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State of Califomiaaiealth and Welfare Agency Department of Health Services <br /> Page 2 of 2 pages <br /> RADIOACTIVE MATERIAL LICENSE License Number. 3764-39 <br /> Supplemerttary Sheet Amendment Number. <br /> 12. Cont. <br /> (2) Have been designated, in writing, by the Radiation Safety Officer as qualified to use <br /> Krypton 85 in these manners. <br /> (c) Use of Krypton 85 in Tracer-Flo and Interest units in automatic mode, and for testing components <br /> removed from such units for amount of radioactivity, shall be performed only by, or under the <br /> supervision and in the physical presence of, individuals who have been designated, in writing,by the <br /> Radiation Safety Officer as qualified to use Krypton 85 in these manners. <br /> 13. Fxcept as specifically provided otherwise by this license,the licensee shall possess and use radioactive material <br /> described in Items 6, 7, 8 and 9 of this license in accordance with statements,representations,and procedures <br /> contained in the documents listed below. The Department's regulations shall govern unless the statements, <br /> representations, and procedures in the licensee's application and correspondence are more restrictive than the <br /> regulations. <br /> (a) The renewal application with attachments dated October 23, 1987, signed by Gordon W. Butler, as <br /> modified by the letters with attachments dated April 5, 1990 and October 30, 1990, signed by <br /> Ronald Jones, April 3, 1990 and October 16, 1990, signed by James K. Cook and by Bernard Lopez, <br /> September 24, 1992 signed by James K. Cook and Redentor S. Sabilano and December 16, 1992, <br /> signed by Redentor S. Sabilano. <br /> (b) The letter with attachments dated June 1, 1993,signed by Redentor S. Sabilano,relative to modification <br /> of Itere Model 1014-BTI Krypton 85 Activation System <br /> (c) The letter with attachments dated December 27, 1993, signed by Redentor S. Sabilano, regarding <br /> refresher training. <br /> (d) The letter with attachment dated June 16, 1994,signed by Redentor S. Sabilano,regarding new radiation <br /> safety organization chart. <br /> 14. (a) The Radiation Safety Officer in this program shall be Thoma P. Joyner. <br /> (b) The Alternate Radiation Safety Officer in this program shall be Allen Reinero. <br /> For the State Department of Health Services <br /> Date September 18 1995 By: <br /> Radiologic Health Branch <br /> P.O. Box 942732, Sacramento, CA 94234-7320 <br />