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Click ‘Get Form’ to open the form e inspection in the editor.
Begin by entering the MDE Tracking # and Certificate # at the top of the form. Ensure these numbers are accurate as they are essential for processing.
Fill in the Inspector's Accreditation # and name, along with the MDE Property # and site address, including street number, name, town, and zip code.
In Section 1 (Interior Surfaces), provide details such as total units this certificate applies to, total XRF readings, and any inconclusive readings.
For Section 2 (Exterior Surfaces), select either Option A or B based on your findings. Record total XRF readings and inconclusive results.
In Section 3 (Factory Applied Coatings), indicate if paint chip samples were collected and circle 'YES' or 'NO' as applicable.
Finally, sign and date the form to certify that it is complete before submitting it along with any required attachments.

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