Code of Maine Rules
06 - DEPARTMENT OF ENVIRONMENTAL PROTECTION
096 - DEPARTMENT OF ENVIRONMENTAL PROTECTION - GENERAL
Chapter 424 - LEAD MANAGEMENT REGULATIONS
Appendix 096-424-E - Lead Abatement Project Clearance Summary Form M

State of Maine

Department of Environmental Protection Lead & Asbestos Hazard Prevention Program 17 State House Station, Augusta, ME 04333 TEL (207) 287-7688 FAX (207) 287-6220 alnotifications.dep@maine.gov

Lead Abatement Project Clearance Summary Form M

Important Notice

This form must be completed and submitted to the Maine Department of Environmental Protection by the Maine certified Lead Inspector/Risk assessor who conducted a clearance examination of a notified lead abatement project in accordance with Maine Lead Management Regulations, 06-096 C.M.R. Chapter 424. A separate completed Lead Abatement Project Clearance Summary Form shall be submitted for each unit within a multi-family building. Submission of this form shall be within 48 hrs. of laboratory results.

Property Information:

Project Code: Abatement Contractor:

Physical Address: Apt #:

City: State: Maine Zip:

Property Owner:

Owner Mailing Address:

City: State: Zip: Telephone #:

Housing Type: [] Private [] Rental [] Child Care

Lead Inspector Information:

Lead Inspector Name: ME Certification #:

Company Name:

Company Mailing Address:

City: State: Zip: Telephone #:

Lead Abatement Clearance Information:

Final Lead Abatement Project Clearance Date (passed both visual assessment & dust testing):

Was a "Lead-Safe Certificate" issued: [] Yes [] No If yes, what is the expiration date:

Inspector Comments:

Signature:

__________________________________________________ ___________________________

Lead Inspector Signature Date

Print Name: