All clinical laboratories operating prior to the effective date of this act shall be issued a license upon submission of a properly completed application form and payment of the requisite fee. Said license shall thereafter be renewable, on a calendar year basis, subject to all provisions of this act. The license application form shall include, but need not be limited to the following information:
a. The name and address of the clinical laboratory owner and his authorized agent and such information regarding the owner and agent as may be required;
b. The name and address of the clinical laboratory director;
c. The name and address of the clinical laboratory for which the license is requested and a description and plan of the premises to be occupied for the operation of said laboratory;
d. A list of the major laboratory equipment to be utilized; and,
e. The tests to be performed in the clinical laboratory.