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State of Califomia—Health and Welfare Agency If <br />RADIOACTIVE MATERIAL LICENSE <br />Department`6f�H a, h Sues <br />5 <br />Page 1 of pages <br />Pursuant to the California Administrative Code, Title 17, Chapter 5, Subchapter 4, Group Z 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 />3. License No. 5766-39 <br />4. Expiration date July 22, 1999 <br />Amendment No. <br />3 <br />5. Inspection agency <br />Attention. Michael D. Reitz, M.D. <br />Radiation Safety Officer Radiologic Health Branch -Sacramento <br />License Number 5766-39 is bereby amended as follows: <br />In accordance with Article 4, Section 30195, the Medical Use Groups specified below <br />grant the use of radioactive material, as approved by the U.S. Food and Drug <br />Administration, the California State Board of Medical Quality Assurance and/or the <br />California State Board of Pharmacy, for diagnosis and treatment of patients, when <br />prescribed and as directed by an appropriately authorized physician listed on this <br />license. <br />Date <br />GROUPS AUTHORIZED UNDER THIS LICENSE <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 />September 15, 1994 <br />RH 2550 (2/81) <br />For the State Department of Health Services <br />by <br />Radiologic Health Section <br />744 P Street, Sacramento, CA 95814 <br />3 <br />