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 kh E a b D 5 c n W , E m L do e .. & 3D 2 E . I 8 E  2 g$ E tr a t Ez; P 0 .<

v: v: L; p! C C 7 ii 0 sf 3j cc d 2 W .. ? 4 2 3 E C V s ii La 0 u 4 M .. 2 c u 2 E U .. 2 m W cc c % a 5 8 .. w 5 % El .. ji U X c w z 3 3 0 u ci r. 5 L M e pc M n . I 2:' 2 b i c: 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,

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

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

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*** 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.

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2: II . X 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:

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z c L a C I I I 1 ACCREDITATION BOOKLET FOR TRAINING PROVIDERSKOURSES DISTRICT OF COLUMBIA STATE LEAD ACCREDITATION PROGRAM FOR I[ NG PROVIDEWCOURSES ....

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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 a 4 .. 0 B vl d G L c: II   I I d0 d E w IP 0 . i= L 0 W2 0 W *** 64 mmo d * a"

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e IZ f . e 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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* a+ 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.

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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.


[Federal Register Volume 84, Number 217 (Friday, November 8, 2019)]
[Notices]
[Pages 60454-60455]
[FR Doc No: 2019-24373]

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DEPARTMENT OF LABOR

Occupational Safety and Health Administration

[Docket No. OSHA-2010-0020]

Additional Requirements for Special Dipping and Coating
Operations (Dip Tanks); Extension of the Office of Management and
Budget's (OMB) Approval of the Information Collection (Paperwork)
Requirement

AGENCY: Occupational Safety and Health Administration (OSHA), Labor.

ACTION: Request for public comments.

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SUMMARY: OSHA solicits public comments concerning the proposal to
extend the Office of Management and Budget (OMB) approval of the
information collection requirement specified in the Standard on Dipping
and Coating Operations (Dip Tanks).

DATES: Comments must be submitted (postmarked, sent, or received) by
January 7, 2020.

ADDRESSES:
    Electronically: You may submit comments and attachments
electronically at http://www.regulations.gov, which is the Federal
eRulemaking Portal. Follow the instructions online for submitting
comments.
    Facsimile: If your comments, including attachments, are not longer
than 10 pages you may fax them to the OSHA Docket Office at (202) 693-
1648.
    Mail, hand delivery, express mail, messenger, or courier service:
When using this method, you must submit a copy of your comments and
attachments to the OSHA Docket Office, OSHA Docket No. OSHA-2010-0020,
Occupational Safety and Health Administration, U.S. Department of
Labor, Room N-3653, 200 Constitution Avenue NW, Washington, DC 20210.
Deliveries (hand, express mail, messenger, and courier service) are
accepted during the OSHA Docket Office's normal business hours, 10:00
a.m. to 3:00 p.m., ET.
    Instructions: All submissions must include the agency name and the
OSHA docket number (OSHA-2010-0020) for the Information Collection
Request (ICR). All comments, including any personal information you
provide, such as social security number and date of birth are placed in
the public docket without change, and may be made available online at
http://www.regulations.gov. For further information on submitting
comments, see the ``Public Participation'' heading in the section of
this notice titled SUPPLEMENTARY INFORMATION.
    Docket: To read or download comments or other material in the
docket, go to http://www.regulations.gov or the OSHA Docket Office at
the above address. All documents in the docket (including this Federal
Register notice) are listed in the http://www.regulations.gov index;
however, some information (e.g., copyrighted material) is not publicly
available to read or download from the website. All submissions,
including copyrighted material, are available for inspection and
copying at the OSHA Docket Office. You may also contact Theda Kenney or
Seleda Perryman at<PHONE_NUMBER> to obtain a copy of the ICR.

FOR FURTHER INFORMATION CONTACT: Theda Kenney or Seleda Perryman,
Directorate of Standards and Guidance, OSHA, U.S. Department of Labor,
telephone:<PHONE_NUMBER>.

SUPPLEMENTARY INFORMATION:

I. Background

    The Department of Labor, as part of a continuing effort to reduce
paperwork and respondent (i.e., employer) burden, conducts a
preclearance consultation program to provide the public with an
opportunity to comment on proposed and continuing information
collection requirements in accordance with the Paperwork Reduction Act
of 1995 (PRA) (44 U.S.C. 3506(c)(2)(A)). This program ensures that
information is in the desired format, the reporting burden (time and
costs) is minimal, the collection instruments are clearly understood,
and OSHA's estimate of the information collection burden is accurate.
The Occupational Safety and Health Act of 1970 (OSH Act) (29 U.S.C. 651
et seq.) authorizes information collection by employers as necessary or
appropriate for enforcement of the Act or for developing information
regarding the causes and prevention of occupational injuries,
illnesses, and accidents (see 29 U.S.C. 657). The OSH Act also requires
OSHA to obtain such information with a minimum burden upon employers,
especially those operating small businesses, and to reduce to the
maximum extent feasible unnecessary duplication of effort in obtaining
said information (see 29 U.S.C. 657).

