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State of Califomia+lsalth anrd VMelrare Agency Deparhnerd of Heafth SerAc <br /> Page 2 of_2 pages <br /> RADIOACTIVE MATERIAL LICENSE License Number. 5399-39 <br /> Sup*rnertary Sheet Amendment Number: <br /> 14. The Radiation Safety Officer in this program shall be Kaushil Patel <br /> 15. Sealed sources described in Subitem A of this license shall be tested for leakage and/or contamination at <br /> intervals not to exceed three years. <br /> 16. 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 /> 17. 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 /> 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 M 7th Street P.O. Box 942732, Sacramento,CA 942347320,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. histallation, relocation, maintenance, repair, and initial radiation survey of devices containing radioactive <br /> material and installation, replacement, and disposal of sealed sources containing radioactive material used in <br /> devices shall be performed only by persons specifically licensed to perform such services. <br /> For the State p rtrneJntth Sermoes <br /> Date September 23 1997 By: — <br /> Radiologic Heat Branch <br /> P.O. Box 942732, Sacramento,CA 942347320 <br />