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CERTIFICATE OF MOLD DAMAGE REMEDIATION
Certiflcate Number Sg39 Date of lssuance AZl25l2O11
Name StacY R. Skinner
Mailins Address 151 Eagle Trail Ct
City Whitewater State CO 7ip 81527
PropertY DescriPtion:
Number 602 Street Saddleback Drive Lot S14 Block Filing I
Addition or Tract AsPen Glen City Glenwood Springs Countv Garfield
Mold Assessme
r I hereby
identified
nt Consultant License Holder Ceftification
cer-tifythatbasedonvisual,proceduralandanalyticalevaluation,themoldcontamination
ij; ìh1" prolect rras ueen ie*"åiut*d as outlined in ihe mold mänagement plan or remediation
a
protocol.
I further cerlify with reasonable certainty that the underlying cause or causes of the mold that were
identified for this project in the mold runug"ÃL;t plàn or iu.ä¿¡ut¡on protocol have been remediated' A
copy of the written
""ãluut¡on
tt-,at forms ri',* ¡ãt¡J for my certification has been provided to the person
named in this certificate.
Mold Assessment Consultant
License Holder Signature
Mold Remediation Contractor
r I hereby certifY that I com
cerlificate to the Property
Mold Remediatíon Contractor
License Holder Signature
Department of State Health Services
Lióense No. and ExPiration Date
Date
License Holder Certification
oleted mold remediation on
:;;; no lãt"i than the l oth
this project and will provide the mold remediation
day after the date of comPletion
i_,-)
-íÇ '¿
Department of State Health Services
Liåánt" No. and ExPiration Date
,,/.;--,/s
Date of
ComPletion
OR
Mold Assessment Consultant or Adiustor Lice nse Holder Certification
I herebY certifY that I have insPected the ProPertY described in this certificate and that based on mY
inspection I have determi ned that the property does not contain evi dence of mold damage A coPY of
a
the written evaluation that forms the basis
this certificate
for mY cerlification has been provided to the Person named in
Motd Assessment Consultant /
Adiustor License Holder
Signature
(Rov. Eff.
'C5)
Department of State Healih Services
li"un"" No. and ExPiration Date
Date