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53-03694-01 iMATERIALS LICENSE I
omei Ner.rena numw tSUPPLEMENTARY SHEET O 03543>
f,Amendment No. 13
Harvey K. Minatoya,inic,,Inc. -
|| M.D. Inc. *dba Minatoya Eye Cl|
l 1003 Pensacola Street !'
l' Honolulu, Hawaii 96814
$; In accordance with NRC Form 314 dated August 7, 1991 License No. 53-03694-01 is herebyterminated.
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8FOR THE U.S. NUCLEAR REGULATORY COMMISSION 8
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!,-Date 'By - N7%d Mmma hs.
l| Beth A. Frange1 Pi'
[l Sr..HealthPhWicist-(Licensing) #2
gl Nuclear Materials and I
h|p- Fuel Fabrication BranchI 91110s00e9 910B13 ' Region V- n1 REGS LIC30 ti NATLSLICENSING PDR
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Docket No.: 030-03543License No.: 53-03694-01Control No.: 571459
Harvey K. Minatoya, M.D., Inc.dba Minatoya Eye Clinic, Inc.1003 Pensacola StreetHonolulu, Hawaii 96814
Attention: Dr. Harvey Minatoya
Gentlemen:
~ Enclosed is'the termination amendment which you requested in your Form NRC-314dated August 7, 1991,
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Sincerely,
Beth A. PrangeSr. Health Ph.vsicist (:.icensing).Nuclear Materials and-
Fuel Fabrication Branch.
Enclosure:- As Stated.
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AUG 1 J 133|t
|' Distribution
bcc w/ original concurrence, copy of license and original correspondence:License docket folder
bec w/ copy of license and correspondence:Inspection folder
bec w/ copy of license:Reading file
bec w/ correspondence and 2 copies of license:Marnella Rodriguez, LFMB, MNBB 4503
License only:State of Hawaii
J. Montgomery D.Skov B. range/ / / / 5/l3/c//
REQUt51 COPY REQUt51 COPY RtQUt51 GQPV'' '
YES / NO YES / NO YES / (Q '__
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INFORMATION FROM)LTSBETWEEN: :; --------------------
License Fee Management Branch, ARM !ProgramCode:and 02210
: Status Code: 0Reptonal Licensing Sections : Fee Category: 7C; Exp. Date: 19930430: Fee Connents::::::::::::::::::::::::::0::::::::!Tf
' 7 1 CENSE FEC TRANSMITTALA. REGION
1. APPLICATION ATTACHED,
Applicant / Licensee: MINAT0YA. M.D., HARVEY, IhC.Received Date: 910807Docket ho: 3003543Control No.: 571459License No.: 53-03694-01Action Type: Termination
2. FEE ATTACHED j (T?MAmount:f
Cneck No.*_
3. COMMENTS'
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B. LICENSE FEE MANAGEMENT BRANCH (Check when mi estone 0.-
/ )1. Fee Category and Amount: YM N(2. Correct Fee Paid. Application n.ay be o d :Amendment s
Renewal ,
License w- ~ _
3. OTHER
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AUG 07 '91 01:45Pl1 M1t%TOYA EYE CLINIC P,1/6.
talNATOYA EYE CUNIC lHC RECEIVED-
1000 PEH5ACOLA ST. HOR HI 96814 ~ - .dIb C ' ' * , ,
PHONE: (808) 537 6151 / bbO!OII Y -'
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FACSIMILE TRANSMITTAI. .~ ~~~~ " " " " ,'.. .REQUEST
DATE: (*) 7 /'I91V,
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To: BJh %w _ _ _ _
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NUMBER OF PACES (INCLUDING COVER): b~~,
jlf 9 7I'06 SWFAX NUMBER:
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! SPECIAL INSTRUCTIONS:
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MINATOYA EYE CUNIC INC HARVEY K MINATOYA, MD., INC_ iCO3 PENSACOLA $7, HOH. Hi 96614 orH7HAtuotogy
August 7. 2991
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Ms. Beth P,rengeNuclear Regulatory ComissionFep, ion V
1450 Maria 1.une. Suita 210Vainut Creek. Califort.fa 94556-536J
Dear Ms. Prange
I at reque. sting to termin. Ate my USNRC license $53-03694-01 tota strontium-90 unit. The unit bne been transferred to Queen's, Hodical- -
Center. Il5FRC #53-16533-02.
_ t.nelored are material license. NRC 314. owitership transfer,ani latest leak test. Please let me know if you r.eed more information.
Sincerely.
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HarveyX.flinatoya.M.D.
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M ATERIALS LICENSE Amendtnent No.12 ]f Pursuant to the Atomic Energy Act of 1954, as arntnded, the Energy Rentganintion Act of 1974 (Pubtw Law 03 4310.and Title 10. ,Ig pg Code af federal Regulations. Chapter 1 Parts 30,31. 32,33,34,35,40 and 70, and in rehance on statements and repraentinoni i
'gq heretofore maf: by the hcensee, a heense is hereby istutd authunneg tt.e ll:enset to receite, acquire, possess, and transfer byproduct.4. Source, and epecial nalent material dit4nated below; to use such materitt fur the purpost(s) and at the p' ace (s) designate.' helow;to 
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R G 07 891 01:49Pt1 f11ti4TOYA bt CLiiilC P. PG, _
RADIOACTIVE MATERIALTEMlSIER OF OVllIRSlllE
Sourcet Tracerlab Strontium-90 Eye ApplicatorModel RA-1A, Sarlal Number 92450 nel nominal activity on 4-29-65
Froto t Harvey Hinatoyn, M.D.1003 Pennacola St.lionolulu, III 96814USNRC Licensa Ho. 53-03694+01
To The Queen's Medical Contor1301 Punchbowl StreetHonolulu, HI 96013UGHRC License No. 53-16533-02
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Datat Augeat 7, 1991
| < nN(lh% VhD(%b tb &~
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liarvey Mind,toya, M.D.\ scott D 5o, M.S.~Radiation Safety officerThe Queer.'s Medical Center
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hJG 07 891 04 15081 tillAlOYA C tt CLINIC P' 3' ~2
RADIATION DETECTION COMPANY M102 Wolfe Road e P.O. Don 1414 o Sunnyvale California 940C8 o (408)735 8700s /
PADIOACTIVE SOURCE LEAK TEST REPORT
REPORT NUMBER 30
m
W.T. Hinatoya. MD'
MADE FOR: 1003 Pensacola Stroet PURCHASE ORDER #Honolulu, HI 90814
,lho.following sample was submitted to Radiation Detection Company foranalysin.
NANOCURIES*RDC No. ISOTOPE ACTIVITY MODEL NO. SERIAL NO. ALPHA BETA-GAMMA. .. ....... ........_ . .. .. .... __ ___ . . . . _ _ . . . .
130435 Sr-90< 0.005
%
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GOURCE NUMBER none IS cot 4SIDERED TO BE LEAKING, '
c The presence of less than 5 nanocuries (0.006 microcuries) ofremovable contamination from leak tests is acceptable to theDepartment of Health, State of California and the NRC.
f $f/ JJALenald C. Shepley [
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w Lcboratory Director
DCS/dde2/14/91
-seawesis ovuaoouct3* ra -ow-ce we.n
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