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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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A <br /> t <br /> State of Callfomia-Health and Welfare Agency Department of Health Services <br /> Page 3 of 5 pages <br /> RADIOACTIVE MATERIAL LICENSE License Number: 5790-39 <br /> Suppleffieritary Sheet Amendment Number: 9 <br /> (c) The letter dated May 13, 1994, signed by Richard Berkowitz, regarding the ECT Scintillation Camera, <br /> Manufacturer Picker, Model Prism 1000 XP. <br /> (d) The letters with attachments dated May 19, 1994 and July 9, 1994, both signed by Richard Berkowitz, <br /> M.D., Radiation Safety Officer, regarding the authorization for Group 4 and the use of Strontium 89. <br /> 14. (a) The Radiation Safety Officer in this program shall be Richard J. Berkowitz, M.D.. <br /> (b) The Chairperson of the Radiation Safety Committee shall be Judie Brown, CNMT. <br /> (c) The Custodian of sealed sources shall be Richard J. Berkowitz, M.D. <br /> (d) The Alternate Radiation Safety Officer in this program shall be Judie Brown, CNMT. <br /> 15. Sealed sources possessed under this license shall be tested for leakage and/or contamination as required by Title <br /> 17, California Radiation Control Regulations, Section 30275 (c). <br /> 16. Quantitative analytical assays for the purpose of tests for leakage and/or contamination of sealed sources shall <br /> be performed only by persons specifically authorized to perform that service. <br /> 17. The following individuals are authorized to collect wipe test samples of sealed sources possessed under this <br /> license 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 <br /> 18. Records of leak test results shall be kept in units of microcuries and maintained for inspection. Records may <br /> be disposed of following Department inspection. Any leak test revealing the presence of 0.005 microcuries <br /> or more of removable radioactive material shall be reported to the Department of Health Services, Radiologic <br /> Health Branch, 601 N. 7th Street P.O. Box 942732, Sacramento,CA 94234-7320, within five days of the test. <br /> This report shall include a description of the defective source or device, the results of the test, and the <br /> corrective action taken. <br /> 19. Any licensed sealed source is exempt from such leak tests when the source contains 100 microcuries or less <br /> of beta and/or gamma emitting material or 10 microcuries or less of alpha emitting material. <br /> 20. Except as otherwise specifically provided by this license, radiopharmaceuticals to be administered to humans <br /> shall be procured in prepackaged,precalibrated form from a supplier who is registered with the U. S. Food and <br /> Drug Administration,or prepared and compounded, from a prescription, in accordance with the regulations of <br /> the California Board of Pharmacy. <br /> 21. Except as otherwise specifically provided by this license, radioactive biologicals (including human serum <br /> albumin)to be administered to humans shall be procured in prepackaged, precalibrated form from a supplier <br /> who is licensed for the preparation and distribution of such products by the Division of Biologics Standards <br /> of the National Institutes of Health, or U. S. Food and Drug Administration;or prepared in accordance with <br /> the regulations of the California Board of Pharmacy. <br /> 22. Radioactive materials prepared, processed, or modified by the licensee shall not be administered to humans <br /> except as specifically authorized by this license. <br />
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