Document ID: EPA-HQ-OPPT-2003-0056-0018
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2020-08-13T04:00Z

Rev.
03/
31/
01
CERTIFICATIONMATEMALS
Department
of
Health
Environmental
Health
Administration
Lead­
Based
Paint
Abatement
Fkogrm
APPENDIX
0
DISTRICT
OF
COLUMBIA
STATE
LEAD
CERTIFICATION
PROGRAM
FOR
INDIVIDUALS
AND
BUSINESS
ENTITIES
***

District
of
Columbia
Government
Department
of
Health
Risk
Assessment,
Remediation
and
Certijkation
Division
December
2000
HEALTH
***
GOVERNMENT
OF
THE
DISTRICT
OF
COLUMBIA
DEPARTMENT
OF
HEALTH
ENVIRONMENTAL
ADMINISTRATION
­
December
1,2000
Dear
Applicant:

Thank
you
for
your
interest
in
becoming
certified
to
engage
in
lead­
based
paint
activities
in
the
District
of
Columbia.
"
The
Lead­
Based
Paint
Abatement
and
Control
Act"
of
1996
and
D.
C.
Law
11­
221
provides
that
workers
performing
lead­
based
paint
activities
in
the
District
of
Columbia
must
be
certified
and
in
compliance
with
the
District
of
Columbia's
work
practice
standards
for
conducting
lead­
based
paint
activities.

Individuals
and
business
entities
who
perform
lead­
based
paint
activities
and
related
services
are
required
to
pay
certification
fees.
The
District
of
Columbia
State
Lead
Certificationand
Training
Program
provides
certification
for
the
following:
Inspectors,
Risk
Assessors,
Supervisors,
Project
Designers,
Abatement
Workers
and
Business
Entities.
Payment
in
hll
must
be
sent
along
with
the
application
and
required
materials.
Please
make
checks
or
money
orders
payable
to
the
D.
C.
Treasurer.
Application
fees
are
NON­
REFUNDABLE.

A.
copy
of
the
list
of
District
of
Columbia
accredited
training
providers
is
available
for
those
applicants
requiring
either
initial
or
refiesher
training
to
meet
District
qualifications
for
certification.
Registration
material
is
available
for
those
requiring
lead
examinations.
Applications
for
certification
should
be
submitted
to:

Department
of
Health
Environmental
Health
Administration
RiskAssessment,
Remediation
and
Certification
Program
51
N
Street,
N.
E.
3"'
Floor
Washington,
D.
C.
20002
Attention:
Dr.
Devasia
Karimpanal
If
you
have
any
questions,
please
contact
Mr.
George
Siaway,
Environmental
Specialist
on
202
­
535­
1926.
I
look
forward
to
receiving
your
application
for
review.

Sincerely,

Richard
N.
Brewster,
Program
Manager
Risk
Assessment,
Remediation
and
Certification
Program
Enclosure
RB/
ca
5
1
4
Street.
N.
E..
Third
Floor.
\
Vasliington.
D.
C.
20002
'
ITI,:
(
202)
535­
2690
I:
IS(
202)
535­
1423
3
4
CERTIFICATION,
ACCREDITATION,
TESTING,
PERMITTING
AND
NOTIFICATION
REQUIREMENTS
Risk
Assessor
(
hands­
on)
SuDervisor
.
r
Bri~
g&
Stru&
Abatement
ProiedCommercial
(
stores/
officesj
Federal
&
District
Government
I
Facilities/
Public
Schools
I
PermitfNotification
Inspector
Supervisor
Risk
Assessor
Project
Designer
I
IndividualDisciDlines
I
Business
Entitv:
(
Contractor/
Consultant)

Risk
Assessor
I
16hours
1
Fee:
$
300
I
4hours
I
32
hours
I
Fee:
$
300
I
I
YeS
Yes
I
Yes
I
I
I
Yes,
at
leastten
(
10)
business
days
Fee:
$
40
plus
3%
of
abatement
contract
orior
to
start
of
work
I
Yes
Yes
Yes
I
No
I
No
I
I
Yes
I
I
I
No
I
I
I
Yes
I
that
anapplicant sinitial
exam
is
equivalent
to
D.
C. 
score
exam,
then
only
the
D.
C.
specific
exam
would
be
reauired.
2
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I1
i
r**
GOVERNMENT
OF
THE
DISTRICT
OF
COLUMBIA
DEPARTMENT
OF
HEALTH
51
N
Street,
N.
E.,
3d
Floor
Washington,
D.
C.
20002
LEAD
CERTIFICATION
AND
TRAINING
PROGRAM
RELEVANT
WORK
EXPERIENCE
(
attach
additional
sheets
if
necessary)

Required
for
Lead
Supervisors,
Inspectors,
Risk
assessors,
and
Project
Designers
lnstructions:
Section
A:
To
be
completed
by
the
applicant.
Section
B:
To
be
completed
by
a
person
familiar
with
the
work
experience
of
the
applicant
(
may
be
a
current
or
former
supervisor).

Section
A
1.
Name:
First
Middle
Last
Title
2.
Home
Address:

City,
State,
Zip
Code:

3.
TelephoneNumbers:
(
)
0
Home
BeepedCellular
4.
Check
the
one
type
of
certification
you
arerequesting.

0Lead
Project
Designer
0Leadhpector
0LeadSupervisor
5.
Iaufhorize
Applicant s
signature:

Section
B
Name
of
Individual
Reference:

PhoneNumber:
(
)

Address:
0Lead
Risk
Assessor
to
hrnish
the
mformation
requested
in
Section
B.

Date:

CompanyA3usiness:

E­
Mad:

street
City
State
Zip
Dates
of
Experience:
From:
To
Describe
the
specrfic
typeof
relevant
work
(
with
whch
you
are
familiar)
performed
by
the
applicant
named
in
Section
A.

Reference
signature:,
Date:
h
a,

8
2
w
:
3
2
w
2
0
E
W
w
b
vj
w
4
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z
Li
c!

h
I
C
Y
onou
<

Iem
DATE:
06­
09­
01
1.­'
I
h
GOVERNMENT
OF
THE
DISTRICT
OF
COLUMBIA
Depanment
of
Health
*
Envvonmental
Health
Adrmnrstration
Bureau
of
Hazardous
Matends
and
TOXIC
Substances
i
 
...

CERTIFICATION
APPLICATION
BOOKLET
...............................

..........

.........
.........
DISTRICT
OF
COLUMBIA
STATE
LEAD
CERTIFICATION
PROGRAM
FOR
.........

............

....

.............................
...........................~.
....

.....,
....
i
..........

/+........
1
L­
R4
(­..:.
:::.:.........
......

