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State of Collfomlo—Heoee and Welfare Agency • • Depodaeat of Heollh Services Page 2 of 2 Pages RADIOACTIVE MATERIAL LICENSE ticenseNumber: 5399-39 Supplementary Sheet Amendment Number: 3 13. Except as specifically provided otherwise by this license, the licensee shall possess and use radioactive material described in Items 6, 7, and 8 of this license in accordance with statements, representations, and procedures contained in the docurnents listed below. The Department's regulations shall govern unless the statements, representations, and procedures in the licensee's application and correspondence are more restrictive than the regulations. (a) The application dated December 7, 1989, signed by Ed Malechek as modified by letter dated December 15, 1989, signed by Ted Brown. (b) The letter with attac bments dated September 23, 1994, signed by Steve Fabela, megard;ag a revised facility diagram. 14. rfbe Radiation Safety Officer in this program shall be Jay Ieslie. 15. sealed sources described in Subitams A of this license shall be tested for leakage and/or contamination at intervals not to exceed three years. 16. The follcwing individuals are authorized to collect wipe test samples of sealed sources possessed under this license using leak test kits acceptable to the California Department of Health Services. (a) The Radiation Safety Officer. (b) Qualified individuals designated by the Radiation Safety Officer. 17. Analytical tests for leakage and/or contamination of sealed sources shall be performed only by persons specifically authorized to perform that service. 18. Records of leak test results shall be kept in units of microcuries and maintained for inspection. Records may be disposed of following Department inspection. Any leak test revealing the presence of 0.005 microcuries or more of removable radioactive material shall be reported to the Department of Health Services, Radiologic Health Branch, P.O. Box 942732, Sacramento, CA 94234-7320, within five days of the test. This report shall include a description of the defective source or device, the results of the test, and the corrective action taken. 19. Installation, relocation, maintenance, repair, and initial radiation survey of devices containing radioactive material and installation, replacement, and disposal of sealed sources containing radioactive material used in devices shall be performed only by persons specifically licensed to perform such services. For the State DD/p�artment p'�H/�/nth Services Date: October 4, 1994 By: 6 Radlolq0t Health Brancff P.O. Box 942732 Sacramento, CA 94234-7320 RH 2551(Int.)(1/91)