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State of caill6mia-Health and Welfare Agency <br />RADIOACTIVE MATERIAL LICENSE <br />Supplementary Sheet <br />Department of Health Services <br />Page 2 of 2 pages <br />License Number: 5556-39 <br />Amendment Number: 5 <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 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 renewal application with attachments dated January 19, 1998 as modified by the letters with <br />attachments dated February 17, 1998 and March 12, 1998, all signed by Benjamin J. Spindler, M.D. <br />14. The Radiation Safety Officer in this program shall be Benjamin J. Spindler, M.D. <br />15. Sealed sources possessed under this license shall be tested for leakage and/or contamination as required by <br />Title 17, California Radiation Control Regulations, Section 30275 (c): <br />16. 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 />17. 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 />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. Installation, relocation, maintenance, repair, and initial radiation survey of devices containing radioactive <br />material and installation, replacement, and disposal of sealed sources containing radioactive material used in <br />devices shall be performed only by persons specifically licensed to perform such services. <br />For the State De ment of Health Services <br />Date March 27 1998 By: <br />Radiologi alth Branch <br />P.O. Box 942732, Sacramento, CA 94234-7320 <br />