Form ECY020-91 "Application to Be an Authorized Emission Specialist in Ecology's Emission Check Program" - Washington

What Is Form ECY020-91?

This is a legal form that was released by the Washington State Department of Ecology - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2016;
  • The latest edition provided by the Washington State Department of Ecology;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form ECY020-91 by clicking the link below or browse more documents and templates provided by the Washington State Department of Ecology.

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Download Form ECY020-91 "Application to Be an Authorized Emission Specialist in Ecology's Emission Check Program" - Washington

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Application to be an Authorized Emission Specialist
in Ecology’s Emission Check Program
Western Washington (800) 272-3780
Eastern Washington (509) 329-3491
I agree that as an Authorized Emission Specialist, I may have only one authorized shop. I may only sign receipts and test forms from
that shop. I also agree to notify Ecology when I change employment.
I agree to use an OBDII scanner that meets or exceeds the requirement of the Emission Check Program. I will report any needed
maintenance or repairs to management. I will notify Ecology within 24 hours if the OBDII scanner is not functioning properly.
I agree to do only diagnosis, repairs and/or adjustments directed toward the vehicle’s emission failure and that will help the vehicle
meet the emission standards.
I agree that, after completing repairs or the diagnosis and/or repair of a vehicle that failed an emission test, I will:
Record the vehicle description, including license number and vehicle identification number (VIN).
List any missing or inoperative primary emission control components.
List any further recommended repairs if needed.
Print and sign my name.
Include the date and time on the emission test report.
I understand that the business where I am employed must meet the requirements of the Emission Check Program for me to do
diagnosis, repairs, and/or adjustments that will qualify for a waiver.
I understand that businesses meeting the requirements of the Emission Check Program may display the Ecology Authorized
Emission Specialist poster and use the logo. The poster and logo must be removed immediately from public view if Ecology
removes or suspends the facility from the program, or if the business fails to meet the requirements of the Emission Check Program
I understand that Ecology and emission testing stations will consider for a waiver only diagnosis, repairs, and/or adjustments
performed by an Ecology Authorized Emission Specialist. All emission control devices must be intact and operational.
I understand that Ecology staff will ensure I am following proper procedures in compliance with the Emission Check Program.
Applicant Information
First Name:
Last Name:
Phone:
Alternate Phone:
Email:
Facility Name:
Phone:
Training Attended:
Score:
Completion Date:
ASE L-1 Certified:
Yes
No If yes, attach copy of certification.
Ecology Test:
Yes
No
Applicant Statement
I have read and understand these requirements.
Signature
Date
For Official Use Only
Ecology Staff
Date
To request ADA accommodation, call (360) 407-6800, 711 (relay service), or (877) 833-6341 (TTY).
ECY 020-91 (Rev. 10/2016)
Page 1
Application to be an Authorized Emission Specialist
in Ecology’s Emission Check Program
Western Washington (800) 272-3780
Eastern Washington (509) 329-3491
I agree that as an Authorized Emission Specialist, I may have only one authorized shop. I may only sign receipts and test forms from
that shop. I also agree to notify Ecology when I change employment.
I agree to use an OBDII scanner that meets or exceeds the requirement of the Emission Check Program. I will report any needed
maintenance or repairs to management. I will notify Ecology within 24 hours if the OBDII scanner is not functioning properly.
I agree to do only diagnosis, repairs and/or adjustments directed toward the vehicle’s emission failure and that will help the vehicle
meet the emission standards.
I agree that, after completing repairs or the diagnosis and/or repair of a vehicle that failed an emission test, I will:
Record the vehicle description, including license number and vehicle identification number (VIN).
List any missing or inoperative primary emission control components.
List any further recommended repairs if needed.
Print and sign my name.
Include the date and time on the emission test report.
I understand that the business where I am employed must meet the requirements of the Emission Check Program for me to do
diagnosis, repairs, and/or adjustments that will qualify for a waiver.
I understand that businesses meeting the requirements of the Emission Check Program may display the Ecology Authorized
Emission Specialist poster and use the logo. The poster and logo must be removed immediately from public view if Ecology
removes or suspends the facility from the program, or if the business fails to meet the requirements of the Emission Check Program
I understand that Ecology and emission testing stations will consider for a waiver only diagnosis, repairs, and/or adjustments
performed by an Ecology Authorized Emission Specialist. All emission control devices must be intact and operational.
I understand that Ecology staff will ensure I am following proper procedures in compliance with the Emission Check Program.
Applicant Information
First Name:
Last Name:
Phone:
Alternate Phone:
Email:
Facility Name:
Phone:
Training Attended:
Score:
Completion Date:
ASE L-1 Certified:
Yes
No If yes, attach copy of certification.
Ecology Test:
Yes
No
Applicant Statement
I have read and understand these requirements.
Signature
Date
For Official Use Only
Ecology Staff
Date
To request ADA accommodation, call (360) 407-6800, 711 (relay service), or (877) 833-6341 (TTY).
ECY 020-91 (Rev. 10/2016)
Page 1