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COMPLIANCE INFO_1993-2006
Environmental Health - Public
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4500 - Medical Waste Program
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PR0450003
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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 lige% fib~ "°~` '' Department of Health Services <br />Page 1 of 4 pages <br />RADIOACTIVE MATERIAL LICENSE <br />Pursuant to the California Code of Regulations, Division 1, Title 17, Chapter 5, Subchapter4, 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 listed below; and to use such radioactive, material for the purpose(s) and at the <br />places(s) designated below. This license is subject to all applicable rules, regulations, and orders of fha Department of Health Services now <br />or hereafter in effect and to any standard or specific condition specified in this license. <br />Lodi <br />2. Address 975 South Fairmont Avenue <br />P.O. Box 3004 <br />Lodi, CA 95241-1908 <br />Attention: Roger P. Vincent, M.D. <br />Radiation Safety Officer <br />UCI <br />1368-39 <br />4. Expiration date <br />March 21, 2002 <br />agency Radiologic 1 <br />Sacramento <br />Amendment Number: 27 <br />(3) <br />In response to the letter dated April 30, 1998, signed by Roger P. Vincent, M.D., Radiation Safety Officer, License <br />Number 1368-39 is hereby amended in its entirety. <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. Any radionuclide with <br />Excluding generators <br />Groups 1, 2, 3 and 4 not to exceed <br />atomic number 3-83. <br />825 mCi. <br />B. Group 6 as specified in Item 9. <br />B. <br />B. <br />1. Cesium -137 <br />1. Sealed sources <br />1. Total 300 mCi, in 6 sources, <br />no single source to exceed <br />75 mCi. <br />2. Radium -226 <br />2. Sealed sources <br />2. Total 100 mg, in 6 sources, no <br />single source to exceed <br />25 mg. <br />3. Iodine-125 <br />3. Seeds <br />3. 100 mCi. <br />4. Palladium -103 <br />4. Seeds <br />4. 500 mCi. <br />5. Strontium -90 <br />5. Applicator <br />5. Total 50 mCi, in 1 source, no <br />single source to exceed <br />50 mCi. <br />C. Group 9 as specified in Item 9. <br />C. Sealed or solid sources, <br />C. Total not to exceed 25 mCi. Each <br />Any radionuclide with atomic <br />manufactured in accordance with a <br />source not to exceed 15 mCi. <br />numbers 3-83, inclusive, except: <br />specific license issued by the <br />Strontium -90 and Lead -210. <br />United States Nuclear Regulatory <br />Commission or an Agreement <br />State. <br />9. Authorized Use <br />To be used for nuclear medicine procedures as specified in groups below: <br />A. Group I Diagnostic studies involving measurement of uptake, dilution, or excretion but not involving <br />imaging. <br />
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