b'RENOVATOR RRP SELFCERTIFICATION OPTION Owner-Occupant:Address: Renovators Self Certification Option (for tenant-occupied dwellings only)DeclinedI certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unitlisted below at the date and time indicated and that the occupant declined to sign the confirmation of receipt. I further certify thatI have left a copy of the pamphlet at the unit with the occupant.Unavailable for signatureI certify that I have made a good faith effort to deliver the lead hazard information pamphlet to therental dwelling unit listed below and that I have left a copy of the pamphlet at the unit by sliding it under the door or by (Fill inhow pamphlet was left).Note Regarding Mailing OptionAs an alternative to delivery in person, you may mail the lead hazard information pamphletto the owner and/or tenant.Pamphlet must be mailed at least seven days before renovation. Mailing must be documented by a cer-tificate of mailing from the post office.Printed Name of Person Certifying DeliveryAttempted Delivery Date:Signature of Person Certifying Lead Pamphlet Delivery:EPA Certified Firm:Certification No.Address: RepresentativeSignature: Date:Additional Comments: 2010- 2014 AWDI, LLC All Rights Reserved Do not Reproduce without Permission'