Forms not submitted in 30 days will be deleted

  1. 1Update Registration Information
  2. 2Add Machines
  3. 3Remove Machines
  4. 4Update Machines
  5. 5Review
  6. 6Sign & Submit

Facility Information

Facility Contact Information

Registrant and Address Information

Please complete all data fields in the left column of the form which represents the information currently on file with CDPH-RHB.

Select the update checkbox if you need to provide updated registrant and/or address information to CDPH-RHB.

Physical Address (cannot be P.O. Box)

Mailing Address