2. Forfeiture Installment Letter AppeAsbestos

1. Letter of Inquiry (response requested) Appendix C3

2. Potential Noncompliance -Official Inquiry (response ordered) Appendix 04

3. Notice of Noncompliance (no further action intended) Appendix C5

4. Notice of Noncompliance — Response Required Appendix 06

5. Notice of Noncompliance -Civil Penalty Forfeiture Imposed Appendix CT

6. Notice of Noncompliance - Order to Stop Activity Appendix 08

7. Notice of Noncompliance - Suspension/Revocation/Denial Appendix 09

8. Notice of Noncompliance- Immediate Suspension of Certifibation Appendix 010Lead

1. Letter of Inquiry (response requested) Appendix Cli

2. Potential Noncompliance - Official Inquiry (response ordered) Appendix 012

3. Notice of Noncompliance (no further action intended) Appendix 013

4. Notice of Noncompliance Response Required Appendix 014

5. Notice of Noncompliance Civil Penalty - Forfeiture Imposed Appendix 015

6. Notice of Noncompliance Order to Stop Activity Appendix 016

7. Notice of Noncompliance - Suspension/Revocation/Denial Appendix 017

8. Notice of Noncompliance - Immediate Suspension of Certification Appendix 018
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Name DHS Cerhi1cation No.

Address

City Slate Zip Telephone

Company Name (ii Known) Telephone

Project Address

City State Zip

Name of Building Unit No.

Violation(s) Found: DHS Compance Staff have found that on the date and site listed above the person or company listed above was in

violation of the following Wisconsin Administrative Code provisions.

Certification Notification Work Practices

U Company not certified [OHS 159.1 4/OHS 163.12] U No notification to OHS U No supervisor on site, when

U Supervisornotcertified [OHS 159.05/OHS 163.10] [OHS 159.20(1)/OHS 163.14(2)] required [DHS 159.21(4)/OHS

U Worker not certified{DHS 159.05/OHS 1 63.10] U No revised notification to DHS 163.13(4)]

U No supervisor card on site [OHS 159.13(4)(c)/OHS [DHS 159.20(6)/OHS 163.14(2)] No occupant protection plan

I 63.13(2)] [OHS 159.21(3)/OHS 183.14(1)(efl

U No worker card on site [OHS 159.13(4)(c)/OHS 163.13(2)]

Notes/Comments

Acknowledgement of receipt: Signing this Notice of Noncompliance does not signify my agreement with the violations listed above.

SIGNATURE OF RECIPIENT DATE SIGNED

PRINT RECIPIENT NAME

OHS coMPLIANCE STAFF SIGNATURE DATE SIGNED

PRINT OHS COMPLIANCE STAFF NAME

—

-
(authorized representative)

(company name)

(company address)

(company city), (company state) (company zip code)

Dear (authorized representative):

The following installment payment schedule has been established for the forfeiture assessed in

the department’s (enforcement letter date) Notice of Noncompliance:

I

2

Installment Number Installment Amount Date Installment Due

I (installment amount) (installment due date)

F___________

(installment amount) (installment due date)

(additional installments L (installment amount) (installment due date)

Total Payment (total forfeiture) Total due by (due date)

You may prepay any or all.installments with nd prepayment penalty. If any of the required

instal!ment payments do not arrive by the due date prescribed in this letter, the entire

outstanding balance of the forfeiture shall be due and payable. You will be charoed an

additional fee if you submit payment that is not honored by the bank.

For each installment, mail your check or money order for the amount of your forfeiture, payable

to State Treasurer-School Fund, to:

Asbestos & Lead Section

Attention (Enforcement Coordinator), Room 137

P.O. Box 2659

Madison. Wisconsin 53701-2659

If you have any questions, please contact (name of lead investigator) at (lead investigator’s

phone number).

Sincerely,

(name of Unit Supervisor), Supervisor

Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health

DHS #: (company number in WALDO)

Wisconsin.gov
(authorized representative)

(company name) DHS #: (company number in WALDO)

(company address)

(company city), (company state) (company zip code)

Subject: (subject of inquiry)

Dear (authorized representative)

(brief explanation of basis for inquiry and information requested).

Please respond with the requested information by (resoonse due date), to the Asbestos & Lead

Section, Attention (Enforcement Coordinator), Room 137, P 0 Box 2659, Madison, Wisconsin

5370 1-2659.

If you-have any questions, please contact (name of lead investigator) at (lead investigators

phone number).

Sincerely,

(name of Unit Supervisor), Supervisor

Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Hea[th

Wisconsingov
(authorized representative) Potential Noncompliance(companyname) DHS#: (company number/n WALDO) official Inquiry

(company address) Response due: (response due date) (company city), (company state) (company zip code) Case #

Dear (authorized representative):

This notice pertains to (brief description of activity) at (location of violation) by (who did it) that

may have violated state statutes and rules administered by the Wisconsin Department of Health

Services (the department).

Under chapter 254, Wis. Stats., and rules promulgated under chapter DHS 159, Wis. Admin.

Code, the department is authorized to take actions to ensure that persons performing asbestos

abatement or asbestos management activities in or on buildings are protected from harm whUe

engaged in those activities and that their activities do not adversely affect the health or safety of

other persons. To do this, the department certifies persons to perform asbestos activities and

takes enforcement action so that only certi5ed persons with proper training and regulatory

oversight conduct abatement.

