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State of California,04ealth and Welfare Agency Department of Health Services
<br />Page 2 of 4 pages
<br />RADIOACTIVE MATERIAL LICENSE License Number: 4097-39
<br />Amendment Number. 15
<br />12. The individuals named below are authorized the specific uses of radioactive material described in Items 6, 7, 8, and 9
<br />of this license as follows:
<br />(a)
<br />H. Walter Pepper, M.D.
<br />Groups 1, 2, 3 and 9
<br />(b)
<br />Anil K. Sain, M.D.
<br />Groups 1, 2, 3, 4 and 9
<br />(c)
<br />Robert A. Lee, M.D.
<br />Groups 1, 2, 3 and 9
<br />(d)
<br />Sam Kokoris, M.D.
<br />Groups 1, 2, 3, 4 (I-131 only) and 9
<br />(e)
<br />Rajiv Punjya, M.D.
<br />Groups 2 and 3, (cardiac studies only) and 9
<br />13. Except as specifically provided otherwise by this license, the licensee shall possess and use radioactive material
<br />described in Items 6, 7, 8 and 9 of this license in accordance with the statements, representations, and procedures
<br />contained in the documents listed below. The Department's regulations shall govern unless the statements,
<br />representations, and procedures in the licensee's application and correspondence are more restrictive than the
<br />regulations.
<br />(a) The application, with attachments, dated August 24, 1989, signed by Anil K. Sain, M.D., Radiation Safety
<br />Officer.
<br />(b) The letter, with attachments, dated November 13, 1991, signed by H. Walter Pepper, M.D., (relative to clearance
<br />survey of the old lab), and letter with attachments dated December 20, 1991, signed by John Atherton and
<br />Anil Sain, M.D., relative to new nuclear medicine and cardiology laboratories and new quality assurance
<br />procedures on cameras.
<br />(c) The letter, with attachments, dated February 26, 1992, signed by John Atherton and Anil Sain, M.D., relative to
<br />storage location.
<br />(d) The letter dated July 13, 1992, with attached revised package receipt procedure, signed by H. Walter Pepper,
<br />M.D.
<br />(e) The letter with attachments dated March 13, 1995, signed by Win Howard II, Director, Diagnostic Imaging,
<br />regarding changes in policies as a result of the inspection conducted on March 1, 1995.
<br />14. (a) The Radiation Safety Officer in this program shall be H. Walter Pepper, M.D.
<br />(b) The Chairperson of the Radiation Safety Committee shall be H. Walter Pepper, M.D.
<br />(c) The Custodian of sealed sources shall be Anil K. Sain, M.D.
<br />(d)The Alternate Radiation Safety Officer in this program shall be Anil K. Sain, M.D.
<br />15. Sealed sources possessed under this license shall be tested for leakage and/or contamination as required by Title 17,
<br />California Code of Regulations, Section 30275 (c).
<br />16. The following individuals are authorized to collect wipe test samples of sealed sources possessed under this license
<br />using leak test kits acceptable to the California Department of Health Services:
<br />(a) The Radiation Safety Officer
<br />(b) Qualified individuals designated in writing by the Radiation Safety Officer
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