Azdhs preparednessstate-laboratoryAZDHSState Laboratory - Arizona Department of Health Services 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the laboratory name in the designated field. Ensure that you provide accurate details as this is crucial for identification.
3. Fill in the laboratory manager’s name, including first, middle initial, and last name. This information helps establish a point of contact.
4. Complete both mailing and business addresses with street, city, state, and zip code. Double-check for accuracy to avoid any delays.
5. Provide the lab phone, fax, and email addresses for communication purposes. Similarly, include the manager's contact details.
6. Select whether this is an initial application or a renewal by checking the appropriate box. If renewing, enter your current certification number if applicable.
7. Indicate the commodity or sample type for which certification is requested.
8. Enter the owner's name and address details similarly to previous sections.
9. Finally, ensure that both the owner and manager sign and date the application to attest to its accuracy before submission.

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