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  • Ci 40w Gla Self Form

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If a portable/mobile device is being utilized at a temporary job site is the assignment utilization log for that device maintained for inspection by the agency at that job site as required I certify the above information is true and correct Signature Date CI-40w Rev. 9/29/2010 SUBMIT THIS INVENTORY TO THE AGENCY and please maintain a copy for inspection by the Texas Department of State Health Services DEVICE SERIAL NUMBER Device Manufacturer .

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How to fill out the Ci 40w Gla Self Form online

Filling out the Ci 40w Gla Self Form is an essential step for compliance with the General License Acknowledgment requirements. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to fill out the Ci 40w Gla Self Form.

  1. Click 'Get Form' button to obtain the form and open it in the editor.
  2. Enter your name as listed on your General License Acknowledgment (GLA) in the appropriate field.
  3. Input your Acknowledgment Number in the designated box, which you can find on your GLA.
  4. Provide the name of the responsible person and include their telephone and fax numbers for contact.
  5. Complete the sections concerning the number of sources, indicating the number possessed, received, and transferred since your last report.
  6. In the administrative requirements section, check 'Yes,' 'No,' or 'N/A' for each question, providing additional details as needed.
  7. Identify and list any devices with their details in the inventory section, including manufacturer, model number, and isotopes.
  8. Review the completed form for accuracy and ensure that all required fields are filled out completely.
  9. Once the form is completely filled out, you can save changes, download a copy, print, or share it as required.

Complete the Ci 40w Gla Self Form online to ensure compliance with health services regulations.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232