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State of Calltornla—Health and Welfare Agency <br />RADIOACTIVE MATERIAL LICENSE <br />Supplementary Sheet <br />Department of Health Services <br />Page 2 of 3 Pages <br />License Number: 2-471 -'J9 <br />Amendment Number: I I <br />11. This license is subject to an annual fee for sources of radioactive material <br />authorized to be possessed at any one time as specified in Item 8 of this <br />license. The annual fee for this license is required by and computed in <br />accordance with Sections 30230-30232 of the California Radiation Control <br />Regulations and is also subject to an annual cost -of -living adjustment pursuant <br />to Section 113 of the California Health and Safety Code. <br />12. Radioactive material shall be used by, or under the supervision of, the <br />following individuals: <br />(a) Joe H. Higgs <br />(b) John E. Hervey <br />13. Except as specifically provided otherwise by this license, the licensee shall <br />possess and use radioactive material described in Items 6, 7, 8, and 9 of this <br />license in accordance with statements, representations, and procedures <br />contained in the documents listed below. The Department's regulations shall <br />govern unless the statements, representations, and procedures in the licensee's <br />application and correspondence are more restrictive than the regulations. <br />(a) The renewal application with attachments dated May 27, 1993, the letter <br />with attachments dated May 18, 1994, and the letter with attachment dated <br />June 16, 1994, all signed by Joe H. Higgs. <br />14. (a) The Radiation Safety Officer in this program shall be Joe H. Higgs. <br />(b) The Alternate Radiation Safety Officer shall be John E. Hervey. <br />15. Sealed sources described in this license shall be tested for leakage and/or <br />contamination at intervals not to exceed three years. <br />16. The following individuals are authorized to collect wipe test samples of sealed <br />sources possessed under this license using leak test kits acceptable to the <br />California Department of Health Services. <br />(a) The Radiation Safety Officer <br />(b) Qualified individuals designated by the Radiation Safety Officer <br />17. Analytical tests for leakage and/or contamination of sealed sources shall be <br />performed only by persons specifically authorized to perform that service. <br />For the State Department of Health Services <br />Date: July 5, 1994 By: 6 <br />Radiologic Health Branch <br />P.O. Box 942732 <br />Sacramento, CA 94234-7320 <br />r1N ?1;M flnt 1 (1191 ) <br />