Get La Deq Drc 22

The La Deq Drc 22 form is essential for registering services related to radiation monitoring. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the La Deq Drc 22 form online.

1. Click 'Get Form' button to access the La Deq Drc 22 form and open it in your preferred online editor.
2. Indicate the type of application by selecting the appropriate checkbox for new registration, renewal registration, or change of address or other information.
3. Enter the name of the individual or entity (e.g., hospital, corporation) responsible for the services in Item 1.
4. Provide your area code and telephone number in Item 2.
5. Fill out the mailing address in Item 3, ensuring you include the zip code.
6. In Item 4, list any additional facilities or branch offices where services are provided, including their complete addresses.
7. For Item 5, select the type of personnel monitoring device utilized by your employees exposed to radiation.
8. In Item 6, specify the frequency of personnel monitoring device exchanges, with options for monthly, quarterly, or other intervals.
9. Enter the name of your personnel monitoring supplier in Item 7, ensuring they are certified.
10. In Item 8, check the boxes corresponding to the types of services provided and include details for calibration services if applicable.
11. Complete Item 9 with details about any X-ray machines used, including manufacturer, model number, and serial number.
12. In Item 10, ensure the application is signed and dated by the applicant or an authorized representative.
13. After completing all sections, save your changes and download or print a copy for your records. Then, submit the original application to the designated mailing address.

Begin completing your La Deq Drc 22 form online today to ensure timely registration.