***­
1
District
of
Columbia
Government
Department
of
Health
Lead
Poisoning
Prevention
Divisiorr
May
3UOl
GOVERNMENTOF
TRE
DISTRICT
OF
COLliMBW
Department
of
Health
Environmental
Health
Administration
***
­
[
Lad
Poisoning
Prz\<
ntloil
Division
Burcati
ot
H'izardoiis
\
Iatcrial
and
Tuui.
Suhtan<
ss
I
May
4.200
1
Dear
Certification
Applicant:

On
January
2,
1998,
Act
11­
438
of
1996
became
D.
C.
Law
11­
223.
All
workers
performing
lead­
based
paint
activities
in
the
District
of
Columbia
must
be
certified
and
in
compliance
with
D.
C.
Law
11­
221,
whch
regulates
the
work
practice
standards
for
conducting
tad­
based
paint
activities.
Please
be
informed
that
all
disciplines
of
lead
workers
and
business
entities
conducting
Lead­
Based
Abatement
activities,
as
defined
by
the
District
of
Columbia
Code$
6­
997.1,
Lvithin
the
District
of
Columbia
are
required
to
obtain
a
District
of
Columbia
certificatiodicense
(
per
District
of
Columbia
Code
Q
6.997.7)
and
pay
the
associated
fee.

The
District
of
Columbia
State
Lead
Certification
and
Training
Program
provides
certification
for
the
following:
Inspectors,
ksk
Assessors:
Supervisors,
Project
Designers­,
Abatement
Workers
and
Business
Entities.
Payment
in
full
must
be
sent
along
with
the
application
andrequired
supporting
materials.
Please
make
separate
checks
or
money
orders
payable
to
the
D.
C.
Treasurer
for
each
categoq
for
which
certification
is
sought.
Application
fees
are
NONREFUNDABLE

The
Department
of
Health
is
currently
reviewing
for
approval
applications
for
those
who
have
taken
the
required
District
of
Columbia
accredited
lead
training
courses,
and
who
possess
any
other
required
training
and
relevant
experience,
as
appropriate.
Applications
should
be
submiaed
to:

&
C
.
Department
of
Health
ental
Health
Admiwtrahon
isoning
Prevention
Division
ertification
and
Training
Program
5
P
N
Street,
N.
E.,
31d
Flow
Washington,
D.
C.
m02
Attn:
Mr.
Tenqx
Enforcement
actlon
wll
be
taken
to
the
hIIest
extent
of
the
law
for
businesses
and
workers
who
fhil
to
comply
with
the
lead
training
and
certification
requirements
ofthe
District's
Lead
Poisoning
Prevention
Program.

A
copy
of
the
District's
State
Lead
Certification
Program
Handbook
for
lndividuals
and
Business
Entities
is
enclosed
for
your
mformation
and
use.
Should
you
have
any
questions,
please
do
not
hesitate
to
contact
this
office
at
(
202)
535­
2637
between
the
hours
of
8:
30
A.
M.
to
4:
30
P.
M.,
Monday
through
Friday
(
except
holidays)
or
contact
our
LEAD
HOTLINE
on
1­
877­
338­
0364.
We
Iook
forward
to
working
with
you.

Sincerely,

V.
Sreenivas,
PbD.
Acting
Program
Manager
Enclosure
FACT
SHEET
May
2001
D.
C.
LEAD­
BASED
FAINT
CERTIFICATION
PROGRAM
SUMMARY
The
EnvironmentalHealth
Administration,
State
Lead
Certification
and
Training
Program
Implements
the
EPA
State
Authorized
Lead­
Based
Paint
Certification,
Accreditation
and
Permitting
activities
within
the
District
of
Columbia.

AUTHORITY
&
EFFECTIVE
DATE
D.
C.
Law
11­
221
became
final
on
January
2,1998
WHAT
IS
REQUIRED?

e
Person(
s)
engaged
to
remove,
.
remodel,
or
renovate
lead
painted
structures
must
be
trained,
certified
andlor
accredited.

e
A
lead
abatementpermit
must
be
obtained
atleast
10
business
days
prior
to
any
lead
reduction
activities.
e
Liability
insurance
must
be
obtained
by
businesses
and
Risk
Assessors
e
Workerflraining
discipline
fees
must
be
paid
to
the
D.
C.
Treasurer
FEE
SCHEDULE
1nspector
Supervisor
Abatement
Worker
Project
Designer
Risk
Assessor
Business
Entity
ReciprocityCertification
Inspector
initial
course
Inspector
refresher
Risk
Assessor
initial
Risk
Assessor
refresher
Supervisor
initial
Supervisor
refresher
Project
Designer
initial
$
30012
years
$
30012
years
$
6012years
$
30012
years
$
30012
years
$
30011
year
Same
as
above
$
1,20O/
year
$
4001year
$
8001year
$
4001year
$
l,
6001year
$
4001year
$
4001year
ProjectDesigner
refresher
$
2001year
Abatement
Worker
initial
$
8001year
Abatement
Worker
refresher
$
4001year
ReciprocityAccreditation
Same
as
above
Abatement
Permit
$
40
+
3%
of
abatement
cost
EXEMPT
ENTITIES
e
Jndividuals
who
perform
lead­
based
Paint
activities
at
residenceswhich
they
own
unlessthe
residence
is
occupied
by
a
non­
owner
or
nonimmediate
family
member@)
or
a
child
residesor
frequently
visits
subject
property
who
is
younger
than
eight
years
old.

e
'
Abatement
Projectpermitfee
must
be
paid
to
the
D.
C.
Treasurer
a
Housingfor
the
elderly
or
persons
e
Housing
constructed
after
1978
PENALTIES/
FINES
Entities
in
violation
of
the
law
will
be
fined
and/
or
imprisoned
pursuant
to
the
Act.

FOR
MORE
INFORMATION
8
APPLICATION
FORMS
Please
contact:

D.
C.
Departmentof
Health,
Environmental
Health
Administration,
Bureau
of
Hazardous
Material
&
Toxic
Substances,
Lead
Poisoning
Prevention
Division,
RARCP
on
202­
535­
2690
or
202­
535­
2637
at
51
N
Street,
N.
W.,
3rd
Floor,
Washington,
D.
C.
zip
20002
TRAINING
PROVlDERS
Aerosol
Monitoring
&
Analysis,
Inc.
­
All
Alice
Hamilton
Occupational
Health
Training
Center
­
All
DC
LEAD
HOTLINE
a
1­
877­
338­
0364
e
Work
Practice
standards
and
proceduresfor
conducting
lead­
based
paint
hazard
reductionand
related
consumer
outreachleducahon
activities.

PROGRAM
FOCUS
Prevention
of
lead
poisoning
and
its
ill
health
effects
on
children
under
the
age
of
eight
with
disabilities;
unless
any
child
under
the
age
of
eight
years
resides,
is
expected
to
reside
in
or
regularly
visits
such
housing.

