
4 ATOOI LAB 950 Biodex ()1-31-2012 4259608 10000
OrigiDai Ua Dames Generic Name Actual area name G1neric Name Actual area name Generic Name
~ Area 1 ROT LAB AREA Area 2 NOCLEAa CAMERA AREA Area 3 o
Ted lDfonruatioll Tech TecbName PW PAUL WAITE
S o
~ ~
Sergtlember 22 2011
Date Range 091012011 To 0913012011
Actual area name --------------shy
NUCLEAR STRESS TEST AREA
Page 1 of2
Rutland Regional Medical Center ~ Nuclear Medicine Department o ~ Area Wipe Report Group Name 1 COMMONS RUltAND HEART CENTER Date Range 090112011 To 0913012011 a
t4-ftiI(At
~ iO IVshy
I lt HIH
~ o
o N N ~ ~
-C-f
L~~
Hirt-UK-j
U w~ -7
2xA-vshy
26C--shy
5-t0 r-G L
r~)((GZ IJt2c ~) lJr-~ I
i
i J
~ l i ~ I
1
I
~ 0 $C4+-f
Page2ot2
Rutland Regional Medical Center II Nudear Medicine Department
o ~ 160 Allen Street Rutland Vermont ~ a Lic44-14121-01
Area Wipe Report
Group Name 6 COMMONS RUTlAND HEART CENTER
In CkSrc Bkq Area 1 Area 2 Area 3 Datelime Tech st Batt CIM CPM CPM DPM CPM DPK CPM DIK
09-14-11 1030 PW 4 -- 456~ 456 0 a o a o a ~
Neill Areas Uaderliaed ue over tricger limit
BattEry Chedc 1m = Pass T = Fail
Tnt Not performed or Not Required - ClllilCk lOIlnlli reading wu dOlle today bat Ret as part Qt tills surveylwipe test
Wipe Area 10000 Sq CII Trigcc Limit= 200000 DPM
COIICIlt Area Trigger Limits (DPM) 100000
InsUumeDt Details I Inst~ument Manufacturer Next Cal Date seziaI Ito Efficiency
A1oo LAB 950 Biodex 01-31-2012 4259608 IOOflO
OriginaJ rea DllllllfS
Generic Name Actual area name Generic blame Actual area name Generic Name----- ------------ shy~ Area 1 HOT LAB AREA Area 2 CAMERA AREA Area J o Tecb rmOll
Tocb TecllName PW PAUL WAITE sectNshyN
~
September 22 2011
Date Range 0910112011 To 093012011
Actual areltl name --- - _---shy
NUCLEAR SlRESS LAB AREA
Page1of2
Rutland Regional Medical Center Nociear Medicine Department Q ~ 160 Allen Street Rutland Vennont
~ Lie 44-14121-01 D ~ernber222011
Area Monitoring Report
Group Name 6 COMMONS RUTLAND HEART CENTER Date Range 0910112011 To 0913012011
In CkSrc Bkg Area 1 Area 2 Area 3 I)ateTime Tech st Batt mRht mRhr mRhr mRht mRhr
09-14-11 1030 PW 1 P 300 002 002 002 002 ~
Notlaquo AreIIJ UIlderlined are over trigxer limit
QC ReadiDgs marbd witIl II (asterisk) iadicates tbat QC wu not pari of the Area Moaitor test
Battery Check P = Pus F = FaU 11_11Test Not performed orNot Required
Trigger Limit 500 ~r
COlDlDena 09-14-2011 1030- CLOSE OUT SORVEYS
CUlTeDt Area Triger Limits (Rlllr) HOT LAB AREA 500 ClIMampRA AREA OGS NUCLEAR STRESS - 005
Iostrwnent lIIformation bull Name Manufacturer Next Cal Serial Number Efficiency
1 LODLOM 3 LudlUl11 06-08-2012 29537 NIA
Origirud area DaDles ~ Generic Name Actual Area Name Generic Name Actual Area Name Generic Name Actual Area Name Q ~~~~~~~------------------~----- Area 1 HOT LAB AREA Area 2 CUlERA ABEA Area 3 NUCLEAR SlRESS LAB AREA
~ tv N-en Q Page 1 of2
Rutland Regional Medical Center o- Nudear Medicine Department g
Area Wipe Report Group Name 6 COMMONS RUTLAND HEART CENTER Date Range 090112011 To 09302011 0
lt- I-IJI-u w ~~J --~
I No ~ fA r r
COUll nOll rxltt -z
y- ~ lt eatI ~ f ~ lt tP rV~
V) ~ UA-Mft t4l tJ
fS6i 70 5cPLL en (i o
o
~ C Page 20f2 ~
CL
QJRL ~fDIoaf 4pound f-~ -r t~Jrtto-en Nuclear Medicine Department
6 Common S1reet RuUand VelTJlOnt$ ~ I shy
lic II aall1Q1 --itt - ilt I Z 1-0 I L-[pound~ 1e--gtr April 04 2011
04-04-2Q11 1417Tat Ibk Time TeclmaJlldJlt SUSAN SCHNEIDER bsfru_ M6de1 ell Maudu1tIrcr Capiec
Strial iii 001414 hanEft 84)00
Bsckp-ocwl 000 CPM Triaw L~d OOOS uCi
IutnIDL UIliIJt 2
~ Cm_Qt
bull CbnWalN_ Mw SGIaJ (11 0 -IIoId Ad Wipo c BIf Oorr F Ibmltwed Ad t ll6(42-9 U-ltlI-2BIB l490SmCi 2l CPM 000 100 aGOOQI3 aCi yCo-17
IOl4-2Q21 Il-ltlI-21lO3 UllOM I uCi CJ CIII 000 100 0000000 aCi y2 C-131
7111lQ-l 11(11-2003 4213419 aCi 107 OM 0110 100 COOOO6O aCi y3 Cs-137
4 0 14Ill~91 12(11-2009 LI09mCi 4) CPM 000 100 0000000 aCi y
ThD RcpJri iadieatts mat alillDove sealed SODIUS ban PASSE)) a LakTest Removed Acttrity ltIt soarCH-1S ~ ooos -alRClSTATE Trigpr Limit
IlSO SigcaItle lt 113 TeclmologistSignature ~
en N o o C N N Page 1 of 1g
(utland Heart Center - 6 Commons Nudear Medicine DepartmentS o ~NniS- -~~ 6 Commons Street Rutland Vermont o -- shy0 Lic 44 se881 8~ l-i - 11 J -z 1- 0 I --N ltxI) f0 i -j
July 01 2011 Tesl Date a Time 87-01-2011 1416 Teehllologist PAUL WAITE
II Cftemical NQIe MaoufadlJrer Model SeriaJtI Localioo CaLDak CaLAdivitv Carrot Act Prtsent iIN
Co-Y7 Eckm aud Ziegler- 1366-42-9 HOT LAB 12-01middot2009 52140 mCi 11949 lOCi Y
2 CS-U7 LPL 1014-20-21 HOT LAB 1l-01-1C03 1730000 uCi 1492S61 uCi Y
3 Cs -1l7 LPL 78~3 HOT LAB 12-01-2003 5000000 j 4200SIl nCi Y~ ~
4 Co-S7 EclIIrt and Ziegfa 1402-091 HOT LAB 12-01-2009 U()OO mCi 11UI8 mCi Y
S (() - S7 Eckm aIId Ziegllaquo 1500-160 HOT LAB O1-O1middotl() It 100000 lnCi 1002515 mCi Y
~- ~- ~- ---~ -_ _ - - - - ~
The Above Report iodicates all of the Sea
RSO Sigoature TeclmoJogist Signature 1
~ 0 shy
shy ~ N
sect N
Page 1 of 1
- bull rutland Heart Center -1 Commons bull NucfearMedicine Departmente 1 Commons Street Rutland Vennont ---o ~
Lic1I 14181-amp1 lilt- -II L i -0 ( J r)Cf)nz -gt------Jyty01 2011 - ___-- ---- shy
Test Date Time O7o1-ltIll D58 Tedmologlst PAlIL W AITJ
I 0HaIImlN_ MaWlllEi MaCJa smI8 LoaIIrm OdnIe Cd~ cmut Ad lnIaItYIN
05-137 LPL 114--3l-3 HOT LAB 03-01middot2006 2OO~OOO uCi l77374Q uct Y
1 Co- 57 ECKERT ZIEGLER 1366-3-12 HOTLAB 03-(11middot2009 547SO mCi 06210 mCi Y
3 Qsmiddot137 LP1 Ull-3-7 HafLAB 03-01middot2006 OQ909 uCi 00804 uCi y
~ 4 Co- 57 LP1 1436-l22 HOT LAB 06-01middot2010 100000 mCi 36504 mCi Y
The AlKwe Reportin bave beeo aaouated for Technologist Signature ~
~-Ilt 71nlll
o ~ o o pound Nmiddot N
~ Page 1 of
3
_c~ J-kliz1 Q~pounde oor Nuclear Medicine Departmento N 1 Common StJeet Rutland Vermont q ---shyQ We 44 jjBa1J~ i-t-l_ -I 1-- cJ I Lf A-lt c _APriL01 2011
Sealed Sources Leak Test Report
late Range 04-01middot2011 thN 04-01-2011 DIID Madel swt Camp DIIdI 01 Ad PnIIIcIM A4 Ad 111- TId- ClluliallName
1no11 01middot137 1145-31-3 03-01-2006 2OOlOuCi 118j8 aCi zaOOCPM 0000000 uCi Y PW
~ CA-YI 1366-3-12 03-01-2009 S47mCi O78mCi Z700CPM OOQQOOO ua y PW
01 - 137 O08UCi 2900CPW 0000001 uCi Y PW1I31-3-7 03-01-2006 Oll9uCi
Co-7 4 59mCi zaooCPM 0000000 uCi Y PW1436-121 06-014010 lOOOmCi
fiutrmIIfIIt DetaiII
Instrument Manufacturer Next Cal Date Serial NQ Efficiency CPPRAC Caplnt~ 001715 10000
bis Report indicates that all above sealed SIlIIIOCS bave PASSED aLeakTest emovecI Adivity1Qr SOOItlfS was below the 0005 uCi NRClSTATE TriggerLimit
redllafonatiia
TedllDitbls OmpJete Name
PW PAULWAlTE
o ~~~ eclmo1ogist Siguatun
N
f~ j(5Jo t Nmiddot
~ Page 1 of1
09222011 1030 (f~) P013014
Rutland Heart Center 8 Commons Nuclear Medicine Department
~R6Ple8t~~ftWnd Vermont ~ Cc)rfft1GN5 Lic~ 1--1- Id-o (
vf Source Co~S7 ManuflSupp Eckert and Ziegler Cal Dote 1210112009 Cal Act S2140mCi Is Souroe In Use Yes Tech TK
f1Comment
Source ClImiddot 137 M811uflSUpp TPL Cal Date 030112006 Cal Act 2005000 uCi Is $OU1ce [n Use No Teoh PW
J3comment
Source Co- 57 ManuflSupp Eckert and Ziegler Cal Date 030112009 Cal Act 540 mCi Is Source In Use No Tech PW
Comment
Soutee Cs shy 137 ManuflSupp lPL Cal Date 031212006 Cal Act 00909 uCi Is Souree In Use Yes Tech PW
~omment 5 Souree Co - 57 MmtuflSupp IPL Cal Date 06012010 Cal Act lOOOOOmCi Is Source In Use No Tech PW CCllnmcnt
vfi Source Cs - 137 ManufSupp IPL Cal Date 110112003 Cal Act t7S0000 uCi Is SOluce In Use Yes fech TK Comment
September 21 2011 -~--- ~
Sealed Sources Database File t~ tXI)rceJ
Name VIAL REFERENCE SOURCE SerlD 1366-429 Model Put Dille LocatIon HOT LAB Current 09654 mCi HL 27100 days
Name VIAL REFERENCE SOURCE SerID 1 1145-31middot3 Model II Pur Date Loation HOT LAB Current 1764453 uCi HL 1101200 days
