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State of California—Health and Welfare Agency <br />TI'l roment of Health Services <br />Page 1 of 5 pages <br />Pursuant to the California Administrative Code, Title 17, Chapter 5, Subchapter 4, Group 2, Licensing of Radioactive Material, and in reliance <br />on statements and representations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, use, possess, <br />transfer, or dispose of radioactive material listed below; and to use such radioactive material for the purpose(s) and at the place(s) designated <br />below. This license is subject to all applicable rules, regulations, and orders of the Department of Health Services now or hereafter in effect and <br />to any conditions specified in this license. <br />1. Licensee <br />San Joaquin General Hospital <br />2 Address P.O. BOX 1020 <br />Stockton, CA 95201 <br />Attention: Michael N. Smith, Director <br />Health Care Services <br />Date <br />3. License No. <br />1294-39 Amendment No. <br />14. Expiration dare <br />August 26, 1997 <br />5. Inspection agency <br />In response - er with attacbments dated November.. <br />3, signed by <br />Michael N. Smith, License Number 1294-39 is hereby amended as follows: <br />in acoordance with Article 4, Section 30195, the Medical Use Groups Specified below <br />grant the use of radioactive material, as approved, by the U.S. Flood and MT9 <br />the califarnia state Board of NWiml Quality Assurance and/or the <br />Califarnia State Board of Fhaxnacy, for diagnosis and treatment, of patients, when <br />Wed and as direated by an appr-priately physician listed on this <br />e -- <br />CEVOPS68L:iJUNDER i11J. 7 ' •e <br />Group 1 - Diagnostic studies involving measurement of uptake, dilution, or excretion <br />but not involving imaging. <br />Group 2 - Use of unit doses for Diagnostic studies involving imaging including the <br />use of Xenon 127 and/or Xenon 133 gas. <br />Group 3 - Use of reagent kits for Preparation of radicPharmaceuticals listed in Group <br />2. <br />Group 4 - Internal Therapy not usually requiring hospitalization (Iodine 131 limited <br />to capsule form only). <br />Group 5 - Internal therapy usually requiring hospitalization for purposes of <br />radiation safety (Iodine 131 limited to capsule form only). <br />RH 2550 (2/81) <br />December 28, 1993 <br />For the State Department of Health Services <br />by <br />Radiologic Health Section <br />744 P Street, Sacramento, CA 95814 <br />3 <br />