Any
zero
bedroom
unit,
such
as
an
efficiency
aparbnent
Y
i
DISTRICT
OF
COLUMBIA
CERTIFICATION,
ACCREDITATION,
TESTING,
PERMITTING
&
NOTIFICATION
REQUIREMENTS
I
<
tart
nfwnrk
Zero
Ekdroom
Residential
Unit
Yes
Individual
Disciplines
Yes
Certlfied
contractor.
supervisorand
worequired.
rkers
Special
attention
to
private
schools,
churches.
museums.
recreational
facilities,
institutional
facilities
.
stc.
frequented
by
children
No
permit
fee
assessed.
Notification
required.
certified
emulovees
&
businessreauued.

for
consultants
and
fums
and
ifperfomung
clearance
residences
which
they
own
unless
the
reside
nce
is
occupied
by
a
ncm­
owner
or
non­
immediate
family
member(
s)
or
a
child
resides
or
hquently
visits
subject
property
is
younger
than
eight
years
old
are
exempt.

Activities
involving
owner­
contrwtor
agreements
with
the
ixitentto
pennanmtly
abate
lead
are
non
exempt.
Owner
must
utilize
a
certsied
contractor.
*
Elderly
column
refers
to
housing
specifically
for
the
elderly­
Housing
for
the
elderly
or
persons
with
disabilities;
unless
any
child
under
the
age
of
eight
years
resides,
is
expected
to
reside
in
or
regularly
visits
such
housing.
I
A
certified
contractor
must
be
used
A
unlt
such
as
an
efinency
apartment,
dormitory,
SIC.,
is
1
exempt.
I
.
Accredited
TrainingProvider
in
order
to
get
certified
in
If
applicant
has
not
received
training
from
a
D.
C.
accredited
provider?
thena
D.
C.
refresher
will
be
required.
(
Must
an
applicant
certified
from
another
Regim
In
State
take
a
3"
Party
Exam
from
a
District
of
Columbia
Exam
Rovider
as
part
of
getting
certified
in
D.
C.
hdividual
Disciplines
(
inspector,
supervisor,&
risk
Yes
Tne
two
part:
disciplineexam
and
the
D.
C.
spedic
exam
assessor)
are
required.
Kit
is
determinedthat
anapplicant's
initial
exam
is
equivalent
to
D.
C.'
s
core
exam,
then
only
the
D.
C.
soeciftc
exam
would
be
reauired.

May
2001
5
h
6
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c
GOVEXNMENT
OF
THE
DISTRICT
OF
COLUMBIA+**
DEPARTMENT
OF
HEALTH
51
N
Street,
N.
E.,
3"'
Floor
Washington,
D.
C.
20002
LEAD
CERTIFICATION
AND
TRAINING
PROGRAM
RELEVANT
WORK
EXPERIENCE
(
attach
additional
sheets
if
necessary)

Required
for
Lead
Supervisors,
Inspectors,
Risk
assessors,
and
Project
Designers
Instructions:
Section
A:
To
be
completed
by
the
applicant.
Section
B:
To
be
completedby
a
personfamdiar
with
the
work
experienceof
the
applicant
(
may
be
a
current
or
former
supewisor).

Section
A
1.
Name:
First
Middle
Last
Title
2.
Home
Address:

City.
State.
Zip
Code:

3.
TelephoneNumbers:
(
)
0
Home
Beeper/
Cellular
1.
Check
the
one
typeof
certificationyou
are
requesting.

0had
Project
Designer
Lead
Supervisor
5.
Iauthorize
Applicant's
signature:

Section
B
Name
of
Individual
Reference:

PhoneNumber:
(
)

Address:
Street
Dates
of
E'uperience:
From:
c]
Lead
Inspector
u
LeadRiskAssessor
to
furnish
the
information
requested
in
Section
B.

Date:

Company/
Business:

E­
Mail:

City
State
Zip
To
Describe
the
specific
typeof
relevant
work
(
withwhich
you
are
familiar)
performed
by
the
applicant
named
in
Section
A.

Reference
signature:
.
Date:

Printed
name:

Revised
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ACCREDITATION
BOOKLET
FOR
TRAINING
PROVIDERSKOURSES
DISTRICT
OF
COLUMBIA
STATE
LEAD
ACCREDITATION
PROGRAM
FOR
I[
NG
PROVIDEWCOURSES
....

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0
***

District
of
Columbia
Government
Department
of
Health
Lead
Poisoning
Prevention
Division
Mq
2001
GOVERNMENT
OF
THE
DISTNCT
OF
COLUMBW
Department
of
Health
Environmental
Health
Administration
*
**
Burcnu
of
Hazardous
\[
aterid
and
Toxic
Substances
May
4,2001
Dear
Training
Provider:

The
District
of
Columbia s
Lead
Poisoning
Prevention
Division
is
encouraging
training
providers
to
seek
District
of
Columbia
accreditation
for
lead­
based
paint
training
courses.
The
District
of
Columbia s
Act
11­
438
of
1996,
 
The
Lead­
Based
Paint
Abatement
and
Control
Act  
became
effective
November
20,
1996.
On
January
2,
1998,
Act
11­
438
became
D.
C.
Law
11­
221.
All
lead
training
courses
given
in
the
District
of
Columbia
must
be
accredited
and
in
compliance
with
D.
C.
Law
11­
221
which
regulates
the
work
practice
standards
for
conducting
lead­
based
paint
activities
inthe
District
of
Columbia.
Fees
are
not
imposed
for
accreditation
of
nonprofit
training
programs.
For
training
courses
given
outside
of
the
District
of
Columbia
to
be
fblly
accepted
as
meeting
the
District s
training
requirements,
the
course
must
have
been
accredited
by
the
District.
If
the
course
has
not
been
accredited
by
the
District
it
may
only
be
 

considered
as
partially
meeting
training
requirement
under
reciprocity
and
a
candidate
would
still
be
required
to
take
a
District
accrediged
refresher
course
before
becoming
eligible
to
take
the
District s
third
party
exams
for
certification.

The
District
of
Columbia s
State
Lead
Certificationand
Training
Program
includes
all
disciplines:
Inspectors,
Risk
Assessors,
Supervisors,
Project
Designers
and
Abatement
Workers.
The
Abatement
Workers
courses
may
be
acmd
ish
course
offerings
Training
providers
are
also
encouraged
to
offer
the
new
course.
Students
seeking
licensinglcertificationin
the
Dist
ng
or
.
betaken
courses
which
are
unaccredited
by
the
District
of
spending
fhds
for
$
om&
which
may
not
fbifill
District
training
requirements.
Trai
e
offerings
as
meeting
District
of
Columbia
requirements
ma
Copies
of
the
District s
Le
information
and
use
in
tailoring
course
offerings
to
include
District
specific
regulations
and
requirements.
shot&
you
wish
to
seek
District
of
Columbia
accreditation
to
provide
training
caurses
to
prepare
applicants
to
meet
District
certification
requirements.
Training
course
accreditation
application
forms
are
also
included
in
the
enclosure.
If
you
have
any
questions,
please
do
not
hesitate
to
contact
this
office
at
(
202)
535­
2637
between
the
hours
of
8:
30
A.
M.
to
4:
30
P.
M.,
Monday
through
Friday
(
except
holidays)
or
contact
our
LEAD
HOTLINE
on
1­
877­
338­
0364.
We
look
forward
to
working
with
you.

