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State t jCalifornW Health amd Welfare Agency Department of Health Services <br />r <br />t <br />Page 1 of 6 pages <br />d <br />t R$� <br />RAf tOffT1YixM ► lAlA�LICENSE <br />I« <br />Pursuant to the California Administrative Code, Title 17, 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(s) 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 />1. Licensee <br />Kaiser Permanente Medical Offices <br />2. Address P • O. BOX 210005 <br />Stockton, CA 95269-9005 <br />Michael D. Reitz, M. D. <br />Attention: Radiation Safety Officer <br />Date <br />3. License No. <br />4. Expiration date <br />5766-39 Amendment No. 2 <br />July 22, 1999 <br />5, inspection agency RadiologiC Health Branch <br />Sacramento <br />response- to the letter dated D_._n•-r'17, 1993, signed by • - D. Reitz,/ <br />in accordance with Article 4, Section 30195, the Medical Use Groups specified beloFd <br />grant the use of radioactive inaterial, as apjx� by the U.S. Flood and Drug <br />, the State Board of Medical Quality Assuranoe and/or the <br />California State B•. • of Pharmacy,for diagnosis . • treatment of patients, <br />prescribed and as directed by an anxcpriately autborized plWsician listed on this <br />♦o <br />Group 1 - Diagnostic studies involving measurement of uptake, dilution, or excretion <br />but not involving imaging. <br />Group 2 - Diagnostic Studies involving imaging 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 <br />atomic numbers 3-83 <br />inclusive except: <br />RH 2550 (2/81) <br />(1) Strontium 90 and <br />(2) Dead 210 <br />February 4, 1994 <br />A. Marker sources and <br />calibration. <br />For the State Department of Health Services <br />M <br />Radiologic Health Section <br />744 P Street, Sacramento, CA 95814 <br />3 <br />