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Stale of CaUfornla—Health and Wellore Agency DepaJmenf al Heoltft SBMCes <br /> 1.W 1.01 <br /> 4 7 <br /> Page of Pages <br /> 1276-39 <br /> RADIOACTIVE MATERIAL LICENSE License Number: <br /> 57 <br /> Supplementary Sheet Amendment Number: <br /> 13. Cont. <br /> (d) The letter dated February 21, 1989, and the letter with attachments <br /> dated February 22, 1989, both signed by Jack L. Funamura, M.D. <br /> (e) The letters dated April 19, 1989 and May 18, 1989, both signed by <br /> 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 <br /> diagram, signed by Jeffrey L. Hall. <br /> 14. (a) The Radiation Safety Officer in this program shall be Jeffrey L. Hall, M.S. <br /> (b) The Chairperson of the Radiation Safety Committee shall be Jack L. <br /> Funamura, 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 <br /> contamination as required by Section 30275(c) of the California Radiation <br /> Control Regulations. <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 individual 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 /> 18. Records of leak test results shall be kept in units of microcuries and <br /> maintained for inspection. Records may be disposed of following Department <br /> inspection. Any leak test revealing the presence of 0.005 microcuries or more <br /> of removable radioactive material shall be reported to the Department of Health <br /> Services, Radiologic Health Branch, 744 P Street, P.O. Box 942732, Sacramento, <br /> CA 94234-7320, within five days of the test. This report shall include a <br /> description of the defective source or device, the results of the test, and the <br /> corrective action taken. <br /> 19. Bioassays shall be performed within 72 hours for persons preparing and/or <br /> administering therapeutic quantities of Iodine 131 in liquid form. <br /> For the State Department of Health Services <br /> April 21, 1994 3 <br /> Date: By: <br /> Radlologlc Health Branch <br /> P.O. Box 942732 <br /> Sacramento, CA 94234-7320 <br /> PH 2551(Int)(1/VI) <br />