Sincerely,

V.
Sreenivas,
Ph.
D.
Acting
Program
Manager
Enclosure
VS/
ca
51
4 
Street,
S.
E..
Third
Floor.
Washington.
D.
C .
2UOO2
TEL
(
202)
535­
2690
F.
LY(
202)
535­
142.3
Instructionsfor
Completing
the
Lead
Training
Provider
Application
Disclosure
Notice
As
a
prospective
D.
C.
accredited
training
provider,
you
are
required
by
D.
C.
Law
to
provide
accurate
information
in
seeking
lead­
training
accreditation
in
the
District
of
Columbia.
False
or
inaccurate
information
could
jeopardize
your
training
provider
accreditation.

I.
"
GeneralApplicant
Information
Please
supply
the
official
name
of
your
company
as
it
appears
in
your
Articles
of
Incorporation,
official
documents
or
public
telephone
directory,
etc.
Your
mailing
address
should
include
a
physical
site
where
your
business
is
housed,
conducted
and
where
you
receive
your
official
mail.
Please
indicate
by
a
check
mark
the
type
of
company
or
business
you're
classified
as:
corporate,
individual
or
partnership.
If
there
is
a
different
address
than
indicated
in
the
initial
mailing
address,
please
supply
an
alternate
location,
which
includes
the
city,,
state
and
zip
code.
If
you
have
corporate
designation,
please
provide
number
included
in
Articles.

iL
Training
Manager
informution
A
training
manager's
experience
and
training
should
conform
to
the
requirements
for
training
managers
as
outlined
in
federal
rules
and
regulations
governing
lead
certification
and
training.

III.
Application
Informution
(
asidentified
in
Section
I
above)

Information
requested
pertains
to
information
you
supplied
in
Section
I.
You
are
also
requested
to
provide
information
as
to
whether
you
have
been
accredited
in
other
states
or
government
municipalities
to
conduct
lead
training
or
whether
you
retain
affiliation
with
other
organizations
that
have
been
accredited
to
perform
lead
training.
You
should
list
courses
you
have
been
accredited
to
provide
training.

iK
Applicant's
History
of
Legal
Actions
If
anyone
identified
in
this
application
has
been
the
subject
of
or
has
pending
disciplinary
or
illegal
actions
against
them,
this
includes
suspensions,
citations,
violations
incurred
by
an
administrative,
governmental
or
regulatory
agency.
These
agencies
include
OSHA,
EPA,
DCDOL,
DCDEP,
DCDCA
and
DCDOH
and
other
established
regulatory/
govemment
entities.
You
should
provide
accurate
requested
information.

K
AppficantStatement
and
Signature
You,
as
applicants,
are
affirming
that
information
requested
and
supplied
by
you
is
true
and
accurate
to
the
best
of
your
knowledge.
Ifyou
have
exercised
deceit,
you
are
liable
for
punishment
and/
or
fines
as
delineated
in
the
rules
and
regulations
governing
certification
application
in
the
District
of
Columbia.
In
addition,
false
information
could
trigger
an
accreditation
denial
in
the
District
of
Columbia,
as
stipulated
in
the
initial
disclosure
notice.

Mail
applications
to:
Department
of
Health
Environmental
Health
Administration
Lead
Poisoning
Prevention
Division
State
Lead
Certification
and
Training
Program
51
N
Street,
N.
E.,
3rdFloor
Washington,
D.
C.
20002
Attention:
Mr.
Terrence
Henry
hi
­
08
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v)
VI
La
P
CA
DISTRICT
OF
COLUMBIA
STATE
LEAD
PERMITTING
AND
NOTIFICATION
FOR
REDUCTION
AND
CONTROL
PROJECTS
CTS
WITH
A
DCRA
CONSTRUCTION
PERPUIIT)
..
.
.
.

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***
I
I
District
of
Columbia
Government
Department
ofHealth
Lead
Poisoning
Preveritiorr
Division
May
2001
L
DISTRICT
OF
COLUMBIA
STATE
LEAD
PERMITTING
AND
NOTIFICATION
FOR
LEAD
HAZARD
REDUCTION
AND
CONTROLPROJECTS
PROJECTS
WHERE
IT
HAS
BEEN
DETERMINED
CRA
CONSTRUCTIONPERMIT
ISNOT
REQUIRED)

..
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m
m
District
of
Columbia
Goverrrmetrt
Department
of
Health
Lead
Poisoning
Prevention
Division
Mq
2001
23
GOVERNMENT
OF
THE
DlSTRECT
OF
COLLI~
IBLA
Department
of
Health
Environmentat
Health
Administration***
Office
of
the
Chief
Operating
Oficer
­

Dear
Contractor:

Please
be
informed
that
effective
November
30,
1999,
all
contractors
conducting
Lead­
Based
Paint
Abatement,
as
defined
by
the
District
of
Columbia
Code
6­
997.1,
within
the
District
of
Columbia
are
required
to
obtain
a
permit
(
per
District
of
Columbia
Code
6.997.7)
and
pay
the
associated
fee.

Permit
applicationshotifications
are
to
be
sent
to
the
Department
of
Health
at
least
ten
(
10)
business
days
prior
to
conducting
a
Lead­
Based
Paint
Abatement
project.
Additional
fees
may
be
due
the
District
when
abatement
project
cost
increase
after
permit
issuance.
Failure
to
pay
any
fee
increases
due
the
District
may
subject
you
to
enforcement
action.
Fees
are
to
be
made
payable
to
the
D.
C.
Treasurer
and
are
non­
refundable.

After
clearing
DCRA s
(
Department
of
Consumer
and
Regulatory
Affairs)
permit
center
at
941
North
Capital
Street,
N.
E.,
2ndfloor,
please
submit
your
completed
applicatiodnotification
forms
to:

D.
C.
Department
of
Health
Environmental
Health
Administration
Lead
Poisoning
Prevention
Division
State
Lead
Permitting
and
Notification
Program
51
N
Street,
N.
E.,
3rdFloor
Washington,
D.
C.
20002
Attn:
Mi.
Terrence
Henry
Enforcement
action
will
be
taken
to
the
hllest
extent
of
the
law
for
contractors
who
fail
to
comply
with
the
certification,
permitting
and
notification
requirements
of
the
District s
Lead
Poisoning
Prevention
Program.

Copies
of
the
District s
Lead
Permitting
and
Notification
Application
Handbooks
with
the
necessary
forms
are
enclosed
for
your
information
and
use.
Should
you
have
any
questions,
please
do
not
hesitate
to
contact
the
Lead
Poisoning
Prevention
Division
at
(
202)
535­
2637
between
the
hours
of
8:
30
A.
M.
and
4:
40P.
M.,
Monday
through
Friday
(
except
holidays)
or
contact
our
LEAD
HOTLINE
on
1­
877­
338­
0364.
We
look
forward
to
working
with
you.

