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Get In State Form 45703 2019-2024

4. Send the completed form to Indiana State Department of Health ATTN Cashier s Office 2 N. Meridian St. Indianapolis Indiana 46204 5. Nrsb.org or the National Radon Proficiency Program www. radongas. org for details. Also if applying for Primary Radon Tester or Radon Laboratory Tester enclose a copy of your Device Performance Test Report Listing Letter. Radongas. org for details. Also if you are applying for Radon Laboratory Tester or Primary Tester enclose your Device Performance Test Report Listing Letter. TYPE OF LICENSE DESIRED Check all that apply Radon Laboratory Tester Fee 100. 00 Secondary Radon Tester Fee 100. Reset Form APPLICATION FOR RADON TESTER / MITIGATOR LICENSE State Form 45703 R5 / 12-14 Approved by State Board of Accounts 2014 INDIANA STATE DEPARTMENT OF HEALTH INSTRUCTIONS 1. This is the radon certification application necessary to satisfy the requirements of 410 IAC 5. 1-1-22. 1-1-24 and 5. 1-1-26. NATIONAL RADON PROFICIENCY PROGRAM NRPP INFORMATION COMPLETE ALL THAT APPLY NRPP ID Number for Residential Measurement Enclose a copy of your current NRPP Certification. Contact either the National Radon Safety Board www. Type of Detector s used B. If the Radon Laboratory Tester and/or Primary Radon Tester is using a radioactive source for calibration list the Indiana State Department of Health Radioactive Materials Registration Number.

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