Request to Re-Issue BPAT #
I have previously held a Texas Backflow Prevention Assembly Tester License.
I have successfully completed the requirements to be re-licensed.
I request TCEQ to re-issue my former BPAT license number.
Name:
Date:
Address:
City:
State:
Zip:
Home #:
Work #:
Cell #:
Fax #:
Email:
Previous Texas BPAT License #:
Date BPAT Exam Successfully Completed: