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COMPLIANCE INFO_1980-2010
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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4500 - Medical Waste Program
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PR0450003
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COMPLIANCE INFO_1980-2010
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Entry Properties
Last modified
2/25/2026 2:54:44 PM
Creation date
7/3/2020 10:17:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4500 - Medical Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
1980-2010
RECORD_ID
PR0450003
PE
4522 - ACUTE CARE FACILITY
FACILITY_ID
FA0000513
FACILITY_NAME
LODI MEMORIAL HOSPITAL
STREET_NUMBER
975
Direction
S
STREET_NAME
FAIRMONT
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
03107039
CURRENT_STATUS
Active, billable
SITE_LOCATION
975 S FAIRMONT AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\MW\MW_4522_PR0450003_975 S FAIRMONT_1980-2010.tif
Site Address
975 S FAIRMONT AVE LODI 95240
Tags
EHD - Public
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r (tate of California -Health and Welfare Age „� Department of Health Services <br />Page 1 of 3 pages <br />RADIOACTIVE MATERIAL LICENSE <br />Pursuant to the California Code of Regulations, Division 1, Title 17, Chapter 5, Subchapter 4, Group 2, Licensing of Radioactive Material, and <br />in reliance on statements and representations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, <br />use, possess, transfer, or dispose of radioactive material listed below; and to use such radioactive material for the purpose(s) and at the <br />places(s) designated below. This license is subject to all applicable rules, regulations, and orders of the Department of Health Services now <br />or hereafter in effect and to any standard or specific condition specified in this license. <br />1. Licensee <br />& Engineering. Inc. <br />2. Address 392 West Larch Road, Suite 19 <br />Tracy, CA 95376 <br />Attention: Russ Carpenter <br />Radiation Safety Officer <br />0 <br />UU, <br />5927-39 <br />August 23, 2000 <br />ection agency Radiologic 1 <br />Sacramento <br />Amendment Number: 4 <br />(5) <br />In response to the letter dated July 10, 1998, signed by Harold Honeyfield, License Number 5927-39 is hereby <br />amended as follows: <br />6. Nuclide <br />7. Form <br />8. Possession Limit <br />A. Cesium- 137/Americium-241:Be <br />A. Sealed sources (Troxler Dwg. No. <br />A. 10 source pairs not to exceed <br />A-102112 and A-102451) <br />9 mCi of Cesium -137 and <br />44 mCi of Americium -241 each.* <br />B. Cesium-137/Americium-241:Be <br />B. Sealed sources (CPN #131) <br />B. 10 source pairs not to exceed <br />10 mCi of Cesium -137 and <br />50 mCi of Americium -241 each.* <br />* Total A. & B. not to exceed <br />10 gauges. <br />9. Authorized Use <br />A. To be used as components of gauges, Troxler Model 3400 series, for determination of moisture/density in <br />engineering materials. <br />B. To be used as components of gauges, CPN Corporation Models A, BR, MC, or 500 series, for determination of <br />moisture/density in engineering materials. <br />LICENSE CONDITIONS <br />10. Radioactive materials may be used at temporary job sites of the licensee in areas not under exclusive federal <br />jurisdiction throughout the State of California (see Condition 23). Radioactive materials may be permanently stored <br />only at: <br />(a) 392 West Larch Road, Suite 19 & 21, Tracy, CA (storage capacity: 10 gauges) <br />11. This license is subject to an annual fee for sources of radioactive material authorized to be possessed at any one time <br />as specified in items 6, 7, 8 and 9 of this license. The annual fee for this license is required by and computed in <br />accordance with Title 17, California Code of Regulations, Sections 30230-30232 and is also subject to an annual <br />cost -of -living adjustment pursuant to Section 100425 of the California Health and Safety Code. <br />
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