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COMPLIANCE INFO_1987-2019
Environmental Health - Public
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EHD Program Facility Records by Street Name
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4500 - Medical Waste Program
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PR0450001
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COMPLIANCE INFO_1987-2019
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Last modified
4/19/2023 4:04:55 PM
Creation date
8/25/2021 3:57:02 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4500 - Medical Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
1987-2019
RECORD_ID
PR0450001
PE
4522
FACILITY_ID
FA0002864
FACILITY_NAME
DAMERON HOSPITAL
STREET_NUMBER
525
Direction
W
STREET_NAME
ACACIA
STREET_TYPE
ST
City
STOCKTON
Zip
95203
APN
13715304
CURRENT_STATUS
01
SITE_LOCATION
525 W ACACIA ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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State of Caiifornia—Health and Welfare Agen <br />Department of Health Services <br />Page 1 of 1 pages <br />RADIOACTIVE MATERIAL LICENSE License Number 1812-39 <br />Supplementory Sheet Amendment Number 29 <br />;s <br />Dameron Hospital Association <br />525 West Acacia Street <br />Stockton, CA 95203 <br />Attention: Nathan H. Woodruff, Jr. M.D. <br />I , ":1 .' 1'], 3, 3 <br />Radiation Safety Officer rA"''' t <br />In response to the letter with attachment dated July 14, 1989, signed by Nathan H. <br />Woodruff, Jr., M.D., License Number 1812-39 is hereby amended in part as follows: <br />To read: <br />7. Form <br />Category H - Non -human uses <br />2. Sealed sources, manufactured, labeled, packaged and distributed in accordance <br />with a specific license issued to the manufacturer by the U.S. Nuclear <br />Regulatory Commission or an Agreement State, not to exceed 12 mCi each. <br />To add: <br />13. (g) The letter with attached Sr -90 storage facility diagram dated <br />June 27, 1989, signed by Nathan H. Woodruff, Jr. M.D. <br />July 26, 1989 <br />Date <br />RH 2551 (2/82) <br />For the State Department of Health Servi s <br />lY <br />Radiologic f4Wth Branch <br />714 P Street, Sacramento, CA 95814 <br />3 <br />
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