Rehs License Number

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CITY OF PLAINFIELD

LICENSE: Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform essential duties of the position. NOTE: Appointments may be made to positions requiring bilingual skills.

REGISTERED SANITARIAN CERTIFICATION

Page 2 of 9 Study Guide Information: National Environmental Health Association 720 S. Colorado Blvd., Suite 970 South Tower, Denver, CO 80222 (303) 756-9090

RUTGERS UNIVERSITY RADIATION SAFETY GUIDE

REHS on a case-by-case basis. 6. Instrument Checks All portable survey instruments are checked for proper operation by REHS during radiation safety inspections. REHS can assist with repairs and, if necessary, coordinate with vendors to arrange repair service. 7. Radiation Safety Training All authorees and radiation workers are required to complete:

Renewal Notice Registered Environmental Contact Info: Health

need your license number, your social security number and a credit or debit card with a MasterCard or Visa logo. Fail to Submit Renewal by Expiration Date: If you fail to submit a completed renewal by the expiration date, your license expires. To practice after this date, your license must be reinstated. If you practice without an active

Application Form - Please Print Clearly Check INCOMPLETE

applicator license. The supervising applicator must be on-site at all times when I am making pesticide applications. I must record both my name and license number and the name and license number of my supervising applicator on all pesticide application records. I must receive training from my supervisor.

REGISTERED SANITARIAN APPLICATION INSTRUCTIONS

Certificate/License Number: Date of Registration: Are you currently certified by NEHA as an REHS/RS? Yes No If Yes, attach proof. 12. Have you ever had a professional license, certification or registration suspended, canceled, revoked or denied in any state? Yes No

Application for Professional Credential

Registered Environmental Health Specialist/Registered Sanitarian (REHS/RS) $55/$85 + $135/$235 $190 $320 REHS/RS In-Training (REHS/RS-IT) $55/$85 + $135/$235 $190 $320

OF NEW JERSEY and 4086 The Stute Unlverslty Road 1 Piscataway

A copy of your action has been forwarded to our License Fee & Accounts Receivable Branch, who will contact you separately if there is a fee issue involved. Your action has been assigned Mail Control Number When calling to inquire about this action, please refer to this control number. You may cal! us on (610) 337-5398, or 337-5260. 1 p* pOcf.

City and County of San Francisco London N. Breed, Mayor

ENVIRONMENTAL HEALTH Stephanie K. J. Cushing, MSPH, CHMM, REHS Director of Environmental Health RETAIL TOBACCO ENFORCEMENT PROGRAM 1390 Market Street, Suite 910, San Francisco, CA 94102 Phone 415-252-3903 Fax 415-252-3894 Date:June 27 , 2019

Montana Board of Sanitarians

State License # License Type Issue Date Expiration Date License Method Requested State Verification Yes No Yes No Yes No Yes No 9.EDUCATION DOCUMENTS: Do you hold a current REHS/RS credential from the National Environmental Yes No Health Association (NEHA)? If yes, provide a copy of your credential.

Requirement and Procedure for the NEHA National Exam for

their driver s license. Please update the Board with any change to your name, address, email address, contact number(s), employer, etc. The exam admission letter will list the eligible date and the in- training certificate expiration date. The exam admission letter can be used for more that one exam schedule, if needed.

OF JERSEY RUTGERS

the Rutgers University license of broad scope, license number 29-052 18-28. Mr. McDermott s training and experience qualifying him as the RSO for the Rutgers license are summarized below: 0 Mr. McDermott has been a full time employee of Rutgers Environmental Health and Safety for nearly 14 years.

