Delaware Health and Social Services
Division of Public Health
Office of Drinking Water

State of Delaware Water Operator Renewal Application 

Renewal is the process that registered operators must comply with under the State of 
Delaware’s standards to maintain their status as registered operators. 
General Instructions 
	
• 	Please read and follow all instructions carefully.  Complete Both Pages 	
	fully and accurately. 

• 	The fee for renewal is $100.00. 

• 	Make check or money order payable to:  Division of Public Health.  We do 	
	not accept credit or debit cards. 

• 	Please allow 4 weeks for processing before calling to check on the status 	
	of your application. 

•	Mail completed application to: 	Division of Public Health
							Office of Drinking Water 
							Blue Hen Corporate Center 
							655 Bay Road
							Suite 203 
							Dover, DE 19901

•	Questions? Phone (302) 741-8630 

General Information	    			Certification Information 

Social Security Number _________________ 	Certificate Number ________________ 

Name ___________________________________  	Endorsements ______________________ 
							     ______________________
Address ________________________________  
        ________________________________ 

City ___________________________________	Status Information 

State __________________________________  	Are you currently working at a water 
						System?  If yes, which system
Zip / Postal Code ______________________                  ____________________
						          ____________________ 
Work Phone _____________________________

Fax ____________________________________	Office Use Only:
								Approved: _________
Home Phone _____________________________
					                        Not Approved: _________
E-Mail Address _________________________

Verification of Work Experience (Optional)

The supervisor of the plant must fill out the following: 
I verify the applicant shown above has actively worked at this water system 
during the period of his/her operator-in training status. 

Signature ___________________________________ Title ____________________________ 

Print Name _________________________________ Phone Number ______________________

System Name _____________________________________________ 

System Address _________________________________________________________________ 

State of Delaware Water Operator Renewal Application 

Continuing Education Requirement: 

Attach documentation of completion of continuing education requirements (20 contact hours with 
endorsements or 12 contact hours with base level) earned within the two-year period of your certificate.   

The documentation can be in the form of training course certificates, transcripts, etc.  

It must contain the following information:  Course Title, Instructor, Date of Completion and Contact Hours.  

The following is only a guideline to the courses accepted: 

• Math and Science courses 
• Environmentally related courses that are useful for drinking water 
• Correspondence courses from California State University in Sacramento, or   
  similar 
• Safety / Security courses 
• Courses sponsored by WEF, AWWA, DRWA, EPA, DPH that are drinking water related 
• In house training, documented with a sign-in sheet listing title, instructor, 
  synopsis of course, date and time 
• Job-related computer courses 

Note:	10 contact hours = 1 continuing education unit (CEU) 
       1 course hour = 1 educational contact hour 

Certification Information 
The certificate is for a 2-year certification.  Before the certificate expires, you will 
receive this renewal application.  If you have a change of address before your certificate expires, 
please notify the Division of Public Health , Office of Drinking Water. 

Acknowledgement 
I, the undersigned, certify that I am the above applicant; that all statements made and 
information contained in this application are true and correct to the best of my knowledge 
and belief; that I understand that any omissions of misrepresentations may result in ineligibility 
for certification or revocation of any certificate granted.  I understand that the enclosed fee 
is non-refundable.  Further, should I have received the certification under false circumstances, 
I will immediately surrender the certificate to the Division of Public Health, Office of Drinking 
Water.  I also consent to a thorough investigation of my application for the purpose of verification 
of my qualifications for certification. I waive all claims and agree to indemnify and hold harmless 
the Division of Public Health, Office of Drinking Water for any action taken pursuant to the rules 
and standards of the Division of Public Health, Office of Drinking Water with regard to my application 
and / or my certification except claims based on gross negligence or lack of good faith. 

Signature of Applicant _______________________________________________ 

Date _______________________ 

Doc.# 35-05-20/07/06/03