3 x!puacldvAppendix

C Sample Enforcement Notices Both Programs 1. ReId-Issue Notice of Noncompliance (DPH 44028) Appendix Cl 2. Forfeiture Installment Letter Appendix C2 Asbestos 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 010 Lead 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 018Appendix Cl DEPARTMENT
OF HEALTH SERVICES

STATE OF WISCONSIN Division of Public Health

Bureau of Environmenta]

& Occupational Health DPH 44028 (01/09)

Asbestos

& Lead Certification Unit OHS 159/DHS 163 Wi& Adm. Code NOTICE OF NONCOMPLIANCE NcjoReciient State law requires you to correct each of these violations belore you conduct any other regulated activities or enter
a regulated work site. Failure to comply with this order may result in further enforcement actions including the imposition of civil forfeitures, revocation or denial of certificaton, and criminal orosecution. This notice does not preclude the Department from taking additional enforcement actions for other violations observed by Department Compliance Staff at the project identified above.
If you have any questions, please conlacl the state Asbestos

& Lead Certification Program
at (608)-261-6876 and ask to speak with tne DHS Compliance staff named below at the bottom of this form. Violation by: U Company
U Supervisor

U Worker Determined on: Date Time 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—-Appendix C2

DIVISION CF PUBJC HEALTH Jim Doyle Governor Karen E. Timberlake SecretaryDepartment
of Health Services

1 WESTWILSDN STREET P 0 BOX 2259 MADIS0.4 W 537O-2659 608-286-1251 FA)( 806-267-2832 TrY 888-7W-1253 (date) (authorized representative) (company name) (company address) (company city), (company state) (company zip code) Dear (authorized representative):

dhs wisconsin- g cv 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 State of Wisconsin DHS #: (company number in WALDO) Wisconsin.govAppendix C3

DIVISION OF PUBLIC HEALTH Jim Doyle Govern-or Karen F. Timberlake SeCretary

State of Wisconsin Department
of Health Services

1 WEST WILSON STREET P o BOX 2653 MADISON Wi 53701-2659 608-266-1251 FA)C 608-267-2832 1T’: 888-701-1253 (date) (authorized representative)

d hs wisconsin
.g cv (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 WisconsingovAppendixC4DIVISIONOFPUBLICHEALTHIWESTWILSONSTREETP0ODX2659JimDoyleMADISONWI53701-2659Governor

State of Wisconsin638-266-251KarenE.Timoerlake Deparzmer’t
of Health ServicesFAX:606-267-2832SecretaryTrY68B-70r-1253dnswisconsin.gcv (date) (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!lowing actions 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 this chaQter. Wisconsin.gov2 Enforcement Action and Possible Sanctions for Violations Thu are directed to provide, by (response 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. Please note that failure to provide

a response by the due date may lead to enforcement action. 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 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 HealthAppendix CS

DIVISION OF PUBLIC HEALTH 

# Z-

1 WEST WILSON STREET P080X 2659 Jin’, Doyle

“
MADSON WI 53701-2559 Governor

State of Wisconsin 508-266-1251 Karen E. Tin1berlake Department
of Health Services

FAX: 608-267-2832 secretary

TTY:

888-701-1253 dhs.wisconsr.gov (date) (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. go vIf youhave any questions, please contact (name of lead investigator)
at (lead invastigators phone number). Sincerely, (name of Unit Supervisor), Supervisor Asbestos and Lead Certification Unit Bureau of Environmental and Occupational Health

2Appendix 06

DIVISION OF PUBLIC HEALTH aSji.

1 WEST WILSON STREET P 0 BOX 2659 Jim Doyle

MADISON

WI 53701-2659 Governor

State of Wisconsin
608-266-1251 Karen E. Timberlake Department
of Health Services

FAX 608-267-2832 Secretary

TTY:

888-701-1253 d Ps .WiS Dons r .9 Dv (date) (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.gov2 Enforcement Action and Possible Sanctions for Violations You aredirected to provide, by (response due date), (explain action required) Please mail your response
tothe Asbestos

& Lead Section, Attention (Enf. Coordinator), Room 137, P.O. Box 2659, Madison, Wisconsin 53701-2659. Right to Appeal Under chapter 227, Wis. Stats., youhave the right to appeal this Department enforcement action by filing
awritten requestfor 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 nolater than 15 calendar days after the date youreceive this letter. You mayfile the appeal by mailing

it to the Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875; delivering

it in personto5005 University Avenue, Room 201, Madison, WI; or faxing

it to 608-264-9885. A request for a hearing should contain the following information: yournameand address;

a description
of the Department’s action youare contesting;

aconcise statement of thereasons for objecting
tothe action; the typeof relief youare seeking; and a request for hearing. If youhave 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 HealthAppendix C?

