Application and address change request form - Office of Drinking Water, Water System Management, WA State Dept. of Health

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Water Works Operator Certification Application Request & Change of Address Form

Privacy Notice

Are you requesting? (check one or both)

Application request
Address change

Which application packet(s)?
How many?

Exam application

Retake application

In training to level one
(Automatic Upgrade)

Reciprocity

Home mailing address:

Name: (required field)

PO Box Number:

Street Address:

City:

State:

Zip Code:

Operator Certification Number:

Backflow Assembly Tester (BAT) Number:

Home Phone Number: Include area code

Cell Phone Number: (optional)

Please allow approximately one week mailing time for application packets.

Address changes are completed as they are received and will be forwarded to
WETRC by the Operator Certification Program.

Contact Larry Granish for information 1-800-525-2536 ext. #7
or (360) 236-3141