Form RCP-6 "Radiation Machine Registration Change of Status Notification" - North Dakota

What Is Form RCP-6?

This is a legal form that was released by the North Dakota Department of Health - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2007;
  • The latest edition provided by the North Dakota Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form RCP-6 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health.

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Download Form RCP-6 "Radiation Machine Registration Change of Status Notification" - North Dakota

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RADIATION MACHINE REGISTRATION
CHANGE OF STATUS NOTIFICATION
To indicate a change of status relative to the registration of radiation machines, please
complete the appropriate sections and forward to the address shown on the reverse side of this
form.
Facility Name:
Registration #:
~ ~ ~ ~
New Radiation Machine, request registration form.
~ ~ ~ ~
I have placed an X-ray machine in Storage:
Use information found on Radiation Machine Registration Form:
Mach
Manufacturer
Date
ID
(placed in storage)
~ ~ ~ ~
I will be replacing the machine(s) listed above.
~ ~ ~ ~
I will not be replacing the machine(s) listed above.
~ ~ ~ ~
I have transferred/sold/junked an X-ray machine:
Use information found on Radiation Machine Registration Form:
Mach
Manufacturer
Action taken: (If sold or transferred
indicate name of purchaser)
ID
~ ~ ~ ~
I will be replacing the machine(s) listed above.
~ ~ ~ ~
I will not be replacing the machine(s) listed above.
Signature:
Date:
RCP-6 (5/07)
RADIATION MACHINE REGISTRATION
CHANGE OF STATUS NOTIFICATION
To indicate a change of status relative to the registration of radiation machines, please
complete the appropriate sections and forward to the address shown on the reverse side of this
form.
Facility Name:
Registration #:
~ ~ ~ ~
New Radiation Machine, request registration form.
~ ~ ~ ~
I have placed an X-ray machine in Storage:
Use information found on Radiation Machine Registration Form:
Mach
Manufacturer
Date
ID
(placed in storage)
~ ~ ~ ~
I will be replacing the machine(s) listed above.
~ ~ ~ ~
I will not be replacing the machine(s) listed above.
~ ~ ~ ~
I have transferred/sold/junked an X-ray machine:
Use information found on Radiation Machine Registration Form:
Mach
Manufacturer
Action taken: (If sold or transferred
indicate name of purchaser)
ID
~ ~ ~ ~
I will be replacing the machine(s) listed above.
~ ~ ~ ~
I will not be replacing the machine(s) listed above.
Signature:
Date:
RCP-6 (5/07)
North Dakota Department of Health
Division of Air Quality
Radiation Control Program
nd
918 East Divide Avenue, 2
Floor
Bismarck, ND 58501-1947
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