Training Request Form - Government Of Nova Scotia

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30 Damascus Road, Suite 115
Phone: 424-7773
Bedford NS B4A 0C1
Fax:
424-0597
TRAINING REQUEST FORM
ON-SITE SEWAGE
G
G
G
SEPTIC INSTALLER
QUALIFIED PERSON II
SEPTIC TANK CLEANER
(Please check activity you are interested in obtaining)
 Pump, repair or modify a septic tank, holding tank or vault privy
 Pump Portable Rest Rooms
 Bed Flusher (clean systems using pressurized water or air)
D
A
:
____________________________________________
ATE OF
PPLICATION
N
:
___________________________________________
AME
B
D
:
____________________________________________
IRTH
ATE
F
M
A
:
____________________________________________
ULL
AILING
DDRESS
____________________________________________
C
:
____________________________________________
OUNTY
T
#:
____________________________________________
ELEPHONE
C
#:
___________________ F
x #: __________________
ELL
A
E
A
:
____________________________________________
MAIL
DDRESS
E
L
:
____________________________________________
DUCATION
EVEL
(must attach proof if applicable)
B
W
H
:
RIEF
ORK
ISTORY
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

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