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COMPLIANCE INFO_1993-2006
Environmental Health - Public
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COMPLIANCE INFO_1993-2006
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Last modified
1/4/2023 2:01:04 PM
Creation date
7/3/2020 10:17:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4500 - Medical Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
1993-2006
RECORD_ID
PR0450003
PE
4522
FACILITY_ID
FA0000513
FACILITY_NAME
LODI MEMORIAL HOSPITAL
STREET_NUMBER
975
Direction
S
STREET_NAME
FAIRMONT
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
03107039
CURRENT_STATUS
01
SITE_LOCATION
975 S FAIRMONT AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\cfield
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FilePath
\MIGRATIONS\MW\MW_4522_PR0450003_975 S FAIRMONT_1993-2006.tif
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EHD - Public
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tate of California-Health and Welfare Age <br />0 <br />RADIOACTIVE MATERIAL LICENSE <br />Department of Health Services <br />Page 2 of 3 pages <br />License Plumber: 5927-39 <br />Amendment Number: 4 <br />12. Radioactive material may be used only by, or under the supervision and in the physical presence of, individuals who: <br />(a) Have satisfactorily completed a course, accepted by the Department as adequate, in safe use of soil/asphalt <br />content gauges containing radioactive material and also; <br />(b) Have been provided with a statement, signed by the Radiation Safety Officer, which designates that individual <br />as an authorized user qualified to use radioactive material under this license. Copies of these documents shall be <br />maintained for inspection by the Department. <br />13. Except as specifically provided otherwise by this license, the licensee shall possess and use radioactive material <br />described in Items 6, 7, 8 and 9 of this license in accordance with the statements, representations, and procedures <br />contained in the documents listed below. The Department's regulations shall govern unless the statements, <br />representations, and procedures in the licensee's application and correspondence are more restrictive than the <br />regulations. <br />(a) The application with attachments dated May 7, 1993, signed by Rodney D. Ballard, the letter with attachments <br />dated June 10, 1993, and the "Emergency Phone Numbers" received August 18, 1993, both signed by <br />Ken J. Blesch. <br />(b) The letter with attachments dated April 7, 1997, signed by Larry Slater, regarding new storage location. <br />14. The Radiation Safety Officer in this program shall be Russ Carpenter. <br />15. Sealed sources contained in soil/asphalt gauges shall be tested for leakage and/or contamination at intervals not to <br />exceed one year. <br />16. The following individuals are authorized to collect wipe test samples of sealed sources possessed under this license <br />using leak test kits acceptable to the California Department of Health Services: <br />(a) The Radiation Safety Officer <br />(b) Qualified individuals designated in writing by the Radiation Safety Officer <br />17. Quantitative analytical assays for the purpose of tests for leakage and/or contamination of sealed sources shall be <br />performed only by persons specifically authorized to perform that service. <br />18. Records of leak test results shall be kept in units of microcuries and maintained for inspection. Records may be <br />disposed of following Department inspection. Any leak test revealing the presence of 0.005 microcuries or more of <br />removable radioactive material shall be reported to the Department of Health Services, Radiologic Health Branch, <br />601 N. 7`h Street, P.O. Box 942732 — MS 178, Sacramento, CA 94234-7320, within five days of the test. This report <br />shall include a description of the defective source or device, the results of the test, and the corrective action taken. <br />19. Maintenance and repair of soiVasphalt content gauges shall be performed only by persons specifically authorized to <br />perform those services. <br />
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