Ariz. Admin. Code § tit. 9, ch. 7, art. 2, app A
An application shall contain the following information as required in R9-7-202(B), before a registration will be issued. The Department shall provide an application form to an applicant with a guide, if available, or shall assist the applicant to ensure that only correct information is provided on the application.
Name and mailing address of applicant | Use location |
Person responsible for radiation safety program | Telephone number |
Type of facility | Facility subtype |
Legal structure and ownership | Signature of certifying agent |
Radiation machine information | Equipment identifiers |
Shielding information | Scale drawing, if applicable |
Equipment operator instructions and restrictions | Physicist name and training, if applicable |
Classification of professional in charge | |
Record of calibration for therapy units | Type of request: amendment, new, or renewal |
Protection survey results, if applicable | |
Type of industrial radiography program, if applicable | |
Radiation Safety Officer name, if applicable | Contact person |
Other registration requirements listed in Articles 2, 6, 8, 9, and 11 | Appropriate fee listed in Article 13 schedule |
Ariz. Admin. Code tit. 9, ch. 7, art. 2, app A