Potential Noncompliance

The department finds you may be in violation of the following:

Wis. Admin. Code s. OHS 159.Qnclude applicable section(s) of rule)

Basis for Findings

(include narrative of inspection, investigation, or other source of evidence)

Department’s Authority to Initiate Enforcement Action

OHS 159.45 Enforcement actions. The department may take one or more of the fo!lowingactions for any applicable reason stated under s. DHS 15944 against a person required to

comply with this chapter:

(3) ORDER. The department may issue any of the following orders, which shall be effective upon

issuance, when a person violates a provision of this chapter or s. 254.20 or 254.21, Stats., if the

department provides written notice of the grounds for the order and an explanation of the

process for appeal of the order under s. DHS 159.46:(e) That within a specified time the person submits for department approval, and implements as

approved by the department, a pan of correction for a vioiation of any provision under thischaQter.

Wisconsin.gov
Right to Appeal

Under chapter 227, Wis. Stats., you have the right to appeal this Department enforcement action by filing a written request for a hearing with the Division of Hearings and Appeals. If you choose to appeal this decision, your appeal must be received by the Division of Hearings and Appeals no later than 20 calendar days after the date you receive this letter.

You may file the. appeal by mailing it to the Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875; delivering it in person to 5005 University Avenue, Room 201, Madison, WI; or faxing it to 608-264-9885.

A request for a hearing should contain the following information: your name and address; a description of the Department’s action you are contesting; a concise statement of tha.reasona...

for objecting to the action; the type of relief you are seeking; anda request for hearing.

If you have any questions, please contact (name oflead investigator) at (lead investigator’s phone number).

Sincerely,

(name of Unit Supervisor), Supervisor

Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health
(authorized representative) I Notice of Noncompliance

(company name) DHS 4: (companynumber’n WALDO) Asbestos (main violation categonj*)

(company address) Case #

(company city), (company state) (company zip code)

*cedification notification, accreditation

Dear (authorized representative):

This notice pertains to (violating activity) at (location of violation) by (who did it) that is a violation

of state statutes and rules administered by the Wisconsin Department of Health Services (the

department).Under chapter 254, Wis. Stats., and rules promulgated underchapter DHS 159, Wis. Admin.

Code, the department is authorized to take actions to ensure that persons performing asbestos

abatement or asbestos management activities in or on buildings are protected from harnrwhlle

engaged in those activities and that their activities do not adversely affect the health or sáféty of

other persons. To do this, the department certifies persons to perform asbestos activities and

takes enforcement action so that only certified persons with proper training and regulatory

oversight conduct abatement.

Finding of Noncompliance

The department finds you in violation of the following:Wis. Admin. Codes. OHS ‘159.(inc!ude section(s) of rule violated)

Basis for Findings

(include narrative of inspection, investigation, or other source of evidence)

Department’s Authority to Initiate Enforcement Action

DHS 159.45 Enforcement actions. The department may take one or moreof the following

actions for any applicable reason stated under s. DHS 159.44 against a person required to

comply with this chapter:

(2) NOTICE OF NONCOMPLIANCE, The department may issue a non-appealable notice of

noncompliance for a violation of a provision of this chapter or s. 254.20 or 254.21, Stats.

Enforcement Action and Possible Sanctions for Violations

At this time, the department does not intend further enforcement action against you beyond this

notice of noncompliance. The department reserves the right to include this violation in any

additonal enforcement action, however, if you or individuals working your company are found in

further vioation of federa!, state, or local asbestos regulations.

Wisconsin. gov
Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health
(authorized representat:ve) Notice of Noncompliance

(company name) DHS #: (company number/n WALDO) Response due: (response due date)

(company address)

(company city), (company state) (company zip code)

ase

Dear (authorized representative):

This notice pertains to (violating activity at (location of violation) by (who did it) that is a violation

of state statutes and rules administered by the Wisconsin Department of Health Services (the

department).Under chapter 254, Wis. Stats., and rules promulgated under chapter DHS 159, Wis. Admin.

Code, the department is authorized to take actions to ensure that persons performing asbestos

abatement or asbestos management activities in or on bufldings are protected from harm while

engaged in those activities and that their activities do not adversely affect the health or safety of

other persons. To do this, the department certifies persons to perform asbestos activities and

takes enforcement action so that only certified persons with proper training and regulatory

oversight conduct abatement.Finding of Noncompliance

The department finds you in violation of the following:Wis. Admin. Code s.DHS 159.Qnclude section(s of rule violated) - . -

Basis for Findings

(!nclude narrative of inspection, investigation, or other source of evidence)Department’s Authority to Initiate Enforcement Action

DHS 159.45 Enforcement actions. The department may take one or more of the following

actions for any applicable reason stated unders. DHS 159.44 against a person required to

comply with this chapter:

(3) ORDER. The department may issue any of the following orders, which shall be effective upon

issuance, when a person violates a provision of this chapter or s. 254.20 Dr 254.21, Stats., if the

department provides written notice of the grounds for the order and an explanation of the

process for appeal of the order under s. DHS 159.46:

(e) That within a specified time the person submits for department approval, and implements as

approved by the department, a plan of correction for a violation of any provision under this

chapter.

Wisconsin.gov
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equest for a hearing with the Division of Hearings and Appeals. If you choose to appeal this decision, your appeal must be received by the Division of Hearings and Appeals no later than 15 calendar days after the date you receive this letter.

You may file the appeal by mailing it to the Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875; delivering it in person to 5005 University Avenue, Room 201, Madison, WI; or faxing it to 608-264-9885.

A request for a hearing should contain the following information: your name and address; a description of the Department’s action you are contesting; a concise statement of thereasons for objecting to the action; the type of relief you are seeking; and a request for hearing.

If you have any questions, please contact (name of lead investigator) at (lead investigator’s phone number). -. .

