Methamphetamine-Affected Properties Individual Application for Certification

General information

Who must apply

All persons who are performing assessment, decontamination or sampling of methamphetamine-affected properties in the State of Colorado, in accordance with 6 CCR 1014-3. Certification is required under 6 CCR 1014-3, Part 2. Certification is valid for two years.

Please indicate if this is an application for renewal or retest.

Yes

If you are renewing, please enter your cert #: ML-I *

Personal information

Applicant first name *

Last name *

Applicant address

Address number *

Street direction

Street name *

Street type

Unit/suite

City (Please spell out the full name.) *

State *

Zip *

Work phone (xxx-xxx-xxxx) *

Home phone (xxx-xxx-xxxx) *

Email *

Employer name *

Employer address

Address number *

Street direction

Street name *

Street type

Unit/suite

City (Please spell out the full name.) *

State *

Zip *

Identification

Hair color *

Eye color *

Height in feet *

inches *

Weight *

ID type *

State of issue * 🛈

"ID type" must be a photo ID issued by a governmental agency, such as a drivers license, passport or state ID. You must bring this ID to the testing site for verification of your identity.

Do you wish to be included on the department's on-line list of certified individuals? *

Yes

No

Type of authorization requested (check all that apply)

We accept payment by check or money order only. Do not use the asbestos pay portal to pay your methamphetamine-affected properties application fees.

Are you applying for a retest? *

Yes

No

Authorization / renewal type

Consultant

$600

Decontamination worker

$300

Decontamination supervisor (includes Worker)

$600

Ventilation contractor

$200

Retest type (After failed test)

Consultant retest

$100

Decontamination worker retest

$100

Decontamination supervisor retest

$100

Ventilation contractor retest

$100

Total fee due

0.00

Note: Providing false statements in this application or providing fraudulent identification constitutes second degree perjury as defined by 18-8-503, C.R.S.

Required attachments by application type

Consultant

Compliance with the industrial hygienist qualification as set forth in 24-30-1402, CRS.** *

40-hr HAZWOPER certificate as set forth in 29 CFR 1910.120

8-hr HAZWOPER refresher (if applicable)

Documentation of successful completion of a department-approved consultant training course within the 60-day period prior to submitting an application. *

Decontamination Supervisor

Documentation of successful completion of a department-approved decontamination worker and supervisor training course within the 60-day period prior to submitting an application. *

Decontamination Worker or Ventilation Contractor

Documentation of successful completion of a department-approved decontamination worker training course within the 60-day period prior to submitting an application. *

Notes:

** If documentation of compliance with the industrial hygienist qualification as set forth in 24-30-1402, C.R.S. was submitted with a previous application it does not need to be re-submitted.

*** If documenation of 40 hour OSHA HAZWOPER training and current 8 hour refresher training was submitted with a previous applicaiton, it does not need to be re-submitted. However, documentation of current 8 hour refresher training must be submitted if the previous refresher training has expired.

Instructions

Once you have completed the form, click on the Submit button. We will send an email to you with a link to your completed form that you can then save as a PDF. Follow the instructions for payment provided in the email to complete your submittal.

Note: Your application will not be processed until we receive your payment.

When you hit Submit, you will be redirected to the Methamphetamine-affected properties environmental cleanup web page.

Signature

For the purposes of this form, the Colorado Department of Public Health and Environment accepts your typed name, title and date as an electronic signature equivalent to your valid signature on a paper copy of the form. As such, this electronically completed form subjects the signatory to the same responsibilities as a hand-signed form. Per Section 18-8-306, C.R.S., it is a felony to submit false information to a state official.

Signature *

Title *

Date * +