Name VIAL REFERENCE SOURCE ScrJlD 1366312 Model Pur Date Location HOT LAB Cunent 05017 mCi HL 27100 days
Name ROD SOURCE ScrID 11313-7 Model Pur Date Location HOT LAB Current 00800 uCi HL 1101200 days
Name FrLOOD SOURCE SerID 1436122 ModelN Pur Date Location HOT LAB Current 29492 mCi HL 27100 days
Name VIAL REFERENCE SOURCE ScrID 1014-20-21 Model It Pur Date Location HOT LAB Current middot484747 uCi HL 1101200 days
Page 1 of2
09222011 1031 (f~ P014014
Rutland Heart Center bull ~ I) c()II) tJ 5 Nuclear Medicine Department
Sealed Sources Database File -~_M__
J Source CS - 137 Nanle ROD SOURCE MMUflSupp IPL SerID 780w68w3 Model Cal Date 120112003 Pur Date Lotlltlon HOT LAB Cal Act SOOOOOO nCi CUII-ent 4178520 nCi HL 1101200 days Is Source In Use No Tech TK Comment
viS SOUICO Co-57 Name FLOOD SOURCE ManuUSupp Eckert and Ziegler SerID II 1402-091 Model Cal Dato 120112009 Pur Datc Location HOT LAB Cal Act 7S000mCi Current 13887 mCi HL 27100 days Is Source In Usc Yes rcch MJS
comment 9 Source Co- 57 Name FLOOD SOURCE ManuflSupp Eckert and Ziegler SarID Ii 1500middot160 ModeJ Cal Date 0710112011 Pur Date Location HOT LAB Cal Act 100000 mCi Currenl 80998 mCi HL 27100 days Is Source In Use Yes Tech SLS Comment
Note Allterisk() indicates that there is a Memo for that Sealed Source
Page 2of2
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
Rutland Regional Medical Center ~ Nuclear Medicine Department o ~ Area Wipe Report Group Name 1 COMMONS RUltAND HEART CENTER Date Range 090112011 To 0913012011 a
t4-ftiI(At
~ iO IVshy
I lt HIH
~ o
o N N ~ ~
-C-f
L~~
Hirt-UK-j
U w~ -7
2xA-vshy
26C--shy
5-t0 r-G L
r~)((GZ IJt2c ~) lJr-~ I
i
i J
~ l i ~ I
1
I
~ 0 $C4+-f
Page2ot2
Rutland Regional Medical Center II Nudear Medicine Department
o ~ 160 Allen Street Rutland Vermont ~ a Lic44-14121-01
Area Wipe Report
Group Name 6 COMMONS RUTlAND HEART CENTER
In CkSrc Bkq Area 1 Area 2 Area 3 Datelime Tech st Batt CIM CPM CPM DPM CPM DPK CPM DIK
09-14-11 1030 PW 4 -- 456~ 456 0 a o a o a ~
Neill Areas Uaderliaed ue over tricger limit
BattEry Chedc 1m = Pass T = Fail
Tnt Not performed or Not Required - ClllilCk lOIlnlli reading wu dOlle today bat Ret as part Qt tills surveylwipe test
Wipe Area 10000 Sq CII Trigcc Limit= 200000 DPM
COIICIlt Area Trigger Limits (DPM) 100000
InsUumeDt Details I Inst~ument Manufacturer Next Cal Date seziaI Ito Efficiency
A1oo LAB 950 Biodex 01-31-2012 4259608 IOOflO
OriginaJ rea DllllllfS
Generic Name Actual area name Generic blame Actual area name Generic Name----- ------------ shy~ Area 1 HOT LAB AREA Area 2 CAMERA AREA Area J o Tecb rmOll
Tocb TecllName PW PAUL WAITE sectNshyN
~
September 22 2011
Date Range 0910112011 To 093012011
Actual areltl name --- - _---shy
NUCLEAR SlRESS LAB AREA
Page1of2
Rutland Regional Medical Center Nociear Medicine Department Q ~ 160 Allen Street Rutland Vennont
~ Lie 44-14121-01 D ~ernber222011
Area Monitoring Report
Group Name 6 COMMONS RUTLAND HEART CENTER Date Range 0910112011 To 0913012011
In CkSrc Bkg Area 1 Area 2 Area 3 I)ateTime Tech st Batt mRht mRhr mRhr mRht mRhr
09-14-11 1030 PW 1 P 300 002 002 002 002 ~
Notlaquo AreIIJ UIlderlined are over trigxer limit
QC ReadiDgs marbd witIl II (asterisk) iadicates tbat QC wu not pari of the Area Moaitor test
Battery Check P = Pus F = FaU 11_11Test Not performed orNot Required
Trigger Limit 500 ~r
COlDlDena 09-14-2011 1030- CLOSE OUT SORVEYS
CUlTeDt Area Triger Limits (Rlllr) HOT LAB AREA 500 ClIMampRA AREA OGS NUCLEAR STRESS - 005
Iostrwnent lIIformation bull Name Manufacturer Next Cal Serial Number Efficiency
1 LODLOM 3 LudlUl11 06-08-2012 29537 NIA
Origirud area DaDles ~ Generic Name Actual Area Name Generic Name Actual Area Name Generic Name Actual Area Name Q ~~~~~~~------------------~----- Area 1 HOT LAB AREA Area 2 CUlERA ABEA Area 3 NUCLEAR SlRESS LAB AREA
~ tv N-en Q Page 1 of2
Rutland Regional Medical Center o- Nudear Medicine Department g
Area Wipe Report Group Name 6 COMMONS RUTLAND HEART CENTER Date Range 090112011 To 09302011 0
lt- I-IJI-u w ~~J --~
I No ~ fA r r
COUll nOll rxltt -z
y- ~ lt eatI ~ f ~ lt tP rV~
V) ~ UA-Mft t4l tJ
fS6i 70 5cPLL en (i o
o
~ C Page 20f2 ~
CL
QJRL ~fDIoaf 4pound f-~ -r t~Jrtto-en Nuclear Medicine Department
6 Common S1reet RuUand VelTJlOnt$ ~ I shy
lic II aall1Q1 --itt - ilt I Z 1-0 I L-[pound~ 1e--gtr April 04 2011
04-04-2Q11 1417Tat Ibk Time TeclmaJlldJlt SUSAN SCHNEIDER bsfru_ M6de1 ell Maudu1tIrcr Capiec
Strial iii 001414 hanEft 84)00
Bsckp-ocwl 000 CPM Triaw L~d OOOS uCi
IutnIDL UIliIJt 2
~ Cm_Qt
bull CbnWalN_ Mw SGIaJ (11 0 -IIoId Ad Wipo c BIf Oorr F Ibmltwed Ad t ll6(42-9 U-ltlI-2BIB l490SmCi 2l CPM 000 100 aGOOQI3 aCi yCo-17
IOl4-2Q21 Il-ltlI-21lO3 UllOM I uCi CJ CIII 000 100 0000000 aCi y2 C-131
7111lQ-l 11(11-2003 4213419 aCi 107 OM 0110 100 COOOO6O aCi y3 Cs-137
4 0 14Ill~91 12(11-2009 LI09mCi 4) CPM 000 100 0000000 aCi y
ThD RcpJri iadieatts mat alillDove sealed SODIUS ban PASSE)) a LakTest Removed Acttrity ltIt soarCH-1S ~ ooos -alRClSTATE Trigpr Limit
IlSO SigcaItle lt 113 TeclmologistSignature ~
en N o o C N N Page 1 of 1g
(utland Heart Center - 6 Commons Nudear Medicine DepartmentS o ~NniS- -~~ 6 Commons Street Rutland Vermont o -- shy0 Lic 44 se881 8~ l-i - 11 J -z 1- 0 I --N ltxI) f0 i -j
July 01 2011 Tesl Date a Time 87-01-2011 1416 Teehllologist PAUL WAITE
II Cftemical NQIe MaoufadlJrer Model SeriaJtI Localioo CaLDak CaLAdivitv Carrot Act Prtsent iIN
Co-Y7 Eckm aud Ziegler- 1366-42-9 HOT LAB 12-01middot2009 52140 mCi 11949 lOCi Y
2 CS-U7 LPL 1014-20-21 HOT LAB 1l-01-1C03 1730000 uCi 1492S61 uCi Y
3 Cs -1l7 LPL 78~3 HOT LAB 12-01-2003 5000000 j 4200SIl nCi Y~ ~
4 Co-S7 EclIIrt and Ziegfa 1402-091 HOT LAB 12-01-2009 U()OO mCi 11UI8 mCi Y
S (() - S7 Eckm aIId Ziegllaquo 1500-160 HOT LAB O1-O1middotl() It 100000 lnCi 1002515 mCi Y
~- ~- ~- ---~ -_ _ - - - - ~
The Above Report iodicates all of the Sea
RSO Sigoature TeclmoJogist Signature 1
~ 0 shy
shy ~ N
sect N
Page 1 of 1
- bull rutland Heart Center -1 Commons bull NucfearMedicine Departmente 1 Commons Street Rutland Vennont ---o ~
Lic1I 14181-amp1 lilt- -II L i -0 ( J r)Cf)nz -gt------Jyty01 2011 - ___-- ---- shy
Test Date Time O7o1-ltIll D58 Tedmologlst PAlIL W AITJ
I 0HaIImlN_ MaWlllEi MaCJa smI8 LoaIIrm OdnIe Cd~ cmut Ad lnIaItYIN
05-137 LPL 114--3l-3 HOT LAB 03-01middot2006 2OO~OOO uCi l77374Q uct Y
1 Co- 57 ECKERT ZIEGLER 1366-3-12 HOTLAB 03-(11middot2009 547SO mCi 06210 mCi Y
3 Qsmiddot137 LP1 Ull-3-7 HafLAB 03-01middot2006 OQ909 uCi 00804 uCi y
~ 4 Co- 57 LP1 1436-l22 HOT LAB 06-01middot2010 100000 mCi 36504 mCi Y
The AlKwe Reportin bave beeo aaouated for Technologist Signature ~
~-Ilt 71nlll
o ~ o o pound Nmiddot N
~ Page 1 of
3
_c~ J-kliz1 Q~pounde oor Nuclear Medicine Departmento N 1 Common StJeet Rutland Vermont q ---shyQ We 44 jjBa1J~ i-t-l_ -I 1-- cJ I Lf A-lt c _APriL01 2011
Sealed Sources Leak Test Report
late Range 04-01middot2011 thN 04-01-2011 DIID Madel swt Camp DIIdI 01 Ad PnIIIcIM A4 Ad 111- TId- ClluliallName
1no11 01middot137 1145-31-3 03-01-2006 2OOlOuCi 118j8 aCi zaOOCPM 0000000 uCi Y PW
~ CA-YI 1366-3-12 03-01-2009 S47mCi O78mCi Z700CPM OOQQOOO ua y PW
01 - 137 O08UCi 2900CPW 0000001 uCi Y PW1I31-3-7 03-01-2006 Oll9uCi
Co-7 4 59mCi zaooCPM 0000000 uCi Y PW1436-121 06-014010 lOOOmCi
fiutrmIIfIIt DetaiII
Instrument Manufacturer Next Cal Date Serial NQ Efficiency CPPRAC Caplnt~ 001715 10000
bis Report indicates that all above sealed SIlIIIOCS bave PASSED aLeakTest emovecI Adivity1Qr SOOItlfS was below the 0005 uCi NRClSTATE TriggerLimit
redllafonatiia
TedllDitbls OmpJete Name
PW PAULWAlTE
o ~~~ eclmo1ogist Siguatun
N
f~ j(5Jo t Nmiddot
~ Page 1 of1
09222011 1030 (f~) P013014
Rutland Heart Center 8 Commons Nuclear Medicine Department
~R6Ple8t~~ftWnd Vermont ~ Cc)rfft1GN5 Lic~ 1--1- Id-o (
vf Source Co~S7 ManuflSupp Eckert and Ziegler Cal Dote 1210112009 Cal Act S2140mCi Is Souroe In Use Yes Tech TK