Sincerely,

(name of Unit Supetvisor), Supervisor

Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health
(authorized representative) Notice of Noncompliance

(company name) DHS 41: (company number in WALDO) . -

(comoany address)

CIvIl Penalty Forfeiture

(company city), (company state) (company zip code) Response due: (response due date) Case#

Dear (authorized representative):

This notice pertains to (violating activity) at (location of violation) by (who did it) that is a violation

of state statutes and rules administered by the Wisconsin Department of Health Services (the

department).

Under chapter 254, Wis. Stats., and rules promulgated under chapter DHS 159, Wis. Admin,

Code, the department is authorized to take actions to ensure that persons performing asbestos

abatement or asbestos management activities in or on buildings are protected from harm while

engaged in those activities and that their activities do not adversely affect the health or safety of

other persons. To do this, the department certifies persons to perform asbestos activities and

takes enforcement action so that only certified persons with proper training and regulatory

oversight conduct abatement.

Finding of Noncompliance

The department finds you in violation of the following:

Wis. Admin. Codes. DHS 159.(include section(s) of rule violated)

Basis for Findings

(include narrative of inspection, investigation, or other source of evidence)

Department’s Authority to Initiate Enforcement Action

DHS 159.45 Enforcement actions. The department may take one or more of the following

actions for any applicable reason stated under s. DHS 159.44 against a person required to

comply with this chapter:

(3) ORDER. The department may issue any of the following orders, which shall be effective upon

issuance, when a person violates a provision of this chapter or s. 254.2D or 254.21, Stats., if the

department provides written notice of the grounds for the order and an explanation of the

process for appeal of the order under s. DHS 1 59;46:

(e) That within a specified time the person submits for department approval, and implements as

approved by the department, a plan of correction for a vioiation of any provision under this

chapter.

Wisconsin. go v
department

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red). In addition, the has reviewed the nature of these violations and determined that thefollowing civil penalty forfeiture is appropriate:

(list individual violations) (associated forfeiture amounts) Total gravity-based forfeiture: (total forfeiture) (list any modifiers and associated increases/reductions) Total amount due: (total forfeiture due)

Mail your response and check or money order for (total forfeiture due), payable to State Treasurer-School

137, P.O.

Fund,to the Asbestos & Lead Section, Attention (Enf. Coordinator), Room Box 2659, Madison, Wisconsin 53701-2659.

Right to Appeal

Under chapter 227, Wis. Stats., you have the right to appeal this Department enforcement

choose

action by filing a written request for a hearing with the Division of Hearings and Appeals. If you

Appeals

to appeal this decision, your appeal must be received by the Division of Hearings and no Later than 15 calendar days after the date you receive this letter.

Madison,

You may file

WI

the appeal by mailing it to the Division of Hearings and Appeals, P.O. Box 7875,

Madison,

53707-7875; delivering it in person to 5005 University Avenue, Room 201, WI; or faxing it to 608-264-9885.

A request for a hearing should contain the following information: your name and address; a description of the Department’s action you are contesting; a concise statement of the reasons for objecting to the action; the type of relief you are seeking; and a request for hearing.

If you have any questions, please contact (name oflead investigator) at (lead investigator’s phone number).

Sincerely,

(name of Unit,Supervisor); Supervisor Asbestos and Lead Certification Unit

Bureau of Environmental and Occupatonal Health
(authorized representative)

(company flame) DHS #: (company number in WALDO)

(company address).

(company city), (company state) (company zip code)

Dear (authorized representative):

Notice of Noncompliance I

Order to Stop Activity I

Effective date: (eff. date)

Case#

Finding of Noncompliance

The department finds you in violation of the following:

Basis for Findings

Department’s Authority to Initiate Enforcement Action

This notice pertains to (violating activity at (location of violation) by (v/ho did it) that is a violation

of s:ate statutes and rules administered by the Wisconsin Department of Health Services (the

department).

Under chapter 254, Wis. Stats., and rules promulgated under chapter DHS 159, Wis. Admin.

Code. the department is authorized to take actions to ensure that persons performing asbestos

abatement or asbestos management activities in or on buildings are protected from harm while

engaged in those activities and that their activities do not adversely affect the health or safety of

other persons. To do this, the department certifies persons to perform asbestos activities and

takes enforcement action so that only certified persons with proper training and regulatory

oversight conduct abatement.

Wis. Admin. Code s. DHS 159.(include section(s) of rule violated)

(include narrative of inspection, investigation, or other source of evidence)

DHS 159.45 Enforcement actions. The department may take one or more of the following

actions for any applicable reason stated under s DHS 159.44 against a person required to

comply with this chapter

(3) ORDER. The department may issue any of the following orders, which shall be effective upon

issuance, when a person violates a provision of this chapter or s. 254.20 or 254.21, Stats., f the

department provides written notice of the grounds for the order and an explanation of the

process for appeal of the order under s. DHS 159.46:

(a) That the person step performing, supervising, advertising, claiming to provide or offering to

perform activities for which certification is required under this chapter.

Wisconsin.gov
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Send any additional information to:

Dept. of Health Services, Aftn: (Enforcement Coordinator) Asbestos and Lead Unit, Room 137

P. 0. Box 2659

Madison, WI 53701-2659

Right to Appeal

Under chapter 227, Wis. Stats., you have the right to appeal this Department enforcement action by filing a written request for a hearing with the Division of Hearings and Appeals. If you choose to appeal this decision, your appeal must be received by the Division of Hearings and Appeals no later than 15 calendar days after the date you receive this.letter.-.

You may file the appeal by mailing it to the Division of Hearings and Appeals, P.O. Box 7875, Madison. WI 53707-7875; delivering it in person to 5005 University Avenue, Room 201, Madison, WI; or faxing it to608-264-9885.

