Ariz. Admin. Code § tit. 9, ch. 7, art. 14, app B
The Department shall issue a registration if an applicant provides the following information and fee as required in R9-7-1401(D). The Department shall provide an application form to the applicant with a guide and upon request, assist the applicant to ensure that correct information is provided on the application form.
Name and mailing address of applicant
Personresponsible for radiation safety program
Typeof facility
Legal structure and ownership
Radiation source information Shielding information
Equipment operator instructions and restrictions
Classification of professional in charge
Type of request: amendment, new, or renewal
Protection survey results, if applicable
Radiation Safety Officer name if applicable
Laser class and type, if applicable
Information required by Article 14 for the specific source
Use location
Telephone number
Facility sub type
Signature of certifying agent
Equipment identifiers
Scale drawing
Physicist name and training, if applicable
Contact person
Applicable fee listed in Article 13 schedule
Ariz. Admin. Code tit. 9, ch. 7, art. 14, app B