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COMPLIANCE INFO_2004-2020
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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Y
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YOSEMITE
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1777
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4500 - Medical Waste Program
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PR0450109
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COMPLIANCE INFO_2004-2020
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Entry Properties
Last modified
11/8/2024 3:08:48 PM
Creation date
7/3/2020 10:18:19 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4500 - Medical Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
2004-2020
RECORD_ID
PR0450109
PE
4522 - ACUTE CARE FACILITY
FACILITY_ID
FA0003978
FACILITY_NAME
KAISER FOUNDATION - MANTECA
STREET_NUMBER
1777
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95337
APN
20018034
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\MW\MW_4522_PR0450109_1777 W YOSEMITE_.tif
Site Address
1777 W YOSEMITE AVE MANTECA 95337
Tags
EHD - Public
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t <br /> State of California4isafti and Miliare Agency <br /> De(kA(btlent of Health SeNICES <br /> Page 2 of_6 pages <br /> RADIOACTIVE MATERIAL LICENSE Uoense Number. X790-39 <br /> supplermirtafy stmmt Amendment Number: <br /> 9. Authorized Use <br /> To be used for nuclear medicine procedures as specified in the groups below: <br /> A. Group 1 Diagnostic studies involving measurement of uptake,dilution,or excretion but not involving <br /> imaging. <br /> B. Group 2 Diagnostic studies involving °imagmg excluding the use of Xenon 127 and/or Xenon 133 <br /> lam° <br /> C. Group 3 Reagent kits for preparation of radiopharmacuticals listed in Group 2. <br /> D. Group 4 Palliative treatment. <br /> E. Group 9 Marker and calibration sources. <br /> LICENSE CONDITIONS <br /> 10. Radioactive material shall be used only at the following locations: <br /> (a) 1777 West Yosemite Avenue, Manteca, CA <br /> 11. This license is subject to an annual fee for sources of radioactive material authorized to be possessed at any <br /> one time as specified in items 6, 7, 8 and 9 of this license. The annual fee for this license is required by and <br /> computed in accordance with Title 17, California Code of Regulations, Sections 30230-30232 and is also <br /> subject to an annual cost-of-living adjustment pursuant to Section 113 of the California Health and Safety <br /> Code. <br /> 12. The individuals named below are authorized the specific uses of radioactive material described in Items 6,7, <br /> 8 and 9 of this license as follows: <br /> (a) Richard J. Berkowitz, ma Groups 1, 2, 3, and 9 <br /> (b) Henry Y. T. Wong, ASD. Group 4 (Sr- 89 only) <br /> 13. Except as specifically provided otherwise by this license,the licensee shall possess and use radioactive material <br /> described in Items 6, 7, and 8 of this license in accordance with statements,representations, and procedures <br /> contained in the documents listed below The Departnmfs 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 July 15, 1992, signed by Richard Aldred <br />
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