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-28575top00ENVIRONMENTAL COMPLAINTS AND LOCAL SERVICESCERTIFIED INSTALLER APPLICATIONRegistration and payment for all certification classesmust be completed 7 days prior to attendance. Please complete all of the information requested. GENERAL INFORMATIONFirst Name FORMTEXT ?????M.I. FORMTEXT ?????Last Name FORMTEXT ?????Home Mailing Address FORMTEXT ?????City FORMTEXT ?????State FORMTEXT ?????Zip FORMTEXT ?????County FORMTEXT ?????Home Phone( FORMTEXT ?????) FORMTEXT ?????- FORMTEXT ?????Cell Phone( FORMTEXT ?????) FORMTEXT ?????- FORMTEXT ?????Date of Birth FORMTEXT ??/ FORMTEXT ??/ FORMTEXT ????PROFESSIONAL LICENSING COMPLIANCE REVIEWSocial Security Number (optional*) FORMTEXT ???- FORMTEXT ??- FORMTEXT ????*Pursuant to OAC 710:95-9-3(a), DEQ must provide to the Oklahoma Tax Commission (“OTC”) a list of all its licensees along with their social security numbers and other identifying information that may be required by OTC. If you choose to not provide DEQ with your social security number, it will be your responsibility to obtain and provide DEQ with documentation of your compliance with Oklahoma Income Tax laws prior to being eligible for renewal next year. You can obtain the required documentation by calling OTC’s Professional Licensing Compliance Unit at 405-522-6800. Please note that it can take six (6) months or more for OTC to provide you with this information; and DEQ cannot renew your license next year without it. BUSINESS INFORMATIONPlease complete this section even if this information is the same as the General Information. FORMCHECKBOX Check this box to give DEQ permission to publish your business information to the general public.Business Name FORMTEXT ?????Mailing Address FORMTEXT ?????City FORMTEXT ?????State FORMTEXT ?????Zip FORMTEXT ?????Business Phone( FORMTEXT ?????) FORMTEXT ?????- FORMTEXT ?????Fax Number( FORMTEXT ?????) FORMTEXT ?????- FORMTEXT ?????E-Mail Address FORMTEXT ?????ATTACHMENTS FORMCHECKBOX $10,000 Bond or Affidavit (Tribal or Govt. only) FORMCHECKBOX DEQ Form 002-028 Affidavit Regarding Citizenship FORMCHECKBOX Experience and Competence of Five (5) On-site Sewage Treatment Systems Inspected and Approved by DEQStatement of Understanding:I hereby certify under penalty of law that this application and any attachments contain no willful or negligent misrepresentation or falsification and that all information is true, accurate and complete. I understand that any misrepresentation or falsification may result in rejection of my application or revocation of any certificate issued as a result of this application.Signature of ApplicantDate FORMTEXT ?????CERTIFICATION AND EXAMINATION FEESPlease check the applicable fees, total the amount owed and select a form of payment below. If you choose Visa or MasterCard or a purchase order as the form of payment, you may fax this request to (405) 702-7120. Otherwise, mail this request and your check or money order made payable to DEQ.SELECT AND TOTAL FEES OWEDAMOUNT FORMCHECKBOX Annual Certification Fee$240.55(100040) Examination Fee: FORMCHECKBOX CSE Category$180.42(100041) FORMCHECKBOX Lagoon Category$180.42(100042) FORMCHECKBOX Aerobic/Spray Category$180.42(100043) FORMCHECKBOX Aerobic/Drip Category$180.42(100044) FORMCHECKBOX Low Pressure Dosing (LPD)$180.42(100045) FORMCHECKBOX Reinstatement Fee (All Categories)$60.14(101046)TOTAL$ FORMTEXT ?????(Continued on the next page.)left-889000ENVIRONMENTAL COMPLAINTS AND LOCAL SERVICESCERTIFIED INSTALLER APPLICATION Registration and payment for all certification classes must be completed 7 days prior to attendance.Please complete all the information requested.-381000556450500DOCUMENTATION OF EXPERIENCE AND COMPETENCE ATTACHMENTApplicant’s Name: FORMTEXT ?????Date of Application: FORMTEXT ?????(PLEASE PRINT)Please list five (5) On-site Sewage Treatment Systems installed in the State of Oklahoma that meet or exceed the rules in Chapter 641 as determined by an inspection performed by DEQ. These systems must have been installed within the two-year time period preceding the date of this application and may not include any joint inspections.DateLegal DescriptionPhysical AddressProperty OwnerCountyWO NumberType of SystemDEQRepresentativeSignature1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????NOTE: Installers seeking certification must have had at least 90% of the systems they installed within the last year approved upon the initial inspection, with any disapproved systems only requiring minor changes.-3549654127500MAIL TO: Oklahoma Department of Environmental Quality Accounts Receivable PO Box 2036 Oklahoma City, OK 73101-2036FAX TO: (405) 702-7120PAYMENT INFORMATION (Select one form of payment) FORMCHECKBOX Check or Money Order made payable to DEQ FORMCHECKBOX Purchase Order (attach copy) FORMCHECKBOX Visa or FORMCHECKBOX MasterCard Name on Card: FORMTEXT ?????Signature of Authorized User:Expiration Date (mo/yr): FORMTEXT ??/ FORMTEXT ?????Card Number: FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ?
How much to renew Oklahoma driver license? Oklahoma Drivers License Renewal Fees Class A License: $56.50 Class B License: $50 Class C License: $46.50 Class D License: $38.50 Class D License (62 years old): $21.25 Class D License and (63 years old): $17.50 Class D License and (64 years old): $13.75 Class D License and (65 years old): Free
