Request to Re-Issue LI #

I have previously held a Texas Landscape Irrigator License. I am currently
completing the requirements to be re-licensed. Upon successful completion of all
licensing prerequisites, I request TCEQ to re-issue my former license number.
Name: Date:
Address:
City: State: Zip:
Home #: Work #:
Cell #: Fax #:
Email:
Previous Texas Landscape Irrigator #:
Date Required Training Completed:
Date Re-Exam Scheduled: