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Mate of California -Health and Welfare A <br />VT_A 91 <br />•= j� <br />Department of Health Services <br />Page 1 of 3 pages <br />Pursuant to the California Code of Regulations, Division 1, Title 97, Chapter 5, Subchapter 4, Group 2, Licensing of Radioactive Material, and <br />in reliance on statements and representations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, <br />use, possess, transfer, or dispose of radioactive material fisted below; and to use such radioactive material for the purpose(s) and at the <br />places(s) designated below. This license is subject to ail applicable rules, regulations, and orders of the Department of Health Services now <br />or hereafter in effect and to any standard or specific condition specified in this license. <br />t. Licensee Kaiser Permanente Medical Facility 13. License Number <br />5766-39 <br />2. Address 7373 West Lane <br />Stockton, CA 95210 <br />Attention: Michael D. Reitz, M.D. <br />Radiation Safety Officer <br />4. <br />July 22, 1999 <br />Amendment Number: 11 <br />5. Inspection agency Radiologic Health Branch <br />4acramentn <br />(3) <br />In response to the letter, with attachments, dated October 23, 2001, signed by Michael Reitz, M.D., Chief of <br />Radiology, Radiation Safety Officer, License Number 5766-39 is hereby amended as follows: <br />6. Nuclide <br />7. Form <br />8. Possession Limit <br />A. Groups 1, 2, 3 and 4 as specified <br />A. Any <br />A. Combined possession limit for <br />in Item 9. <br />Excluding generators <br />Groups 1, 2, 3 and 4 not to exceed <br />Any radionuclide with atomic <br />650 mCi. <br />numbers 3-83. <br />B. Group 9 as specified in Item 9. <br />B. Sealed or solid sources <br />B. Total not to exceed 20 mCi. <br />Any radionuclide with atomic <br />manufactured in accordance with a <br />Each source not to exceed <br />numbers 3-83, inclusive, except: <br />specific license issued by the <br />13 mCi. <br />Strontium -90 and Lead -210. <br />United States Nuclear Regulatory <br />Commission, an Agreement State <br />or a LicensinE State. <br />9. Authorized Use <br />To be used for nuclear medicine procedures as specified in groups below: ry <br />A. Group 1 Diagnostic studies involving measurement of uptake, dilution, or excretion but not iyolving <br />4 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 and palliative treatment not usually requiring hospitalization. <br />B. Group 9 Marker and calibration sources. <br />LICENSE CONDITIONS <br />10. Radioactive material shall be used only at the following location: <br />(a) 7373 West Lane, Stockton, CA. <br />