37 Delead 5-2-19 Department of Public Health- Childhood Lead Poisoning Prevention Program
Deleading Notification
D'Qase complete all sections of this f i rm clearly.Incomplete or illegible forms will be returned.
Lead Paint Inspector S License# 11�a� Inspection Date a
Property Owner c'1 rJl_
Property Owner's Address 7 Muj i/uy v- AjAw"Pi,JWA dWW Zip Code
Authorized person performing work: Lic#/Auth.# 39 0,? - om
Address of authorized person371 IU04rff9 A�D�k jam, M Zip Code O► 369
Telephone Number
Address where the work will be done:
Building Name(if any I Floor IL
Street Address /+VL- Apt No. 01
City o'r hp Code D 1 U Cn The property is a_multi-family f/ single family.
Deleading Method(s):
❑ Making paint intact(high ❑ Dipping ❑ Applying vinyl siding on
risk) &"Making paint intact exterior
❑ Demolitionmoderate risk) ❑ Component removal(low
craping �iquid encapsulant risk components)
component elovering ❑ Other:
removal/replacement
The work will begin on /9 _L9and will finish byi I I@LV 11 The work be done in the_am_!4m or�
- weekends.
In Case of Emergency Contact a Ate S Sq D" YW)VjV
Daytime Phone 913 L1 d Lf 1 6 Eveni Phone 111 ? )6 Li 3
The Property Owner must complete and sign the following information:
I certify that only authorized persons who have complied with the training requirements of the Massachusetts
Lead Poisoning Prevention and Control Regulations, 105 CMR 460.000,-will conduct deleading work.I further
certify that the authorized personl(s)will not exceed the scope of his/her authority and will be performing only
those activities indicated above.All of the information contained in this document is true and correct to the best
of my knowledge and belief.
Date dj'q Signed
The fo owin people/agencies must be notified before beginning work:
1. Occupants of the dwelling unit
2. All other occupants of the residential premises, if any work will be done in the common areas
3. Childhood Lead Po soning Prevention Program,DPH Fax(781)774-6700-
5
74-67005 Randolph St,Canton,MA 02021
4. Asbestos and Lead Program,DLS /www.mass.gov/service-details/deleading
r
5. Local Board of Health/Code Enforcement Agency
*If the home is on the State Register of Historic Places,call the MA Historical Commission at(617)727-8470.
45
Choosing Different Deleading Categories and Methods
General Information
• Often times the most difficult and time-consuming part of a deleading project is not the
actual work, but planning the work.
• Most people use a variety of deleading methods to delead their homes.
• Consider:
Cost Occupancy
Convenience Required level of authorization
(who can do the work)
Aesthetics (how it looks) Skills
• Owners should think about the following questions:
Which deleading method(s) you want to use?
How do you want your home to look when you are through?
=> How much time and money have you spent on maintenance in the past and will likely
spend in the future?
=> What is the level of wear and tear on the home?
=> How much can you afford to spend?
Is it practical for you to do this work?
What training is required of you to become authorized to do the work?
=> Do you have the carpentry skills to do this work in a workmanlike manner so it will
pass a reinspection?
=> Do you have the time to complete this work in a timely fashion?
46