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`State of b44foinlo—Heolth and We"dre Agency <br />13. Continued <br />Supplementary Sheet <br />Deparimenf of Heolth Services <br />4 6 <br />Page of Pages <br />5766-39 <br />License Number: <br />2 <br />Amendment Number: <br />(2) Provisions of subparagraph 13(i) became effective on January 1, <br />1994, and remain in effect until such time as amendments to <br />Title 17, CCR, Subchapter 4, Group 3 that implement the above <br />specified provisions of Title 10, CFR, Part 20, become effec- <br />tive. <br />(e) A user may apply to the Department for authorization to operate up to <br />an annual dose limit, for an individual member of the public, of 0.5 <br />Rem (5 mSv), pursuant to provisions of Title 10, CFR, Part 20, Sec- <br />tions 20.1301 and 20.1302, by submitting their request on Department <br />Form RH 500. <br />(ii) Except as specifically provided otherwise by this license, the licensee <br />shall possess and use radioactive material described in this license in <br />accordance with statements, representations, and procedures contained in <br />the documents listed below: <br />(a) The application received on May 2, 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 />16. Analytical tests for leakage and/or contamination of sealed sources shall be <br />performed only by persons specifically authorized to perform that service. <br />17. The following individuals are authorized to collect wipe test samples of sealed <br />sources possessed under this license using leak test kits acceptable to the <br />California Department of Health Services. <br />(a) The Radiation Safety Officer <br />(b) Qualified individuals designated by the Radiation Safety Officer <br />Date: February 4, 1994 <br />RH 2551 (Int.) (1 /91) <br />For the State Department of Health Services <br />3 <br />By: <br />Radiologic Health Branch <br />P.O. Box 942732 <br />Sacramento, CA 94234-7320 <br />