|
State of California -Health and Welfare Agency ® Department of Health Services
<br />Page 2 of 4 pages
<br />RADIOACTIVE MATERIAL LICENSE License Number: 4097-39
<br />Amendment Number: 17
<br />LICENSE CONDITIONS
<br />10. Radioactive material shall be used only at the following location:
<br />(a) 1420 North Tracy Boulevard, Tracy, CA.
<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 />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 />(b)
<br />Anil K. Sain, M.D.
<br />(c)
<br />Sam Kokoris, M.D.
<br />(d)
<br />Rajiv Punjya, M.D.
<br />(e)
<br />Chull Song M.D.
<br />(f)
<br />Barry Tepperman, M.D.
<br />Groups 1, 2, 3 and 9
<br />Groups 1, 2, 3, 4 and 9
<br />Groups 1, 2, 3, 4 (I-131 only) and 9
<br />Groups fl, 2 and 3: cardiac studies only) and 9
<br />Groups 1, 2, 3 and 9
<br />Groups 6 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 attac ents 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 />(f) The letter dated March 8, 2000, with attachments, signed by Gary Rapaport, Chief Executive Officer, and
<br />H. Walter Pepper, M.D., Radiation Safety Officer, the letter dated April 24, 2000, with attachments, signed by
<br />Gary Rapaport, Chief Executive Officer, H. Walter Pepper, M.D., Radiation Safety Officer, and David Bowlsby,
<br />Diagnostic Imaging Manager, and the letter dated May 11, 2000, with attachments signed by H. Walter Pepper,
<br />M.D., Radiation Safety Officer, regarding the addition of Group 6 use and decay in storage.
<br />
|