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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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State of California -Health and Welfare Agency <br />RADIOACTIVE MATERIAL LICENSE <br />Supplementary Sheet <br />9. Authorized Use <br />400 <br />Department of Health Services <br />To be used for nuclear medicine procedures as specified in the groups below: <br />Page 2 of 4 pages <br />License Number: 5766-39 <br />Amendment Number: 4 <br />Group 1 Diagnostic studies involving measurement of uptake, dilution, or excretion but not involving <br />imaging. <br />Group 2 Diagnostic studies involving imaging including the use of Xenon 127 and/or Xenon 133 gas. <br />Group 3 Reagent kits for preparation of radiopharmaceuticals listed in Group 2. <br />Group 4 Internal therapy not usually requiring hospitalization. <br />Group 9 Nonhuman use, marker, calibration sources, in vitro test, animal studies and Blood irradiator. <br />LICENSE CONDITIONS <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 authorized to be possessed at any <br />one time as specified in Item 8 of this license. The annual fee for this license is required by and computed <br />in accordance with Sections 30230-30232 of the California Radiation Control Regulations and is also subject <br />to an annual cost -of -living adjustment pursuant to Section 113 of the California Health and Safety Code. <br />12. The individuals named below are authorized the specific uses of radioactive material described in Items 6, <br />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, 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 possess and use radioactive <br />material described in Items 6, 7, 8 and 9 of this license in accordance with statements, representations, and <br />procedures contained in the documents listed below. The Department's regulations shall govern unless the <br />statements, representations, and procedures in the licensee's application and correspondence are more <br />restrictive than the regulations. <br />(a) The application received on May 28, 1992, as modified by letter with attachments dated June 29, 1992, <br />both signed by Michael D. Reitz, M.D. <br />
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