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190, 35.290, and 35.590 APPROVED BY OMB: NO. 3150-0120 EXPIRES: (05/31/2015) State or Territory Where Licensed Name of Proposed Authorized User Requested Authorization(s) (check all that apply) 35.100 Uptake, dilution, and excretion studies 35.200 Imaging and localization studies 35.500 Sealed sources for diagnosis (specify device) PART I -- TRAINING AND EXPERIENCE (Select one of the three methods below) * Training and Experience, including board certification, must have been obtained with.

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