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V 3 Am <br />State of Catifomia-Health and Welfare Agency Mpartmen f He Services <br />Page 1 of 6 pages <br />( i ai^iiT <br />C`1 <br />RADIOACTIVEt�OE S 1 <br />Pursuant to the California Administrative Code, Title 17, Chapter 5, Subchapter 4, Group 2, Licensing of Radioactive Material, and in reliance <br />on statements and representations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, use, possess, <br />transfer, or dispose of radioactive material listed below; and to use such radioactive material for the purpose(s) and at the place(s) designated <br />below. This license is subject to all applicable rules, regulations, and orders of the Department of Health Services now or hereafter in effect and <br />to any conditions specified in this license. <br />1. Licensee <br />Tracy Gommnity Hospital <br />2. Address 1420 North Tracy Boulevard <br />Tracy, CA 95376 <br />3. License No. <br />4097-39 Amendment No. 10 <br />14. Expiration date <br />September 15, 1997 <br />Attention: H. Wal5. Inspection agency <br />Walter Pepper, M.D. RadiologiC Health Branch <br />Radiation Safety Officer Sacramento <br />][11 resl� to the lettex, dated November 1, 1993, signed by Anil K. Sain, License <br />Number +. bereby amerided in part as follows: <br />In moo• • r a- with Article 4, Sectim <br />30195, the MedicalUse Groups <br />ii... .p e• below <br />grant the use of radioactive material., as approved by the U.S. Food and Drug <br />,Admin■ticn,the Cali-fdrmia state Board • t Medical.Quality Assurancle• •r the <br />license.California State Board of Phaympy, for diagnosis and treatnent of patients, uhm <br />prescribed and as directed by an appropriately autblorized physician listed on this <br />!!S♦'!I• 1 4: ',1 IVA D '1 VI D`' i 1140 <br />itis �y <br />Group 1 - Diagnostic studies involy' ement of uptake but not involving <br />imaging. <br />Group 2 - Diagnostic studies involving imaging including the use of Xenon 127 and/or <br />Xenon 133 gas. <br />Group 3 - Use of reagent kits for preparation of radiopharmaceuticals listed in Group <br />2. <br />Group 4 - Internal Therapy not usually requiring hospitalization. <br />Group 9 - Nonhuman Uses <br />6. Nuclide <br />A. Any radionuclide with <br />atomic numbers 3-83 <br />inclusive except: <br />(1) Strontium 90 and <br />(2) Lead 210 <br />February 3, 1994 <br />Date <br />RH 2550 (2/81) 0 <br />7. Form <br />8. Possession Limit <br />A. Sealed sources, manufa- <br />c_• labeled,padcaged <br />and distributed in accor- <br />dance <br />. .•. <br />license to the manufacturer <br />. the U.S.Nuclear Regulatol <br />conimission or an Agreement <br />State <br />. - - <br />- riot notto exceed <br />10 mCi eadi. <br />A. Marker sources and <br />calibration. <br />For the State Department of Health Services <br />Radiologic Health Section <br />744 P Street, Sacramento, CA 95814 <br />