    The Standard on Dipping and Coating Operations (29 CFR
1910.126(g)(4)) requires employers to post a conspicuous sign near each
piece of electrostatic detearing equipment that notifies employees of
the minimum safe distance they must maintain between goods undergoing
electrostatic detearing and the electrodes or conductors of the
equipment used in the process. Doing so reduces the likelihood of
igniting the explosive chemicals used in electrostatic detearing
operations.

II. Special Issues for Comment

    OSHA has a particular interest in comments on the following issues:
     Whether the proposed information collection requirement is
necessary for the proper performance of the agency's functions to
protect workers, including whether the information is useful;
     The accuracy of OSHA's estimate of the burden (time and
costs) of the information collection requirement, including the
validity of the methodology and assumptions used;
     The quality, utility, and clarity of the information
collected; and
     Ways to minimize the burden on employers who must comply;
for example, by using automated or other technological information
collection and transmission techniques.

III. Proposed Actions

    The agency is requesting to retain the previous burden hour
estimate of one (1) hour. There are no program changes or adjustments
associated with the information collection requirement in the Standard.
The agency has correspondingly adjusted the per response burden to
maintain a time burden as close as is possible to the actual time of no
hours (1 hour). OSHA is requesting that OMB extend approval of the
information collection requirement contained in the Standard on
Additional Requirements for Special Dipping and Coating Operations (Dip
Tanks) (29 CFR 1910.126(g)(4)). This provision requires the employer to
determine how far away goods being electrostatically deteared should be
separated from electrodes or conductors, is called the ``safe
distance.'' This minimum distance must be displayed conspicuously on a
sign located near the equipment.
    OSHA has determined that where electrostatic equipment is being
used, the information has already been ascertained and that the ``safe
distance'' has been displayed on a sign in a permanent manner. The
agency will summarize the comments submitted in response to this
notice, and will include this summary in the request to OMB.
    Type of Review: Extension of a currently approved information
collection.
    Title: Additional Requirements for Special Dipping and Coating
Operations (Dip Tanks) (29 CFR 1910.126(g)(4)).
    OMB Control Number: 1218-0237.
    Affected Public: Business or other for-profits; Federal Government;
State, Local, or Tribal Government.
    Number of Respondents: 10.
    Frequency of Recordkeeping: On occasion.
    Total Responses: 10.
    Average Time per Response: 0.
    Estimated Total Burden Hours: 1.
    Estimated Cost (Operation and Maintenance). $0.

IV. Public Participation--Submission of Comments on This Notice and
Internet Access to Comments and Submissions

    You may submit comments in response to this document as follows:
(1) Electronically at http://www.regulations.gov, which is the Federal
eRulemaking Portal; (2) by facsimile (fax); or (3) by hard copy. All
comments, attachments, and other material must identify the agency name
and the OSHA docket number (Docket No. OSHA-2010-0020) for the ICR. You
may supplement electronic submissions by uploading document files
electronically. If you wish to mail additional materials in reference
to an electronic or facsimile submission, you must submit them to the
OSHA Docket Office (see the section of this notice titled ADDRESSES).
The additional materials must clearly identify electronic comments by
your name, date, and the docket number so the agency can attach them to
your comments.
    Due to security procedures, the use of regular mail may cause a
significant delay in the receipt of comments. For information about
security procedures concerning the delivery of materials by hand,
express delivery, messenger, or courier service, please contact the
OSHA Docket Office at<PHONE_NUMBER>, (TTY<PHONE_NUMBER>).
    Comments and submissions are posted without change at http://www.regulations.gov. Therefore, OSHA cautions commenters about
submitting personal information such as social security numbers and
dates of birth. Although all submissions are listed in the http://www.regulations.gov index, some information (e.g., copyrighted
material) is not publicly available to read or download from this
website.
    All submissions, including copyrighted material, are available for
inspection and copying at the OSHA Docket Office. Information on using
the http://www.regulations.gov website to submit comments and access
the docket is available at the website's ``User Tips'' link. Contact
the OSHA Docket Office for information about materials not available
from the website, and for assistance in using the internet to locate
docket submissions.

V. Authority and Signature

    Loren Sweatt, Principal Deputy Assistant Secretary of Labor for
Occupational Safety and Health, directed the preparation of this
notice. The authority for this notice is the Paperwork Reduction Act of
1995 (44 U.S.C. 3506 et seq.) and Secretary of Labor's Order No. 1-2012
(77 FR 3912).

    Signed at Washington, DC, on November 1, 2019.
Loren Sweatt,
Principal Deputy Assistant Secretary of Labor for Occupational Safety
and Health.
[FR Doc. 2019-24373 Filed 11-7-19; 8:45 am]
 BILLING CODE 4510-26-P