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State of California -Health and Human Ser Agency Department of Health Services
<br />Page 1 of 4 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 />Sutter Tracy Community Hospital
<br />2. Address: 1420 North Tracy Boulevard
<br />Tracy, CA 95376
<br />Attention: Sam Kokoris, M.D.
<br />Radiation Safety Officer
<br />License Number.'
<br />4097-39
<br />Amendment Number: 19
<br />4. Expiration date:
<br />September 15, 2012 (3)
<br />b. inspection agency: Radiologic Health Branch
<br />Sacramento
<br />In response to the letter dated July 14, 2003, signed by Gary Rapaport, Chief Executive Officer, H. Walter Pepper,
<br />M.D., Radiation Safety Officer, and David Bowlsby, CNMT, and the letter dated August 6, 2003, signed by Gary
<br />Rappaport, Chief Executive Officer, David Bowlsby, CNMT, Imaging Manager, and Anil K. Sain, M.D., License
<br />Number 4097-39 is hereby amended as follows:
<br />6.
<br />Nuclide
<br />7.
<br />Form
<br />8.
<br />Possession Limit
<br />A.
<br />Group 1, 2, 3 and 4 as specified in
<br />A.
<br />Any
<br />A.
<br />Combined possession limit for
<br />Item 9.
<br />Excluding Xenon
<br />Groups 1, 2, 3 and 4 not to exceed
<br />Any radionuclide with atomic
<br />Excluding generators
<br />462 mCi.
<br />number 3-83.
<br />B.
<br />Group 6 as specified in Item 9.
<br />B.
<br />B.
<br />1. Iodine-125
<br />1. Seeds
<br />1. Total 100 mCi. Each seed not
<br />to exceed 0.6 mCi.
<br />2. Palladium -103
<br />2. Seeds
<br />2. Total 500 mCi. Each seed not
<br />to exceed 2.0 mCi.
<br />C.
<br />Group 9 as specified in Item 9.
<br />C.
<br />Sealed or solid sources
<br />C.
<br />Total not to exceed 38 mCi. Each
<br />Any radionuclide with atomic
<br />manufactured in accordance with a
<br />source not to exceed 22 mCi.
<br />numbers 3-83, inclusive, except:
<br />specific license issued by the
<br />Strontium -90 and Lead -210.
<br />United States Nuclear Regulatory
<br />Commission or an Agreement
<br />State or a Licensing State.
<br />9. Authorized Use
<br />To be used for nuclear medicine procedures as specified in groups below:
<br />A. Group 1 Diagnostic studies involving measurement of uptake, dilution, or excretion but not involving
<br />imaging.
<br />Group 2 Diagnostic studies involving imaging excluding the use of Xenon -127 and/or Xenon -133 gas.
<br />Group 3 Reagent kits utilizing bulk technetium prepared by a radiopharmacy for preparation of
<br />radiopharmaceuticals listed in Group 2.
<br />Group 4 Internal therapy and palliative treatment not usually requiring hospitalization.
<br />B. Group 6 Brachytherapy utilizing sealed or solid sources manufactured, labeled, packaged, and
<br />distributed in accordance with a specific license issued pursuant to Title 10, Code of Federal
<br />Regulations, Part 32.74, or a specific license issued by an Agreement State or a Licensing State
<br />pursuant to equivalent state regulations (except for sources manufactured prior to August 16, 1974).
<br />C. Group 9 Marker and calibration sources.
<br />
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