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Stais of California -Health and Human Servi gency
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<br />RADIOACTIVE MATERIAL LICENSE
<br />Department of Health Services
<br />Page 2 of 4 pages
<br />License Number: 1812-39
<br />Amendment Number: 53
<br />11. This license is subject to an annual fee for sources of radioactive material authorized to be possessed at any one time
<br />as specified in Items 6, 7, 8 and 9 of this license. The annual fee for this license is required by and computed in
<br />accordance with Title 17, California Code of Regulations, Sections 30230-30232 and is also subject to an annual
<br />cost -of -living adjustment pursuant to Section 100425 of the California Health and Safety Code.
<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) Anil K. Sain, M.D.
<br />(b) Chull S. Song, M.D.
<br />(c) James D. Rooke, M.D.
<br />Groups 1, 2, 3, 4, 5 and 9
<br />Groups 1, 2, 3 and 9
<br />Groups (4 and 5,1-131 only)
<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 application, with attachments, dated April 13, 1999, signed by Luis Arismendi, M.D.,
<br />Administrator, as supplemented by the letters, with attachments, dated June 11, 1999, and July 20, 1999, all
<br />signed by Anil Sain, M.D., Radiation Safety Officer.
<br />(b) The letters dated November 28, 2001, and January 23, 2002, both signed by Anil K. Sain, M.D., Radiation
<br />Safety Officer, regarding a replacement gamma camera and associated procedures and commitments.
<br />(c) The letter, with attached diagram, dated December 5, 2002, and the letter, with attached diagrams, dated January
<br />9, 2003, both signed by Anil K. Sain, M.D., Radiation Safety Officer, regarding the addition of a secondary
<br />waste storage area.
<br />(d) The letter, dated December 19, 2003, signed by Anil K. Sain, M.D., Radiation Safety Officer, regarding
<br />the acquisition of a Pinestar "Nuclear Medicine Information System" computer to be used for
<br />documenting and storing facility's RAM records with associated procedures and commitments.
<br />14. (a) The Radiation Safety Officer in this program shall be Anil K. Sain, M.D.
<br />(b) The Chairperson of the Radiation Safety Committee shall be Anil K. Sain, M.D.
<br />(c) The Custodian of sealed sources shall be Anil K. Sain, M.D.
<br />(d) The Alternate Radiation Safety Officer in this program shall be Chull S. Song, 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
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