Get Portable Gauge License Application - Maine.gov

Filling out the Portable Gauge License Application is an essential step for users seeking to utilize radioactive materials in portable gauges. This guide provides clear and comprehensive instructions to help you complete the application accurately and efficiently.

Follow the steps to complete your application successfully.

1. Click ‘Get Form’ button to access the application and open it in your chosen editor.
2. Indicate the type of application you are submitting by checking one of the options: new license, renewal, or amendment.
3. Fill in your name and mailing address as the applicant in the specified fields.
4. Provide the address or addresses where the materials will be used and/or stored, including phone numbers.
5. Enter the name of the individual who can be contacted regarding your application, along with their phone number, address (if different), and email.
6. For items 5 through 11, if additional space is needed, you may submit the required information on standard size paper. Clearly indicate 'not applicable' for any items that do not apply to your situation.
7. List the radioactive materials for unsealed and/or sealed sources, including essential details such as element, mass number, chemical form, maximum possession amount, and for sealed sources, the manufacturer and model number.
8. Provide details regarding the radiation safety officer, including their name, contact information, and evidence of relevant training.
9. On a separate sheet, list all individuals who will use or supervise the use of the radioactive materials, and ensure to include training certification.
10. Describe your facility, including diagrams where necessary, detailing how the materials will be used and stored.
11. Outline your radiation safety program, including audit procedures, emergency procedures, routine maintenance, and waste management protocols.
12. Complete the certification section, confirming that the information is true to the best of your knowledge, and include the date, your signature, title, and printed name.
13. Once you have reviewed all sections for accuracy, you can then save your changes, download the application, print a copy, or share the form as needed.

Complete your Portable Gauge License Application online today for a streamlined process.