Manual Order Form

Wastewater Training Manual Order Form
MISSISSIPPI DEPARTMENT OF ENVIRONMENTAL QUALITY
TRAINING MATERIALS ORDER FORM
(Complete this form, print and mail with payment to address below)

Name  

Address  

Phone No:  

Shipping Address  

Operations Training Manual
5th Edition		 Quantity   X $50.00 = $
Operations Training Manual
CD Rom - includes study guide		 Quantity   X $25.00 = $
Exam Study Guide Quantity   X $20.00 = $
 Total  $
Please attach check or money order payable to the State of Mississippi for total amount. Mail to:

Mississippi Department of Environmental Quality
Attention: Mona Varner
P. O. Box2339
Jackson, MS 39225

(Allow 4 weeks for delivery)

MDEQ USE ONLY
Received by:______________________________    Date: __________
Check or Money Order Enclosed: Yes _____ No ____
Invoice Mailed: Yes ____ No ____ Date __________
Receipt Mailed: Yes ____ No ____ Date __________
Order Forwarded To: _____________________ Date ___________
Manual/Study Guide: Mailed ___ Delivered ___ Shipped ___ P/U ___ Date _______