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State of California-Health and Welfare Agency Department of Health Services
<br /> Page 4 of 7 pages
<br /> RADIOACTIVE MATERIAL LICENSE License Number. 1276-39
<br /> Supplementary Sheet Amendment Number: 65
<br /> 13. Except as specifically provided otherwise by this license,the licensee shall possess and use radioactive material
<br /> described in Items 6, 7, 8 and 9 of this license in accordance with statements, representations, and procedures
<br /> contained in the documents listed below. The Department's regulations shall govern unless the statements,
<br /> representations, and procedures in the licensee's application and correspondence are more restrictive than the
<br /> regulations.
<br /> (a) The application with attachments dated September 28, 1987, signed by Jack L. Funamura, M.D.
<br /> (b) The letter with attachments dated October 6, 1988, signed.by Lawrence A. Philipp.
<br /> (c) The letter with attachments dated November 18, 1988, signed by Jack L. Funamura, M.D.
<br /> (d) The letter dated February 21, 1989, and the letter with attachments dated February 22, 1989, both signed
<br /> by Jack L. Funamura, M.D.
<br /> (e) The letters dated April 19, 1989 and May 18, 1989,.both signed by Richard A. Seidler, Vice President.
<br /> (f) The letter dated August 4, 1989, signed by Jack L. Funamura, M.D.
<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, Ph.D., 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,
<br /> both signed by Maria Chan,Ph.D.,Radiation Safety Officer,regarding radiolocalization procedures.
<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, M.D.
<br /> (c) The Custodian of sealed sources shall be Jack L. Funamura, M.D.
<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
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