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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
Supplemental fields
FilePath
\MIGRATIONS\MW\MW_4522_PR0450003_975 S FAIRMONT_1993-2006.tif
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EHD - Public
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C <br />State of Calftri ia-Health and Welfare Agency <br />L&, —7-A T7 Fr <br />Departrnent of Health Services <br />Page 4 of 7 pages <br />License Number: 1368-39 <br />13. <br />8- <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 renewal application with attachments dated February 15, 1994 signed by Verna Gallery as <br />amended by the letters with attachments dated January 13, 1995 and April 13, 1995, both signed by <br />Roger P. Vincent, NLD., Radiation Safety Officer. <br />14. (a) The Radiation Safety Officer in this program shall be Roger P. Vincent, NLD., <br />(b) The Chairperson of the Radiation Safety Committee shall be R Brandon Rankin, III, NLD. <br />(c) The Custodian of sealed sources shall be Roger P. Vincent, NLD. <br />(d) The Alternate Radiation Safety Officer in this program shall be R Brandon Rankin, III, NLD. <br />15. Sealed sources possessed under this license shall be tested for leakage and/or contamination as required by <br />Section 30275 (c) of the California Radiation Control Regulations. <br />16. Quantitative analytical assays for the purpose of tests for leakage and/or contamination of sealed sources shall <br />be performed only by persons specifically authorized to perform that service. <br />17. The following individuals are authorized to collect wipe test samples of sealed sources possessed under this <br />license 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 />18. Records of leak test results shall be kept in units of microcuries and maintained for inspection. Records may <br />be disposed of following Department inspection Any leak test revealing the presence of 0.005 microcuries <br />or more of removable radioactive material shall be reported to the Department of Health Services, Radiologic <br />Health Branch, 601 N. 7th Street P.O. Box 942732, Sacramento, CA 94234-7320, within five days of the test. <br />This report shall include a description of the defective source or device, the results of the test, and the <br />corrective action taken <br />19. The licensee shall conduct a physical inventory every six months to account for all sealed sources and/or <br />devices received and possessed under the license. Records of the inventories shall be maintained for <br />inspection, and may be disposed of following Department inspection. <br />20. Except as otherwise specifically provided by this license, radiopharmaceuticals to be administered to humans <br />shall be procured in prepackaged, precalibrated form from a supplier who is registered with the U. S. Food <br />and Drug Administration, or prepared and compounded, from a prescription, in accordance with the <br />regulations of the California Board of Pharmacy. <br />
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