Learn More. Temporary Licensure for Medical Imaging or Radiation Therapy Application Form REQUEST FOR WRITTEN VERIFICATION APPLICATION FORM LEGAL NAME CHANGE APPLICATION FORM Contact us RCB Main Phone Number: 505-476-8600 Contact information for Radiation Control Bureau staff is available here. 2 N. Meridian, 5th Floor. Fax: +1 214.473.8563, 2023 Society of Diagnostic Medical Sonography NMED works with all types of businesses in New Mexico to issue permits and licenses for complying with state and federal regulations. 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StatementGovernmental Entity Disclosure StatementKey Employee Disclosure StatementMain Disclosure StatementPersonal History Disclosure StatementBusiness Concern (Public Owner, Private Operator) Disclosure Statement, MyRCRAid Quick GuideMyRCRAid User GuideHard copy RCRA Subtitle C Activities Site Identification Form 8700-12RCRA Subtitle C Activities Site Identification Instructions, Whistleblower formInjury Tracking ApplicationOSHA 300, 300A, 301 Formsand InstructionsOSHA Poster, Initial Incident Report (must be filed within 24 hours of discovering a release)Instructions for completing Initial Incident Report30-Day Notification Form for Installations, Modifications, and Repairs30-Day Notification Form for Permanent Closure and Changes in Service30-Day Notification Form for Temporary Closure30-Day Notification WaiverTank Installer, Qualified Tester, and Operator Trainer Forms, ALLD and Electronic Sump Sensor Testing Evaluation Work SheetATG (Automatic Tank Gauge) and Interstitial or Sump 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Application form for first time installer certificationApplication form for renewal of installer certificationApplication form for first time Junior Installer certificationTester qualifications submittal formOperator Training Review Application and Matrix, Aquatics Operating Permit ApplicationConstruction Permit Application FormVariance Application FormVariance Indemnification / Release of Liability FormEmergency Action Plan TemplateDaily Opening ChecklistPool Daily Log sheet ExampleInspection FormInspection FormCheat Sheet, License Renewal Application form for Medical Imaging or Radiation TherapyInitialLicensure for Medical Imaging or Radiation Therapy Application formDuplicate or Replacement Certificate of Licensure Application formProvisional License Application formTemporary Licensure for Medical Imaging or Radiation Therapy Application formRequest for Written Verification Application formLegal Name Change Application form, Particle Accelerator Facility Registration, Amendment or Renewal formParticle Accelerator Registration GuideRegistration to Operate Radiation Machine formInstructions for Applying to use Radiation MachinesMedical Diagnostic or Industrial Radiation Machine Facility Application Form Required for Change of Control or Change of Ownership or both (including name change), Radiation Safety Officer PreceptorAuthorized Medical Physicist Preceptor (pdf)Authorized Nuclear Pharmacist Perceptor (pdf)Authorized User Diagnostic Use Preceptor (pdf)Authorized User Therapy Use Preceptor (pdf)Authorized User Sealed Source Therapy Use Preceptor (pdf)Instruction on How to fill-out Preceptor Form (pdf)Licensee Ownership Transfer Name Change FormGeneral License Application Small Uranium Thorium water filtration systemsGeneral License Registration Form Device AttachmentGeneral License Registration FormRCB Form 014RCB Form 016, Vendor Application GuidanceRadiological Services Application, Instruction Reciprocity RecognitionReciprocity 3-day Notification FormOut of State Radiation Machine 2 day notificationReciprocity Recognition form instructions, Log in to SEPAnnual Report InstructionsLandfill Capacity Calculation WorksheetFinancial Assurance Estimate Summary (for landfills)Financial Assurance Estimate Summary Simplified (for transfer stations)Environmental Monitoring SummaryAnnual Reporting Information FormTutorial: SEP RegistrationTutorial: Logging in to SEP2022 Annual Report Form: Tire Recycling Facility2022 Annual Report Form: Scrap Tire Hauler2022 Annual Report Form: Civil Engineering Applications, Collection Center Registration ApplicationCompost Facility Registration ApplicationRecycling Facility Registration ApplicationAir Curtain Incinerator Registration ApplicationSmall Animal Crematorium Registration Application, Main Disclosure StatementBusiness Concern Disclosure StatementGovernmental Entity Disclosure StatementKey Person Disclosure StatementPersonal History Disclosure StatementBusiness Concern (Public Owner, Private Operator) Disclosure StatementSubsidiary Disclosure Statement, Annual Financial Assurance Cost Estimate Form Transfer StationAnnual Financial Assurance Estimate WorksheetsCertificate of InsuranceIrrevocable Standby Letter of Credit (NM Gov Ent as Payee)Irrevocable Standby Letter of Credit (NMED as Payee)Local Government Reserve ResolutionPerformance Bond (NM Gov Ent as Beneficiary)Performance Bond (NMED as Beneficiary)Standby Trust Agreement (NM Gov Ent as Beneficiary)Standby Trust Agreement (NMED as Beneficiary)Trust Agreement (NM Gov Ent as Beneficiary)Trust Agreement (NMED as Beneficiary), Commercial & Special Waste Hauler Registration FormHelp Completing Hauler Registration FormHelp Completing Contingency Plan (Special Waste Haulers Only)Special Waste Manifest FormHauler Unauthorized Waste Tng Outline, Scrap Tire Hauler Registration FormScrap Tire Hauler Bond FormScrap Tire Manifest Form for HaulersScrap Tire Manifest for Generators (for scrap tire generators that self-haul), Civil Engineering Application (Small) for projects using 101 to 999 scrap tires and that are no more than 2 bales highCivil Engineering Application (Medium) for projects using 1000 to 99,999 scrap tires and that are no more than 2 bales highCivil Engineering Application (Large) for projects using 100,000 scrap tires or more or that are more than 2 bales highTire Recycling/Storage Facility ApplicationAffidavit Of Compliance with Local RegulationsProperty Owner Affidavit of Acknowledgement, Operator Certification Application (Initial)Operator Certification Application (Renewal)Alternate CEU Approval Form, FY24 RAID Grant Recycling ApplicationFY24 RAID Grant Illegal Dumpsite Abatement ApplicationFY24 RAID Grant Additional Dumpsite Information page, Solid Waste Facility Grant Fund Application FY24, On-Site Disposal of Domestic Waste Request FormSWB Rules Document, Headquarters Location

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