State of Nevada / Nevada Water Environment Association
State of Nevada / Nevada Water Environment Association
Wastewater Application for Replacement/Duplicate Certificate
Name Certificate Number
Grade Expiration Date
Address
INSTRUCTIONS:
Please complete this form and return with a $20 non-refundable check or money order made payable to NDEP (Nevada Division of Environmental Protection).
Please provide the following information to help us stay in contact with you:
Email: Phone: Fax:
Mailing Address (if changed from above):
Present Employer
Employer Address
Present Job Title Date of Hire
YES, you may release my personal information.
NO, please do not release my personal information.
Signature Date
Mail this form and your $20 payment to:
NDEP
901 S. Stewart St., Suite 4001
Carson City, NV 89701
FOR OFFICE USE ONLY:
Check # To contact us:
Date Received Hotline: 775-465-2045
Database Updated E-mail: certification@
Renewal Mailed Web Site:
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