Ariz. Admin. Code § R9-7-209
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 |
New Article 2, Appendix A recodified from 12 A.A.C. 1, Article 2, Appendix A, at 24 A.A.R. 813, effective March 22, 2018 (Supp. 18-1).
New Section R9-7-209 recodified from R12-1-209, at 24 A.A.R. 813, effective March 22, 2018 (Supp. 18-1).