Request To Conduct Deq Approved Standard Training Class And Online Exam Form (Page 2 of 2) in pdf

Date of Request: ________________________

Class #: ______________________

Request to Conduct DEQ Approved Standard Training Class and Online Exam

1. Sponsoring Group: _________________________________________________________________________________

2. Approved Instructor: ______________________________________________Operator License # __________________

Mailing Address (for Attendance Record Forms): _________________________________________________________

City: ____________________________________________________ State: ______ Zip Code: __________________

Telephone # (Work / Home / FAX): _____________________ /______________________ /______________________

E-mail Address: ___________________________________________________________________________________

3. Class Location: ____________________________________________________________________________________

Street Address: _______________________________________________________________________________

City: _________________________________________ State: ______ Zip Code: _________________

4. Is this class OPEN to anyone wishing to take the class? _____Yes _____No

5. Type of Class (check more than 1 if it applies):

_____Class C Distribution & Collection

_____Distribution & Collection Technician

_____Class D Water Operator

_____Class D Wastewater Operator

_____Class C Water Operator

_____Class C Wastewater Operator

_____Class B Water Operator

_____Class B Wastewater Operator

_____Class A Water Operator

_____Class A Wastewater Operator

_____Class C Water Laboratory Operator

_____Class C Wastewater Laboratory Operator

_____Class B Water Laboratory Operator

_____Class B Wastewater Laboratory Operator

_____Class A Water Laboratory Operator

_____Class A Wastewater Laboratory Operator

Session #1 Date:______________ Starting Time:__________ Ending Time:__________ # of Hours:______

Session #2 Date:______________ Starting Time:__________ Ending Time:__________ # of Hours:______

Session #3 Date:______________ Starting Time:__________ Ending Time:__________ # of Hours:______

Session #4 Date:______________ Starting Time:__________ Ending Time:__________ # of Hours:______

Session #5 Date:______________ Starting Time:__________ Ending Time:__________ # of Hours:______

Session #6 Date:______________ Starting Time:__________ Ending Time:__________ # of Hours:______

Session #7 Date:______________ Starting Time:__________ Ending Time:__________ # of Hours:______

Session #8 Date:______________ Starting Time:__________ Ending Time:__________ # of Hours:______

Total Training Hours Requested: ________

6. Expected attendance (for Attendance Record Forms): ________

7. Is an ONLINE EXAM offered? _____Yes

Date: ______/______/______

Time_________

Exam Location (If different from the class): ______________________________________________________________

Street Address: ____________________________________________________City_________________________

Cell/Pager # or direct line to classroom where exam is given: __________________________________

LL STANDARD TRAINING CLASSES AND ASSOCIATED ONLINE EXAM REQUEST FORMS MUST BE SUBMITTED

WEEKS PRIOR TO THE FIRST DAY OF THE CLASS

Mail to: Okla. Dept. of Environmental Quality, Operator Certification, P. O. Box 1677, Oklahoma City, OK 73101-

1677 or FAX to: 405-702-8101 or E-MAIL to: opcerttraining@deq.ok.gov.

Rev. 3/11/2015

Request To Conduct Deq Approved Standard Training Class And Online Exam Form Page 2

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