APPLICATION FOR REGISTERED POOL OPERATOR
1720 Commerce Street
Garland, TX 75040
Phone: (972) 205-3460
Fax: (972) 205-3505
Email: EnvHealth@GarlandTX.gov
HEALTH DEPT. OFFICE USE ONLY
Area: __________________
PT#: __________________
Issue Date: __________________
Exp. Date: __________________
By/Receipt #:____________________
City Registration:
Garland
Mesquite Other
Name:
Date of Birth:
Address:
City:
Zip:
Phone:
The name and location of the pool where I will be the Registered Pool Operator is:
Name of H.O.A. or
Apartment/Condo:
Address:
City:
Zip:
Phone:
If you are employed by a management company or a pool service please complete the
following:
Name:
Address:
City/State:
Zip:
Phone:
MY REGISTERED POOL OPERATOR COURSE WAS TAKEN THRU:
CITY OF GARLAND CITY OF DALLAS OTHER
I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND ACCURATE TO THE
BEST OF MY KNOWLEDGE:
Applicant's Signature
Email:___________________________
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signature
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