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State of California-Health and Welfare Agen Department of Health Services
<br /> Page 2 of 3 pages
<br /> RADIOACTIVE MATERIAL LICENSE License Number: 1294-39
<br /> Amendment Number:57
<br /> 12. The individuals named below are authorized the specific uses of radioactive material described in Items 6, 7, 8,and 9
<br /> of this license as follows:
<br /> (a) Douglas McGirr,M.D. Groups 1,2,3 and 9
<br /> (b) Michael R.Rigdon,M.D. Groups 1,2,3 and 9
<br /> (c) Roger S. Eng,Jr.,M.D. Groups 1,2,3,4, 5 and 9
<br /> (d) Majid Majidian,M.D. Groups 1,2,3 and 9
<br /> (e) Ramesh N.Dharawat, M.D. Groups (1,2,3: cardiac studies only)and 9
<br /> (f) Roger P.Vincent,M.D. Groups 1,2,3,4, 5 and 9
<br /> (g) Dennis D. Jacobson,M.D. Groups 1,2,3,4, 5 and 9
<br /> (h) Frank M.Hartwich,M.D. Groups 1,2,3,(4&5,1-131 only)and 9
<br /> (i) R.Branden Rankin, III,M.D. Groups 1,2,3, (4& 5,1-131 only)and 9
<br /> 0) Grant W.Rogero,M.D. Groups 1,2,3 and 9
<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 license renewal application, with attachments, dated April 10, 2001, signed by Steve Ebert, Hospital
<br /> Director, and the letter,with attachments,received June 18,2001, signed by James King,Director of Diagnostic
<br /> Imaging.
<br /> 14. (a) The Radiation Safety Officer in this program shall be Dennis D. Jacobsen,M.D.
<br /> (b) The Chairperson of the Radiation Safety Committee shall be James King, CRT.
<br /> (c) The Custodian of sealed sources shall be Dennis D.Jacobsen,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 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.
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