f1Comment
Source ClImiddot 137 M811uflSUpp TPL Cal Date 030112006 Cal Act 2005000 uCi Is $OU1ce [n Use No Teoh PW
J3comment
Source Co- 57 ManuflSupp Eckert and Ziegler Cal Date 030112009 Cal Act 540 mCi Is Source In Use No Tech PW
Comment
Soutee Cs shy 137 ManuflSupp lPL Cal Date 031212006 Cal Act 00909 uCi Is Souree In Use Yes Tech PW
~omment 5 Souree Co - 57 MmtuflSupp IPL Cal Date 06012010 Cal Act lOOOOOmCi Is Source In Use No Tech PW CCllnmcnt
vfi Source Cs - 137 ManufSupp IPL Cal Date 110112003 Cal Act t7S0000 uCi Is SOluce In Use Yes fech TK Comment
September 21 2011 -~--- ~
Sealed Sources Database File t~ tXI)rceJ
Name VIAL REFERENCE SOURCE SerlD 1366-429 Model Put Dille LocatIon HOT LAB Current 09654 mCi HL 27100 days
Name VIAL REFERENCE SOURCE SerID 1 1145-31middot3 Model II Pur Date Loation HOT LAB Current 1764453 uCi HL 1101200 days
Name VIAL REFERENCE SOURCE ScrJlD 1366312 Model Pur Date Location HOT LAB Cunent 05017 mCi HL 27100 days
Name ROD SOURCE ScrID 11313-7 Model Pur Date Location HOT LAB Current 00800 uCi HL 1101200 days
Name FrLOOD SOURCE SerID 1436122 ModelN Pur Date Location HOT LAB Current 29492 mCi HL 27100 days
Name VIAL REFERENCE SOURCE ScrID 1014-20-21 Model It Pur Date Location HOT LAB Current middot484747 uCi HL 1101200 days
Page 1 of2
09222011 1031 (f~ P014014
Rutland Heart Center bull ~ I) c()II) tJ 5 Nuclear Medicine Department
Sealed Sources Database File -~_M__
J Source CS - 137 Nanle ROD SOURCE MMUflSupp IPL SerID 780w68w3 Model Cal Date 120112003 Pur Date Lotlltlon HOT LAB Cal Act SOOOOOO nCi CUII-ent 4178520 nCi HL 1101200 days Is Source In Use No Tech TK Comment
viS SOUICO Co-57 Name FLOOD SOURCE ManuUSupp Eckert and Ziegler SerID II 1402-091 Model Cal Dato 120112009 Pur Datc Location HOT LAB Cal Act 7S000mCi Current 13887 mCi HL 27100 days Is Source In Usc Yes rcch MJS
comment 9 Source Co- 57 Name FLOOD SOURCE ManuflSupp Eckert and Ziegler SarID Ii 1500middot160 ModeJ Cal Date 0710112011 Pur Date Location HOT LAB Cal Act 100000 mCi Currenl 80998 mCi HL 27100 days Is Source In Use Yes Tech SLS Comment
Note Allterisk() indicates that there is a Memo for that Sealed Source
Page 2of2
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
Rutland Regional Medical Center II Nudear Medicine Department
o ~ 160 Allen Street Rutland Vermont ~ a Lic44-14121-01
Area Wipe Report
Group Name 6 COMMONS RUTlAND HEART CENTER
In CkSrc Bkq Area 1 Area 2 Area 3 Datelime Tech st Batt CIM CPM CPM DPM CPM DPK CPM DIK
09-14-11 1030 PW 4 -- 456~ 456 0 a o a o a ~
Neill Areas Uaderliaed ue over tricger limit
BattEry Chedc 1m = Pass T = Fail
Tnt Not performed or Not Required - ClllilCk lOIlnlli reading wu dOlle today bat Ret as part Qt tills surveylwipe test
Wipe Area 10000 Sq CII Trigcc Limit= 200000 DPM
COIICIlt Area Trigger Limits (DPM) 100000
InsUumeDt Details I Inst~ument Manufacturer Next Cal Date seziaI Ito Efficiency
A1oo LAB 950 Biodex 01-31-2012 4259608 IOOflO
OriginaJ rea DllllllfS
Generic Name Actual area name Generic blame Actual area name Generic Name----- ------------ shy~ Area 1 HOT LAB AREA Area 2 CAMERA AREA Area J o Tecb rmOll
Tocb TecllName PW PAUL WAITE sectNshyN
~
September 22 2011
Date Range 0910112011 To 093012011
Actual areltl name --- - _---shy
NUCLEAR SlRESS LAB AREA
Page1of2
Rutland Regional Medical Center Nociear Medicine Department Q ~ 160 Allen Street Rutland Vennont
~ Lie 44-14121-01 D ~ernber222011
Area Monitoring Report
Group Name 6 COMMONS RUTLAND HEART CENTER Date Range 0910112011 To 0913012011
In CkSrc Bkg Area 1 Area 2 Area 3 I)ateTime Tech st Batt mRht mRhr mRhr mRht mRhr
09-14-11 1030 PW 1 P 300 002 002 002 002 ~
Notlaquo AreIIJ UIlderlined are over trigxer limit
QC ReadiDgs marbd witIl II (asterisk) iadicates tbat QC wu not pari of the Area Moaitor test
Battery Check P = Pus F = FaU 11_11Test Not performed orNot Required
Trigger Limit 500 ~r
COlDlDena 09-14-2011 1030- CLOSE OUT SORVEYS
CUlTeDt Area Triger Limits (Rlllr) HOT LAB AREA 500 ClIMampRA AREA OGS NUCLEAR STRESS - 005
Iostrwnent lIIformation bull Name Manufacturer Next Cal Serial Number Efficiency
1 LODLOM 3 LudlUl11 06-08-2012 29537 NIA
Origirud area DaDles ~ Generic Name Actual Area Name Generic Name Actual Area Name Generic Name Actual Area Name Q ~~~~~~~------------------~----- Area 1 HOT LAB AREA Area 2 CUlERA ABEA Area 3 NUCLEAR SlRESS LAB AREA
~ tv N-en Q Page 1 of2
Rutland Regional Medical Center o- Nudear Medicine Department g
Area Wipe Report Group Name 6 COMMONS RUTLAND HEART CENTER Date Range 090112011 To 09302011 0
lt- I-IJI-u w ~~J --~
I No ~ fA r r
COUll nOll rxltt -z
y- ~ lt eatI ~ f ~ lt tP rV~
V) ~ UA-Mft t4l tJ
fS6i 70 5cPLL en (i o
o
~ C Page 20f2 ~
CL
QJRL ~fDIoaf 4pound f-~ -r t~Jrtto-en Nuclear Medicine Department
6 Common S1reet RuUand VelTJlOnt$ ~ I shy
lic II aall1Q1 --itt - ilt I Z 1-0 I L-[pound~ 1e--gtr April 04 2011
04-04-2Q11 1417Tat Ibk Time TeclmaJlldJlt SUSAN SCHNEIDER bsfru_ M6de1 ell Maudu1tIrcr Capiec
Strial iii 001414 hanEft 84)00
Bsckp-ocwl 000 CPM Triaw L~d OOOS uCi
IutnIDL UIliIJt 2
~ Cm_Qt
bull CbnWalN_ Mw SGIaJ (11 0 -IIoId Ad Wipo c BIf Oorr F Ibmltwed Ad t ll6(42-9 U-ltlI-2BIB l490SmCi 2l CPM 000 100 aGOOQI3 aCi yCo-17
IOl4-2Q21 Il-ltlI-21lO3 UllOM I uCi CJ CIII 000 100 0000000 aCi y2 C-131
7111lQ-l 11(11-2003 4213419 aCi 107 OM 0110 100 COOOO6O aCi y3 Cs-137
4 0 14Ill~91 12(11-2009 LI09mCi 4) CPM 000 100 0000000 aCi y
ThD RcpJri iadieatts mat alillDove sealed SODIUS ban PASSE)) a LakTest Removed Acttrity ltIt soarCH-1S ~ ooos -alRClSTATE Trigpr Limit
IlSO SigcaItle lt 113 TeclmologistSignature ~
en N o o C N N Page 1 of 1g
(utland Heart Center - 6 Commons Nudear Medicine DepartmentS o ~NniS- -~~ 6 Commons Street Rutland Vermont o -- shy0 Lic 44 se881 8~ l-i - 11 J -z 1- 0 I --N ltxI) f0 i -j
July 01 2011 Tesl Date a Time 87-01-2011 1416 Teehllologist PAUL WAITE
II Cftemical NQIe MaoufadlJrer Model SeriaJtI Localioo CaLDak CaLAdivitv Carrot Act Prtsent iIN
Co-Y7 Eckm aud Ziegler- 1366-42-9 HOT LAB 12-01middot2009 52140 mCi 11949 lOCi Y
2 CS-U7 LPL 1014-20-21 HOT LAB 1l-01-1C03 1730000 uCi 1492S61 uCi Y
3 Cs -1l7 LPL 78~3 HOT LAB 12-01-2003 5000000 j 4200SIl nCi Y~ ~
4 Co-S7 EclIIrt and Ziegfa 1402-091 HOT LAB 12-01-2009 U()OO mCi 11UI8 mCi Y
S (() - S7 Eckm aIId Ziegllaquo 1500-160 HOT LAB O1-O1middotl() It 100000 lnCi 1002515 mCi Y
~- ~- ~- ---~ -_ _ - - - - ~
The Above Report iodicates all of the Sea
RSO Sigoature TeclmoJogist Signature 1
~ 0 shy
shy ~ N
sect N
Page 1 of 1
- bull rutland Heart Center -1 Commons bull NucfearMedicine Departmente 1 Commons Street Rutland Vennont ---o ~
Lic1I 14181-amp1 lilt- -II L i -0 ( J r)Cf)nz -gt------Jyty01 2011 - ___-- ---- shy
Test Date Time O7o1-ltIll D58 Tedmologlst PAlIL W AITJ
I 0HaIImlN_ MaWlllEi MaCJa smI8 LoaIIrm OdnIe Cd~ cmut Ad lnIaItYIN
05-137 LPL 114--3l-3 HOT LAB 03-01middot2006 2OO~OOO uCi l77374Q uct Y
1 Co- 57 ECKERT ZIEGLER 1366-3-12 HOTLAB 03-(11middot2009 547SO mCi 06210 mCi Y
3 Qsmiddot137 LP1 Ull-3-7 HafLAB 03-01middot2006 OQ909 uCi 00804 uCi y
~ 4 Co- 57 LP1 1436-l22 HOT LAB 06-01middot2010 100000 mCi 36504 mCi Y
The AlKwe Reportin bave beeo aaouated for Technologist Signature ~
~-Ilt 71nlll
o ~ o o pound Nmiddot N
~ Page 1 of
3
_c~ J-kliz1 Q~pounde oor Nuclear Medicine Departmento N 1 Common StJeet Rutland Vermont q ---shyQ We 44 jjBa1J~ i-t-l_ -I 1-- cJ I Lf A-lt c _APriL01 2011
Sealed Sources Leak Test Report
late Range 04-01middot2011 thN 04-01-2011 DIID Madel swt Camp DIIdI 01 Ad PnIIIcIM A4 Ad 111- TId- ClluliallName
1no11 01middot137 1145-31-3 03-01-2006 2OOlOuCi 118j8 aCi zaOOCPM 0000000 uCi Y PW
~ CA-YI 1366-3-12 03-01-2009 S47mCi O78mCi Z700CPM OOQQOOO ua y PW
01 - 137 O08UCi 2900CPW 0000001 uCi Y PW1I31-3-7 03-01-2006 Oll9uCi
Co-7 4 59mCi zaooCPM 0000000 uCi Y PW1436-121 06-014010 lOOOmCi
