b'RRP SURCHARGEACCEPTANCE Customer Name:Address: Lead-Safe Work Practices Surcharge AcceptanceI understood that The EPA RRP Renovation, 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% byweight in or on one or more components that will be disturbed during the renovations be conducted using Lead Safe WorkPractices.Lead 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 andremoved during the renovation.Due to the increased materials cost and time mandated by the EPA RRP Rule 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 WorkPractices Surcharge for the planned work on your property as follows:Lead-Safe Work Practices Surcharge:Lead-Safe Surcharge to be Paid:Upon Execution of this form Upon Completion of the Work Other:Homeowner Signature: Date:EPA Certified Firm:Certification No.Address: RepresentativeSignature: Date:Additional Comments: 2010-2014 AWDI, LLC.- All Rights Reserved. May be copied without changes for personal use but not resold in any form.'