Get Radiation Producing Machine Transfer Or Disposal Request Form - Health Nv

Completing the Radiation Producing Machine Transfer or Disposal Request Form is essential for the proper management of radiation-producing machines. This guide will provide you with clear, step-by-step instructions to ensure that you fill out the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to acquire the form and open it for editing.
2. Fill in the Nevada registration number. This number identifies the radiation-producing machine in the state registry.
3. Enter the registrant’s name, street address, city, state, zip code, telephone number, email address, and fax number. Ensure all information is complete and accurate.
4. For the machine information section, provide the manufacturer’s name, model number, and serial number of the machine being transferred or disposed of.
5. Complete the section for the new owner by entering their name, date of sale or transfer, state, street address, zip code, telephone number, city, email address, and fax number.
6. Indicate if the machine was disassembled or made inoperable and provide the date of removal.
7. Answer whether the machine was removed from the state of Nevada by selecting 'Yes' or 'No'.
8. Enter the name and address of the service company responsible for the disassembly of the machine, if applicable.
9. Attach a copy of the service invoice or de-installation report to your completed form.
10. Acknowledge the operational status verification requirement by signing in the designated area and providing your name, title, and the date.
11. Review all entered information for accuracy before saving changes, downloading, printing, or sharing the completed form.

Complete your documents online today to ensure compliance and proper management of your radiation-producing machine.