DIVISION OF PUBLIC HEALTH • S a

1 WEST WILSON STREET P 0 BOX 2659 Jrr Doy;e

MADISON w: 53701-2659 Governor

State of Wisconsin 536-266-251 Karen E. Timberlake Department
of Health Services

FAx 608-267-2832 Secretary

iTi’: 838-701-1253 dhs.wisconsin.gov (date) (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 v2 (5) CIVIL FORFEITURE. The department may impose

a daily forfeiture under subch. jjof ch. 254, Stats., against any personwho violates

a provision of this chapter ors.254.20 or 254.21, Stats., fails to respond to aletter of inquiry oranotice of non-Compliance

by the time specified

in the letter or notice, ortails to comply with anorder issued under sub. (3) by the time specified
in the order,
if the department provides written notice of the grounds for forfeiture and an explanation of the processfor appeal under s.DHS 159.46. Enforcement Action and Possible Sanctions for Violations You aredirected to provide, by (response due date), (explain action required).

In addition, the department 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 anymodifiers and associated increases/reductions) Total amount due: (total forfeiture due) Mail your responseand check or moneyorder for (total forfeiture due), payable toState 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., youhave the right to appeal this Department enforcement action by filing awritten 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 noLater than 15 calendar days after the date youreceive this letter. You mayfile the appeal by mailing

it tothe Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875; delivering

it in personto 5005 University Avenue, Room 201, Madison, WI; or faxing
it to 608-264-9885. A request for a hearing should contain the following information: yournameand address;

a description
of the Department’s action youare contesting;

aconcise statement of the reasons for objecting
to the action; the type of relief youare seeking; and a request for hearing. If youhave 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 Occupatonal HealthAppendix CS

DIVISION OP PUBLIC HEALTH aSa

1 WEST WILSON STREET P o Box 2659 Jim Doyle

MADISON WI 53701-2659 Governor

State of WISCOnSIn 608-266-1251 Karen B. Timberlake Department
of HeaTh Services

FAx: 600-267-2632 Secretary

TrY: 838-701-’253 ohs .wis consin- gov (date) (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.gov2 Enforcement Action and Possible Sanctions for Violations You are hereby ordered to stop (applicable regulated activity) by nolater than (effective date). Failure to comply with order by the effective date wifl result in additional enforcement action, which mayinclude

acivil penalty forfeiture and/or suspension
of anycertifications

or approvals you may currently possess. In addition to filing
a request for a hearing, as expained
atthe end of this notice, you may submit information
tothe department that mayaffect thisfinding
of violation. Send anyadditional 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., youhave the right to appeal this Department enforcement action by filing
awritten 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 nolater than 15 calendar days after the date youreceive this.letter.-. You mayfile the appeal by mailing

it to the Division of Hearings and Appeals, P.O. Box 7875, Madison. WI 53707-7875; delivering

it in personto 5005 University Avenue, Room 201, Madison, WI; or faxing
it to608-264-9885. A request for a hearing should contain the following information: yournameand address;

a description
of the Department’s action youare contesting;

aconcise statement of the reasons for objecting
tothe action; the typeof relief youare seeking; and a request for hearing. If youhave 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 HealthAppendix C9

DIVISION OP PUBLIC HEALTH a . a

I WEST WILSON STREET P 0 BOX 2859 Jim Obyle

MADISONW

53701-2659 Governor

State of Wisconsin 608-266-1251 Karen E. Timberlake Department
of Health Services

FAX: 508-267-2832 Secretary

TTY:

888-701-1253 d hs Wisconsin. QOv (date) (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 vfrom the date of thenotice,unless the department notifies the personthat substantial compliance has been achieved.

A suspension shall remain
in effect, regardless whether

it is appealed, until the department determines that the interests of the residents of the stateareserved orafinal decision issued in an appeal reversesthe department’s action. No person may perform an activity for which certification, accreditation
or approval has been suspended. Enforcement Action and Possible Sanctions for Violations Under the authority of s.DHS 159.45(6), the department

is suspending your (applicable certification disciplines) for failure to paycertification fees. The effective date of these suspensions is (effective date). Upon the effective date of this suspension, youmust immediately return your (applicable discipline(s))certificationcard(s), and you mayriotperformregulated asbestos (applicable activities) activities
in Wisconsin. In order to avoid the suspension
of your certifications, youmust, prior to (effective date), (required action). Send your responseto: 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., youhave the right to appeal this Department enforcement action by fifing
awritten request for a hearing with the Division of Hearings and Appeals.

