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ppppHrtanl 01 HepHH Services Stole of CONlolnb—HOOHM1 antl WellO�e ApencY Page 4 of 7 Pages RADIOACTIVE MATERIAL LICENSE License Number: 1276-39 Supplementary Sheet Amendment Number: 58 14. (a) The Radiation Safety Officer in this program shall be Jeffrey L. Hall, M.S. (b) The Chairperson of the Radiation Safety Camtittee shall be Jack L. Flanamura, M.D. (c) The Custodian of sealed sources shall be Jack L. F1n)amura, M.D. 15. Sealed sources possessed under this license shall be tested for leakage and/or contamination as required by Section 30275(c) of the California Radiation Control Regulations. 16. The following individuals are authorized to collect wipe test samples of sealed sources possessed under this license using leak test kits acceptable to the California Department of Health Services: (a) The Radiation Safety Officer. (b) Qualified individuals designated by the Radiation Safety Officer. 17. Analytical • tests for leakage and/or contamination of sealed sources shall be performed only by persons specifically authorized to perform that service. 18. Records of leak test results shall be kept in units of microcuries and maintained for inspection. Records may be disposed of following Department inspection- Any leak test revealing the presence of 0.005 microcuries or more of removable radioactive material shall be reported to the Department of Health Services, Radiologic Health Branch, p. O. Box 942732, Sacramento, CA 94234-7320, within five days of the test. This report shall include a description of the defective source or device, the results of the test, and the corrective action taken. 19. FSccept as otherwise specifically provided by this license, mathcp "•Ecauricals to be administered to ►mans shall be procured in prepackaged, nrecalibrated form, from a supplier wbo is registered with the U. S. Food and Drug Administration, or prepared and eonpounded, from a prescription, in accordance with the regulations of the California Board of Pharmacy. 20. &coept as otherwise specifically provided by this lig, radioactive biologicals (including human serum albumin) to be administered to humans shall be procured in prepackaged, precalibrated form, from a supplier who is licensed for the prnparatien and distribution of such products by the Division of Biologics Standards of the National Institutes of Health, or U. S. Food and Drug Administration; or prepared in accordance with the regulations of the California Board of Pharmacy. For the State Department of Health Services Date: October 11, 1994 By: 3 Radiologic Health Branch P.O. Box 942732 Sacramento, CA 94234-7320 PH 2551(Int.)(l lel)