A request for a hearing should contain the following information: your name and address; a description of the Department’s action you are contesting; a concise statement of the reasons for objecting to the action; the type of relief you are seeking; and a request for hearing.

If you have any questions, please contact (name of lead investigator) at (lear.! investigator’s phone number).

Sincerely,

(name of Unit Supervisor), Supervisor

Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health
(authorized representative) Notice of Suspension

(company name) DHS #: (company number/n WALDO) Asbestos Certification

(company address)

-

Effective date: (eff. date)

(company city), (company state) company ZIP code) Case#

Dear (authorized representative):

This notice pertains to your (violating activity) at (location of violation), in vioation of state statutes

and rules administered by the Wisconsin Department of Health Services (the department).

Under chapter 254, Wis. Stats., and rules promulgated under chapter HFS 159, W[s. Admin. Code,

the department is authorized to take actions to ensure that persons who provide training courses in

asbestos abatement or asbestos management activities comply with the standards for accredited

training courses found in subchapter Ill of chapter HES 159. To do this, the department reviews

accreditation applications and audits training courses, approves or denies accreditation of’courses,

and takes enforcement action so that only courses that meet these standards are conducted.Finding of Noncompliance -

The department finds you in violation of the foflowing:

Wis. Mmin. Codes. OHS 159.(include section(s) of rule violated)

Basis for Findings

(include narrative of inspection, investigation, or other source of evidence)Department’s Authority to Initiate Enforcement Action

OHS 159.44 Reasons for enforcement actions. (3) REASONS FOR CER]]FICATION ENFORcEMENT

Ac]10NS. The department may take an action under s. DHS 159.45 against a person required to be

certified under this chapter, regardless whether the person is certified, if the person has violated a

provision of this chapter. The specific reason for a certification enforcement action may include, but

is not limited to, any of the following:

(provide applicable sections of code)

DHS 159.45 Enforcement actions. The department may take one or more of the following actions

for any applicable reason stated under s. DHS 159.44 against a person required to comply with

this chapter:

(8) SUSPENSiON. The department may suspend certification, accreditation or approval issued under

this chapter if the department provides written nofice of the suspension, the grounds for

suspension and an expanation of the process for appeal under s. DHS 159.46 not less than 30

days before the date of the suspension, and the violation on which the suspension is based

remains substantially uncorrected at the end of the 30-day period. Suspension is effective 30 days

Wisconsin-go v
(

)

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the 

fective date of this suspension, you must immediately return your (applicable discipline(s)) certification card(s), and you may riot perform regulated asbestos (applicable activities) activities in Wisconsin.

In order to avoid the suspension of your certifications, you must, prior to (effective date), (required action). Send your response to:

Dept. of Health Services, Attn: (Enforcement Coordinator) Asbestos and Lead Unit, Room 137

P. 0. Box 2659

Madison, WI 53701-2659

Right to Appeal

Under chapter 227, Wis. Stats., you have the right to appeal this Department enforcement action by fifing a written request for a hearing with the Division of Hearings and Appeals. If you choose to appeal this decision, your appeal must be received by the Division of Hearings and Appeals no later than 15 calendar days after the date you receive this letter.

You may file the appeal by mailing it to the Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875; delivering it in person to 5005 University Avenue, Room 201, Madison, WI; or faxing it to 608-264-9885.

A request for a hearing should contain the following information: your name and address; a description of the Department’s action you are contesting; a concise statement of the reasons for objecting to the action; the type of relief you are seeking; and a request for hearing.

If you have any questions, please contact (name oflead investigator) at (lead investigator’s phone number).

Sincerely,

(name of Unit Supervisor), Supervisor; Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health
(authorized representative) Notice of Suspension

(company name) OHS #: (company number in WALDO) immediate Suspension of Certification

(company address) Effective Upon Receipt

(company city), (company state) (company zip code) Case #Dear (authorized representative):

This notice pertains to your (violating activity) at (location of violation), in violation of state statutes

and rules administered by the Wisconsin Department of Hearth Services (the department).Under chapter 254, Wis. Stats., and rules promulgated under chapter HES 159, Wis. Admin. Code,

the department is authorized to take actions to ensure that persons who provide training courses in

asbestos abatement or asbestos management activities comply with the standards for accredited

training courses found in subchapter Ill of chapter HFS 159. To dc this, the department reviews

accreditation applications and audits training courses, approves or denies accreditation ofcourses,

and takes enforcement action so that only courses that meet these standards are conducted.Finding of Noncompliance

The department finds you in violation of the following:

Wis. Admin. Codes. OHS 159.Qnclude section(sofrule violated)

Basis for Findings

(include narrative of inspection, investigation, or other source of evidence)Department’s Authority to Initiate Enforcement Action

DHS 159.44 Reasons for enforcement actions. (5) REASONS FOR SUMMARY SuSPENSION. The

reasons the department may impose summary suspension under s. DHS 159.45 (7) include, but

are not limited to, the following:

(provide applicable sections of code)

OHS 159.45 Enforcement actions. The department may take one or more of the following actions

for any applicable reason stated under s. OHS 159.44 against a person required to cornp!y with

this chapter:

(7) SUMMARY SUSPENSION.

(a) The department may summari!y suspend certification, accreditation, or apprcval under the

authority of s. 227.51 (3), Stats., based on but not limited to one of the reasons under s. DHS

159.44 (5), if the department finds that the health, safety or welfare of any person imperatively

requires emergency action and incorporates a finding to that effect in the order

(b) An order for summary suspension shaH be in writing and is effective immediately upon

Wisconsin.gov
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(

), 

partment is suspending your (applicable certification disciplines), effective immediately upon receipt of this notice. You must immediately return your Asbestos Abatement Supervisor and Asbestos Inspector certification cards, and you may not perform (applicable regulated activities) in Wisconsin.