fiutrmIIfIIt DetaiII
Instrument Manufacturer Next Cal Date Serial NQ Efficiency CPPRAC Caplnt~ 001715 10000
bis Report indicates that all above sealed SIlIIIOCS bave PASSED aLeakTest emovecI Adivity1Qr SOOItlfS was below the 0005 uCi NRClSTATE TriggerLimit
redllafonatiia
TedllDitbls OmpJete Name
PW PAULWAlTE
o ~~~ eclmo1ogist Siguatun
N
f~ j(5Jo t Nmiddot
~ Page 1 of1
09222011 1030 (f~) P013014
Rutland Heart Center 8 Commons Nuclear Medicine Department
~R6Ple8t~~ftWnd Vermont ~ Cc)rfft1GN5 Lic~ 1--1- Id-o (
vf Source Co~S7 ManuflSupp Eckert and Ziegler Cal Dote 1210112009 Cal Act S2140mCi Is Souroe In Use Yes Tech TK
f1Comment
Source ClImiddot 137 M811uflSUpp TPL Cal Date 030112006 Cal Act 2005000 uCi Is $OU1ce [n Use No Teoh PW
J3comment
Source Co- 57 ManuflSupp Eckert and Ziegler Cal Date 030112009 Cal Act 540 mCi Is Source In Use No Tech PW
Comment
Soutee Cs shy 137 ManuflSupp lPL Cal Date 031212006 Cal Act 00909 uCi Is Souree In Use Yes Tech PW
~omment 5 Souree Co - 57 MmtuflSupp IPL Cal Date 06012010 Cal Act lOOOOOmCi Is Source In Use No Tech PW CCllnmcnt
vfi Source Cs - 137 ManufSupp IPL Cal Date 110112003 Cal Act t7S0000 uCi Is SOluce In Use Yes fech TK Comment
September 21 2011 -~--- ~
Sealed Sources Database File t~ tXI)rceJ
Name VIAL REFERENCE SOURCE SerlD 1366-429 Model Put Dille LocatIon HOT LAB Current 09654 mCi HL 27100 days
Name VIAL REFERENCE SOURCE SerID 1 1145-31middot3 Model II Pur Date Loation HOT LAB Current 1764453 uCi HL 1101200 days
Name VIAL REFERENCE SOURCE ScrJlD 1366312 Model Pur Date Location HOT LAB Cunent 05017 mCi HL 27100 days
Name ROD SOURCE ScrID 11313-7 Model Pur Date Location HOT LAB Current 00800 uCi HL 1101200 days
Name FrLOOD SOURCE SerID 1436122 ModelN Pur Date Location HOT LAB Current 29492 mCi HL 27100 days
Name VIAL REFERENCE SOURCE ScrID 1014-20-21 Model It Pur Date Location HOT LAB Current middot484747 uCi HL 1101200 days
Page 1 of2
09222011 1031 (f~ P014014
Rutland Heart Center bull ~ I) c()II) tJ 5 Nuclear Medicine Department
Sealed Sources Database File -~_M__
J Source CS - 137 Nanle ROD SOURCE MMUflSupp IPL SerID 780w68w3 Model Cal Date 120112003 Pur Date Lotlltlon HOT LAB Cal Act SOOOOOO nCi CUII-ent 4178520 nCi HL 1101200 days Is Source In Use No Tech TK Comment
viS SOUICO Co-57 Name FLOOD SOURCE ManuUSupp Eckert and Ziegler SerID II 1402-091 Model Cal Dato 120112009 Pur Datc Location HOT LAB Cal Act 7S000mCi Current 13887 mCi HL 27100 days Is Source In Usc Yes rcch MJS
comment 9 Source Co- 57 Name FLOOD SOURCE ManuflSupp Eckert and Ziegler SarID Ii 1500middot160 ModeJ Cal Date 0710112011 Pur Date Location HOT LAB Cal Act 100000 mCi Currenl 80998 mCi HL 27100 days Is Source In Use Yes Tech SLS Comment
Note Allterisk() indicates that there is a Memo for that Sealed Source
Page 2of2
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
Rutland Regional Medical Center Nociear Medicine Department Q ~ 160 Allen Street Rutland Vennont
~ Lie 44-14121-01 D ~ernber222011
Area Monitoring Report
Group Name 6 COMMONS RUTLAND HEART CENTER Date Range 0910112011 To 0913012011
In CkSrc Bkg Area 1 Area 2 Area 3 I)ateTime Tech st Batt mRht mRhr mRhr mRht mRhr
09-14-11 1030 PW 1 P 300 002 002 002 002 ~
Notlaquo AreIIJ UIlderlined are over trigxer limit
QC ReadiDgs marbd witIl II (asterisk) iadicates tbat QC wu not pari of the Area Moaitor test
Battery Check P = Pus F = FaU 11_11Test Not performed orNot Required
Trigger Limit 500 ~r
COlDlDena 09-14-2011 1030- CLOSE OUT SORVEYS
CUlTeDt Area Triger Limits (Rlllr) HOT LAB AREA 500 ClIMampRA AREA OGS NUCLEAR STRESS - 005
Iostrwnent lIIformation bull Name Manufacturer Next Cal Serial Number Efficiency
1 LODLOM 3 LudlUl11 06-08-2012 29537 NIA
Origirud area DaDles ~ Generic Name Actual Area Name Generic Name Actual Area Name Generic Name Actual Area Name Q ~~~~~~~------------------~----- Area 1 HOT LAB AREA Area 2 CUlERA ABEA Area 3 NUCLEAR SlRESS LAB AREA
~ tv N-en Q Page 1 of2
Rutland Regional Medical Center o- Nudear Medicine Department g
Area Wipe Report Group Name 6 COMMONS RUTLAND HEART CENTER Date Range 090112011 To 09302011 0
lt- I-IJI-u w ~~J --~
I No ~ fA r r
COUll nOll rxltt -z
y- ~ lt eatI ~ f ~ lt tP rV~
V) ~ UA-Mft t4l tJ
fS6i 70 5cPLL en (i o
o
~ C Page 20f2 ~
CL
QJRL ~fDIoaf 4pound f-~ -r t~Jrtto-en Nuclear Medicine Department
6 Common S1reet RuUand VelTJlOnt$ ~ I shy
lic II aall1Q1 --itt - ilt I Z 1-0 I L-[pound~ 1e--gtr April 04 2011
04-04-2Q11 1417Tat Ibk Time TeclmaJlldJlt SUSAN SCHNEIDER bsfru_ M6de1 ell Maudu1tIrcr Capiec
Strial iii 001414 hanEft 84)00
Bsckp-ocwl 000 CPM Triaw L~d OOOS uCi
IutnIDL UIliIJt 2
~ Cm_Qt
bull CbnWalN_ Mw SGIaJ (11 0 -IIoId Ad Wipo c BIf Oorr F Ibmltwed Ad t ll6(42-9 U-ltlI-2BIB l490SmCi 2l CPM 000 100 aGOOQI3 aCi yCo-17
IOl4-2Q21 Il-ltlI-21lO3 UllOM I uCi CJ CIII 000 100 0000000 aCi y2 C-131
7111lQ-l 11(11-2003 4213419 aCi 107 OM 0110 100 COOOO6O aCi y3 Cs-137
4 0 14Ill~91 12(11-2009 LI09mCi 4) CPM 000 100 0000000 aCi y
ThD RcpJri iadieatts mat alillDove sealed SODIUS ban PASSE)) a LakTest Removed Acttrity ltIt soarCH-1S ~ ooos -alRClSTATE Trigpr Limit
IlSO SigcaItle lt 113 TeclmologistSignature ~
en N o o C N N Page 1 of 1g
(utland Heart Center - 6 Commons Nudear Medicine DepartmentS o ~NniS- -~~ 6 Commons Street Rutland Vermont o -- shy0 Lic 44 se881 8~ l-i - 11 J -z 1- 0 I --N ltxI) f0 i -j
July 01 2011 Tesl Date a Time 87-01-2011 1416 Teehllologist PAUL WAITE
II Cftemical NQIe MaoufadlJrer Model SeriaJtI Localioo CaLDak CaLAdivitv Carrot Act Prtsent iIN
Co-Y7 Eckm aud Ziegler- 1366-42-9 HOT LAB 12-01middot2009 52140 mCi 11949 lOCi Y
2 CS-U7 LPL 1014-20-21 HOT LAB 1l-01-1C03 1730000 uCi 1492S61 uCi Y
3 Cs -1l7 LPL 78~3 HOT LAB 12-01-2003 5000000 j 4200SIl nCi Y~ ~
4 Co-S7 EclIIrt and Ziegfa 1402-091 HOT LAB 12-01-2009 U()OO mCi 11UI8 mCi Y
S (() - S7 Eckm aIId Ziegllaquo 1500-160 HOT LAB O1-O1middotl() It 100000 lnCi 1002515 mCi Y
~- ~- ~- ---~ -_ _ - - - - ~
The Above Report iodicates all of the Sea
RSO Sigoature TeclmoJogist Signature 1
~ 0 shy
shy ~ N
sect N
Page 1 of 1
- bull rutland Heart Center -1 Commons bull NucfearMedicine Departmente 1 Commons Street Rutland Vennont ---o ~
Lic1I 14181-amp1 lilt- -II L i -0 ( J r)Cf)nz -gt------Jyty01 2011 - ___-- ---- shy
Test Date Time O7o1-ltIll D58 Tedmologlst PAlIL W AITJ
I 0HaIImlN_ MaWlllEi MaCJa smI8 LoaIIrm OdnIe Cd~ cmut Ad lnIaItYIN
05-137 LPL 114--3l-3 HOT LAB 03-01middot2006 2OO~OOO uCi l77374Q uct Y
1 Co- 57 ECKERT ZIEGLER 1366-3-12 HOTLAB 03-(11middot2009 547SO mCi 06210 mCi Y
3 Qsmiddot137 LP1 Ull-3-7 HafLAB 03-01middot2006 OQ909 uCi 00804 uCi y
~ 4 Co- 57 LP1 1436-l22 HOT LAB 06-01middot2010 100000 mCi 36504 mCi Y
The AlKwe Reportin bave beeo aaouated for Technologist Signature ~
~-Ilt 71nlll
o ~ o o pound Nmiddot N
~ Page 1 of
3
_c~ J-kliz1 Q~pounde oor Nuclear Medicine Departmento N 1 Common StJeet Rutland Vermont q ---shyQ We 44 jjBa1J~ i-t-l_ -I 1-- cJ I Lf A-lt c _APriL01 2011
Sealed Sources Leak Test Report
late Range 04-01middot2011 thN 04-01-2011 DIID Madel swt Camp DIIdI 01 Ad PnIIIcIM A4 Ad 111- TId- ClluliallName
1no11 01middot137 1145-31-3 03-01-2006 2OOlOuCi 118j8 aCi zaOOCPM 0000000 uCi Y PW
~ CA-YI 1366-3-12 03-01-2009 S47mCi O78mCi Z700CPM OOQQOOO ua y PW
01 - 137 O08UCi 2900CPW 0000001 uCi Y PW1I31-3-7 03-01-2006 Oll9uCi
Co-7 4 59mCi zaooCPM 0000000 uCi Y PW1436-121 06-014010 lOOOmCi
fiutrmIIfIIt DetaiII
Instrument Manufacturer Next Cal Date Serial NQ Efficiency CPPRAC Caplnt~ 001715 10000
bis Report indicates that all above sealed SIlIIIOCS bave PASSED aLeakTest emovecI Adivity1Qr SOOItlfS was below the 0005 uCi NRClSTATE TriggerLimit
redllafonatiia
TedllDitbls OmpJete Name
PW PAULWAlTE
o ~~~ eclmo1ogist Siguatun
N
f~ j(5Jo t Nmiddot
~ Page 1 of1
09222011 1030 (f~) P013014
Rutland Heart Center 8 Commons Nuclear Medicine Department