Sincerely,

Theodore
J.
Gordon
Chief
Operating
Oficer
Enclosure
TJG/
ca
825
Nodi
Capitol
Street.
N.
E..
4  
Floor.
Washington
D.
C.
20002
Tel:
202
442­
8982
Fa.:
202
4424886
W
INSTRUCTIONS
FOR
COMPLETLNG
THE
LEAD­
BASED
PAINT
HA2XRD
REDUCTION&
CONTROL
PERMIT
APPLICATION
AND
NOTIFICATION
FORM
Per
D.
C.
Code
5
6­
997.7,
contractors
who
conduct
lead­
based
paint
activities,
as
defined
in
D.
C.
Code
8
6­
997.1(
1),
in
the
District
of
Columbia
shall
obtain
a
permit.
Permits
are
required
for
all
lead­
based
paint
hazard
reduction
and
control
projects,
regardless
of
type
of
stmctur
or
building
and
size
of
the
hazard
reduction
and
control
project.
Please
read
and
follow
these
instructions
when
completing
the
application.

TYPE
OR
PRINT
alJ
answers
in
ink
1.
Check
the
type
of
application.
2.
Include
the
address
of
the
property,
square
number.
lot
and
ward.
if
applicable.

­
4
­
1.
Insert
the
name
and
address
of
the
general
contractor.
4.
Insert
the
name
and
telephone
number
of
the
abatement
contractor s
contact
person
for
this
particularproject
and
insert
the
abatement
contractor s
District
of
Columbia
Business
Entity
lead
certificationnumber
and
provide
a
copy
of
the
D.
C.
lead
certification
card.
5.
Insat
name
of
the
assigned
supervisorfor
thisproject.
6.
Insert
the
telephone
number
and
beeper
or
cellular
telephone
number
for
the
assigned
supervisor.
7.
Insert
the
property
owner
(
Full
Name):
and
if
different
from
the
abatement
address.
insert
the
address
of
the
property
o\\
ner
8.
Describe
the
present
use
of
the
property
or
structure:
Le..
residential
building,
commercial
building.
bridge.
tower.
etc.
9.
Insert
the
approximatedate
the
facility/
structure
was
built.
A
year
will
suffice.
10.
Insert
the
start
and
completiondates.
(
If
you
are
applying
for
the
permit
and
do
not
knowthe
exact
start
dates.
you
may
leave
this
blank
and
notify
this
office
no
less
than
10
business
days
prior
to
the
start
of
the
project.)
11.
Indicate
the
hours
in
which
lead
reduction
and/
or
controlactivitieswill
be
conducted.
12.
Insert
the
approximate
amount
of
lead­
based
paint
hazard
to
be
reduced
and/
or
controlled.
13.
Give
a
brief
descriptionof
the
work
to
be
performed.
14.
Insert
the
type
of
lead
reduction
or
control
method
to
be
employed;
Le.,
removal,
mcapsulation,
replacement
etc.
15.
Insert
the
provisions
for
medical
sweiilanceand
workerprotection.
16.
Give
a
brief
descriptionof
the
areasadjacent
to
the
lead
hazard
reduction
or
control
project.
i.
e.,
residential
housing/
apartmenf
commercialbuildings,
officebuildings,
playground,
etc.
17.
Please
state
the
intended
disposal
site
of
generated
waste.
If
hazardouswaste
is
generated
please
describe
how
you
intend
to
comply
with
the
hazardous
waste
requirements
of
Title
20
DCMR
Chapters
40­
54.
18.
Please
state
the
amount
of
the
contract
to
conduct
the
lead
hazard
reduction
or
control.
If
the
project
involves
other
work
that
is
not
considered
Iead­
basedpaint
reduction
or
control
:
do
not
include
that
aspart
of
the
contract
amount.
19.
Please
state
the
amount
of
reduction
and/
or
controlpermit
fee
submitted.
As
indicatedon
the
application,
permit
fee
equals
$
40.00
plus
3%
ofthe
lead
related
project
cost
Ifthe
contract
for
lead­
related
work
is
for
$
2.000.00.
the
total
permit
fee
equals:
$
60.00
+
(.
03
X
$
2.000.00)
=
$
40.00
f
$
60.00=
$
100.00
Please
be
sure
to
sign
and
date
the
application,
and
include
the
attachments
that
are
requiredto
be
submitted.
Upon
review
and
approval
of
the
application.
a
permit
will
be
issued.
The
pennit
wiU
be
valid
only
for
the
duration
of
the
project
or
for
one
year.
whichever
is
less.
Any
change
in
start
or
completion
dates
will
require
an
amended
notifcation.
The
permit
must
be
maintainedat
the
project
site
at
all
times
and
available
upon
request
from
the
Departmeat
of
Health
inspectors.
mi
application
for
permithotificathn
must
be
submitted
at
Ieast
ten
(
10)
business
days
prior
to
the
start
of
thebad
reduction
and/
or
control
pmject.

Please
submit
to:

DEPARTMENT
OF
HEALTH
ENVIRONMENTAL
EEALTH
ADMINISTRATION
BUREAU
OF
fiAzARDOUS
MATERIAL
AND
TOXIC
SUBSTANCES
LEAD
POISONING
PREVENTION
DIVISION
STATE
LEADPERMITTING
AND
NOTIFICATIONPROGRAM
51
NSTREET,
N.
E.,
3RDFLOOR
WASHINGTON,
D.
C.
20002
ATTENTION:
MR
TERRENCE
HENRY
++*
GOVERVSfEXT
OF
THE
DISTRICTOF
COLC,%
fB[
c%

­
DEPARTMENT
OF
HEALTH'I
EiWRONMENTAL
HEALTHADMINISTRATION
BUREAU
OF
HAZARDOUS
IMATERIAL
AND
TOXIC
SUBSTAVCES
LEAD
POISONING
PREVENTION
DIVISION
51
N
STREET,
YE.,
3m
FLOOR
WASHINGTON,
D.
C.
20002
LEAD­
BASED
PAINT
EAZARD
REDUCTION
AND
CONTROL
PERMIT
APPLICATION
AND/
OR
NOTIFICATION
FORM
VOTE.
This
form
is
applicable
to
projects
designed
to
eliminate
or
reduce
lead­
based
paint
hazards
in
pre
1978
structures.

