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[This text is machine generated and may contain errors.]
January 3, 1965
TO: DR. ALFRED C. SCHRAM
MR. ERNEST CARLSON
DR. ABSALON
FROM: DR. ALFRED A. KRAUS, JR.
We are in the process of amending our license
for radloactive materials. We would like te have your
name included as one of these who can assume primery
responsibliity for the handling of these materials. tn
order to have your name Included we need some Information
about you. Please find enclosed a copy of TRC Form 41-2.
We would appreciate it if you would Iaciude the data
requested on the top of the page having te do with your
training end experiance,
A list of the Isotopes we are interested In
handilng Is given below. Please comment about the advise-
ablitty of any other additions. if possible, we would I tke
the forms returned by January 18.
TRC FORM 41-2
(3 - 64)
TEXAS STATE DEPARTMENT OF HEALTH
APPLICATION FOR RADIOACTIVE MATERIAL LICENSE
INSTRUCTIONS - Complete Items 1 through 16 if this is an initial application. If application is for renewal of a license, complete
only Items 1 through 7 and indicate new information or changes in the program as requested in Items 8 through 15. Use supple-
mental sheets where necessory. Item 16 must be completed on all applications. Mail two copies to: Texas State Department of
Health, Division of Occupationc! Health and Radiotion Control, 1100 West 49th Street, Austin, Texas 78756. Upon approval of this
applicotion, the applicant will receive a Texas Radioactive Materia! License, issued in accordance with the general requirements
contained in Texas State Department of Health regulations on radiotion and the Texas Radiation Control Act.
1. (a) NAME AND STREET ADDRESS OF APPLICANT. (Institution,
firm, hespital, person, etc.)
West Texas State University
Canyon, Texas
(b) LOCATION(S) AT WHICH RADIOACTIVE MATERIAL WILL
BE USED. (If different from 1 (a).)
Science Building
Room 117
2. DEPARTMENT TO USE RADIOACTIVE MATERIAL
Physics, Chemistry and Biology
3. PREVIOUS LICENSE NUMBER(S). (If this is an application
for renewal of a license, please indicate and give number.)
1-583 and 1-584
4. INDIVIDUAL USER(S). (Name and title of individual(s) who will
use or directly supervise use of radioactive materials. Give
training and experience in Items 8 and 9).
Alfred A, Kraus, Jr.
Alfred C. Schram
Ernest R, Carlson
5. RADIATION PROTECTION OFFICER (Name of person desig-
nated as radiation protection officer if other than individual
user. Attach resume of his training and experience as in
Items 8 and 9.)
Alfred A. Kraus, Jr.
6. (a) RADIOACTIVE MATERIAL | (b) CHEMICAL AND/OR | (c) NUMBER OF MILLICURIES OF EACH FORM
(element and mass number) | PHYSICAL FORM | THAT YOU WILL POSSESS AT ANY ONE TIME.
Hydrogen 3 | Any | 25
Carbon 14 | Any | 25
Sodium 22 | Any | 25
Manganese 54 | Any | 25
Cobalt 57 | Any | 25
Cobalt 60 | Any | 25
Iodine 131 | Any | 100
Barium 133 | Any | 25
Cesium 137 | Any | 25
Cerium 139 | Any | 50
Polonium 210 | Any | 25
Thorium 228 | Any | 25
7. DESCRIBE PURPOSE FOR WHICH RADIOACTIVE MATERIAL WILL BE USED. (If radioactive material is for "human use," Supplement A
(TRC FORM 41- 2a) must be completed in lieu of this Item. If radioactive material is In the form of sealed sources, include the make and
mode! number of the storage container and/or device in which the source will be stored and/or used).
To fabricate small sources (approx. 50 uc) for instructional purposes
Low temperature nuclear physics research (adiabadic demagnetization to produce nuclear
orientation)
Chemical reaction kinetics, perhaps in (non-human) biological systems
Tracer techniques in (non-human) biological systems
Experiments in a radio-chemistry course (such as Cs!37. Bal3? separation).
TRC FORM 41-2
Page Two
TRAINING AND EXPERIENCE OF EACH INDIVIDUAL NAMED IN ITEM 4 (Use supplemental sheets if necessary)
8. TYPE OF TRAINING | WHERE TRAINED | DURATION OF TRAINING | ON THE JOB (Circle answer) | FORMAL COURSE (Circle answer)
a. Principles and practices of radiation | Yes No | Yes No
protection
b. Radioactivity measurement standard- | Yes No | Yes No
ization and monitoring techniques and
instruments
c. Mathematics and calculations basic to | Yes No | Yes No
the use and measurement of radio-
activity
d. Biclogical effects of radiation | Yes No | Yes No
9. EXPERIENCE WITH RADIATION (Actual use of radioisotopes of equivalent experience.)
ISOTOPE | MAXIMUM AMOUNT | WHERE EXPERIENCE WAS GAINED | DURATION OF EXPERIENCE | TYPE OF USE
10. RADIATION DETECTION INSTRUMENTS (Use supplemental sheets if necessary.)
TYPE OF INSTRUMENTS (include make and model number of each) | NUMBER AVAILABLE | RADIATION DETECTED | SENSITIVITY RANGE (mr/hr) | WINDOW THICKNESS (mg/cm2) | USE (Monitoring, Surveying, measuring)
11. METHOD, FREQUENCY, AND STANDARDS USED IN CALIBRATING INSTRUMENTS LISTED ABOVE
12. LEAK TESTS. Submit leak testing procedures where applicable, name, training, and experience of person to perform leak tests and
arrangements for performing initial radiation survey, servicing, maintenance and repair of the source.
INFORMATION TO BE SUBMITTED ON ADDITIONAL SHEETS
13. FACILITIES AND EQUIPMENT. Describe laboratory facilities and remote handling equipment storage containers, shielding, fume hoods, etc.
Explanatory sketch of facility is attached (Circle answer) Yes No
14. RADIATION PROTECTION PROGRAM. Describe the radiation protection program including control measures. For film badges, specify
method of calibrating and processing, or name of supplier and arrangements for performing initial radiation survey, servicing, maintenance
and repair of the source.
15. WASTE DISPOSAL. If a commercial waste disposal service is employed, specify name of company. Otherwise, submit detailed description
of methods which will be used for disposing of radioactive wastes and estimates of the type and amount of activity involved.
CERTIFICATE
(This item must be completed by applicant)
16. THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATE ON BEHALF OF THE APPLICANT NAMED IN ITEM I,
CERTIFY THAT THIS APPLICATION IS PREPARED IN CONFORMITY WITH TEXAS STATE DEPARTMENT OF HEALTH REGULA-
TIONS ON RADIATION AND THAT ALL INFORMATION CONTAINED HEREIN, INCLUDING ANY SUPPLEMENTS ATTACHED HERETO,
IS TRUE AND CORRECT TO THE BEST OF OUR KNOWLEDGE AND BELIEF.
Applicant named in Item 1
Date
By:
Title of certifying official authorized to act on behalf of the applicant