In addition to filing a request for a hearing, aS explained at the end of this notice, you may submit information to the department that may affect this finding of vioIation

Send any additional information to:

Dept. of Health Services, Attn: (Enforcement Coordinator) Asbestos and Lead Unit, Roam 137

P. 0. Box 2659

Madison, WI 53701-2659

Right to Appeal

Under chapter 227, Wis. Stats., you have the right to appeal this Department enforcement action by filing a written request for a hearing with the Division of Hearings and Appeals. If you choose to appeal this decision, your appeal must be received by the Division of Hearings and Appeals no later than 15 calendar days after the date you receive this letter.

You may file the appeal by mailing it to the Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875; delivering it in person to 5005 University Avenue, Room 201, Madison, WI; or taxing it to 608-264-9885.

A request for a hearing should contain the following information: your name and address; a description of the Department’s action you are contesting; a concise statement of the reasons for objecting to the action; the type of relief you are seeking; and a request for hearing.

If you have any questions, please contact (name oflead investigator) at (lead in vestigator’s phone number).

Sincerely,

(name of Unit Supervisor), Supervisor Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health
(authorized representative)

(company name) DHS #: (company number in WALDO)

(company address) -

(company city), (company state) (company zip code)

Subject: (subject of inquiry)

Dear (authorized representative):

(brief explanation of basis for inquiiy and information requested).

Piease respond with the requested information by (response due date), to the Asbestos & Lead

Section, Attention (Enforcement Coordinator), Room 137, P 0 Box 2659, Madison, Wisconsin

53701-2659.

If you have any questions, please contact (name of lead investigator) at (lead investigator!s

phone number).

Sincerely,

(name of Unit Supervisor), Supervisor

Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health

Wisconsin.gov
(authorized representative) fltiaINoncoIianc

(companyname) DHS#: (companynumberin WALDO) Official Inquiry

(company address) Response due: (response due date)

(company city), (company state) (company zip code) Case #

Dear (authorized representative):

This notice pertains to (brief description of activity) at (/ocation of violation) by (who did it) that

may have violated state statutes and rules administered by the Wisconsin Department of Health

Services (the department).

Under Chapter 254, Wisconsin Statutes, and rules promulgated under Chapter DHS 163,

Wisconsin Administrative Code, the department is authcrized to take actions to ensure that

persons performing ead-based paint activities are protected from harm while engaged in those

activities and that their activities do not adversely affect the health or safety of other persons.

To accomplish this, the department certifies persons to perform lead-based paint activities,

evaluates compliance with certification requirements and work practice standards for leadbased paint, and takes enforcement actions, as appropriate.

Potential NoncomplianceThe department finds you may be in violation of the following:

Wis..Admin. Code s. DHS 163.Qnclude applicable section(s) of rule)

Basis for Findings

(include narrative of inspection, investigation, or other source of evidence)

Department’s Authority to Initiate Enforcement ActionHFS 163.32 Enforcement actionsjn addition to issuing letters of inquiry and noncompliance

statements, which are not appealable, the department may take one or more of the following

appealable actions for any reason stated under s. HFS 163.31 a9ainst a certified individual or

lead company, an approved training manager or instructor, a person offering an accredited

training course or a person required to comply with a provision of this chapter:

(1) ORDER. If the department provides written notice of the grounds for an order and an

explanation of the process for appealing an order imposed under this subsection, the

department may order any of the foflowing when a person violates a provision under this

chapter or continues to violate or resumes violation of a provision for which notice was

previously issued:

(e) That the person submit a plan of correction for violation of any provision under this chapter.

Wisconsin.gov
Right to Appeal

Under chapter 227, Wis. Stats., and s. HFS 163.33, Wis. Adrnin. Code, you have the right to appeal this Department enforcement action by filing a written request for a hearing with the Division of Hearings and Appeals. If you choose to appeal this decision, your appeal must be received by the Division of Hearings and Appeals no later than 10 working days after the date you receive this letter.

You may file the appeal by mailing it to Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875, delivering it in person to 5005 University Avenue, Room 201, Madison, WI, or faxing itto 608-264-9885.

Any

description

requestfora hearing should contain thefollowing information: yourname.and address; a of the Department’s action you are contesting; a concise statement of the reasons for objecting to the action; the type of relief you are seeking; and a request for hearing.

If you have any questions, please contact (name of lead investigator) at (lead investigator’s phone number).

Sincerely,

(name of Unit Supervisor), SupeNisor Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health
(authorized representative) Notice of Noncompliance 1 (company name) DHS : (company number in WALDO) Lead (main violation catego/*)(company address) Case

(company city), (company state) (company zip code)

*cenification notification, accreditation

Dear (authorized representative):

This notice pertains to (violating activity) at (location of violation) by (who did it) that is a violation

of state statutes and rules administered by the Wisconsin Department of Health Services (the

department).

Under Chapter 254, Wisconsin Statutes, and rules promulgated under Chapter DHS 163,

Wisconsin Administrative Code, the department is authorized to take actions to ensure that

persons performing lead-based paint activities are protected from harm while engaged nthose

activites and that their activities do not adversely affect the health or safety of other persons.

To accomplish this, the department certifies persons to perform lead-based paint activities,

evaluates compliance with certification requirements and work practice standards for leadbased paint, and takes enforcement actions, as appropriate.