~
~~

USEONLY
­
PEIuQfF
ORNoTfFIcAaON
WhiBEE
1
1
TYPE
OF
APPLICATION
(
check
ail
that
apply)
INITIAL,
PERMIT
'
PROPERTY
LOCATION/
ADDRESS
SQUARE
#

GENERAL
CONTRACTOR
ADDRESS:

CITY:

CONTACT
NAME:

ABATEMENT
CONTRACTOR:

ADDRESS
CITY
CONTACT
NAME
LOT
#

STATE:

PHONE
MIMBER:

STATE
PHONE
NUMBER
D
C
LEAD
(
BUSINESS
ENTITY)
CERTIFICATIONNUMBER
NM
OF
SUPERVISOR
ASSIGNED
TO
THE
PROJECT
SUPERVISOR'S
D
C
LEAD
CERTIFICATION
NUMBER
CONTACT
NUMBERS
FOR
ASSIGNED
SUPERVISOR
I
PROJECT
NOTIFiCATION
WARD#

ZIP
CODE:

FAX:

ZIP
CODE
FAX
EXPIRATION
DATE
EXPIRATION
DATE
TELEPHONE
BEEPER
CELL
PHOSE
PROPERTY
OWNER
ADDRESS
OF
OWNER
(~
Werent
fkom
project
location)

CITY
STATE
ZIPCODE
PRESENT
USE
OF
PROPERTY/
STRUCTURE:

DATE
THEFACILiTY~~
DING/
STRUCTUREWAS
BUILT:

t
START/
COMPLETIONDATE(
S)
OF
PROJECT(
Not@
th~
soffice
no
less
than
10
business
daysprior
to
the
start
of
the
project.
If
dates
are
unknown
at
the
time
of
initial
application,
dates
may
be
left
blank
and
thisoffice
must
be
notifiedby
the
use
of
the
"
NotificationRevision
Form"
no
Iess
than10
business
days
prior
to
the
start
of
the
leadactivity.

PROECT
START
DATE:
ENDKOMPLETION
DATE:

WORK
HOURS­
FROM
A.
M./
P.
M.
TO
A.
M.
P.
M.
PAGE
2
LEAD­
BASED
PmT
HAZARDREDUCTION
AND
CONTROL
PERMIT
APPLICATION
AND
NOTIFICATION
FORM
12.
APPROXIMATE
AMOUNT
OF
LEAD­
BASED
PAINT
HAZARD
TO
BE
REDUCED
AM)/
OR
CONTROLLED
(
in
square
or
linearfeet):
Square
Feet:
Linear
Feet:

13.
DESCRETION
OF
WORK
TO
BE
PERFORMED
Indoor/
Outdoor.
lead
components
­
windows.
doors.
walls.
etc..
areas
of
Fvork
­
attach
&
wings
&
related
specs.
if
available)

15.
DESCRIPTIONOF
LEAD
 EDUCTION
AND/
OR
ENVIRONMENTAL
CONTROL
METHODS
TO
BE
EMPLOYED
:

15.
PROVISIONSFORMEDICAL
SURVEILLANCEAND
WORKER
PROTECTION:

16.
DESCRIPTIONOF
AREA(
S)/
NEIGHBORINGPROPERTIESIMMEDIATELY
ADJACENT
TO
HAZARD
REDUCTION
AND/
ORCONTROL
SITE:

17.
LIST
THE
INTENDED
DISPOSAL
SITE
OF
GENERATED
WASTE,
AND
IF
HAZARDOUS
WASTE
IS
GENERATED.
PLEASE
DESCRIBE
THE
ENTENDED
COMPLIANCE
WITH
THE
REQUIREMENTS
FOR
HAZARDOUS
WASTE
PRESCRIBED
BY
TITLE
20
DCMR
CHAPTERS40­
54:

18.
ESTAMATEDOR
ACTUAL
COST
OF
HAZARD
REDUCTION
AND
CONTROL
CONTRACT:
$

19.
FEESUBMITTEDFOR
LEAD
HAZARDREDUCTION
AND
CONTROL
PERMIT
(
PERMIT
FEES
ARE
WAIVEDFOR
GOVERNMENT
CONTRACTS):
$

AFFIDAVIT
I
cemfythat
the
above
information
is
accurate,
me
and
correctto
the
best
of
my
knowledge
and
that
aU
lead
abatementwill
be
conducted
in
accordance
with
all
applicable
work
practice
standards
ofFederal
and
District
of
Columbia
laws.
I
also
certify
that
any
hazardous
waste
generated
as
a
result
of
thisproject
will
be
disposed
of
incompliance
with
the
requirementsfor
hazardous
waste
disposal
as
prescribed
by
Title
20
DCMR
Chapters
30­
54.
Finally,
I
attest
that
only
appropriatelyD.
C.
certifed
individuals
will
be
used
for
all
hazard
reduction
andor
control
work
and
that
no
outstandingdebts
are
owed
to
the
District
of
Columbia
Government.

Signatureof
Contractorflitle
Date
NOTE
PLEASE
ENSURE
THE
FOLLOWING
ARE
ATFACED
WITHTHIS
APPLICATION
COPY
OF
ABATEMENT
CONTRACTOR'SDISTRICT
OF
COLUMBIA
CERTIFICATION
COPY
OF
CONTRACTORS
CURRENT
LIABILIlY
INSURANCE.
INCLUDING
PROFESSIONAL,
ENVIRONMENTALAND
GENERALLIABILITf
COPY
OF
CONTRACTFOR
THE
LEAD­
HAZARD
REDUCTION
AND/
OR
REDUCTION
PROJECT
APPROPRIATEPERMITFEE(
make
check
or
money
order
payable
to
the
D.
C.
Treasurer:
applicauon
fees
are
non­
refundable)
SCOPE
OF
WORK
RETURN
APPLICATIONlNOTIFIGATION
TO:
D
C
Department
of
Health
Lead
Poisorung
Prevention
Division
51NSt1­
eet.
NE.
3~
Floor
Washington
DC
20002
Attention
Lead
Abatement
Peimttrng
OFFICE
USE
ONLY
DATE
RECEIVED
PERMIT
OR
NOTIFICATION
NUMBER
IURCPREVIEW
BY:
SIGNATURE:
DATE
APPROVED
n
PENDING
n
DENIED
0
NOTIFIC
ATION
GSIGNMENT
FOR
INSPECTION:
INSPECTOR
DATE:
­

TO
REPORT
WASTE,
FRAUD,
OR
ABUSE
BY
ANY
DC
GOVERNMENT
OFF'ICE
OR
OFFICIAL,
CALL
THE
INSPECTOR
GENERAL
ON
1­
800­
521­
1639
Revised
J
30
01
***
GOVERNMENTOF
THE
DETRICT
OF
COLUMBIA
DEPARTMENTOF
HEALTH
ENVIRONMENTALHEALTHADMINISTRATION
BUREAU
OF
HAZARDOUS
MATERIAL
AND
TOXIC
SUBSTANCES
LEAD
POBONING
PREVENTION
DMSION
51
N
STREET,
N.
E.,
3m
FLOOR
WASHINGTON,
D.
C.
20002
202­
535­
2690
LEAD­
BASED
PAINT
HAZARD
REDUCTION
AND
CONTROL
NoTIFICATION
REVISION
FORM
TYPE
OR
PRINT
YOUR
AWSWERS
IN
DARK
INK
PERMIT
OR
NOTIFICATION
NUMBER:

1.
TYPE
OF
NOTIFICATION:
AmendmentProject
Change
U
Cancellation
0
2.
PROPERTY
ADDRESS:

3.
START/
COMPLETIONDAWS)
OF
PROJECT:
(
No@
this
office
no
less
than
10
businessdays
prior
to
the
start
of
the
project:

4.