~R6Ple8t~~ftWnd Vermont ~ Cc)rfft1GN5 Lic~ 1--1- Id-o (
vf Source Co~S7 ManuflSupp Eckert and Ziegler Cal Dote 1210112009 Cal Act S2140mCi Is Souroe In Use Yes Tech TK
f1Comment
Source ClImiddot 137 M811uflSUpp TPL Cal Date 030112006 Cal Act 2005000 uCi Is $OU1ce [n Use No Teoh PW
J3comment
Source Co- 57 ManuflSupp Eckert and Ziegler Cal Date 030112009 Cal Act 540 mCi Is Source In Use No Tech PW
Comment
Soutee Cs shy 137 ManuflSupp lPL Cal Date 031212006 Cal Act 00909 uCi Is Souree In Use Yes Tech PW
~omment 5 Souree Co - 57 MmtuflSupp IPL Cal Date 06012010 Cal Act lOOOOOmCi Is Source In Use No Tech PW CCllnmcnt
vfi Source Cs - 137 ManufSupp IPL Cal Date 110112003 Cal Act t7S0000 uCi Is SOluce In Use Yes fech TK Comment
September 21 2011 -~--- ~
Sealed Sources Database File t~ tXI)rceJ
Name VIAL REFERENCE SOURCE SerlD 1366-429 Model Put Dille LocatIon HOT LAB Current 09654 mCi HL 27100 days
Name VIAL REFERENCE SOURCE SerID 1 1145-31middot3 Model II Pur Date Loation HOT LAB Current 1764453 uCi HL 1101200 days
Name VIAL REFERENCE SOURCE ScrJlD 1366312 Model Pur Date Location HOT LAB Cunent 05017 mCi HL 27100 days
Name ROD SOURCE ScrID 11313-7 Model Pur Date Location HOT LAB Current 00800 uCi HL 1101200 days
Name FrLOOD SOURCE SerID 1436122 ModelN Pur Date Location HOT LAB Current 29492 mCi HL 27100 days
Name VIAL REFERENCE SOURCE ScrID 1014-20-21 Model It Pur Date Location HOT LAB Current middot484747 uCi HL 1101200 days
Page 1 of2
09222011 1031 (f~ P014014
Rutland Heart Center bull ~ I) c()II) tJ 5 Nuclear Medicine Department
Sealed Sources Database File -~_M__
J Source CS - 137 Nanle ROD SOURCE MMUflSupp IPL SerID 780w68w3 Model Cal Date 120112003 Pur Date Lotlltlon HOT LAB Cal Act SOOOOOO nCi CUII-ent 4178520 nCi HL 1101200 days Is Source In Use No Tech TK Comment
viS SOUICO Co-57 Name FLOOD SOURCE ManuUSupp Eckert and Ziegler SerID II 1402-091 Model Cal Dato 120112009 Pur Datc Location HOT LAB Cal Act 7S000mCi Current 13887 mCi HL 27100 days Is Source In Usc Yes rcch MJS
comment 9 Source Co- 57 Name FLOOD SOURCE ManuflSupp Eckert and Ziegler SarID Ii 1500middot160 ModeJ Cal Date 0710112011 Pur Date Location HOT LAB Cal Act 100000 mCi Currenl 80998 mCi HL 27100 days Is Source In Use Yes Tech SLS Comment
Note Allterisk() indicates that there is a Memo for that Sealed Source
Page 2of2
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
Rutland Regional Medical Center o- Nudear Medicine Department g
Area Wipe Report Group Name 6 COMMONS RUTLAND HEART CENTER Date Range 090112011 To 09302011 0
lt- I-IJI-u w ~~J --~
I No ~ fA r r
COUll nOll rxltt -z
y- ~ lt eatI ~ f ~ lt tP rV~
V) ~ UA-Mft t4l tJ
fS6i 70 5cPLL en (i o
o
~ C Page 20f2 ~
CL
QJRL ~fDIoaf 4pound f-~ -r t~Jrtto-en Nuclear Medicine Department
6 Common S1reet RuUand VelTJlOnt$ ~ I shy
lic II aall1Q1 --itt - ilt I Z 1-0 I L-[pound~ 1e--gtr April 04 2011
04-04-2Q11 1417Tat Ibk Time TeclmaJlldJlt SUSAN SCHNEIDER bsfru_ M6de1 ell Maudu1tIrcr Capiec
Strial iii 001414 hanEft 84)00
Bsckp-ocwl 000 CPM Triaw L~d OOOS uCi
IutnIDL UIliIJt 2
~ Cm_Qt
bull CbnWalN_ Mw SGIaJ (11 0 -IIoId Ad Wipo c BIf Oorr F Ibmltwed Ad t ll6(42-9 U-ltlI-2BIB l490SmCi 2l CPM 000 100 aGOOQI3 aCi yCo-17
IOl4-2Q21 Il-ltlI-21lO3 UllOM I uCi CJ CIII 000 100 0000000 aCi y2 C-131
7111lQ-l 11(11-2003 4213419 aCi 107 OM 0110 100 COOOO6O aCi y3 Cs-137
4 0 14Ill~91 12(11-2009 LI09mCi 4) CPM 000 100 0000000 aCi y
ThD RcpJri iadieatts mat alillDove sealed SODIUS ban PASSE)) a LakTest Removed Acttrity ltIt soarCH-1S ~ ooos -alRClSTATE Trigpr Limit
IlSO SigcaItle lt 113 TeclmologistSignature ~
en N o o C N N Page 1 of 1g
(utland Heart Center - 6 Commons Nudear Medicine DepartmentS o ~NniS- -~~ 6 Commons Street Rutland Vermont o -- shy0 Lic 44 se881 8~ l-i - 11 J -z 1- 0 I --N ltxI) f0 i -j
July 01 2011 Tesl Date a Time 87-01-2011 1416 Teehllologist PAUL WAITE
II Cftemical NQIe MaoufadlJrer Model SeriaJtI Localioo CaLDak CaLAdivitv Carrot Act Prtsent iIN
Co-Y7 Eckm aud Ziegler- 1366-42-9 HOT LAB 12-01middot2009 52140 mCi 11949 lOCi Y
2 CS-U7 LPL 1014-20-21 HOT LAB 1l-01-1C03 1730000 uCi 1492S61 uCi Y
3 Cs -1l7 LPL 78~3 HOT LAB 12-01-2003 5000000 j 4200SIl nCi Y~ ~
4 Co-S7 EclIIrt and Ziegfa 1402-091 HOT LAB 12-01-2009 U()OO mCi 11UI8 mCi Y
S (() - S7 Eckm aIId Ziegllaquo 1500-160 HOT LAB O1-O1middotl() It 100000 lnCi 1002515 mCi Y
~- ~- ~- ---~ -_ _ - - - - ~
The Above Report iodicates all of the Sea
RSO Sigoature TeclmoJogist Signature 1
~ 0 shy
shy ~ N
sect N
Page 1 of 1
- bull rutland Heart Center -1 Commons bull NucfearMedicine Departmente 1 Commons Street Rutland Vennont ---o ~
Lic1I 14181-amp1 lilt- -II L i -0 ( J r)Cf)nz -gt------Jyty01 2011 - ___-- ---- shy
Test Date Time O7o1-ltIll D58 Tedmologlst PAlIL W AITJ
I 0HaIImlN_ MaWlllEi MaCJa smI8 LoaIIrm OdnIe Cd~ cmut Ad lnIaItYIN
05-137 LPL 114--3l-3 HOT LAB 03-01middot2006 2OO~OOO uCi l77374Q uct Y
1 Co- 57 ECKERT ZIEGLER 1366-3-12 HOTLAB 03-(11middot2009 547SO mCi 06210 mCi Y
3 Qsmiddot137 LP1 Ull-3-7 HafLAB 03-01middot2006 OQ909 uCi 00804 uCi y
~ 4 Co- 57 LP1 1436-l22 HOT LAB 06-01middot2010 100000 mCi 36504 mCi Y
The AlKwe Reportin bave beeo aaouated for Technologist Signature ~
~-Ilt 71nlll
o ~ o o pound Nmiddot N
~ Page 1 of
3
_c~ J-kliz1 Q~pounde oor Nuclear Medicine Departmento N 1 Common StJeet Rutland Vermont q ---shyQ We 44 jjBa1J~ i-t-l_ -I 1-- cJ I Lf A-lt c _APriL01 2011
Sealed Sources Leak Test Report
late Range 04-01middot2011 thN 04-01-2011 DIID Madel swt Camp DIIdI 01 Ad PnIIIcIM A4 Ad 111- TId- ClluliallName
1no11 01middot137 1145-31-3 03-01-2006 2OOlOuCi 118j8 aCi zaOOCPM 0000000 uCi Y PW
~ CA-YI 1366-3-12 03-01-2009 S47mCi O78mCi Z700CPM OOQQOOO ua y PW
01 - 137 O08UCi 2900CPW 0000001 uCi Y PW1I31-3-7 03-01-2006 Oll9uCi
Co-7 4 59mCi zaooCPM 0000000 uCi Y PW1436-121 06-014010 lOOOmCi
fiutrmIIfIIt DetaiII
Instrument Manufacturer Next Cal Date Serial NQ Efficiency CPPRAC Caplnt~ 001715 10000
bis Report indicates that all above sealed SIlIIIOCS bave PASSED aLeakTest emovecI Adivity1Qr SOOItlfS was below the 0005 uCi NRClSTATE TriggerLimit
redllafonatiia
TedllDitbls OmpJete Name
PW PAULWAlTE
o ~~~ eclmo1ogist Siguatun
N
f~ j(5Jo t Nmiddot
~ Page 1 of1
09222011 1030 (f~) P013014
Rutland Heart Center 8 Commons Nuclear Medicine Department
~R6Ple8t~~ftWnd Vermont ~ Cc)rfft1GN5 Lic~ 1--1- Id-o (
vf Source Co~S7 ManuflSupp Eckert and Ziegler Cal Dote 1210112009 Cal Act S2140mCi Is Souroe In Use Yes Tech TK
f1Comment
Source ClImiddot 137 M811uflSUpp TPL Cal Date 030112006 Cal Act 2005000 uCi Is $OU1ce [n Use No Teoh PW
J3comment
Source Co- 57 ManuflSupp Eckert and Ziegler Cal Date 030112009 Cal Act 540 mCi Is Source In Use No Tech PW
Comment
Soutee Cs shy 137 ManuflSupp lPL Cal Date 031212006 Cal Act 00909 uCi Is Souree In Use Yes Tech PW
~omment 5 Souree Co - 57 MmtuflSupp IPL Cal Date 06012010 Cal Act lOOOOOmCi Is Source In Use No Tech PW CCllnmcnt
vfi Source Cs - 137 ManufSupp IPL Cal Date 110112003 Cal Act t7S0000 uCi Is SOluce In Use Yes fech TK Comment
September 21 2011 -~--- ~
Sealed Sources Database File t~ tXI)rceJ
Name VIAL REFERENCE SOURCE SerlD 1366-429 Model Put Dille LocatIon HOT LAB Current 09654 mCi HL 27100 days
Name VIAL REFERENCE SOURCE SerID 1 1145-31middot3 Model II Pur Date Loation HOT LAB Current 1764453 uCi HL 1101200 days
Name VIAL REFERENCE SOURCE ScrJlD 1366312 Model Pur Date Location HOT LAB Cunent 05017 mCi HL 27100 days
Name ROD SOURCE ScrID 11313-7 Model Pur Date Location HOT LAB Current 00800 uCi HL 1101200 days
Name FrLOOD SOURCE SerID 1436122 ModelN Pur Date Location HOT LAB Current 29492 mCi HL 27100 days
Name VIAL REFERENCE SOURCE ScrID 1014-20-21 Model It Pur Date Location HOT LAB Current middot484747 uCi HL 1101200 days
Page 1 of2
09222011 1031 (f~ P014014
Rutland Heart Center bull ~ I) c()II) tJ 5 Nuclear Medicine Department
