b'Chip Sample CHIP SAMPLE CONTAINER LABEL Use Avery Labels for 2x3.5 or similar for sterile container or sealed baggie.Container Label - 2E SAMPLE NO. ___________ DATE: _____________ SAMPLE NO. ___________ DATE: _____________LOCATION__________________________________ LOCATION__________________________________RENOVATION ADDRESS:_________________ RENOVATION ADDRESS:_____________________________________________________ ____________________________________When collecting paint chip samples, each must be ____________________________________ ____________________________________handled in a way that does not contaminate them. Sterile, on-time-use containers and/or zip lockSAMPLE NO. ___________ DATE: _____________ SAMPLE NO. ___________ DATE: _____________baggies are used to keep the samples pristineLOCATION__________________________________ LOCATION__________________________________RENOVATION ADDRESS:_________________ RENOVATION ADDRESS:_________________until they arrive at the lab. ____________________________________ ________________________________________________________________________ ____________________________________Each container or baggie must be marked with thejob name, date and location where the sample was SAMPLE NO. ___________ DATE: _____________ SAMPLE NO. ___________ DATE: _____________LOCATION__________________________________ LOCATION__________________________________taken to match the paint chip sample collectionRENOVATION ADDRESS:_________________ RENOVATION ADDRESS:_________________form. ____________________________________ ________________________________________________________________________ ____________________________________ SAMPLE NO. ___________ DATE: _____________ SAMPLE NO. ___________ DATE: _____________LOCATION__________________________________ LOCATION__________________________________RENOVATION ADDRESS:_________________ RENOVATION ADDRESS:_____________________________________________________ ________________________________________________________________________ ____________________________________ SAMPLE NO. ___________ DATE: _____________ SAMPLE NO. ___________ DATE: _____________LOCATION__________________________________ LOCATION__________________________________RENOVATION ADDRESS:_________________ RENOVATION ADDRESS:_____________________________________________________ ________________________________________________________________________ ____________________________________ 2010- 2014 AWDI, LLC Al Rights Reserved Do not Reproduce without PermissionSurcharge Acceptance RRPSURCHARGEForm - 2H Customer Name: ACCEPTANCE Address: Perhaps the best way to introduce the additionalcosts of Lead Safe Work Practices into the sale is to Lead-Safe Work Practices Suircharge AcceptanceI understood that The EPARRPRenovation, Repair and Painting Rule requires that all renovations performed on Target Housingand Child Occupied facilities built prior to 1978, that contain lead in quantities equal to or in excess of 1.0 mg/cm2 or 0.5% byuse the approach of an RRP Surcharge much as weight in or on one or more components that will be distrurbed during the renovations be conducted using Lead Safe WorkPractices.environmental disposal fees are used for everydayLead Safe Work Practices involve containment materials, cleaning materials, disposal procedures, documentation special clothingfor the workers, and a final clearance testing to establish the full containment and removal of all dust and debris disturbed andoil changes for your car. removed duringn the renovation.Due to the increased materials cost and time mandated by the EPARRPRule Lead Safe Work Practices, the work planned for yourproperty will be subject to a Lead Safe Work Practices Surcharge.You, the customer, and the Contractor have fully discussed these materials and time additions, and have agreed to a Lead Safe WorkThis approach keeps pricing competitive for the Practices Surcharge for the planned work on your property as follows:product and installation, and treats the RRP costs Lead-Safe Work Practices Surcharge:as third-party requirements out of yours and your Lead-Safe Surcharge to be Paid:customers control. Upon Execution of this form Upon Completion of the Work Other:Homeowner Signature: Date:The Form, while not from the EPA, is a valid sales EPACertified Firm:Certification No.document that can be made part of your contract Address: and accompany all the other documentation that RepresentativeSignature: Date:the homeowner must be given, which also serves to support the charges. Additional Comments:2010-AWDI, LLC - Al Rights Reserved. May be Reproduced without changes. TLC Logo used with permission.'