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State of California -Health and Human Serv0gency 40 Department of Health Services ,T—M*JXAfli A_ ru _`rI *M— I"[41A 71 Page 5 of 5 pages License Number: 1368-39 Amendment Number: 30 27. For a period not to exceed 60 days in any calendar year, a visiting physician is authorized to use licensed materials for human use under the terms of this license, provided the visiting physician: (a) Has the prior written permission of the hospital's Administrator and its Radiation Safety Committee. (b) Is specifically named as a user on a U.S. Nuclear Regulatory Commission, an Agreement State or a Licensing State license authorizing human use. (c) Performs only those procedures for which the physician is specifically authorized by the U.S. Nuclear Regulatory Commission, an Agreement State or a Licensing State license. The licensee shall maintain for inspection copies of the written permission specified in (a) above and the licensee(s) specified in (b) and (c) above. These records shall be maintained for five years from the time the licensee grants its permission under (a) above. 28. In addition to the possession limits in Item 8, the licensee shall further restrict the possession of licensed material so that at no time will the total quantity of radioactive material possessed require financial surety for decommissioning in accordance with the California Code of Regulations, Title 17, Section 30195.1. A value of 100 microcuries is assigned to Cobalt -57 to supplement the Code of Federal Regulations, Title 10, Part 30, Appendix B. 29. A copy of this license and a copy of all records and documents pertaining to this license shall be maintained available for inspection at 975 South Fairmont Avenue, Lodi, CA. rd Prepared By: Reviewed B Issued For ment of Health ..� 7D, Services Printed Name: Printed Name: Printe am : Heidi S. O'Connell Ira Schneider Gonzalo L. P ez Date: June 14, 2004 Radiologic Health Branch MS 7610, P.O. Box 997414, Sacramento, CA 95899-7414