Sealed Sources Database File -~_M__
J Source CS - 137 Nanle ROD SOURCE MMUflSupp IPL SerID 780w68w3 Model Cal Date 120112003 Pur Date Lotlltlon HOT LAB Cal Act SOOOOOO nCi CUII-ent 4178520 nCi HL 1101200 days Is Source In Use No Tech TK Comment
viS SOUICO Co-57 Name FLOOD SOURCE ManuUSupp Eckert and Ziegler SerID II 1402-091 Model Cal Dato 120112009 Pur Datc Location HOT LAB Cal Act 7S000mCi Current 13887 mCi HL 27100 days Is Source In Usc Yes rcch MJS
comment 9 Source Co- 57 Name FLOOD SOURCE ManuflSupp Eckert and Ziegler SarID Ii 1500middot160 ModeJ Cal Date 0710112011 Pur Date Location HOT LAB Cal Act 100000 mCi Currenl 80998 mCi HL 27100 days Is Source In Use Yes Tech SLS Comment
Note Allterisk() indicates that there is a Memo for that Sealed Source
Page 2of2
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
CL
QJRL ~fDIoaf 4pound f-~ -r t~Jrtto-en Nuclear Medicine Department
6 Common S1reet RuUand VelTJlOnt$ ~ I shy
lic II aall1Q1 --itt - ilt I Z 1-0 I L-[pound~ 1e--gtr April 04 2011
04-04-2Q11 1417Tat Ibk Time TeclmaJlldJlt SUSAN SCHNEIDER bsfru_ M6de1 ell Maudu1tIrcr Capiec
Strial iii 001414 hanEft 84)00
Bsckp-ocwl 000 CPM Triaw L~d OOOS uCi
IutnIDL UIliIJt 2
~ Cm_Qt
bull CbnWalN_ Mw SGIaJ (11 0 -IIoId Ad Wipo c BIf Oorr F Ibmltwed Ad t ll6(42-9 U-ltlI-2BIB l490SmCi 2l CPM 000 100 aGOOQI3 aCi yCo-17
IOl4-2Q21 Il-ltlI-21lO3 UllOM I uCi CJ CIII 000 100 0000000 aCi y2 C-131
7111lQ-l 11(11-2003 4213419 aCi 107 OM 0110 100 COOOO6O aCi y3 Cs-137
4 0 14Ill~91 12(11-2009 LI09mCi 4) CPM 000 100 0000000 aCi y
ThD RcpJri iadieatts mat alillDove sealed SODIUS ban PASSE)) a LakTest Removed Acttrity ltIt soarCH-1S ~ ooos -alRClSTATE Trigpr Limit
IlSO SigcaItle lt 113 TeclmologistSignature ~
en N o o C N N Page 1 of 1g
(utland Heart Center - 6 Commons Nudear Medicine DepartmentS o ~NniS- -~~ 6 Commons Street Rutland Vermont o -- shy0 Lic 44 se881 8~ l-i - 11 J -z 1- 0 I --N ltxI) f0 i -j
July 01 2011 Tesl Date a Time 87-01-2011 1416 Teehllologist PAUL WAITE
II Cftemical NQIe MaoufadlJrer Model SeriaJtI Localioo CaLDak CaLAdivitv Carrot Act Prtsent iIN
Co-Y7 Eckm aud Ziegler- 1366-42-9 HOT LAB 12-01middot2009 52140 mCi 11949 lOCi Y
2 CS-U7 LPL 1014-20-21 HOT LAB 1l-01-1C03 1730000 uCi 1492S61 uCi Y
3 Cs -1l7 LPL 78~3 HOT LAB 12-01-2003 5000000 j 4200SIl nCi Y~ ~
4 Co-S7 EclIIrt and Ziegfa 1402-091 HOT LAB 12-01-2009 U()OO mCi 11UI8 mCi Y
S (() - S7 Eckm aIId Ziegllaquo 1500-160 HOT LAB O1-O1middotl() It 100000 lnCi 1002515 mCi Y
~- ~- ~- ---~ -_ _ - - - - ~
The Above Report iodicates all of the Sea
RSO Sigoature TeclmoJogist Signature 1
~ 0 shy
shy ~ N
sect N
Page 1 of 1
- bull rutland Heart Center -1 Commons bull NucfearMedicine Departmente 1 Commons Street Rutland Vennont ---o ~
Lic1I 14181-amp1 lilt- -II L i -0 ( J r)Cf)nz -gt------Jyty01 2011 - ___-- ---- shy
Test Date Time O7o1-ltIll D58 Tedmologlst PAlIL W AITJ
I 0HaIImlN_ MaWlllEi MaCJa smI8 LoaIIrm OdnIe Cd~ cmut Ad lnIaItYIN
05-137 LPL 114--3l-3 HOT LAB 03-01middot2006 2OO~OOO uCi l77374Q uct Y
1 Co- 57 ECKERT ZIEGLER 1366-3-12 HOTLAB 03-(11middot2009 547SO mCi 06210 mCi Y
3 Qsmiddot137 LP1 Ull-3-7 HafLAB 03-01middot2006 OQ909 uCi 00804 uCi y
~ 4 Co- 57 LP1 1436-l22 HOT LAB 06-01middot2010 100000 mCi 36504 mCi Y
The AlKwe Reportin bave beeo aaouated for Technologist Signature ~
~-Ilt 71nlll
o ~ o o pound Nmiddot N
~ Page 1 of
3
_c~ J-kliz1 Q~pounde oor Nuclear Medicine Departmento N 1 Common StJeet Rutland Vermont q ---shyQ We 44 jjBa1J~ i-t-l_ -I 1-- cJ I Lf A-lt c _APriL01 2011
Sealed Sources Leak Test Report
late Range 04-01middot2011 thN 04-01-2011 DIID Madel swt Camp DIIdI 01 Ad PnIIIcIM A4 Ad 111- TId- ClluliallName
1no11 01middot137 1145-31-3 03-01-2006 2OOlOuCi 118j8 aCi zaOOCPM 0000000 uCi Y PW
~ CA-YI 1366-3-12 03-01-2009 S47mCi O78mCi Z700CPM OOQQOOO ua y PW
01 - 137 O08UCi 2900CPW 0000001 uCi Y PW1I31-3-7 03-01-2006 Oll9uCi
Co-7 4 59mCi zaooCPM 0000000 uCi Y PW1436-121 06-014010 lOOOmCi
fiutrmIIfIIt DetaiII
Instrument Manufacturer Next Cal Date Serial NQ Efficiency CPPRAC Caplnt~ 001715 10000
bis Report indicates that all above sealed SIlIIIOCS bave PASSED aLeakTest emovecI Adivity1Qr SOOItlfS was below the 0005 uCi NRClSTATE TriggerLimit
redllafonatiia
TedllDitbls OmpJete Name
PW PAULWAlTE
o ~~~ eclmo1ogist Siguatun
N
f~ j(5Jo t Nmiddot
~ Page 1 of1
09222011 1030 (f~) P013014
Rutland Heart Center 8 Commons Nuclear Medicine Department
~R6Ple8t~~ftWnd Vermont ~ Cc)rfft1GN5 Lic~ 1--1- Id-o (
vf Source Co~S7 ManuflSupp Eckert and Ziegler Cal Dote 1210112009 Cal Act S2140mCi Is Souroe In Use Yes Tech TK
f1Comment
Source ClImiddot 137 M811uflSUpp TPL Cal Date 030112006 Cal Act 2005000 uCi Is $OU1ce [n Use No Teoh PW
J3comment
Source Co- 57 ManuflSupp Eckert and Ziegler Cal Date 030112009 Cal Act 540 mCi Is Source In Use No Tech PW
Comment
Soutee Cs shy 137 ManuflSupp lPL Cal Date 031212006 Cal Act 00909 uCi Is Souree In Use Yes Tech PW
~omment 5 Souree Co - 57 MmtuflSupp IPL Cal Date 06012010 Cal Act lOOOOOmCi Is Source In Use No Tech PW CCllnmcnt
vfi Source Cs - 137 ManufSupp IPL Cal Date 110112003 Cal Act t7S0000 uCi Is SOluce In Use Yes fech TK Comment
September 21 2011 -~--- ~
Sealed Sources Database File t~ tXI)rceJ
Name VIAL REFERENCE SOURCE SerlD 1366-429 Model Put Dille LocatIon HOT LAB Current 09654 mCi HL 27100 days
Name VIAL REFERENCE SOURCE SerID 1 1145-31middot3 Model II Pur Date Loation HOT LAB Current 1764453 uCi HL 1101200 days
Name VIAL REFERENCE SOURCE ScrJlD 1366312 Model Pur Date Location HOT LAB Cunent 05017 mCi HL 27100 days
Name ROD SOURCE ScrID 11313-7 Model Pur Date Location HOT LAB Current 00800 uCi HL 1101200 days
Name FrLOOD SOURCE SerID 1436122 ModelN Pur Date Location HOT LAB Current 29492 mCi HL 27100 days
Name VIAL REFERENCE SOURCE ScrID 1014-20-21 Model It Pur Date Location HOT LAB Current middot484747 uCi HL 1101200 days
Page 1 of2
09222011 1031 (f~ P014014
Rutland Heart Center bull ~ I) c()II) tJ 5 Nuclear Medicine Department
Sealed Sources Database File -~_M__
J Source CS - 137 Nanle ROD SOURCE MMUflSupp IPL SerID 780w68w3 Model Cal Date 120112003 Pur Date Lotlltlon HOT LAB Cal Act SOOOOOO nCi CUII-ent 4178520 nCi HL 1101200 days Is Source In Use No Tech TK Comment
viS SOUICO Co-57 Name FLOOD SOURCE ManuUSupp Eckert and Ziegler SerID II 1402-091 Model Cal Dato 120112009 Pur Datc Location HOT LAB Cal Act 7S000mCi Current 13887 mCi HL 27100 days Is Source In Usc Yes rcch MJS
comment 9 Source Co- 57 Name FLOOD SOURCE ManuflSupp Eckert and Ziegler SarID Ii 1500middot160 ModeJ Cal Date 0710112011 Pur Date Location HOT LAB Cal Act 100000 mCi Currenl 80998 mCi HL 27100 days Is Source In Use Yes Tech SLS Comment
Note Allterisk() indicates that there is a Memo for that Sealed Source
Page 2of2
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
(utland Heart Center - 6 Commons Nudear Medicine DepartmentS o ~NniS- -~~ 6 Commons Street Rutland Vermont o -- shy0 Lic 44 se881 8~ l-i - 11 J -z 1- 0 I --N ltxI) f0 i -j
July 01 2011 Tesl Date a Time 87-01-2011 1416 Teehllologist PAUL WAITE
II Cftemical NQIe MaoufadlJrer Model SeriaJtI Localioo CaLDak CaLAdivitv Carrot Act Prtsent iIN
Co-Y7 Eckm aud Ziegler- 1366-42-9 HOT LAB 12-01middot2009 52140 mCi 11949 lOCi Y
2 CS-U7 LPL 1014-20-21 HOT LAB 1l-01-1C03 1730000 uCi 1492S61 uCi Y
3 Cs -1l7 LPL 78~3 HOT LAB 12-01-2003 5000000 j 4200SIl nCi Y~ ~
4 Co-S7 EclIIrt and Ziegfa 1402-091 HOT LAB 12-01-2009 U()OO mCi 11UI8 mCi Y
S (() - S7 Eckm aIId Ziegllaquo 1500-160 HOT LAB O1-O1middotl() It 100000 lnCi 1002515 mCi Y
~- ~- ~- ---~ -_ _ - - - - ~
The Above Report iodicates all of the Sea
RSO Sigoature TeclmoJogist Signature 1
~ 0 shy
shy ~ N
sect N
Page 1 of 1
- bull rutland Heart Center -1 Commons bull NucfearMedicine Departmente 1 Commons Street Rutland Vennont ---o ~
Lic1I 14181-amp1 lilt- -II L i -0 ( J r)Cf)nz -gt------Jyty01 2011 - ___-- ---- shy
