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Stec of Cal M"ervi gency Department of Health Services <br />IQ) V 0 Page 1 of 4 pages <br />FEB18 2004 RADIOACTIVE MATERIAL LICENSE <br />Pursuant toy{ utations, Division 1, Title 17, Chapter 5, Subchapter 4, Group 2, Licensing of Radioactive Material, and <br />In reliance �V tations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, <br />use, possess, *T,1@fl0@of radioactive material listed below; and to use such radioactive material for the purpose(s) and at the <br />places(s) designated below. This ►cense is subject to all applicable rules, regulations, and orders of the Department of Health Services now <br />or hereafter in effect and to any standard or specific condition specified in this license. <br />1. Licensee: Dameron Hospital Association <br />2. Address: 525 West Acacia Street <br />Stockton, CA 95203 <br />Attention: Anil K. Sain, M.D. <br />Radiation Safety Officer <br />License Number 1812-39 is hereby amended as follows: <br />3. <br />1812-39 <br />Amendment Number: 53 <br />14. Expiration date: <br />January 24, 2009 (3) <br />5. Inspection agency: Radiologic Health Branch <br />Sacramento <br />6. Nuclide <br />7. Form <br />8. Possession Limit <br />A. Group 1, 2, 3, 4 and 5 as specified <br />A. Any <br />A. Combined possession limit for <br />in Item 9. Any radionuclide with <br />Groups 1, 2, 3, 4, and 5 not to <br />atomic number 3-83. <br />exceed 1.251 Ci. <br />B. Group 9 as specified in Item 9. <br />B. Sealed or solid sources <br />B. Total not to exceed 25 mCi. <br />Any radionuclide with atomic <br />manufactured in accordance with a <br />Each source not to exceed 20 mCi. <br />number 3-83 inclusive, except: <br />specific license issued by the <br />Strontium -90 and Lead -210. <br />United States Nuclear Regulatory <br />Commission, an Agreement State <br />or Licensing State. <br />9. Authorized Use <br />To be used for nuclear medicine procedures as specified in groups below: <br />A. Group 1 Diagnostic studies involving measurement of uptake, dilution, or excretion but not involving <br />imaging. <br />Group 2 Diagnostic studies involving imaging including the use of Xenon -127 and/or Xenon -133 gas. <br />Group 3 Reagent kits including Mo/Tc 99m and Rb/Kr 81m generators and utilizing bulk technetium <br />prepared by a radiopharmacy for preparation of radiopharmaceuticals listed in Group 2. <br />Group 4 Internal therapy and palliative treatment not usually requiring hospitalization. <br />Group 5 Internal therapy and palliative treatment requiring hospitalization for purposes of radiation safety. <br />B. Group 9 Marker and calibration sources. <br />LICENSE CONDITIONS <br />10. Radioactive material shall be used only at the following location: <br />(a) 525 West Acacia Street, Stockton, CA. <br />