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State o*:ailfomia—Health and Welfare Agen <br />Department of Health Services <br />H-LIV-4H 1VINIAIN081ANI Page 1 of 4 pages <br />z661 9 o env <br />R�.IOACTIVE MATERIAL LICENSE <br />0.4-33�13Pursuant to the California Administrative Co17, Chapter 5, Subchapter 4, Group 2, Licensing of Radioactive Material, and in reliance <br />on statements and representations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, use, possess, <br />transfer, or dispose of radioactive material listed below,• and to use such radioactive material for the purpose(s) and at the place(.$) designated <br />below. This license is subject to all applicable rules, regulations, and orders of the Department of Health Services now or hereafter in effect and <br />to any conditions specified in this license. <br />T. Licensee Kaiser Permanente Medical Offices <br />Z Address <br />P. O. BOX 210005 <br />Stockton, CA. 95269-9005 <br />Attention: Michael D. Reitz, M.D. <br />6. Nuclide <br />3. License No. <br />5766-39 Amendment No. <br />1 4. expiration date July 22, 1999 <br />5. Inspection agency <br />9. Authorized Use <br />These authorizations are as specified below except that for Groups 1 through 5, when <br />granted herein, these authorizations are as specified in the Department's form RH <br />2010R, "Well Established Medical Uses.,, <br />Group 1 - Diagnostic studies involving measurement of uptake, dilution, or excretion <br />but not involving imaging. <br />Group 2 - Diagnostic Studies involving 1M91M including the use of Xenon 127 and/or <br />Xenon 133 gas. <br />Group 3 - Use of reagent kits for preparation of radiopharmaceuticals listed in Group <br />2. <br />Group 4 - Internal therapy not usually requiring hospitalization. <br />Group 9 - Nonhuman uses <br />A. Any radionuclide with A. Sealed sources, A. Marker sources and <br />atomic numbers 3-83 manufactured, calibration. <br />inclusive except: labeled, packaged, <br />and distributed <br />(1) Strontium 90 and in accordance with <br />(2) Lead 210 a specific license <br />issued to the manu- <br />facturer by the U.S. <br />Nuclear Regulatory <br />Ccmuission or an <br />Agreement State, <br />not to exceed 10 <br />mCi each. <br />Date July 22, 1992 <br />RH 2550 (2/81) <br />For the State Department of Health Services <br />by 3 <br />Radiologic Health Section <br />744 P Street, Sacramento, CA 95814 <br />