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State of Callforme-Hcelth and Human services Agency <br />California Department of Public Health <br />Page 3 of 4 pages <br />RADIOACTIVE MATERIAL LICENSE umnse Number 6852-19 <br />Amendment Number. 17 <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 Public Health: <br />(a) The Radiation Safety Officer <br />(b) Qualified individuals designated in writing by the Radiation Safety Officer <br />17, Quantitative nnalytical assays for the purpose of tests for leakage and/or contamination of sealed sources shall be <br />perfumed only by persons specifically authorized to perform that service. <br />18. Records of leak test results shall be kept in units of becquerls (micruouries) and maintained for inspection. Records <br />may be disposed of following Department inspection. Any leak test revealing the presence of 185 Bq (0.005 µCi) or <br />more of removable radioactive material shall be reported to the California Department of Public health, Radiologic <br />Health Branch, MS 7610, P.O. Box 997414, Sacramento, CA 95999-7111, within five days of the test. This report <br />shall include a description of the defective source or device, the results of the test, and the corrective action taken. <br />19. Maintenance and repair of soillasphalt content gauges shall be performed only by persons specifically authorized to <br />perform those services. - <br />20. At any time the licensee is engaged in making measurements by authority of this license at either a permanent or <br />temporary job site, the licensee shall have a current copy of each of the following documents available for inspection <br />at the job site: <br />(a) A statement authorizing each qualified individual to use radioactive material (See Condition 12). <br />(b) This license. <br />(c) The manufacturer's instruction manual with appropriate erucrgeney procedures. <br />21. 1'he licensee shall comply with all requirements of Title 17, California Code of Regulations, Section 30373 when <br />transporting or delivering radioactive materials to a carrier for shipment. These requirements include; packaging, <br />marking, labeling, loading, storage, placarding, monitoring, and accident reporting. Shipping papers shall be <br />maintained for inspection pursuant to the U.S. Department of Transportation requirements (1 itle 49, Code of Federal <br />Regulations, Part 172, Sections 172.200 through 172.204). <br />22. The licensee shall conduct a physical inventory every six months to account for all sealed sources and/or devices <br />received and possessed under the license. Records of the inventories shall be maintained for inspection, and may be <br />disposed of following Department inspection. <br />23. Before radioactive materials may be used at a temporaryjob site at any federal facility, the jurisdictional status of the <br />job site oust be determined. If the jurisdictional status is unknown, the federal agency should be contacted to <br />determine if the job site is under exclusive federal jurisdiction. A response shall he obtained in writing or a record <br />made of the name and title of the person at the federal agency who provided the determination and the date that it <br />was provided. Authorization for use of radioactive materials at the job sites under exclusive federal jurisdiction shall <br />be obtained either by: <br />(a) Filing an NRC Form-241 in accordance with the Code of Federal Regulations, Title 10, Part 150.20 (b), <br />"Recognition of Agreement State Licenses", or <br />(b) By applying for a specific NRC license. <br />Before radioactive material can be used at a tempornryjob site in another State, authorization shall be obtained from <br />the State if it is an Agreement State, or from the NRC for any non -Agreement State, either by tiling for reciprocity or <br />applying for a specific license. <br />S ubsp; <br />C;ily Council <br />Banbsp;21 lndash;lnbsp;l90 <br />7/6/2021 <br />'@nhsp; <br />