Test Date Time O7o1-ltIll D58 Tedmologlst PAlIL W AITJ
I 0HaIImlN_ MaWlllEi MaCJa smI8 LoaIIrm OdnIe Cd~ cmut Ad lnIaItYIN
05-137 LPL 114--3l-3 HOT LAB 03-01middot2006 2OO~OOO uCi l77374Q uct Y
1 Co- 57 ECKERT ZIEGLER 1366-3-12 HOTLAB 03-(11middot2009 547SO mCi 06210 mCi Y
3 Qsmiddot137 LP1 Ull-3-7 HafLAB 03-01middot2006 OQ909 uCi 00804 uCi y
~ 4 Co- 57 LP1 1436-l22 HOT LAB 06-01middot2010 100000 mCi 36504 mCi Y
The AlKwe Reportin bave beeo aaouated for Technologist Signature ~
~-Ilt 71nlll
o ~ o o pound Nmiddot N
~ Page 1 of
3
_c~ J-kliz1 Q~pounde oor Nuclear Medicine Departmento N 1 Common StJeet Rutland Vermont q ---shyQ We 44 jjBa1J~ i-t-l_ -I 1-- cJ I Lf A-lt c _APriL01 2011
Sealed Sources Leak Test Report
late Range 04-01middot2011 thN 04-01-2011 DIID Madel swt Camp DIIdI 01 Ad PnIIIcIM A4 Ad 111- TId- ClluliallName
1no11 01middot137 1145-31-3 03-01-2006 2OOlOuCi 118j8 aCi zaOOCPM 0000000 uCi Y PW
~ CA-YI 1366-3-12 03-01-2009 S47mCi O78mCi Z700CPM OOQQOOO ua y PW
01 - 137 O08UCi 2900CPW 0000001 uCi Y PW1I31-3-7 03-01-2006 Oll9uCi
Co-7 4 59mCi zaooCPM 0000000 uCi Y PW1436-121 06-014010 lOOOmCi
fiutrmIIfIIt DetaiII
Instrument Manufacturer Next Cal Date Serial NQ Efficiency CPPRAC Caplnt~ 001715 10000
bis Report indicates that all above sealed SIlIIIOCS bave PASSED aLeakTest emovecI Adivity1Qr SOOItlfS was below the 0005 uCi NRClSTATE TriggerLimit
redllafonatiia
TedllDitbls OmpJete Name
PW PAULWAlTE
o ~~~ eclmo1ogist Siguatun
N
f~ j(5Jo t Nmiddot
~ Page 1 of1
09222011 1030 (f~) P013014
Rutland Heart Center 8 Commons Nuclear Medicine Department
~R6Ple8t~~ftWnd Vermont ~ Cc)rfft1GN5 Lic~ 1--1- Id-o (
vf Source Co~S7 ManuflSupp Eckert and Ziegler Cal Dote 1210112009 Cal Act S2140mCi Is Souroe In Use Yes Tech TK
f1Comment
Source ClImiddot 137 M811uflSUpp TPL Cal Date 030112006 Cal Act 2005000 uCi Is $OU1ce [n Use No Teoh PW
J3comment
Source Co- 57 ManuflSupp Eckert and Ziegler Cal Date 030112009 Cal Act 540 mCi Is Source In Use No Tech PW
Comment
Soutee Cs shy 137 ManuflSupp lPL Cal Date 031212006 Cal Act 00909 uCi Is Souree In Use Yes Tech PW
~omment 5 Souree Co - 57 MmtuflSupp IPL Cal Date 06012010 Cal Act lOOOOOmCi Is Source In Use No Tech PW CCllnmcnt
vfi Source Cs - 137 ManufSupp IPL Cal Date 110112003 Cal Act t7S0000 uCi Is SOluce In Use Yes fech TK Comment
September 21 2011 -~--- ~
Sealed Sources Database File t~ tXI)rceJ
Name VIAL REFERENCE SOURCE SerlD 1366-429 Model Put Dille LocatIon HOT LAB Current 09654 mCi HL 27100 days
Name VIAL REFERENCE SOURCE SerID 1 1145-31middot3 Model II Pur Date Loation HOT LAB Current 1764453 uCi HL 1101200 days
Name VIAL REFERENCE SOURCE ScrJlD 1366312 Model Pur Date Location HOT LAB Cunent 05017 mCi HL 27100 days
Name ROD SOURCE ScrID 11313-7 Model Pur Date Location HOT LAB Current 00800 uCi HL 1101200 days
Name FrLOOD SOURCE SerID 1436122 ModelN Pur Date Location HOT LAB Current 29492 mCi HL 27100 days
Name VIAL REFERENCE SOURCE ScrID 1014-20-21 Model It Pur Date Location HOT LAB Current middot484747 uCi HL 1101200 days
Page 1 of2
09222011 1031 (f~ P014014
Rutland Heart Center bull ~ I) c()II) tJ 5 Nuclear Medicine Department
Sealed Sources Database File -~_M__
J Source CS - 137 Nanle ROD SOURCE MMUflSupp IPL SerID 780w68w3 Model Cal Date 120112003 Pur Date Lotlltlon HOT LAB Cal Act SOOOOOO nCi CUII-ent 4178520 nCi HL 1101200 days Is Source In Use No Tech TK Comment
viS SOUICO Co-57 Name FLOOD SOURCE ManuUSupp Eckert and Ziegler SerID II 1402-091 Model Cal Dato 120112009 Pur Datc Location HOT LAB Cal Act 7S000mCi Current 13887 mCi HL 27100 days Is Source In Usc Yes rcch MJS
comment 9 Source Co- 57 Name FLOOD SOURCE ManuflSupp Eckert and Ziegler SarID Ii 1500middot160 ModeJ Cal Date 0710112011 Pur Date Location HOT LAB Cal Act 100000 mCi Currenl 80998 mCi HL 27100 days Is Source In Use Yes Tech SLS Comment
Note Allterisk() indicates that there is a Memo for that Sealed Source
Page 2of2
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
- bull rutland Heart Center -1 Commons bull NucfearMedicine Departmente 1 Commons Street Rutland Vennont ---o ~
Lic1I 14181-amp1 lilt- -II L i -0 ( J r)Cf)nz -gt------Jyty01 2011 - ___-- ---- shy
Test Date Time O7o1-ltIll D58 Tedmologlst PAlIL W AITJ
I 0HaIImlN_ MaWlllEi MaCJa smI8 LoaIIrm OdnIe Cd~ cmut Ad lnIaItYIN
05-137 LPL 114--3l-3 HOT LAB 03-01middot2006 2OO~OOO uCi l77374Q uct Y
1 Co- 57 ECKERT ZIEGLER 1366-3-12 HOTLAB 03-(11middot2009 547SO mCi 06210 mCi Y
3 Qsmiddot137 LP1 Ull-3-7 HafLAB 03-01middot2006 OQ909 uCi 00804 uCi y
~ 4 Co- 57 LP1 1436-l22 HOT LAB 06-01middot2010 100000 mCi 36504 mCi Y
The AlKwe Reportin bave beeo aaouated for Technologist Signature ~
~-Ilt 71nlll
o ~ o o pound Nmiddot N
~ Page 1 of
3
_c~ J-kliz1 Q~pounde oor Nuclear Medicine Departmento N 1 Common StJeet Rutland Vermont q ---shyQ We 44 jjBa1J~ i-t-l_ -I 1-- cJ I Lf A-lt c _APriL01 2011
Sealed Sources Leak Test Report
late Range 04-01middot2011 thN 04-01-2011 DIID Madel swt Camp DIIdI 01 Ad PnIIIcIM A4 Ad 111- TId- ClluliallName
1no11 01middot137 1145-31-3 03-01-2006 2OOlOuCi 118j8 aCi zaOOCPM 0000000 uCi Y PW
~ CA-YI 1366-3-12 03-01-2009 S47mCi O78mCi Z700CPM OOQQOOO ua y PW
01 - 137 O08UCi 2900CPW 0000001 uCi Y PW1I31-3-7 03-01-2006 Oll9uCi
Co-7 4 59mCi zaooCPM 0000000 uCi Y PW1436-121 06-014010 lOOOmCi
fiutrmIIfIIt DetaiII
Instrument Manufacturer Next Cal Date Serial NQ Efficiency CPPRAC Caplnt~ 001715 10000
bis Report indicates that all above sealed SIlIIIOCS bave PASSED aLeakTest emovecI Adivity1Qr SOOItlfS was below the 0005 uCi NRClSTATE TriggerLimit
redllafonatiia
TedllDitbls OmpJete Name
PW PAULWAlTE
o ~~~ eclmo1ogist Siguatun
N
f~ j(5Jo t Nmiddot
~ Page 1 of1
09222011 1030 (f~) P013014
Rutland Heart Center 8 Commons Nuclear Medicine Department
~R6Ple8t~~ftWnd Vermont ~ Cc)rfft1GN5 Lic~ 1--1- Id-o (
vf Source Co~S7 ManuflSupp Eckert and Ziegler Cal Dote 1210112009 Cal Act S2140mCi Is Souroe In Use Yes Tech TK
f1Comment
Source ClImiddot 137 M811uflSUpp TPL Cal Date 030112006 Cal Act 2005000 uCi Is $OU1ce [n Use No Teoh PW
J3comment
Source Co- 57 ManuflSupp Eckert and Ziegler Cal Date 030112009 Cal Act 540 mCi Is Source In Use No Tech PW
Comment
Soutee Cs shy 137 ManuflSupp lPL Cal Date 031212006 Cal Act 00909 uCi Is Souree In Use Yes Tech PW
~omment 5 Souree Co - 57 MmtuflSupp IPL Cal Date 06012010 Cal Act lOOOOOmCi Is Source In Use No Tech PW CCllnmcnt
vfi Source Cs - 137 ManufSupp IPL Cal Date 110112003 Cal Act t7S0000 uCi Is SOluce In Use Yes fech TK Comment
September 21 2011 -~--- ~
Sealed Sources Database File t~ tXI)rceJ
Name VIAL REFERENCE SOURCE SerlD 1366-429 Model Put Dille LocatIon HOT LAB Current 09654 mCi HL 27100 days
Name VIAL REFERENCE SOURCE SerID 1 1145-31middot3 Model II Pur Date Loation HOT LAB Current 1764453 uCi HL 1101200 days
Name VIAL REFERENCE SOURCE ScrJlD 1366312 Model Pur Date Location HOT LAB Cunent 05017 mCi HL 27100 days
Name ROD SOURCE ScrID 11313-7 Model Pur Date Location HOT LAB Current 00800 uCi HL 1101200 days
Name FrLOOD SOURCE SerID 1436122 ModelN Pur Date Location HOT LAB Current 29492 mCi HL 27100 days
Name VIAL REFERENCE SOURCE ScrID 1014-20-21 Model It Pur Date Location HOT LAB Current middot484747 uCi HL 1101200 days
Page 1 of2
09222011 1031 (f~ P014014
Rutland Heart Center bull ~ I) c()II) tJ 5 Nuclear Medicine Department
Sealed Sources Database File -~_M__
J Source CS - 137 Nanle ROD SOURCE MMUflSupp IPL SerID 780w68w3 Model Cal Date 120112003 Pur Date Lotlltlon HOT LAB Cal Act SOOOOOO nCi CUII-ent 4178520 nCi HL 1101200 days Is Source In Use No Tech TK Comment
viS SOUICO Co-57 Name FLOOD SOURCE ManuUSupp Eckert and Ziegler SerID II 1402-091 Model Cal Dato 120112009 Pur Datc Location HOT LAB Cal Act 7S000mCi Current 13887 mCi HL 27100 days Is Source In Usc Yes rcch MJS
