C.M.R. 06, 096, ch. 424, app 096-424-E
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: | |
C.M.R. 06, 096, ch. 424, app 096-424-E