Form ECY020-31 "Voluntary Withdrawal From the Emission Check Program" - Washington

Form ECY020-31 or the "Voluntary Withdrawal From The Emission Check Program" is a form issued by the Washington State Department of Ecology.

Download a PDF version of the Form ECY020-31 down below or find it on the Washington State Department of Ecology Forms website.

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Download Form ECY020-31 "Voluntary Withdrawal From the Emission Check Program" - Washington

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Voluntary Withdrawal from the Emission Check Program
Western Washington (800) 272-3780
Eastern Washington (509) 329-3491
I request that my shop be removed from the Washington State Emission Check Program as of
Date
I understand that repair invoices/receipts dated after the date above will not be accepted for waivers at any Emission
Check Station
I understand that my shop’s name will be removed from all Emission Check Program lists and publications.
Manager/Owner Information
Facility:
Shop No:
Manager
Owner
First Name:
Last Name:
Manager/Owner Statement
I have read and understand these requirements.
Signature
Date
To have your shop reinstated in the Emission Check Program, contact Ecology.
For Official Use Only
Ecology Staff
Date
To request ADA accommodation, call (360) 407-6800, 711 (relay service), or (877) 833-6341 (TTY).
ECY 020-31 (Rev. 10/2016)
Page 1
Voluntary Withdrawal from the Emission Check Program
Western Washington (800) 272-3780
Eastern Washington (509) 329-3491
I request that my shop be removed from the Washington State Emission Check Program as of
Date
I understand that repair invoices/receipts dated after the date above will not be accepted for waivers at any Emission
Check Station
I understand that my shop’s name will be removed from all Emission Check Program lists and publications.
Manager/Owner Information
Facility:
Shop No:
Manager
Owner
First Name:
Last Name:
Manager/Owner Statement
I have read and understand these requirements.
Signature
Date
To have your shop reinstated in the Emission Check Program, contact Ecology.
For Official Use Only
Ecology Staff
Date
To request ADA accommodation, call (360) 407-6800, 711 (relay service), or (877) 833-6341 (TTY).
ECY 020-31 (Rev. 10/2016)
Page 1
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