"Application for Reexamination or Rescheduling of Wastewater Operator Certification Exam" - Oregon

Application for Reexamination or Rescheduling of Wastewater Operator Certification Exam is a legal document that was released by the Oregon Department of Environmental Quality - a government authority operating within Oregon.

Form Details:

  • Released on March 1, 2021;
  • The latest edition currently provided by the Oregon Department of Environmental Quality;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Oregon Department of Environmental Quality.

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Send Application and Fee
DEQ USE ONLY
to:
DEQ Business Office
L2K Receipt #: __________
700 NE Multnomah St,
Application #: ___________
Application for
Ste 600
Amount Received:________
Portland, OR 97232-4100
Date Received: _________
Reexamination or Rescheduling of
Check #: ______________
OpCert info:
Wastewater Operator Certification Exam
503-229-5349
INSTRUCTIONS: To retake the exam you failed, or to reschedule a missed exam, complete this form and
submit the form to DEQ with the required fees, within one year of the date from which the initial exam was
taken or scheduled. If one year has passed from the initial exam date, a new application for examination along
with the proper fees must be submitted. Contact DEQ for eligibility questions.
A. Applicant Information
Last Name:
First:
Middle Initial:
Last four of SSN:
B. Contact Information
Address:
City:
State:
ZIP Code:
Work Phone:
Home/Alt. Phone:
Email (required):
Is this a change of mailing address?
☐ Yes
☐ No
Employer:
Do you require a disability accommodation in testing? (If “yes”, please submit an accommodation form)
☐ Yes
☐ No
C. Certificate Type And Grade (select one exam per form)
☐ Small Wastewater System
☐ Wastewater Collection:
☐ Grade I
☐ Grade II
☐ Grade III
☐ Grade IV
☐ Grade I
☐ Grade II
☐ Grade III
☐ Grade IV
☐ Wastewater Treatment:
D. Reexamination Fee
$240 (attach check)
☐ Payment Receipt Requested (no fee, to be mailed with exam results letter)
E. Applicant Signature and Date (Required)
Applicant
Date
Application Checklist
Include check made payable to “Oregon DEQ.”
Please allow approximately thirty (30) days for DEQ to process your application.
All application requirements must be met and the application must be approved by DEQ before an exam can be
scheduled. Be sure you qualify for the re-exam (see one year criteria listed in INSTRUCTIONS paragraph above).
You will receive email notification of your eligibility to schedule an online exam date, similar to your initial notice.
Oregon DEQ Application, Wastewater Operator Certificate Reexamination or Exam Rescheduling
March 2021
Send Application and Fee
DEQ USE ONLY
to:
DEQ Business Office
L2K Receipt #: __________
700 NE Multnomah St,
Application #: ___________
Application for
Ste 600
Amount Received:________
Portland, OR 97232-4100
Date Received: _________
Reexamination or Rescheduling of
Check #: ______________
OpCert info:
Wastewater Operator Certification Exam
503-229-5349
INSTRUCTIONS: To retake the exam you failed, or to reschedule a missed exam, complete this form and
submit the form to DEQ with the required fees, within one year of the date from which the initial exam was
taken or scheduled. If one year has passed from the initial exam date, a new application for examination along
with the proper fees must be submitted. Contact DEQ for eligibility questions.
A. Applicant Information
Last Name:
First:
Middle Initial:
Last four of SSN:
B. Contact Information
Address:
City:
State:
ZIP Code:
Work Phone:
Home/Alt. Phone:
Email (required):
Is this a change of mailing address?
☐ Yes
☐ No
Employer:
Do you require a disability accommodation in testing? (If “yes”, please submit an accommodation form)
☐ Yes
☐ No
C. Certificate Type And Grade (select one exam per form)
☐ Small Wastewater System
☐ Wastewater Collection:
☐ Grade I
☐ Grade II
☐ Grade III
☐ Grade IV
☐ Grade I
☐ Grade II
☐ Grade III
☐ Grade IV
☐ Wastewater Treatment:
D. Reexamination Fee
$240 (attach check)
☐ Payment Receipt Requested (no fee, to be mailed with exam results letter)
E. Applicant Signature and Date (Required)
Applicant
Date
Application Checklist
Include check made payable to “Oregon DEQ.”
Please allow approximately thirty (30) days for DEQ to process your application.
All application requirements must be met and the application must be approved by DEQ before an exam can be
scheduled. Be sure you qualify for the re-exam (see one year criteria listed in INSTRUCTIONS paragraph above).
You will receive email notification of your eligibility to schedule an online exam date, similar to your initial notice.
Oregon DEQ Application, Wastewater Operator Certificate Reexamination or Exam Rescheduling
March 2021