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State of[allfornlo—Health and Welfare Agency • - • Depadment of Health Services <br /> Page 2 of 3 Pages <br /> RADIOACTIVE MATERIAL LICENSE License Number: 3226-39 <br /> Supplementary Sheet Amendment Number: 11 <br /> 11. This license is subject to an annual fee for sources of radioactive material <br /> authorized to be possessed at any one time as specified in Item 8 of this <br /> license. The annual fee for this license is required by and.computed in <br /> accordance with Sections 30230-30232 of the California Radiation Control <br /> Regulations and is also subject to an annual cost-of-living adjustment pursuant <br /> to Section 113 of the California Health and Safety Code. <br /> 12. Radioactive material shall be used by, or under the supervision of, the <br /> following individuals: <br /> (a) Jerry T. Tucker <br /> (b) Larry Watkins <br /> (c) John Simonson <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 <br /> license in accordance with statements, representations, and procedures contained <br /> in the documents listed below. The Department's regulations shall govern unless <br /> the statements, representations, and procedures in the licensee's application <br /> and correspondence are more restrictive than the regulations. <br /> (a) The renewal application with attachments dated August 13, 1991, signed <br /> by Jerry Tucker. <br /> (b) The letter with diagram dated November 13, 1991, signed by Jerry T. <br /> Tucker, regarding location of new devices. <br /> 14. The radiation safety officer in this program shall be Jerry T. Tucker. <br /> 15. Sealed sources described in Subitems A, B, and C of this license shall be tested <br /> for leakage and/or contamination at intervals not to exceed 3 years. <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. Analytical tests for leakage and/or contamination of sealed sources shall be <br /> performed only by persons specifically authorized to perform that service. <br /> For the State Department of Health Services <br /> Date: March 24, 1993 By: 6 <br /> Radiologic Health Branch <br /> P.O. Box 942732 <br /> Sacramento, CA 94234-7320 <br /> PH 9551 not t Ir ton <br />