Il 473 0013-2025

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40 votes

The document is a registration form from the Illinois Emergency Management Agency's Division of Nuclear Safety, detailing the requirements for registering radiation machine installations. It includes sections for operator information, facility details, equipment specifications, and status updates on the machines. Compliance with state regulations is emphasized, and failure to provide required information may result in legal consequences.

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Click ‘Get Form’ to open the il 473 0013 in the editor.
Begin by filling in the 'Operator' section with your name and title, followed by the 'Facility Name' and complete address including city, state, and ZIP code.
Enter your FEIN/Tax Filing number, telephone number, email address, and fax number in the designated fields.
For each piece of equipment, provide the Equipment Reference Number. If it’s new, check the corresponding box.
Fill in the manufacturer name, model name/number, control serial number, acquisition date, and location for each unit listed.
Indicate the status of each unit by selecting from options such as 'Operable', 'Inoperable', or 'Sold to supplier'.
Finally, print or type your name, sign the form, and include the date before submitting it.

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Versions	Form popularity	Fillable & printable
2010	4.9 Satisfied (40 Votes)

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