5.

6.

7.

8.
Notifications
may
be
faxed
to
LEAD
ABATEMENT
PERMITING
at
FAX:
(
202
535­
1396)

START
DATE:
END/
COMF'LETION
DATE:

WORK
HOURS:
FROM
A.
M.
R.
M.
T.
0
A.
M.
R.
M.

GENERAL
CONTRACTOR:
ABATEMENT
CONTRACTOR:

ADDRESS:
ADDRESS:

PHONE:
PHONE:

D.
C.
LEAD
CERTIFICATIONNUMBER:
BUSINESS
ENTITY
=

ABATEMENT
SUPERVISOR:
D.
C.
LEAD
CERTIFICATIONNUMBER:
NAME
SUPERVISOR
g
ABATEMENT
SUPERVISOR'S
CONTACTNUMBERS:
TELEPHONE
BEEPEWCELL
PHONE
CHANGESEXPANSIONT0­
W
SCOPEOF
WORKAM>
ASSOCIATED
COST
INCREASES:

ADDITIONAL
PERMIT
FEE:
FAX
or
RETURN
TO:
D.
C.
Department
of
Health
Lead
Poisoning
Prevention
Division
5
1
N
Street,
N.
E.,
3"'
Floor
Washington,
D.
C.
20002
Attention:
Lead
Abatement
Permitting
FAX:
202
535­
13%

I
OFFICE
USE
ONLY
DATE
RECEIVED.
PERMIT/
NOTIFICATION
NUMBER
REVIEW
BY:
SIGNATURE:
DATE:

APPROVED
0
PENDING
a
DENIED
0'

NOTIFICATION
ASSIGNMENTFORINSPECTION
INSPECTOR
DATE:

I
TO
REPORT
WASTE,
FRAUD,
OR
ABUSE
BY
ANY
DC
GOVERNMENTOFFICE
OR
OFFICIAL,
CALL
THE
INSPECTOR
GENERAL
ON
1­
800­
521­
1639
Rsviszd
J
10
01
LEAD
WARD
CONTROLQUESTIONNAIRE
AND
EXEMPTION
FOkV
'
roject
Address:

\
lame
of
Owner(
s).

'
hone
Number
Square
#:
­
Lot
#:
Ward
#:

'
roject
Start
Date:
Project
End
Date:
Contractor
Name:

(
uilding
T!
Te:
Commercial
­
Office
Institutional­
Hospital
Government­
Federal
0
Multi­
family
Single
family
0
Elderly
or
handicapped
0
Mixed
Use
@.
uplain)
Museum
0
District
0
Residential
School
or
child
care
0
Is
the
project
planned
in
response
to
a
child
being
identified
as
being
lead
poisoned?

0
YES
Contact
the
Lead
Poisoning
Prevention
Division
at
5
1
N
Street
N.
E..
3rd
Floor.
(
202)
535­
2637
for
a
lead­
based
paint
hazard
reduction
and
controlpermit
and/
or
notificationform.
0
NO
Proceed
to
question
2.

Is
the
project
designed
to
eliminate
or
reduce
lead­
based
paint
hazards
in
a
pre­
1978
building
or
structure?

0
YES
Contact
the
Lead
Poisoning
Prevention
Division
at
5
1
N
Street
NlE..
3rd
Floor.
(
202)
535­
2637
for
a
lead­
based
Paint
hazard
reduction
and
control
permit
and/
or
notificationform.,
unless
an
exemption
listed
below
applies.

EXEMPTIONS
Please
indicate
the
applicableexemption
fromthe
following
list:
Individualswho
perform
lead­
based
paint
activities
at
residences
which
they
own.
unless
the
residence
is
occupied
by
a
person
or
persons
other
than
the
owner
or
the
owner's
immediate
family;
unless
any
child
under
the
age
of
8
years
resides,
is
expected
to
reside
in.
or
regularly
visits
such
housing.
0
Housing
for
the
elderly
or
persons
with
disabilities;
unless
any
child
under
the
age
of
8
years
resides.
is
eipected
to
reside
in,
or
regularly
visits
such
housing.
Any
zero
(
0)
bedroom
unit.
such
as
an
efficiency
apamnent.

0
NO
Lqd
permit
is
not
required,
but
you
are
required
to
answer
the
followingquestions:

is
the
project
dishthing
deteriorated
lead­
based
paint
on
surfaces
totaling
more
than
two
(
2)
square
:
t
per
room.
or
twenty
(
20)
square
feet
on
exterior
surfaces.
or
lP/
o
of
a
building
component
with
a
1
AFFIDAVIT
Jars
that
the
dormation
provided
is
accurate,
true
and
complete
to
the
best
of
my
knowledge
andior
that
I
certtfy
that
I
have
the
authority
to
representthe
owner
of
prop**
to
answer
this
application
and
sign
on
behalf
of
the
company
andiorpmons
listed
as
owners.
I
understandthat
if'

such
information
contained
in
this
3licatron
is
false.
I
am
subject
to
the
penalty
provision
of
D.
C.
Law
11­
221.
hy
fraud
or
misrepresentationon
an
ilpplicationshaii
be
grounds
for
autom$
ic
.
ction
mnd,
or
civil
administrative
penalties.
I
understandthat
failure
to
provide
full
disclosure
of
any
of
the
requested
or
required
information
may
result
in
rejection
his
application
for
approval.

*'

SIGNATURE
DATE
PRINTNAME
DEPARTMENTOF
HEALTH
ENVIRONMENTALHEALTHADMINISTRATION
CONSTRUCTIONPERMITAPPLICATION­
SUPPLEMENTAL
FORM­
ENVIRONMENTALQUESTIONNAIRE
PROJECTADDRESS:
LOT:
SQUARE:
PROJECT
DESCRIPTION:

Note.
please
answer
all
10
questions
in
this
questionnaire,
by
checking
either
column
 
Yes 
or
 
No 
for
each
question.
Ifyou
answer
 
Yes 
to
any
of
the
questions,
you
should
contact
the
correspondingoffice@)
indicated
in
column
 
contact
person/
office 
as
soon
as
possible.
Until
this
applicationis
reviewed
and
approved
by
the
concerned
office(
s),
the
permitwill
not
be
isswd.

SCOPE
OF
PROJECT
YES
NO
CONTACT
PERSONlOFFlCE
Will
the
proposeduse
involve
the
construction
of
a
facility
for
the
handling,
transfer,
storage,
disposalor
treatment
of
solid
waste.
medical
waste.
or
racydable
materials?

