Fillable REQUEST FOR PUBLIC DOCUMENTS (AZ Radiation Regulatory Agency)

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REQUEST FOR PUBLIC DOCUMENTS (AZ Radiation Regulatory Agency)

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4814 South 40th Street WWW.ARRA.AZ.GOV
PHONE (602) 255-4845
Phoenix, Arizona 85040-2940 Fax (602) 437-0705
REQUEST FOR PUBLIC DOCUMENTS
(Commercial Purpose)
I request the documents described herein from the Arizona Radiation Regulatory Agency.
Make your information request selection from the drop down menu below the specific agency program. Please use
the space on the right to provide any additional information or to describe a selection of other .
X-Ray Radiation
(Use this space to describe a menu selection of other or
for providing additional information.)
Radioactive Materials
Nonionizing Radiation
Medical Radiological Board of Examiners
Radiation Measurements Lab
Pursuant to Arizona Revised Statutes
§ 39-121.03 (A), describe the purpose
of this request at right and provide
requestor information below.
Requestor’s Name
Title
Street Address or POB
City
Subscribed and Sworn to before me on
this _____ day of _________ 20______ .
Notary Public:______________________
My commission expires: _____________
Affix seal:
State
Zip Code
By signing below, I affirm that the above described
purpose is an accurate description of the purposed
use of these requested public records.
Signature
There is a $30.00 charge per list in excel format e-mailed as an attachment; $35.00 on disc and mailed
via US Mail. For hard copy request call 602-255-4845.
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REQUEST FOR PUBLIC DOCUMENTS (AZ Radiation Regulatory Agency)

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Completed 20 July 2020

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