Get Reciprocity 3-day Notification Form - New Mexico Environment ... - Nmenv State Nm

Filling out the Reciprocity 3-day Notification Form is a crucial step for users planning to work with radioactive materials in New Mexico. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to access the Reciprocity 3-day Notification Form and open it in your preferred document editor.
2. Enter the scheduled dates of work in the designated fields: Start Date, End Date, and the Number of days worked. Ensure that these dates are accurate and reflect your intended work schedule.
3. Fill in the Licensee Information section. Include your Licensee Name and Radioactive Materials License Number. Use the Add or Delete options if you need to include or remove additional licensee information.
4. Indicate if this is a previous notification by selecting Yes or No. If you select Yes, provide the Notification Date and specify whether this is a revision of a previous notification.
5. Complete the section for the reason for late notification if applicable, and fill in the Reciprocal License Number and Issuing Agency if relevant.
6. Provide your Contact Name, Fax Number, Telephone Number, and Email Address for communication purposes, making sure all details are current.
7. Attach a copy of your current license and any amendments in the attachments required section.
8. List the types of work to be performed by selecting from options such as Pipeline, Concrete/Foundation, Lead Paint Analysis, among others, or specify if other.
9. Enter work location information, including the physical address or a description of the work site.
10. Fill in the Equipment details, including the make, model, and serial number, as well as the Company Name of the equipment used.
11. Include details on isotopes by specifying the chemical abbreviation, activity, and units (Ci or mCi) for each isotope.
12. Certify the information by signing in the designated area, dating the form to confirm your acknowledgement of the terms and regulations outlined.
13. Finally, save any changes, download, print, or share the completed form as needed in your online document management system.

Complete your Reciprocity 3-day Notification Form online to ensure compliance and timely submission.