2.
Will
the
work
to
be
performed
involvethe
assessment
or
dean­
up
01
sob
associated
wiih
!
he
release
of
materialsfrom
an
undergroundstorage
tank
(
UST)?

1
I
3.
Will
the
work
to
be
performed
invulve
the
assessment
or
dean­
up
of
groundwater
associated
with
the
release
of
materialsfrom
an
underground
storage
tank
(
UST)?

4.
Will
the
proposedproject
involvethe
installaim
or
drillingof
welts
other
than
for
the
purposesstated
in
questions
3
and
4?

5.
Willthe
proposed
prop
invoke
the
generation.
treatment.
storage,
diqmsl
or
transportationof
chemicalsor
other
substances
which
may
be
considered
hazardous?

4.
Will
the
proposed
prow
invoke
constructonthat
Will
disturb
the
sediment
in
rivers,
streams
or
wetlands?
I
I
5.
Will
the
work
to
be
performed
involvethe
installation,
removal,
abandonment.
or
repair
of
an
undergmund
storagetank
(
US )
system?

6.
WdI
the
proposed
project
resuR
in
the
dischargeinto
the
air
of
gases
dust,
or
the
creation
of
any
objfdionable
odors?

7.
Wdl
the
proposed
prop3
involvethe
removal.
handling,
transpartation,
disposal,
or
encapsulationof
asbestos?

II
 
Pkase
bringHlith
you
a
copy
of
pur
asbestos
survey,
ten­

IO.
Was
the
building
buin
before
1978?
(
Lead
paint
may
be
present.)
(
202)
535­
2289.
EIS
coordinator,
EHA
(
202)
535­
2525,
UndergroundStorage
Tank
Division,
 HA
(
202)
535­
2250.
Air
qual*
Division,
EHA
(
202)
535­
2525,
UndergroundStorage
Tank
Division,
 HA
(
202)
535­
2190,
Water
Quality
Diviion,
EHA
(
202)
535­
2250,
Air
Quality
Division.
EHA
(
202)
535­
2190,
Water
Quality
Division.
EHA
(
202)
535­
2290,
Hazardouswaste
Division,
EHA
(
202)
535.7190,
Water
Quality
Division.
 HA
(
202)
5352525.
UndergroundStorage
Tank
Division,
EM
(
202)
535­
2250,
Air
QualityDivision.
 HA
(
202)
535­
2250,
Air
Quality
Division,
 HA
If
you
anstref
Yes 
to
this
question.
please
answer
the
questions
and
follow
the
instructionson
the
 
Lead
Hazard
ControlQuestionnaire 
to
determine
if
you
need
a
permit
to
condud
a
Lead
Abatement
Prom.
IT
OFFICE
USE
(
Initial/
Date)

 

I
hereby
certiv
that
I
have
the
autbnty
of
the
owner
of
the
property
to
make
this
application.
I
declare
that
the
answers
to
the
above
questions
in
this
Questionnaire
are
complete
and
corn&
to
the
best
of
my
knowledge.

Signature
Name
(
pnnt)

Address
Date
Phone
OFFICE
USE
ONLY
COMMENTS
X\
iD
PERMIT
RESTRICTIONS:

(
USE
REVERSE
IF
NECESS.\
RY)
E IA
FOITII#
99­
13CO
­
RZWSLX~
U.
3
01
1
FACT
SHEET
May
2001
D.
C.
LEAD­
BASED
PAINT
CERTIFICATION
PROGRAM
SUMMARY
The
EnvironmentalHealth
Administration,
State
Lead
Certification
and
Training
Program
Implementsthe
EPA
State
Authorized
Lead­
Based
Paint
Certification,
Accreditation
and
Permittingactivities
within
the
Districtof
Columbia.

AUTHORITY
&
EFFECTIVE
DATE
D.
C.
Law
11­
221
became
final
on
January
2,1998
WHAT
ISREQUIRED3
Person(
s)
engaged
to
remove,
remodel,
or
renovate
lead
painted
structures
must
be
trained,
certified
andlor
accredited.

D
A
lead
abatement
permit
must
be
obtained
at
least
10
business
days
prior
to
any
lead
reduction
activities.

D
Liability
insurancemust
be
obtained
by
businesses
and
Risk
Assessors
B
Workernraining
discipline
fees
must
be
paid
to
the
D.
C.
Treasurer
I
*
Abatement
Project
permitfee
must
be
i
I
paid
to
the
D.
C.
Treasurer
I
e
Work
Practice
standards
and
procedures
for
conductinglead­
based
paint
hazard
reductionand
related
consumer
outreachleducation
activities.

PROGRAMFOCUS
FEE
SCHEDULE
Inspector
Supervisor
Abatement
Worker
Project
Designer
Risk
Assessor
Business
EnQ
ReciprocityCertification
Inspector
initial
course
Inspector
refresher
Risk
Assessor
initial
Risk
Assessor
refresher
Supervisor
initial
Supervisor
refresher
Project
Designer
initial
Project
Designer
refresher
Abatement
Worker
initial
$
30012
years
Housing
$
30012
years
constructed
$
6012
years
after
1978
$
30012
years
$
30012
years
PENALTIES/
FINES
$
30011
year
Entities
in
violation
of
Same
as
above
the
law
will
be
fined
andl
$
l,
2001year
or
imprisoned
pursuant
$
4001year
to
the
Act.
$
8001year
$
4001year
FOR
MORE
$
l,
6001year
INFORMATION
$
4001year
b
APPLICATION
$
4001year
FORMS
$
2001year
Please
contact:
$
8001year
Abatement
Worker
refresher
$
4001year
D.
C.
Department
of
ReciprocityAccreditation
Same
asabove
Health,
Environmental
Abatement
Permit
$
40
+
3%
of
Health
Administration,
abatement
cost
Bureau
of
Hazardous
EXEMPT
ENTITIES
Material
8
Toxic
0
Individuals
who
perform
lead­
based
Substances,
Lead
Paint
activities
at
residenceswhich
Poisoning
Prevention
they
own
unless
the
residence
is
Division,
RARCP
on
occupied
by
a
non­
owner
or
non­
202­
535­
2690
or
immediatefamily
member(
s)
or
a
202­
535­
2637
at
child
residesor
frequently
visits
51
N
Street,
N.
W.,
subject
property
who
is
younger
than
3rd
Floor,
eight
years
old.
Washington,
D.
C.
zip
20002
0
Housingfor
the
elderly
or
persons
with
disabilities;
unless
any
child
RAINING
PROVIDERS
under
the
age
of
eight
years
resides,
Aerosol
Monitoring&
is
expected
to
reside
in
or
regularly
Analysis,
Inc.
­
All
visits
such
housing.
Alice
Hamilton
OccupationalHealth
8
Any
zero
bedroom
unit,
such
as
an
Training
Center
­
All
efficiency
apartment
DC
LEAD
HOTLINE
0
Prevention
of
lead
poisoning
and
its
illhealth
1­
877­
338­
0364
effects
on
children
under
the
age
of
eight.