comment 9 Source Co- 57 Name FLOOD SOURCE ManuflSupp Eckert and Ziegler SarID Ii 1500middot160 ModeJ Cal Date 0710112011 Pur Date Location HOT LAB Cal Act 100000 mCi Currenl 80998 mCi HL 27100 days Is Source In Use Yes Tech SLS Comment
Note Allterisk() indicates that there is a Memo for that Sealed Source
Page 2of2
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
3
_c~ J-kliz1 Q~pounde oor Nuclear Medicine Departmento N 1 Common StJeet Rutland Vermont q ---shyQ We 44 jjBa1J~ i-t-l_ -I 1-- cJ I Lf A-lt c _APriL01 2011
Sealed Sources Leak Test Report
late Range 04-01middot2011 thN 04-01-2011 DIID Madel swt Camp DIIdI 01 Ad PnIIIcIM A4 Ad 111- TId- ClluliallName
1no11 01middot137 1145-31-3 03-01-2006 2OOlOuCi 118j8 aCi zaOOCPM 0000000 uCi Y PW
~ CA-YI 1366-3-12 03-01-2009 S47mCi O78mCi Z700CPM OOQQOOO ua y PW
01 - 137 O08UCi 2900CPW 0000001 uCi Y PW1I31-3-7 03-01-2006 Oll9uCi
Co-7 4 59mCi zaooCPM 0000000 uCi Y PW1436-121 06-014010 lOOOmCi
fiutrmIIfIIt DetaiII
Instrument Manufacturer Next Cal Date Serial NQ Efficiency CPPRAC Caplnt~ 001715 10000
bis Report indicates that all above sealed SIlIIIOCS bave PASSED aLeakTest emovecI Adivity1Qr SOOItlfS was below the 0005 uCi NRClSTATE TriggerLimit
redllafonatiia
TedllDitbls OmpJete Name
PW PAULWAlTE
o ~~~ eclmo1ogist Siguatun
N
f~ j(5Jo t Nmiddot
~ Page 1 of1
09222011 1030 (f~) P013014
Rutland Heart Center 8 Commons Nuclear Medicine Department
~R6Ple8t~~ftWnd Vermont ~ Cc)rfft1GN5 Lic~ 1--1- Id-o (
vf Source Co~S7 ManuflSupp Eckert and Ziegler Cal Dote 1210112009 Cal Act S2140mCi Is Souroe In Use Yes Tech TK
f1Comment
Source ClImiddot 137 M811uflSUpp TPL Cal Date 030112006 Cal Act 2005000 uCi Is $OU1ce [n Use No Teoh PW
J3comment
Source Co- 57 ManuflSupp Eckert and Ziegler Cal Date 030112009 Cal Act 540 mCi Is Source In Use No Tech PW
Comment
Soutee Cs shy 137 ManuflSupp lPL Cal Date 031212006 Cal Act 00909 uCi Is Souree In Use Yes Tech PW
~omment 5 Souree Co - 57 MmtuflSupp IPL Cal Date 06012010 Cal Act lOOOOOmCi Is Source In Use No Tech PW CCllnmcnt
vfi Source Cs - 137 ManufSupp IPL Cal Date 110112003 Cal Act t7S0000 uCi Is SOluce In Use Yes fech TK Comment
September 21 2011 -~--- ~
Sealed Sources Database File t~ tXI)rceJ
Name VIAL REFERENCE SOURCE SerlD 1366-429 Model Put Dille LocatIon HOT LAB Current 09654 mCi HL 27100 days
Name VIAL REFERENCE SOURCE SerID 1 1145-31middot3 Model II Pur Date Loation HOT LAB Current 1764453 uCi HL 1101200 days
Name VIAL REFERENCE SOURCE ScrJlD 1366312 Model Pur Date Location HOT LAB Cunent 05017 mCi HL 27100 days
Name ROD SOURCE ScrID 11313-7 Model Pur Date Location HOT LAB Current 00800 uCi HL 1101200 days
Name FrLOOD SOURCE SerID 1436122 ModelN Pur Date Location HOT LAB Current 29492 mCi HL 27100 days
Name VIAL REFERENCE SOURCE ScrID 1014-20-21 Model It Pur Date Location HOT LAB Current middot484747 uCi HL 1101200 days
Page 1 of2
09222011 1031 (f~ P014014
Rutland Heart Center bull ~ I) c()II) tJ 5 Nuclear Medicine Department
Sealed Sources Database File -~_M__
J Source CS - 137 Nanle ROD SOURCE MMUflSupp IPL SerID 780w68w3 Model Cal Date 120112003 Pur Date Lotlltlon HOT LAB Cal Act SOOOOOO nCi CUII-ent 4178520 nCi HL 1101200 days Is Source In Use No Tech TK Comment
viS SOUICO Co-57 Name FLOOD SOURCE ManuUSupp Eckert and Ziegler SerID II 1402-091 Model Cal Dato 120112009 Pur Datc Location HOT LAB Cal Act 7S000mCi Current 13887 mCi HL 27100 days Is Source In Usc Yes rcch MJS
comment 9 Source Co- 57 Name FLOOD SOURCE ManuflSupp Eckert and Ziegler SarID Ii 1500middot160 ModeJ Cal Date 0710112011 Pur Date Location HOT LAB Cal Act 100000 mCi Currenl 80998 mCi HL 27100 days Is Source In Use Yes Tech SLS Comment
Note Allterisk() indicates that there is a Memo for that Sealed Source
Page 2of2
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
09222011 1030 (f~) P013014
Rutland Heart Center 8 Commons Nuclear Medicine Department
~R6Ple8t~~ftWnd Vermont ~ Cc)rfft1GN5 Lic~ 1--1- Id-o (
vf Source Co~S7 ManuflSupp Eckert and Ziegler Cal Dote 1210112009 Cal Act S2140mCi Is Souroe In Use Yes Tech TK
f1Comment
Source ClImiddot 137 M811uflSUpp TPL Cal Date 030112006 Cal Act 2005000 uCi Is $OU1ce [n Use No Teoh PW
J3comment
Source Co- 57 ManuflSupp Eckert and Ziegler Cal Date 030112009 Cal Act 540 mCi Is Source In Use No Tech PW
Comment
Soutee Cs shy 137 ManuflSupp lPL Cal Date 031212006 Cal Act 00909 uCi Is Souree In Use Yes Tech PW
~omment 5 Souree Co - 57 MmtuflSupp IPL Cal Date 06012010 Cal Act lOOOOOmCi Is Source In Use No Tech PW CCllnmcnt
vfi Source Cs - 137 ManufSupp IPL Cal Date 110112003 Cal Act t7S0000 uCi Is SOluce In Use Yes fech TK Comment
September 21 2011 -~--- ~
Sealed Sources Database File t~ tXI)rceJ
Name VIAL REFERENCE SOURCE SerlD 1366-429 Model Put Dille LocatIon HOT LAB Current 09654 mCi HL 27100 days
Name VIAL REFERENCE SOURCE SerID 1 1145-31middot3 Model II Pur Date Loation HOT LAB Current 1764453 uCi HL 1101200 days
Name VIAL REFERENCE SOURCE ScrJlD 1366312 Model Pur Date Location HOT LAB Cunent 05017 mCi HL 27100 days
Name ROD SOURCE ScrID 11313-7 Model Pur Date Location HOT LAB Current 00800 uCi HL 1101200 days
Name FrLOOD SOURCE SerID 1436122 ModelN Pur Date Location HOT LAB Current 29492 mCi HL 27100 days
Name VIAL REFERENCE SOURCE ScrID 1014-20-21 Model It Pur Date Location HOT LAB Current middot484747 uCi HL 1101200 days
Page 1 of2
09222011 1031 (f~ P014014
Rutland Heart Center bull ~ I) c()II) tJ 5 Nuclear Medicine Department
Sealed Sources Database File -~_M__
J Source CS - 137 Nanle ROD SOURCE MMUflSupp IPL SerID 780w68w3 Model Cal Date 120112003 Pur Date Lotlltlon HOT LAB Cal Act SOOOOOO nCi CUII-ent 4178520 nCi HL 1101200 days Is Source In Use No Tech TK Comment
viS SOUICO Co-57 Name FLOOD SOURCE ManuUSupp Eckert and Ziegler SerID II 1402-091 Model Cal Dato 120112009 Pur Datc Location HOT LAB Cal Act 7S000mCi Current 13887 mCi HL 27100 days Is Source In Usc Yes rcch MJS
comment 9 Source Co- 57 Name FLOOD SOURCE ManuflSupp Eckert and Ziegler SarID Ii 1500middot160 ModeJ Cal Date 0710112011 Pur Date Location HOT LAB Cal Act 100000 mCi Currenl 80998 mCi HL 27100 days Is Source In Use Yes Tech SLS Comment
Note Allterisk() indicates that there is a Memo for that Sealed Source
Page 2of2
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
09222011 1031 (f~ P014014
Rutland Heart Center bull ~ I) c()II) tJ 5 Nuclear Medicine Department
Sealed Sources Database File -~_M__
J Source CS - 137 Nanle ROD SOURCE MMUflSupp IPL SerID 780w68w3 Model Cal Date 120112003 Pur Date Lotlltlon HOT LAB Cal Act SOOOOOO nCi CUII-ent 4178520 nCi HL 1101200 days Is Source In Use No Tech TK Comment
viS SOUICO Co-57 Name FLOOD SOURCE ManuUSupp Eckert and Ziegler SerID II 1402-091 Model Cal Dato 120112009 Pur Datc Location HOT LAB Cal Act 7S000mCi Current 13887 mCi HL 27100 days Is Source In Usc Yes rcch MJS
comment 9 Source Co- 57 Name FLOOD SOURCE ManuflSupp Eckert and Ziegler SarID Ii 1500middot160 ModeJ Cal Date 0710112011 Pur Date Location HOT LAB Cal Act 100000 mCi Currenl 80998 mCi HL 27100 days Is Source In Use Yes Tech SLS Comment
Note Allterisk() indicates that there is a Memo for that Sealed Source
Page 2of2
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
This is to acknowledge the receipt of yoUr~~pPliCatiOn dated
qflo IJo II and to inform you that the initial processing which
includA-~ adminViC~~ef~oi~0 t ) [j] There wettfdadministrative omissions Your application was assigned to a
technical reviewer Please note that the technical review may identify additional omissions or require additional information
D 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 FE~e amp Accounts Receivable Branch who will contact you separately if there is a fee issue involved
Your action has been assigned Mail Control Number 57 (0)7 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
