DDW-2024-011598

pg 1 of 1 - revised 5/8/2020
Division of Drinking Water
Operator Certification Program
195 North 1950 West
P.O. Box 144830
Salt Lake City, Utah 84114-4830
Phone: [phone]
E-mail: [e-mail]
DDWOpCert.utah.gov
Utah Division of Drinking Water
Water Operator Certification Program
RENEWAL CYCLE ADJUSTMENT APPLICATION
A dual certified operator may request to move one of their certification’s expiration date
back one year to unify both certifications’ renewal cycles for Continuing Education (CEU’s).
Qualifications:
Both certifications must be current and/or within their grace period for renewal or
reinstatement.
o Renewal Grace Period: less than 6 months past certification’s expiration
date (deadline is June 30th)
o Reinstatement Grace Period: more than 6 months but less than 18 months
past certification’s expiration date (from July 1st after expiration & the
deadline is June 30th).
Continuing Education Units (CEU’s) from the new 3-year renewal cycle will be utilized for both certifications if applicable
(training was completed, submitted, and approved).
The standard renewal and/or reinstatement fees will apply to the adjusted certification.
o Operators will not be credited for renewing early . Requesting to move a certification back one year is optional.
o Operators only option to change their certifications’ renewal cycle forward is through examination.
Checklist Instructions:
☐Step 1 Check to see if you meet the qualifications.
☐Step 2 Complete this application and send to the Division of Drinking Water via email or postal mail.
☐Step 3 You will be notified if your request is approved
If approved, your certifications’ renewal requirements will be adjusted
Certification #:
Work Phone:
Cell phone:
Home Phone:
Zip:
PERSONAL INFORMATION
First, Middle, Last Name (Mr. or Ms.):
Work Email address:
Personal Email address:
Home Address:
City: State:
CERTIFICATION ADJUSTMENT REQUEST
Distribution Grade level (SS,1,2,3,4):________ Expiration Year:___________
Treatment Grade level (1,2,3,4):__________ Expiration Year: _________
New expiration year for both certifications (oldest year of current certifications):
Operator's Signature Date:
"By signing, I certify the above information is correct and complete.
I understand that all info may be verified by Drinking Water Staff."