Frequently Asked Questions Regarding the Continuing Education

A number of agencies, organizations, and other interested parties have strongly supported continuing education as a means of professional development for REHS s. These entities include the Environmental Health Specialist Registration Committee,

STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH

the lice nse number and the effective date. The three part licensing documents shall be sent to the licensee's address of record within 4-6 weeks after approval. 4. Requirements License requirements are subject to change due to new legislation, regulations, or policies adopted by the Department. Applicants shall meet current licensing

April Meneghetti, REHS Environmental Health Division Manager

License Plate Number: By signing below, the REHS is verifying that the facility indicated meets the California Retail Food Code: Section 114294-114297

New Jersey Registered Environmental Health Specialist

applicable license and/or certificate information ☐ Question # 12 completely answered ☐ Question # 13 completely answered ☐ Question # 14 completely answered ☐ Question # 15 completely answered ☐ Question # 16 completely answered ☐ Question # 17 completely answered ☐ Question # 18 completely answered ☐ Education record provided

State of Utah Official Use Only Department of Commerce

Nov 22, 2016 An EHS-In-Training license is an optional license for applicants who meet all requirements except a passing score on the REHS/RS or REHS/RS-In-training Examination. This form only needs to be submitted by individuals applying for an EHS-In-Training license. See the checklist at the end of this application for additional instructions.

NEBRASKA APPLICATION INFORMATION FOR REGISTERED/PROVISIONAL

LICENSE FEE WAIVER: f you meet one of the following waiver options, your initialStarting January 1, 2020, i license fee and temporary license fee may be waived. 1. Young Worker: You are between the ages of 19 and 25 (under the age of 26). 2. Low-Income Individual: You are enrolled in a state or federal public assistance program such as the medical

OFFICIAL FOOD INSPECTION REPORT Phone # (530) 527-8020 Tim

Tim Potanovic, REHS - Director Owner Site Address 734 MAIN ST Facility Name ::: Owner Address : 216 PINE ST FIREHOUSE PIZZA FRANCISCO BOBADILLA Facility ID Inspector EE0000019 - David Lopez Inspector Phone Not Specified License/Permit Number Person in Charge Program: Inspection Date Total Inspection Time Inspection Number DA0008615

NEHA Application for Professional Credential

B. REHS/RS Reciprocity only: If you checked the REHS/RS by Reciprocity option, you must meet the criteria below. If you meet the criteria, please fill out the requested information. If you do not meet the criteria, you cannot check this option. CRITERIA: 1. Have a valid, current state registration; and 2.

Liquid Waste OWTS Contractor/Company License Number/Type

OWTS Contractor/Company License Number/Type Phone HaulersNumber Qualified Consultants Qualified Designer Installers Liquid Waste Acorn Onsite, Inc. Civil Engineer (925) 447-5200 x x Alves Tractor Service 500016/ Type A (831) 674-3009 x x BG Construction 1026995/ Type A (831) 595-8806 x

STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH

the license number and the effective date. The three part licensing documents shall be sent to the licensee's address of record within 4-6 weeks after approval. 4. Requirements License requirements are subject to changedue tonew legislation, regulations , or policies adopted by the Department. Applicants shall meet current licensing requirements.

NEHA Registered Environmental Health Specialist/Registered

Jan 24, 2013 NEHA REHS/RS Candidate Information Brochure 4 test sites, arrangements must be made a minimum of 4 6 weeks prior to the requested date. The fee to set up a special test site is $350. For groups of 10 or more REHS/RS and/or CP-FS candidates, the special test site fee is waived.

ENVIRONMENTAL HEALTH SPECIALIST REGISTRATION

website at CDPH.ca.gov/REHS. Certification I certify, under penalty of perjury by the State of California, that the information on this application as well as any documents submitted in support of this application are true and correct to the best of my knowledge. Name: Title: Signature: Date: CDPH 8002 (9/19) Page 3 of 3

COMMISSARY or MSU FA #VERIFICATION

License Plate Number (if applicable): REHS signature verifies that the facility indicated in above meets CALCODE Section 114294-114297. Out of County REHS Name

APPLICATION FOR LICENSE TO CONDUCT A RECREATION CAMP FOR CHILDREN

Roland Lankah, REHS/RS, MPH, PhD. Tel: 617-730 MA License Number: Age: Type of Medical License, Registration or Training 105 CMR 430.159(C):

Registration Renewal Application

I have a Nevada Business License number assigned by the Secretary of State upon compliance with the provisions of NRS Chapter 76. Name on business license: State License #: I have applied for a Nevada business license with the Nevada Secretary of State upon compliance with the provision of NRS Chapter 76 and my application is pending.

