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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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State of California-Health and Welfare Agen Department of Health Services <br />RADIOACTIVE MATERIAL LICENSE <br />13. Except as specifically provided otherwise by this license, the licensee shall posse <br />described in Items 6, 7, 8 and 9 of this license in accordance with the statements, <br />contained in the documents listed below. The Department's regulations shall <br />representations, and procedures in the licensee's application and correspondence <br />regulations. <br />Page 3 of 5 pages <br />License Number: 1368-39 <br />Amendment Number: 28 <br />ss and use radioactive material <br />representations, and procedures <br />govern unless the statements, <br />are more restrictive than the <br />(a) The renewal application, with attachments, dated February 15, 1994, signed by Verna Gallery, as amended by <br />the letters, with attachments, dated January 13, 1995, and April 13, 1995, both signed by Roger P. Vincent, <br />M.D., Radiation Safety Officer. <br />(b) The letter dated November 9, 1999, signed by Roger P. Vincent, M.D., Radiation Safety Officer, regarding the <br />addition of Ir -192 brachytherapy procedures and commitments. <br />14. (a) The Radiation Safety Officer in this program shall be Roger P. Vincent, M.D. <br />(b) The Chairperson of the Radiation Safety Committee shall be R. Brandon Rankin, III, M.D. <br />(c) The Custodian of sealed sources shall be Roger P. Vincent, M.D. <br />(d) The Alternate Radiation Safety Officer in this program shall be R. Brandon Rankin, III, M.D. <br />15. Sealed sources possessed under this license shall be tested for leakage and/or contamination as required by Title 17, <br />California Code of Regulations, Section 30275 (c). <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. The licensee shall conduct a physical inventory every six months to account for all sealed sources and/or devices <br />received and possessed under the license. Records of the inventories shall be maintained for inspection, and may be <br />disposed of following Department inspection. <br />18. The licensee is authorized to hold radioactive materials with a physical half-life of less than 65 days for decay in <br />storage before disposal in ordinary trash provided: <br />(a) Radioactive waste to be disposed of in this manner shall be held for decay in storage for at least 10 half-lives. <br />(b) Before disposal as normal waste, radioactive waste shall be surveyed to determine that its radioactivity cannot <br />be distinguished from background. All radiation labels shall be removed or obliterated. <br />19. The licensee may use any commercially available device, acceptable to the U.S. Nuclear Regulatory Commission, an <br />Agreement State or a Licensing State, for doing linearity tests of its dose calibrator provided the procedures <br />described by the manufacturer of the linearity device are followed. <br />20. Nuclear medicine technology procedures shall be performed by nuclear medicine technologists pursuant to Title 17, <br />California Code of Regulations, Subchapter 4.6. Such procedures shall be performed under the supervision of <br />individuals listed as authorized users on this license who meet the criteria specified in Section 30510. Certificates or <br />special permits issued pursuant to Subchapter 4.6 shall be prominently displayed at the facility authorized on this <br />license. <br />
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