Finding of Noncompliance

The department finds you in violation of the following:

Wis. Admin. Code s. DHS 163.(include section(s) of rule violated)

Basis for Findings

(include narrative of inspection, investigation, or other source of evidence)Department’s Authority to Initiate Enforcement Action

HFS 163.30 General provisions (1) DEPARTMENTAL ACTION. The department may initiate an

action in the name of this state against any person to require compliance with this chapter or for

failure to comply.

Enforcement Action and Possible Sanctions for Violations

At this time, the department does not intend further enforcement action against you beyond this

notice of noncompliance. The department reserves the right to include this violation in any

additional enforcement action, howeve, if you or individuafs working your company are found in

further violation of federal, state, or local asbestos regulations.

If you have any questions, please contact (name of lead investigator) at (lead investigators

phone number.

Wisconsin.gov

(authorized representative) Notice of Noncompliance

(company name) DHS it: (company number in WALDO) Response due: (response due date)

(company address) Case it p

(company city), (company state) (company zip code)

Dear (authorized representative):

This notice pertains to (violatihy activity) at (location of violation) by (who did it) that is a violation

of state statutes and rules administered by the Wisconsin Department of Health Services (the

department).

Under Chapter 254, Wisconsin Statutes, and rules promulgated under Chapter DHS 163,

Wisconsin Administrative Code, the department is authorized to take actions to ensure that

persons performng lead-based paint activities are protected from harm while engaged in those

activities and that their activities do not adversely affectthe health or safety of other persons.

To accomplish this, the department certifies persons to perform lead-based paint activities,

evaluates compliance with certification requirements and work practice standards for leadbased paint, and takes enforcement actions, as appropriate.

Finding of Noncompliance

The department finds you in violation of the following:

Wis. Admiri. Code s. DHS 163.(include section(s) of rule violated)

Basis for Findings(include narrative of inspection, investigation, or other source of evidence)

Department’s Authority to Initiate Enforcement Action

(4) REASONS FOR CERTIFICATION ENFORCEMENT ACTIONS. The departinent may take an action

under s. HES 163.32 against a person required to be certified under this chapter, whether an

individual or a lead company, if the person has violated any provision of this chapter. Reasons

for certification enforcement actions may include any of the following violations:

(provide applicable sections of code)

HFS 163.32 Enforcement actions. In addition to issuing letters of inquiry and noncompliance

statements, which are not appealable, the department may take one or more of the following

appealable actions for any reason stated unders. HFS 163.31 against a certified individual or

lead company, an approved training manager or instructor, a person offering an accredited

training course or a perscn required to comply wit a provisicn of ths chapter:

Wisconsin. gov
p

, by (

esponse due date), (explain action required)

Please mail your response to the Asbestos & Lead Section, Attention (Enf. Coordinator), Room 137, P.O. Box 2659, Madison, Wisconsin 53701-2659.

Right to Appeal

Under chapter 227, Wis. Stats., you have the right to appeal this Department enforcement action by filing a written request for a hearing with the Division of Hearings and Appeals. If you choose to appeal this decision, your appeal must be received by the Division of Hearings and Appeals no later than 15 calendar days after the date you receive this letter.

You may file the appeal by mailing it to the Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875; delivering it in person to 5005 University Avenue, Room 201, Madison, WI; or faxing it to 608-264-9885.

A request for a hearing should contain the following information: your name and address; a description of the Department’s action you are contesting; a concise statement of the reasons for objecting to the action; the type of relief you are seeking; and a request for hearing.

If you have any questions, please contact (name oflead investigator) at (lead investigator’s phone number).

Sincerely,

(name of Unit Supervisor), Supervisor Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health
(authorized representative) Notice of Noncompliance

(company name) DHS #: (company number in WALDO)

(cornoany address)

Civil Penalty Forfeiture

(company city), (company state) (company zip code) Response due: (response due date) Case #

Dear (authorized representative):

This notice pertains to (violating activity) at (location of violation) by (who did it) that is a violation

of state statutes and rules administered by the Wisconsin Department of Health Services (the

department).

Under Chapter 254, Wisconsin Statutes, and rules promulgated under Chapter DHS 163,

Wisconsin Administrative Code, the department is authorized to take actions to ensure that

persons performing lead-based paint activities are protected from harm while engaged lirthose

activities and that their activities do not adversely affect the health or safety of other persons.

To abcomplish this, the department certifies persons to perform lead-based paint activities,

evaluates compliance with certification requirements and work practice standards for leadbased paint, and takes enforcement actions, as appropriate.

Finding of Noncompliance

The department finds you in violation of the following:Wis. Admin. Code a. DHS 163,Qnc/ude section(s) of rule violated)

Basis for Findings

(include narrative of inspection, investigation, or other source of evidence)Department’s Authority to Initiate Enforcement Action

HFS 163.32 Enforcement actions. In addition to issuing leffers of inQuiry and noncompliance

statements, which are not appealable, the department may take one or more of the following

appealable actions for any reason stated under s. HFS 163.31 against a certified individual or

lead company, an approved training manager or instructor, a person offering an accredited

training course or a person required to comply with a provision of this chapter

(1) oROR. If the department provides written notice of the grounds for an order and an

explanation of the process for appealing an order imposed under this subsection, the

department may order any of the following when a person violates a provision under this

chapter or continues to voIate or resumes voIation of a provision for which notice was

previously issued:

(e) That the person submit a plan of correction for violation of any prcvision under this chapter

Wisconsin.gov
You are directed to provide, by (response due date), (explain action required). In addition, the department has reviewed the nature of these violations and determined that the following civil penalty forfeiture is appropriate:

(list individual violations) (associated forfeiture amounts) Total gravity-based forfeiture: (total forfeiture) (fist any modifiers and associated increases/reductions) Total amount due: (total forfeiture due)

Mail your response and check or money order for (total forfeiture due), payable to State Treasurer-School Fund, to the Asbestos & Lead Section, Attention (Enf. Coordinator), Room 137, P.O. Box 2659, Madison, Wisconsin 53701-2659,

Right to Appeal

Under Chapter 227, Wis. Stats., and s. HFS 163.33, Wis. Admin. Code, you have the right to appeal this Department enforcement action by filing a written request for a hearing with the Division of Hearings and Appeals. If you choose to appeal this decision, your appeal must be received by the Division of Hearings and Appeals no later than 10 working days after the date you receive this letter

You may file the appeal by mailing it to Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875, delivering it in person to 5005 University Avenue, Room 201, Madison, WI, or faxing it to 608-264-9885.

Any request for a hearing should contain the following information: your name and address; a description of the Department’s action you are contesting; a concise statement of the reasons for

objecting to the action; the type of relief you are seeking; and a request for hearing.If you have any questions, please contact (name of lead investigator) at (lead investigator’s phone number).

Sincerely,

(name of Unit Supervisor), Supervisor

Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health
(authorized representative) 

Notice of Noncompliance

(company name) DHS #: (company number in WALDO) Order to Stop Activity

(company address)

(company city), (company state) (company zip code) Effective date: (eff date) I Case#

Dear (authorized representative):

This notice pertains to (violating activityj at (location of violation) by (who did it) that is a violation

of state statutes and rules administered by the Wisconsin Department of Health Services (the

department).

Under Chapter 254, Wisconsin Statutes, and rules promulgated under Chapter DHS 163,

Wisconsin Administrative Code, the department is authorized to take actions to ensure that

persons performing lead-based paint activities are protected from harm while engaged in those

activities and that their activities do not adversely affect the health or safety of other persons.

To accomplish this, the department certifies persons to perform lead-based paint activities,

evaluates compliance with certification requirements and work practice standards for leadbased paint, and takes enforcement actions, as appropriate. - Finding of Noncompliance

The department finds you in violation of the following:

Wis. Admin. Code s. DHS 163.Qnclude section(s) of rule vioiated)

Basis for Findings(include narrative of inspection, investigation, or other source of evidence)

Department’s Authority to Initiate Enforcement Action

HFS 163.32 Enforcement actions. In addition to issuing letters of inquiry and noncompliance

statements, which are not appealable, the department may take one or more of the following

appealable actions for any reason stated under s. HFS 163.31 against a certified individual or

lead company, an approved training manager or instructor, a person offering an accredited

training course or a person required to comply with a provision of this chapter

(1) ORDER. If the department provides written notice of the grounds for an order and an

exp!anation of the process for appealing an order imposed under this subsection, the

department may order any of the foflowing when a person violates a provision under this

chapter or continues to vioiate or resumes violation of a prcvison for which notice was

prev[ously issued:

Wis consin.gov
pp

you may currently possess.

In addition to filing a request for a hearing, as explained at the end of this notice, you may submit information to the department that may affect this finding of violation.

Send any additional information to:

Dept. of Health Services, Attn: (Enforcement Coordinator) Asbestos and Lead Unit, Room 137

P. 0. Box 2659

Madison, WI 53701-2659

Right to Appeal

Under chapter 227, Wis. Stats., and s. HFS 163.33, Wis. Admin. Code, you have the right to

Division

appeal this Department enforcement action by filing a written request for a hearing with the of Hearings and Appeals. If you choose to appeal this decision, your appeal must be received by the Division of Hearings and Appeals no later than 10 working days after the date you receive this letter.

You

Madison,

may file the appeal by mailing it to Division of Hearings and Appeals, P.O. Box 7875,

Madison,

WI 53707-7875, delivering it in person to 5005 University Avenue, Room 201, WI, or faxing it to 608-264-9885.

Any request for a hearing should contain the following information: your name and address; a description of the Department’s action you are contesting; a concise statement of the reasons for

objecting to the action; the type of relief you are seeking; and a request for hearing.

If you have any questions, please contact (name of lead investigator) at (lead investigator’s phone number).

Sincerely,

(name of Unit Supervisor), Supervisor Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health
(authorized representative)

(company name) DHS #: (company number in WALDO)

(company address)

(company city), (company state) (company zip code)

Dear (authorized representative):

Finding of Noncompliance

The department finds YOU in violation of the following:

Basis for Findings

Department’s Authority to Initiate Enforcement Action

HFS 163.31 Reasons for enforcement actions.

(provide applicable sections of code)

Notice of Suspension

Asbestos Certification

Effective date: (eff date)

Case #

This notice pertains to your (violating activity at (location of violation), in violation of state statutes

and rules administered by the Wisconsin Department of Health Services (the department).

Under Chapter 254, Wisconsin Statutes, and rules promulgated under Chapter DHS 163,

Wisconsin Administrative Code, the department is authortzed to take actions to ensure that

persons performing cad-based paint activities are protected from harm while engaged in those

activities and that their activities do not adversely affect the health or safety of other persons. To

accomplish this, the department certifies persons to perform lead-based paint activities, evaluates

compliance with certification requirements and work practice standards for lead-based paint, and

takes enforcement actions, as appropriate.

