On December 15, 2021, the NRC issued a Notice of Violation to Mountain View Hospital (Licensee) for six violations. The violations consist of a Severity Level (SL) III problem associated with two (A+B) related violations and four SL IV violations (C-F). The violations involved the licensee’s failure to: (A) develop, implement, and maintain written procedures to provide high confidence that each administration is in accordance with the written directive as required by Title 10 of the Code of Federal Regulations (10 CFR) 35.41(a)(2); (B) maintain its radiation dose release criteria for individuals in accordance with 10 CFR 35.75(a); (C) retain a record of safety instructions provided to individuals caring for patients administered lutetium-177 (Lu-177) as required by 10 CFR 35.2310; (D) document radiation surveys to demonstrate that rooms used for Lu-177 patients could be released for unrestricted use in accordance with 10 CFR 20.2103(a); (E) meet discharge of Lu-177 contaminated materials in accordance with 10 CFR 20.2003(a)(1); and (F) label a Lu-177 radioactive waste storage container and its contents as required by 10 CFR 20.1904(a). Specifically, from September 4, 2018, to November 16, 2020, the licensee failed to develop, implement, and maintain written procedures for the administration of Lu-177 and on multiple occasions the licensee authorized the release of individuals who had been administered Lu-177, when their exposure of radiation dose to others was likely to exceed the licensee’s release criteria. Further, the licensee failed to retain a record of safety instructions, did not maintain records showing the results of the surveys of the contaminated areas, discharged Lu-177 contaminated wipes into the sanitary sewer that were not readily soluble in water or biological materials, and, finally, did not label the Lu-177 radioactive waste storage containers with the radiation symbol and markings required by NRC requirements.