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COMPLIANCE INFO_1991-2005
Environmental Health - Public
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EHD Program Facility Records by Street Name
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4500 - Medical Waste Program
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PR0450116
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COMPLIANCE INFO_1991-2005
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Last modified
12/20/2022 12:11:51 PM
Creation date
7/3/2020 10:16:32 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4500 - Medical Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
1991-2005
RECORD_ID
PR0450116
PE
4520
FACILITY_ID
FA0002602
FACILITY_NAME
KAISER PERMANENTE
STREET_NUMBER
7373
STREET_NAME
WEST
STREET_TYPE
LN
City
STOCKTON
Zip
95210
APN
09416023
CURRENT_STATUS
01
SITE_LOCATION
7373 WEST LN
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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SJGOV\cfield
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FilePath
\MIGRATIONS\MW\MW_4520_PR0450116_7373 WEST_1991-2005.tif
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EHD - Public
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.. 7 - _ <br />State ciCalifornia-Health and Human Service ency Department of Heann Services <br />.* <br />is <br />RADIOACTIVE MATERIAL LICENSE of 4 pages <br />Pursuant to the Califomia Code of Regulations, Division 1, Title 17, Chapter 5, Subchapter 4, Group 2, i��9g ��ff cove Material, and <br />In reliance on statements and representations heretofore made by the licensee, a license is hereby issu thbri�in icensee to receive, <br />use, possess, transfer, or dispose of radioactive material listed below; and to use such radloactive material for the u e(s) and at the <br />places(s) designated below. This license is subject to all applicable rules, regulations, and orders ices now <br />or hereafter in effect and to any standard or specific condition specified in this license. IE <br />Kaiser Permanente Medical Facility <br />2. Address: 7373 West Lane <br />Stockton, CA 95210 <br />Attention: Michael D. Reitz, M.D. <br />Radiation Safety Officer <br />0W. <br />5766-39 NOV JAnianlWINumber. 14 <br />4. Expiratlon date: E VI ORMENT HEALTH <br />July 22, 2012 ERMITISEVI ,ES (3) <br />agency: Radiologic Health Branch <br />Sacramento <br />In response to the letter, with attachments, dated October 29, 2003, signed by Michael Reitz, M.D., Radiation <br />Safety Officer, License Number 5766-39 is hereby amended as follows: <br />6. Nuclide <br />7. Form <br />8. Possession Limit <br />A. Groups 1, 2, 3 and 4 as specified <br />A. Any <br />A. Combined possession limit for <br />in Item 9. Any radionuclide with <br />Excluding Xenon <br />Groups 1, 2, 3 and 4 not to exceed <br />atomic numbers 3-83. <br />Excluding generators <br />650 mCi. <br />B. Group 9 as specified in Item 9. <br />B. Sealed or solid sources <br />B. Total not to exceed 20 mCi. <br />Any radionuclide with atomic <br />manufactured in accordance with a <br />Each source not to exceed <br />numbers 3-83, inclusive, except: <br />specific license issued by the <br />13 mCi. <br />Strontium -90 and Lead -210. <br />United States Nuclear Regulatory <br />Commission, an Agreement State <br />or a Licensing State. <br />9. Authorized Use <br />To be used for nuclear medicine procedures as specified in groups below: <br />A. Group 1 Diagnostic studies involving measurement of uptake, dilution, or excretion but not involving <br />imaging. <br />Group 2 Diagnostic studies involving imaging excluding the use of Xenon -127 and/or Xenon -133 gas. <br />Group 3 Reagent kits for preparation of radiopharmaceuticals listed in Group 2. <br />Group 4 Internal therapy and palliative treatment not usually requiring hospitalization. <br />B. Group 9 Marker and calibration sources. <br />LICENSE CONDITIONS <br />10. Radioactive material shall be used only at the following location: <br />(a) 7373 West Lane, Stockton, CA. <br />
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