Board of Health Steven J. Tostrick, MPH, REHS, RS Sidney

The license application and fee may be submitted with the plans, but no MPH, REHS, RS Health Commissioner Phone: (937) 498-7249 number of guests and vehicles

New Jersey Local Boards of Health Association

Oct 20, 2020 Pursuant to this rule waiver/modification, individuals with an active health officer or REHS license in good standing for the 2020 licensing period may renew their respective license for the 2021 licensing period without completing the required 15 contact hours of CE credits or providing

SANITARIAN REGISTRATION GUIDE

Licenses, select Modification next to your license number and then select Reregistration. If your registration has been lapsed for 3 years or more, you must retake and pass the NEHA REHS/RS Examination.

County of San Diego

Feb 23, 2021 NAME LICENSE # LOCATION PHONE NUMBER PERC V-PIT OWTS SLOPE OWTS-STS Abada, Danny C 45381 San Diego 619-347-3322 X X Acuna, Roland RG 6733 Long Beach 310-968-2999 X X X X X Ahmed, Zafar GE 2720, C 64785 Irvine 949-331-3232 X X X X X Alles, Matthew RG 8390, C57 874005 Escondido 760-802-4407 X X X X X

North Carolina State Board of Environmental Health Specialist

Call the Board Office at 919.304.1168 or email at [email protected] Payment Type Online Check/Money Order Intern Name (as it appears on your Driver s License) Intern # Last 4-Digits of Social Security # Employer. Work Mailing Address Work Email Work Phone Number. Mobile Number Supervisor Name and Title

NEHA Registered Environmental Health Specialist/Registered

NEHA REHS/RS® Candidate Information Brochure 2 can apply on the In Training Track. You would choose REHS/RS®-In Training (I.T.) on the application. You will not be required to submit proof of work experience. If you pass the exam, your certificate will say, REHS/RS® In Training. You will then have 3

Guidance and Frequently Asked Questions (FAQs) for COVID-19

health specialist (REHS) license was placed into inactive status within the past five years (July 13, 2015 to July 13, 2020) are eligible for COVID-19 Public Health Professional Licensure Reactivation so long as the applicant is not disqualified.

DIVISION OF PROFESSIONAL CREDENTIAL PROCESSING

Wisconsin Department of Safety and Professional Services Mail To: P.O. Box 8935 Ship To: 4822 Madison Yards Way Madison, WI 53708-8935 Madison, WI 53705 FAX #: (608) 251-3036 E-Mail: [email protected]

Chuck Khan: Warren County Health Department Registered

passing the NJ REHS exam in 2002, Khan s instructors helped him find an REHS job as a Warren County Health Department Public Health Inspector. He has been there for six years. Starting a New Career. Since earning his REHS license, Khan has enjoyed what he calls a stress-free lifestyle and a wonderful career.

Registration Application CHECKLIST

Photocopy of driver s license TWO fingerprint cards Civil Applicant Waiver Form Official Transcripts (unopened) directly from educational institution Credit Card Payment of $405.00 or Check or Money Order payable to: o Nevada REHS Board Please make sure to keep a copy of all documents for your records.

Michigan Department of Licensing and Regulatory Affairs

4. License(s) in Other State(s) and/or Province(s) Do you hold or have you held a permanent license or registration in any state or Canadian. Yes province, for the type of license for which you are applying? No Please list each state or province, the license or registration number, the date issued, the number of years you

NEW JERSEY ADMINISTRATIVE CODE TITLE 8, CHAPTER 7 LICENSURE

(a) Any license issued in accordance with the provisions of P.L. 1947, c.177 (N.J.S.A. 26:1A-41) and the rules governing the licensing of health officers and registered environmental health specialists , heretofore issued by the New Jersey Department of Health and Senior Services , may

State of Utah Official Use Only Department of Commerce

A EHS-In-Training license is an optional license for applicants who meet all requirements except a passing score on the REHS/RS or REHS/RS-in-training Examination. This form only needs to be completed by individuals applying for an EHS-In-Training license. See the checklist at the end of this application for additional instructions.