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S;ata,s.f Call forma—Health and Welfare Agem; Department of Haalth Services <br /> l, <br /> i <br /> Page_-2 of 2 pages <br /> I <br /> RADIOACTIVE MATERIAL LICENSE License Number 5199-39 <br /> Supplementary Sheet Amendment Number <br /> 13. Except as specifically provided otherwise by this license, the licensee shall <br /> possess and use radioactive material described in Items 6, 7, and 8 of this license <br /> in accordance with statements, representations, and procedures contained in the <br /> documents listed below. The Department' s regulations shall govern unless the <br /> statements, representations, and procedures in the licensee' s application and <br /> correspondence are more restrictive than the regulations. <br /> (a) The application with attachments received on August 18, 1988 (unsigned) as <br /> supplemented by the letter dated November 1, 1988 signed by Richard M. Dittmer <br /> with attached diagram and application dated August 9, 1988 signed by <br /> James B. O'Connor. <br /> 14. The radiation safety officer in this program shall be Joanne Raby. <br /> 15. Sealed sources possessed under this license shall be tested for leakage and/or <br /> contamination as required by Section 30275 (c) of the California Radiation Control <br /> Regulations. <br /> 16. The following individuals are authorized to collect wipe test samples of sealed <br /> sources possessed under this license using leak test kits acceptable to the <br /> • California Department of Health Services. <br /> (a) The radiation safety officer. <br /> (b) Qualified individuals designated by the radiation safety officer. <br /> 17. Records of leak test results shall be kept in units of microcuries and maintained <br /> for inspection. Records may be disposed ofwing Department inspection. Any <br /> leak test revealing the presence of 0. rocurie or more of removable <br /> radioactive material shall be reported 6 4wartment of Health Services, <br /> Radiologic Health Branch, 744 P Street, ,10,§p' O. Ix 942732, Sacramento, CA <br /> 94234-7320, within five days of the testFj Thl erepor� f all include a description <br /> of the defective source or device, the etults. f th yYst, and the corrective <br /> action taken. /9q �/� <br /> 18. Analytical tests for leakage and/or contami' .ri of sealed sources shall be <br /> performed only by persons specifically authorizedp>Cperform that service. <br /> • For the State Department of Health Services <br /> December 2, 1988 1 / 5 <br /> Date by r� �l <br /> Radiolcgic Health anch <br /> PO 2551(2/e2) 714 P Street, Sacramento, CA 95814 <br />