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Waterworks Operator Certification Application Packet

Request and Change of Contact Information Submittal

Are you requesting? (check which ones) Application request Address change Email address change
Which application packet(s)?	How many?
Exam application
Automatic Upgrade (In training to Level 1)
Reciprocity *
* Disclaimer: Washington does not have reciprocity with all states. Prior to submitting an application for reciprocity call (360) 236-3137 or Toll Free (800) 525-2536 Ext. 3.

Home mailing address:
Name:	(required field)
PO Box Number:
Street Address:
City:
State:
Zip Code:
Email Address:

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 Washington Certification Services by the Operator Certification Program.

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