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State of CalifomiiT.4ealth and Welfare Agency Department of Health Services • • Page 1 of 4 pages Y RADIOACTIVE MATERIAL LICENSE Pursuant to the California Code of Regulations, Division 1, Title 17, Chapter 5, Subchapter 4, Group 2, licensing of Radioactive Material, and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, use, possess, transfer, or dispose of radioactive material listed below, and to use Such radioactive,.rry aenal for the purpose(s) and at the places(s) designated below. This license is subject to all applicable rules, regulations,f"'I =`and orders o#@lent of Health Services now or hereafter in effect and to any standard or specific condition specified in this license. 1. Licensee Sutter Tracy Community Hospital 3. License Number 4097-39 Amendment Number: 15 2. Address 1420 North Tracy Boulevard 4. Expiration date Tracy, CA 95376 September 15, 1997 (3) 5. Inspection agency Radiologic Health Branch Attention: H. Walter Pepper, M.D. Radiation Safety Officer Sacramento In response to the letter dated April 13, 1998, with attachments, signed by Dave Bowlsby, Diagnostic Imaging Manager, License Number 4097-39 is hereby amended in its entirety. 6. Nuclide 7. Form 8. Possession Limit A. Group 1, 2, 3 and 4 as specified in A. Any A. Combined possession limit for Item 9. Excluding generators Groups 1, 2 and 3 and 4 not to Any radionuclide with atomic exceed 490 mCi. number 3-83. (See Condition 25) B. Group 9 as specified in Item 9. B. Sealed or solid sources B. Total not to exceed 10 mCi. Each Any radionuclide with atomic manufactured in accordance with a source not to exceed 10 mCi. numbers 3-83, inclusive, except: specific license issued by the Strontium -90 and Lead -210. United States Nuclear Regulatory Commission or an Agreement State. 9. Authorized Use To be used for nuclear medicine procedures as specified in groups below: A. Group 1 Diagnostic studies involving measurement of uptake, dilution, or excretion but not involving imaging. Group 2 Diagnostic studies involving imaging including the use of Xenon -127 and/or Xenon -133 gas. Group 3 Reagent kits for preparation of radiopharmaceuticals listed in Group 2. Group 4 Internal therapy and palliative treatment not usually requiring hospitalization. B. Group 9 Marker and calibration sources. LICENSE CONDITIONS 10. Radioactive material shall be used only at the following locations: (a) 1420 North Tracy Boulevard, Tracy, CA. 11. This license is subject to an annual fee for sources of radioactive material authorized to be possessed at any one time as specified in items 6, 7, 8 and 9 of this license. The annual fee for this license is required by and computed in accordance with Title 17, California Code of Regulations, Sections 30230-30232 and is also subject to an annual cost -of -living adjustment pursuant to Section 100425 of the California Health and Safety Code.