Air Care Colorado

REI APPEAL REQUEST FORM

Please complete this form and submit all supporting documentation, including the Vehicle Inspection Report (if available) and Repair Orders, via e-mail, bill.haan@esph.com, or by mail to Envirotest Systems, Corp., ATTN: REI Coordinator, 5175 Marshall St., Arvada, CO 80002.

Name of Repair Facility:

Street Address:

City:

Zip Code:

Telephone Number:

Contact Person:

E-mail Address:

Date:

REASON FOR APPEAL

Select the listing that best describes your appeal.

THIS APPEAL WILL NOT BE PROCESSED UNLESS REQUIRED DOCUMENTS ARE RECEIVED.

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As manager/owner of this registered emissions repair faciltiy, by checking this box, I confirm that all information provided in this appeal is accurate and verifiable.

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