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• Stale of Colilornlo—Health and Welfare Agency Supplementary Sheet Page 3 Department of Health Services — of 5 Pages (cense Number: 5766-39 Amendment Number: 3 13. Except as specifically provided otherwise by this license, the licensee shall possess and use radioactive material described in Items 6, 7., 8, and 9 of this license in accordance with statements, representations, and procedures contained in the documents listed below. The Department's regulations shall govern unless the statements, representations, and procedures in the licensee's application and correspondence are more restrictive than the regulations. (a) The application received. on May 28, 1992, as modified by letter with attachments dated June 29, 1992, both signed by Michael D. Reitz, M.D. (b) The letters dated Jurbe 24, 1994, and August 9, 1994 both sided by Michael D. Reitz, M.D., as modified by the letter with_attaciments dated August 30, 1994, signed by Diane D. Banning, Radiology ManageX, regarding the use of the Strontium 89. 14. (a) The Radiation Safety Officer in this program shall be Michael D. Reitz, M.D. (b) The Chairperson of the Radiation Safety Committee shall be Michael D. Reitz, M.D. (c) The Custodian of sealed sources shall be Michael D. Reitz, M.D. 15. Sealed sources possessed under this license shall be tested for leakage and/or contamination as required by Section 30275 (c) of the California Radiation Control Regulations. 16. Analytical tests for leakage and/or contamination of sealed sources shall be performed only by persons specifically authorized to perform that service. 17. The following individuals are authorized to collect wipe test samples of sealed sources possessed under this license using leak test kits acceptable to the California Department of Health Services. (a) The Radiation Safety Officer (b) Qualified individuals designated by the Radiation Safety Officer 18. Records of leak test results shall be kept in units of microcuries and maintained for inspection. Records may be disposed of following Department inspection. Any leak test revealing the presence of 0.005 microcuries or more of removable radioactive material shall be reported to the Department of Health Services, Radiologic Health Branch, P. O. Box 942732, Sacramento, CA .94234-7320, within five days of the test. This report shall include a description of the defective source or device, the results of the test, and the corrective action taken. For the State Department of Health Services Date: September 15, 1994 By: 3 Radlologic Health Branch P.O. Box 942732 Sacramento, CA 94234-7320 RH 2551 (Int.) (1/01)