Application for Renewal of Drinking Water Treatment and Distribution Operator Certification
This information is required by the Michigan Safe Drinking Water Act, 1976 PA 399, as amended.
*Required-If you do not know a required field please enter "N/A"
*First Name: *Middle Initial: *Last Name:
*City: *State: AKALAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY *Zip:
*Operator ID #: (Look up your Operator ID)
*Expiration Date of Current Certificate:
*Work Phone: *Home Phone:
*Title of Current Job Position:
*Employer: Water Supply Serial Number:
*Full Treatment F-NoneF-1F-2F-3F-4F-5 *Limited Treatment D-NoneD-1D-2D-3D-4D-5 *Distribution S-NoneS-1S-2S-3S-4S-5
Check the renewal certification status you are applying for:
*Renew Now: I currently hold a drinking water certificate and have met the continuing education credit requirement.
There are no refunds for renewal of certification under any circumstances.
*None: Please delete my name and certification information from your records.
If selecting None, certify the application and submit it-DO NOT SEND PAYMENT.
Course Completion Certificates file:
Supported file types are: png, bmp, jpg, gif, tif, doc, rtf, and pdf. Please limit an attachment's file size as much as possible. We may not get your form submittal if it is larger than 2 MB.
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