DW Operator Designation REMOVAL/RESIGNATION Form To remove designation or resign as ORC, please submit the following information: Indicates required field Facility Name PWS ID # (Submit this form for each PWS ID #) Operator's First Name Operator's Last Name Operator's Certificate # Effective Date Contact Phone Number Email Resign ALL Designations? Yes No Select designation(s) you are resigning below Cross Connection Distribution Well Surface
DW Operator Designation REMOVAL/RESIGNATION Form To remove designation or resign as ORC, please submit the following information: Indicates required field Facility Name PWS ID # (Submit this form for each PWS ID #) Operator's First Name Operator's Last Name Operator's Certificate # Effective Date Contact Phone Number Email Resign ALL Designations? Yes No Select designation(s) you are resigning below Cross Connection Distribution Well Surface
