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Stabs of California+leaNfi and MIfare Agency Depart hent of Health Services Page 3 of 6 pages RADIOACTlVE MATERLAL UCENSE License Number: 129439 Sup*ernertary- - 13. Cont. (a) The license renewal application with attachments dated March 31, 1989 signed by Michael N. Smith as modified by letters with attachments dated June 29, 1990, July 12, 1990 and September 18, 1990, all signed by Douglas McGirr, M.D. (b) The letter with attachments dated October 7, 1994, signed by Michael N. Smith, Director, regarding procedural changes and instruments calibration. (c) The letter with attachments dated November 21, 1994 signed by Steve Ebert, Hospital Director, regarding the new Radiation Training module. (d) The letter dated December 13, 1994, signed by Douglas McGirr, MLD., regarding the use of Calicheck device for the quarterly linearity test of the Dose calibrator. (e) The letter with attachments dated September 16, 1995, signed by Douglas B. WGim, MD., Radiation Safety Officer, regarding the purchase of new equipment (Picker Prism 1000 SPECT imaging system, Atomlab 950 thyroid probe and Atomlab 100 Plus dose calibrator). 14. (a) The Radiation Safety Officer in this program shall be Douglas McGirr, NLD. (b) The Chairperson of the Radiation Safety Cominittee shall be Douglas McGnTXD. (c) The Custodian of sealed sources shall be Douglas McGirr, MD. 15. Sealed sources possessed under this license shall be tested for leakage and/or contamination as required by Section 30275 (c) of the California Radiation Control Regulations. 16. Quantitative analytical assays for the purpose of tests for leakage and/or contamination of sealed sources shall be performed only by persons specifically authorized to perform that service. 17. The following individuals are authorized to collect wipe test samples of sealed sources posse6sed under this license using leak test kits acceptable to the California Departnent of Health Services: (a) The Radiation Safety Officer (b) Qualified individuals designated in writing by the Radiation Safety Officer 18. Records of leak test results shall be kept in units of microcuries and maintained for inspection. Records may be disposed of following Department inspection y leak test revealing the presence of 0.005 microcuries or more of removable radioactive material shall be reported to the Department of Health Services, Radiologic Health Branch, 601 N. 7th Street P.O. Box 942732, Sacramento, CA 94234-7320, within five days of the test. This report shall include a description of the defective source or device, the results of the test, and the corrective action taken.