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State of California-Health and Welfare Agency Department of Health Services
<br /> Page 4 of 9 pages
<br /> RADIOACTIVE MATERIAL LICENSE license Number. 1276-39
<br /> Supplementary Sheet Amendment Number:S$
<br /> (f) The letter dated August 4, 1989, signed by Jack L. Funamura, MD.
<br /> (g) The letter dated March 9, 1992, with attached survey procedure and diagram, signed by Jeffrey L. Hall.
<br /> (h) The letters dated April 1, 1996, May 21, 1996 and June 5, 1996, all signed by Maria Chan, Ph.D.,
<br /> Radiation Safety Officer, regarding the request for use of a Strontium 90 applicator and the associated
<br /> procedures.
<br /> (i) The letter dated April 1, 1996, signed by Maria Chan, PhD., Radiation Safety Officer, regarding the
<br /> addition of Iodine 125 seeds and the associated procedures for use and storage of the seeds.
<br /> (j) The letter dated April 3, 1997, as supplemented by the letter, with attachments, dated July 8, 1997, both
<br /> signed by Maria Chan PhD., Radiation Safety Officer, regarding radiolocalization procedures.
<br /> (k) The letter dated March 4, 1998, signed by Maria Chan, Ph.D., Radiation Safety Officer, and Donald J.
<br /> Wiley,COO,with attached diagram and survey, signed by Moishe C. Yerushalimsky, MS.,regarding the
<br /> procedures, commitments and surveys for the use of a portable HDR to be provided by a transportable
<br /> service company, RML 6152.
<br /> 14. (a) The Radiation Safety Officer in this program shall be Maria F. Chan, Ph.D.
<br /> (b) The Chairperson of the Radiation Safety Committee shall be Royce J. Biddle, MD.
<br /> (c) The Custodian of sealed sources shall be Jack L. Funamura, MD.
<br /> 15. Sealed sources possessed under this license shall be tested for leakage and/or contamination as required by
<br /> Section 30275 (c) of the California Radiation Control Regulations.
<br /> 16. Quantitative analytical assays for the purpose of tests for leakage and/or contamination of sealed sources shall
<br /> be performed only by persons specifically authorized to perform that service.
<br /> 17. The following individuals are authorized to collect wipe test samples of sealed sources possessed under this
<br /> license using leak test kits acceptable to the California Department of Health Services:
<br /> (a) The Radiation Safety Officer
<br /> (b) Qualified individuals designated in writing by the Radiation Safety Officer
<br /> 18. Records of leak test results shall be kept in units of microcuries and maintained for inspection. Records may
<br /> be disposed of following Department inspection. Any leak test revealing the presence of 0.005 microcuries or
<br /> more of removable radioactive material shall be reported to the Department of Health Services, Radiologic
<br /> Health Branch, 601 N. 7th Street P.O. Box 942732, Sacramento, CA 94234-7320, within five days of the test.
<br /> This report shall include a description of the defective source or device,the results of the test,and the corrective
<br /> action taken.
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