Wis. Admin. Codes. OHS 163.(include sect/on(s) of rule violated)

(include narrative of inspection, investigation, or other source of evidence)(4) REASONS FOR CERTIFICATION ENFORCEMENT ACTIONS The department may take an action under

s. HFS 163.32 against a person required to be certified under this chapter, whether an individual or

a lead company, if the person has violated any provision of this chapter. Reasons for certification

enforcement actions may include any cf the fotlowing violations:

HFS 163.32 Enforcement actions. In addition to issuing letters of inquiry and noncompliance

statements, which are not appealable, the department may take one or more of the following

appealable actions for any reason stated under s. HFS 163.31 against a certified individual or lead

company, an approved training manager or instructor, a person offering an accredited training

course or a person required to comply with a provision of this chapter

(4) SUSPENSION. The department may suspend a certification, an accreditation or an approval

issued under this chapter f the department provides written notice of suspension, the grounds for

Wiscansin.gov
p

e of this suspension, you must immediately return your (applicable discipline(s)) certification card(s), and you may not perform regulated lead (applicable activities) activities in Wisconsin.

In order to avoid the suspension of your certifications, you must, prior to (effective date), (required action). Send your response to:

Dept. of Health Services, Attn: (Enforcement Coordinator) Asbestos and Lead Unit, Room 137

P. 0. Box 2659

Madison, WI 53701-2659

Right to Appeal

Under chapter 227, Wis. Stats., and s. HFS 163.33, Wis. Admin. Code, you havetheright to appeal this Department enforcement action by filing a written request for a hearing with the Division of Hearings and Appeals. If you choose to appeal thisdecision, your appeal must be received by the Division of Hearings and Appeals no later than 10 working days after the date you receive this letter.

WI

You may file the appeal by mailing it to Division of Hearings and Appeals, P.O. Box 7875, Madison, 53707-7875, delivering itin personto 5005 University Avenue, Room 201, Madison, WI, or faxing it to 608-264-9885.

Any request for a hearing should cOntain the following information: your name and address; a description of the Department’s action you are contesting; a concise statement of the reasons for objecting to the action; the type of relief you are seeking; and a request for hearing.

If you have any questions, please contact (name oflead investigator) at (lead investigator’s phone number).

Sincerely,

(name of Unit Supervisor), Supervisor Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health
(authorized representative) Not

p

(company name) DHS #: (company number in WALDO) Immediate Suspension of Certification

(company address)

(company city), (company state) (company zip code) Effective Upon Receipt Case#

Dear (authorized representative):

This notice pertains to your (violating activity) at.(location of violation), in violation of state statutes

and rules administered by the Wisconsin Department of Health Services (the department).

Under Chapter 254, Wisconsin Statutes, and rules promulgated under Chapter DHS 163,

Wisconsin Administrative Code, the department is authorized to take actions to ensure that

persons performing lead-based paint activities are protected from harm while engaged in thoseactivities and that their activities do not adversely affect the health or safety of other persons. To

accomplish this, the department certifies persons to perform ead-based paint activities, evaluates

compliance with certification requirements and work practice standards for lead-based paint, and

takes enforcement actions, as appropriate.

Finding of Noncompliance

The department finds you in violation of the following:

Wis. Admin. Codes. DHS 163.(include section(s) of rule violated)

Basis for Findings

(include narrative of inspection, investigation, or other source of evidence)

Department’s Authority to Initiate Enforcement Action

HFS 163.31 Reasons for enforcement actions.

(6) REASONS FOR SUMMARY SUSPENSION,

A finUing of a requirement for summary suspension under

s. HES 163.32 (5) may be based on, but is not limited to, any the following:

(provide applicable sections of code)

[IFS 163.32 Enforcement actions. In addition to issuing letters of inquiry and noncompliancestatements, which are not appealable, the department may take one or more of the following

appealable actions for any reason stated under s. HFS 16331 against a certified individual or lead

company, an approved training manager or instructor, a person offering an accredited trainingcourse or a person required to comply with a provision of this chapter:

(5) SUMMARY SUSPENSION. (a) Under the authority of s. 227.51 (3), Stats., the department may

summarily suspend a certification when the department finds that this action is required to protect

the health, safety or welfare of any person.

A finding of a requirement for summary suspension

may be based on but is not limited to one or more reasons under s. HFS 163.31 (6).

Wiscons!n.gov
Under the authority of s. DHS 159.45(7), the department is suspending your (applicable certification disciplines), effective immediately upon receipt of this notice. You must immediately

may

return your Asbestos Abatement Supervisor and Asbestos Inspector certification cards, and you not perform (applicable regulated activities) in Wisconsin.

In addition to filing a request for a hearing, as explained at the end of this notice, you may submit information to the department that may affect this finding of violation.

Send any additional information to:

Dept. of Heafth Services, Attn: (Enforcement Coordinator) Asbestos and Lead Unit, Room 137

P.O. Box 2659

Madison, WI 53701-2659

Right to Appeal

Under chapter 227, ‘Ms. Stats., and s. HFS 163.33, Wis. Admin. Code, you have the right to

Division

appeal this Department enforcement action by filing a written request for a hearing with the of Hearings and Appeals. If you choose to appeal this decision, your appeal must be

receive

received by the Division of Hearings and Appeals no later than 10 working days after the date you this letter.

WI

You may file the appeal by maiUng it to Division of Hearings and Appeals, P.O. Box 7875, Madison, 53707-7875, delivering it in person to 5005 University Avenue, Room 201, Madison, WI, or faxing it to 608-264-9885.

Any

description

request for a hearing should contain the following information: your name and address; a

objecting

of the Department’s action you are contesting; a concise statement of the reasons for to the action; the type of relief you are seeking; and a request for hearing.

If you have any questions, please contact (name oflead investigator) at (lead investigator’s phone number).

Sincerely,

(name of Unit Supeivisor), Supervisor Asbestos and Lead Certification Unit

Bureau of Environmental and Occupational Health