If youchoose 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 youreceive this letter. You mayfile the appeal by mailing

it tothe Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875; delivering

it in personto 5005 University Avenue, Room 201, Madison, WI; or faxing

it to 608-264-9885. A request for a hearing should contain the following information: yournameand address;

a description
of the Department’s action youare contesting;

aconcise statement of the reasonsfor objecting tothe action; the type of relief youare seeking; and a requestfor hearing. If youhave 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 HealthAppendix 010-
DIVISION

OF PUBLIC HEALTH I WEST WILSOJ STREET POBOX2E59 Zim Doyle

MADISON

W 53701-2659 Governor

State of Wisconsin 608—266-125j Karen E. Timberlake Department
of Health Services

FAX: 808-257-2632 Secretary

Tfl’:

888-701-1253 dhs wisconsin gay (date) (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 (sof rule 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.gov2 issuance.

A person maynot perform any activity for which certification, accreditation,

or approval has been summarily suspended. Within

7 working days after anorder is given, the department shall either permit the continuation
of the regulated activity orinitiate proceedings

torevoke certification.

If the department initiates revocation proceedings,
aninformal hearing onThe sole issue of whether certification, accreditation
or approval shall remain suspended during revocation proceedings shall be conducted by a department representative

or designee within 15 working days after the date of suspension, unless waived by the person subject tothe order. Enforcement Action and Possible Sanctions for Violations 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 return yourAsbestos Abatement Supervisor and Asbestos Inspector certification cards, and you maynot perform (applicable regulated activities)
in Wisconsin. In addition to filing a request for a hearing, aS explained
atthe end of this notice, you maysubmit information
tothe department that mayaffect this finding of vioIation Send anyadditional 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., youhave the right to appeal this Department enforcement action by filing
awritten request for a hearing with the Division of Hearings and Appeals.

If youchoose 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 youreceive this letter. You mayfile the appeal by mailing

it tothe Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875; delivering

it in personto 5005 University Avenue, Room 201, Madison, WI; or taxing
it to 608-264-9885. A request for a hearing should contain the following information: yournameand address;

a description
of the Department’s action youare contesting;

aconcise statement of the reasonsfor objecting tothe action; the typeof relief youare seeking; and a request for hearing. If youhave any questions, please contact (name of lead investigator)

at (lead in vestigator’s phone number). Sincerely, (name of Unit Supervisor), Supervisor Asbestos and Lead Certification Unit Bureau of Environmental and Occupational HealthAppendix CII

DIVSI0N

OF PUBLIC HEALTH Jim Doyle Governor Karen 2. TmberIake Secretary

State of Wisconsin Department
of Health Services

1 WEST WILSON STREET P 0 BOX 2659 MADISON WI 53701-2659 606-265-1 251 FAX: 508-257-2632 TTY 885-701-1253 (date) (authorized representative) dhswisconsingov (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.govAppendix C12

DIvISIoN OF PUBUC HEALTH 1 WEST WILSON STREET PD BOX 2659 Jim Doyle

MADISON

W; 5370-265g Governor

State of Wisconsin 608-266-1251 Karen E. Tlmberlake Depsrtment

of Health Services

FAX; 6O8-257-232 Secretary

Tfl:

866-701-253 dhs.wisconsin gov (date) (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 forleadbased paint, and takes enforcement actions, as appropriate. Potential Noncompliance The 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 Action HFS 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.gov2 Enforcement Action and Possible Sanctions for Violations You aredirected to provide, by (response 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. Please note that failure to provide

a response by the due date maylead to enforcement action. Right to Appeal Under chapter 227, Wis. Stats., and s.HFS 163.33, Wis. Adrnin. Code, youhave the right to appeal this Department enforcement action by filing awritten request for a hearing with the Division of Hearings and Appeals.

If youchoose to appeal this decision, your appeal must be received by the Division of Hearings and Appeals nolater than 10 working days after the date youreceive this letter. You mayfile the appeal by mailing

it to Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875, delivering

it in personto 5005 University Avenue, Room 201, Madison, WI, or faxing itto 608-264-9885. Any requestfora hearing should contain thefollowing information: yourname.and address; a description
of the Department’s action youare contesting;

aconcise statement of the reasons for objecting
tothe action; the type of relief youare seeking; and a request for hearing. If youhave 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 HealthAppendix Cl 3

DMSION OF PUBLIC HEALIH .0*

1 WEST WILSON STREET P o BOX 2659 Jim Doyle

MAD:SDN

WI 53701-265 Governor

State of Wisconsin 608-266-1251 Karen E. Timberlake Department
of Health Services

