Certified Wastewater Evaluator/Designer/Installer Registration Application
Applicant Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relation to Business
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Owner
Employee
Other
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Business Name
Is the business address different from mailing address?
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Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Counties of operation:
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REGISTERED EVALUATOR:
Show proof of level 1 certification from the Utah Department of Environmental Quality.
REGISTERED DESIGNER:
Show proof of level 2 certification from the Utah Department of Environmental Quality.
REGISTERED INSTALLER:
Show proof of level 2 certification from the Utah Department of Environmental Quality or attend the Wastewater Class provided by Tricounty Health Department.
Demonstrate competency through 3 approved installations. While prospective installers are in the process of becoming registered, they will be listed under the subheading “in process” to secure jobs and demonstrate their competency.
Present the appropriate DOPL license (B100, E100, P200, P201 or S410) per administrative rule R156-55a.
Check all roles you are applying for:
*
Registered Evaluator
Registered Designer
Registered Installer
DOPL License (For Installers only)
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Registration Application
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