Get Doh Form 4204

Filling out the Doh Form 4204 online is a straightforward process that ensures proper designation of a water operator in responsible charge. This guide will provide you with step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the Doh Form 4204 online.

1. Click the ‘Get Form’ button to access the form and open it in your editor.
2. Enter the system name in the designated field to identify the water system for which the operator is being designated.
3. Select the classification of the system from the provided options to indicate its management level.
4. Fill in the system address, including street, city, state, and zip code, to ensure accurate identification of the physical location.
5. Provide the owner’s name, entering it in the format of last name, first name, and middle initial if applicable.
6. Complete the owner's address fields, including street, city, state, and zip code, so that they can be reached for any inquiries.
7. Input system phone and owner home/work phone numbers for communication purposes. Ensure the numbers are accurate.
8. Enter the NYS DOH certificate number for the operator in responsible charge, ensuring to keep personal identification numbers secure.
9. Provide the ORC's name in the same format as the owner to maintain consistency across the document.
10. Select the grade of certification for the operator in responsible charge to confirm their qualifications.
11. Complete the ORC's address, ensuring it includes street, city, state, and zip code for accurate identification.
12. Fill in the ORC's home and work phone numbers for reliable contact points.
13. Read the verification statement carefully before signing to ensure all provided information is accurate and truthful.
14. Both the system owner and the operator in responsible charge must sign and date the form to finalize the designation.
15. After completing the form, save changes, and consider downloading, printing, or sharing the form as necessary.

Begin your online documentation process by filling out the Doh Form 4204 today.