FAX: 608-267-2832 SecretEry

1TY

888-701-1253 dhswisconsinov (date) (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 forleadbased 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.govSincerely,(nameofUnitSupe±’visor),SupervisorAsbestosandLeadCertificationUnitBureauofEnvironmentalandOccupationalHealth2Appendix C14

DIVISION OF PUBLIC HEALTH 1 WEST WILSON STREET 00 BOX 2659 Jim Doyle

MADISON

WI 53701-2659 Governor- State of Wisconsin

SUB-266-1251 Karen E Timoerlake Department
of Health Services

FAx: 608-257-2832 Sscetary

flY 688-701-1253 dhswisconsin.gov (date) (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 forleadbased 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. go v2 (1) ORDER.
If the department provides written notice of the grounds for anorder and an explanation
of the processfor appeahng anorder imposed under this subsection, the department mayorder anyof the following when
a personviolates

a provision under this chapter orcontinues
to vioate orresumesviolation of a provision for which notice was previously issued: Ce) That the personsubmit

a plan of correction for violation of any provision under this chapter. Enforcement Action and Possible Sanctions for Violations You aredirected to provide, by (response due date), (explain action required) Please mail your responsetothe Asbestos

& Lead Section, Attention (Enf. Coordinator), Room 137, P.O. Box 2659, Madison, Wisconsin 53701-2659. Right to Appeal Under chapter 227, Wis. Stats., youhave the right to appeal this Department enforcement action by filing
awritten 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 nolater than 15 calendar days after the date youreceive this letter. You mayfile the appeal by mailing

it tothe Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875; delivering

it in personto 5005 University Avenue, Room 201, Madison, WI; or faxing
it to 608-264-9885. A requestfor a hearing should contain the following information: yournameand address;

a description of the Department’s action youare contesting;

aconcise statement of the reasons for objecting
tothe action; the typeof relief youare seeking; and a request for hearing. If youhave 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 HealthAppendix Cl S t 4 _
DIVISION OF PUBLIC HEALTH 1 WEST WILSON STREET P 0 SOY 2659 Jim Doyle.
MADISON

W 53701-2659 Governor

State of Wisconsin 608-266-1251 Karen 2. limberIake Department
of Health Services

FAX. 608-257-2632 Secretary

TTY:

886-701-253 dhswiscon&n .gov (date) (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 forleadbased 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.gov2 (3) CIVIL FORFEITURE. The department may impose

a daily forfeiture of not less than $100 nor morethan $1 .000 for each violation against any personwho violates

a provision under this chapter, faNs to respond toaletter of inquiry by the time specified
in the order, continues
to violate orresumesviolation of a provision for which notice was previously issued orfail to comply with anorder issued under sub. (1) by the time specified
in the order if the department provides written notice of the grounds for aforfeiture and an explanation
of the processunder s. HFS 163.33 for appealing

aforfeiture. Enforcement Action and Possible Sanctions for Violations You aredirected 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 anymodifiers and associated increase s/reductions) Total amount due: (total forfeiture due) Mail your responseand check or moneyorder for (total forfeiture due), payable toState Treasurer-School Fund, tothe 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, youhave the right to appeal this Department enforcement action by filing
awritten request for a hearing with the Division of Hearings and Appeals.

If youchoose to appeal this decision, your appeal must be received by the Division of Hearings and Appeals nolater than 10 working days after the date youreceive this letter You mayfile the appeal by mailing

it to Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875, delivering

it in personto5005 University Avenue, Room 201, Madison, WI, or faxing
it to 608-264-9885. Any request for a hearing should contain the following information: yournameand address;

a description
of the Department’s action youare contesting;

aconcise statement of the reasons for objecting
tothe action; the typeof relief youare seeking; and a request for hearing. If youhave 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 HealthAppendix Cl 6

-DIVISION OF PUBLIC HEALTH aS

I WSST WILSON STREET P o BOX 2659 Jim Doyle

MADISON

W 5370-2659 Governor

State of Wisconsin 608-266-1251 Karen S. 7irnberlake Department
of Health Services

FAX 608-267-2832 Secretary

TTY.

