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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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`` -.� �c:au�orn anit� telfa�a � ..�� t�. ���.� � °� ���•, . �'���.s� x �.N. <br /> RA©IC?ACTIV TERIAL LIC N E <br /> A Pursuant to the California Code of Regulations,Division 1,rt/e 17, Chapter 5,Sutichapfer 4, Group 2,Licensing of Radfoactive Material and ., <br /> in reliance on statements and representations heretofore made by the licensee,a Bicense is hereby issued authorising fhe licensee to receive, <br /> use, possess, transfer, or dispose of radioactive materia!listed below;and to use such raddoactive material for the purpbse(s) and at the <br /> places(s)designated below. This license is sub%ect to all applfcabfe 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 /> 1. Licensee St. Dominic's Hospital 3. License Number <br /> 1777 West Yosemite Avenue 5790-39 Amendment Number: 18 <br /> 2. Address Box 1307 4. Expiration date <br /> Manteca, CA 95336 October 6,2008 (3) <br /> Attention: Judie Brown,CNMT 5. Inspection agency Radiologic Health Branch <br /> Alternate Radiation Safety Officer Sacramento ``j <br /> In response to the letter, with attachment, dated January 8, 2001, signed by Judie Brown, CNMT, Alternate <br /> Radiation Safety Officer,License Number 5790-39 is hereby amended as follows: <br /> 6. Nuclide 7. Form 8. Possession Limit <br /> A. Groups 1. 2. and 3 as specified in A. Any A. Combined possession limit for <br /> Item 9. Anv radionuclide with Excluding Xenon Groups 1, 2, and 3 not to exceed <br /> atomic number 3-83. Excluding generators 301 mCi. <br /> B. Group 4 as specified in Item 9. B. B. Total not to exceed 120 mCi. <br /> 1. Strontium-89 1. Any <br /> 2. Samarium-153 2. Any <br /> C. Group 9 as specified in Item 9. C. Sealed or solid 5,1.10c -� � 3 .-. I c,!a1 L -ceed 50 mCi. Each <br /> Any radionuclide with atomic manufactured in accordance with a source not to exceed 12 mCi. <br /> numbers 3-83, inclusive,except: specific license issued by the <br /> Strontium-90 and Lead-210. United States Nuclear Regulatory <br /> Commission, an Agreement State <br /> 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 for preparation of radiopharmaceuticals listed in Group 2. <br /> B. Group 4 Palliative treatment. <br /> C. Group 9 Marker and calibration sources. <br /> LICENSE CONDITIONS w <br /> 10. Radioactive material shall be used only at the following location: <br /> (a) 1777 West Yosemite Avenue, Manteca,CA. 4' <br />
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