Arizona Administrative Code
Title 9 - HEALTH SERVICES
Chapter 7 - DEPARTMENT OF HEALTH SERVICES - RADIATION CONTROL
Article 2 - REGISTRATION, INSTALLATION, AND SERVICE OF IONIZING RADIATION-PRODUCING MACHINES; AND CERTIFICATION OF MAMMOGRAPHY FACILITIES
Appendix A - Application Information
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.
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Name and mailing address of applicant |
Use location |
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Person responsible for radiation safety program |
Telephone number |
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Type of facility |
Facility subtype |
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Legal structure and ownership |
Signature of certifying agent |
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Radiation machine information |
Equipment identifiers |
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Shielding information |
Scale drawing, if applicable |
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Equipment operator instructions and restrictions |
Physicist name and training, if applicable |
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Classification of professional in charge |
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Record of calibration for therapy units |
Type of request: amendment, new, or renewal |
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Protection survey results, if applicable |
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Type of industrial radiography program, if applicable |
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Radiation Safety Officer name, if applicable |
Contact person |
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Other registration requirements listed in Articles 2, 6, 8, 9, and 11 |
Appropriate fee listed in Article 13 schedule |