886-701-1253 dhswscon&r,.gov (date) (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 forleadbased 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.gov2 (a) That the person stop performing, supervising, advertising, claiming to provide or offering activities for which certification

is required under this chapter when the person
is not certified under this chapter. Enforcement Action and Possible Sanctions for Violations You are hereby ordered to stop (applicable regulated activity) by nolater than (effective date). Failure to comply with order by the effective date will result in additional enforcement action, which mayinclude

acivil penalty forfeiture and/or suspension
of anycertifications
or approvals you may currently possess. In addition to filing a request for a hearing, as explained
atthe end of this notice, you may submit information
tothe department that mayaffect this finding of violation. Send anyadditional 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, youhave the right to appeal this Department enforcement action by filing
awritten request for a hearing with the Division of Hearings and Appeals.

If youchoose to appeal this decision, your appeal must be received by the Division of Hearings and Appeals nolater than 10 working days after the date youreceive this letter. You mayfile the appeal by mailing

it to Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875, delivering

it in 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: yournameand address;

a description
of the Department’s action youare contesting;

aconcise statement of the reasons for objecting
tothe action; the typeof relief youare seeking; and a request for hearing. If youhave 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 HealthAppendix Cl 7

DMSION

OF PUBLIC HEALTH-

1 WEST WILSON STREET POBOX 2659 Jim DyIe

VADISONW!

53701-2559 Governor

State of Wisconsin 606-266-1251 Karen 2. TimberIake Dezartment
of Health Services

FAX 608-267-2832 secretary

1W:

888-701-1253 dhs w,sconsingov (date) (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.govsuspension and an explanation
of the processunder
s.HFS 163.33 for appealing

a suspension not less than 30 days before the date of the suspension, and the violation onwhich the suspension

is based remains substantially uncorrected
atthe end of the 30-day notice period. Any suspension
of a cerfification, accreditation

or approval shall remain
in effect until the department determines the interests of the residents
of the state areserved. Enforcement Action and Possible Sanctions for Violations Under the authority of s.DHS 163.32(4), the department

is suspending your (applicable certification disciplines) for failure to paycertification fees. The effective date of this suspension

is (effective date). Upon the effective date of this suspension, youmust immediately return your (applicable discipline(s)) certification card(s), and you maynot perform regulated lead (applicable activities) activities
in Wisconsin. In order toavoid the suspension
of your certifications, youmust, prior to (effective date), (required action). Send your responseto: 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 awritten request for a hearing with the Division of Hearings and Appeals.

If youchoose to appeal thisdecision, your appeal must be received by the Division of Hearings and Appeals nolater than 10 working days after the date you receive this letter. You mayfile the appeal by mailing

it to Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 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: yournameand address;

a description
of the Department’s action youare contesting;

aconcise statement of the reasonsfor objecting
tothe action; the typeof relief youare seeking; and a request for hearing. If youhave 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 HealthAppendix Cl B

DIVISION

OF PUBLIC HEALTH as.

1 WEST WILSON STREET P 0 BOX 2659 Jim Doyie

MADISON W 537C1-2659 Governor



## State of Wisconsin

608-266-1251 Karen S. ‘flrnberlake 

## Department

of Health Services

FAX: 608-267-2832 Secretary

TTY: 888-701-1253 dhs wisconsin .gov 

## (date) (authorized representative)

Notice of Suspension (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 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 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 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 16331 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: (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.gov2 (b) An order by a representative

of the department

to summarily suspend certification
of a person and therefore stop a regulated activity maybe averbal orwritten order. Within
7 working days after the order takes effect, the department shall either permit the continuation
of the regulated activity orinitiate proceedings

to revoke the certification. Unless waived by the certified person,an informal hearing onthe sole issue of whether certification shall remain suspended during revocation proceedings shall be conducted by a department designee within 15 working days after the date of suspension

if the department has initiated revocation proceedings. Enforcement Action and Possible Sanctions for Violations 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 return yourAsbestos Abatement Supervisor and Asbestos Inspector certification cards, and you maynot perform (applicable regulated activities)

in Wisconsin. In addition to filing a request for a hearing, as explained at the end of this notice, you maysubmit information
to the department that mayaffect this finding of violation. Send anyadditional 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, youhave the right to appeal this Department enforcement action by filing awritten request for a hearing with the Division of Hearings and Appeals.

If youchoose to appeal this decision, your appeal must be received by the Division of Hearings and Appeals nolater than 10 working days after the date you receive this letter. You mayfile the appeal by maiUng

it to Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875, delivering

it in 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: yournameand address;

a description
of the Department’s action youare contesting;

aconcise statement of the reasonsfor objecting tothe action; the type of relief youare seeking; and a request for hearing. If youhave any questions, please contact (name of lead investigator)
at (lead investigator’s phone number). Sincerely, (name of Unit Supeivisor), Supervisor Asbestos and Lead Certification Unit Bureau of Environmental and Occupational Health