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COMPLIANCE INFO_1991-2005
Environmental Health - Public
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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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Sfa?e of4alifofnia—Health and Welfare Agency <br />8. Possession Limits <br />Supplementary Sheet <br />67116— <br />Department of Hecttr, Services <br />Page 2 of — 4 Pages <br />License Number: 5766-39 <br />Amendment Number: <br />Combined Possession Limit for Group 1, Group 2, Group 3, Group 4, and Group 9: <br />• to exceed •• millicuries. <br />10. Radioactive 'material shall be used only at the following locations: <br />(a) 7373 West lane, Stockton, CA <br />11. This license is subject to an annual fee for sources of radioactive material <br />authorized to be possessed at arry one time as specified in Item 8 of this license. <br />The annual fee for this license is required by and carputed in accordance with <br />Sections 30230-30232 of the California Radiation Control Regulations and is also <br />subject to an annual cost -of -living adjustment pursuant to section 113 of the <br />California Health and Safety Code. <br />12. The individuals named below are authorized the specific uses of radioactive <br />material described in Items 6, 7, 8 and 9 of this license as follows: <br />(a) Michael D. Reitz, M.D. Groups 1, 2, 3, 4 and 9 <br />(b) B. Rama Rao, M.D. Groups 1, 2, 3, 4 (1-131 only) and 9 <br />(c) David J. Moitoza, M.D. Groups 1, 2, 3, 4 and 9 <br />13. Except as specifically provided otherwise by this license, the licensee shall <br />possess and use radioactive material described in Items 6, 7, and 8 of this <br />license in accordance with statements, representations, and procedures contained <br />in the documents listed below. The Department's regulations shall govern unless <br />the statements, representations, and procedures in the licensee's application and <br />correspondence are more restrictive than the regulations. <br />(a) The application received on May 28, 1992, as modified by letter with <br />attachments dated June 29, 1992, both signed by Michael D. Reitz, M.D. <br />14. (a) The radiation safety officer in this program shall be Michael D. Reitz, M.D. <br />(b) The chairperson of the radiation safety committee shall be Michael D. Reitz, <br />M.D. <br />(c) The custodian of sealed sources shall be Michael E. Reitz, M.D. <br />15. Sealed Sources possessed under this license shall be tested for leakage and/or <br />contamination as required by Section 30275 (c) of the California Radiation Control <br />Regulations. <br />Date: July 22, 1992 <br />RH 2551 (Int.) (1/91) <br />For the State Department of Health Services <br />By: 3 <br />Radiologic Health Branch <br />P.O. Box 942732 <br />Sacramento, CA 94234-7320 <br />
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