b'TEST KIT DOCUMENTATION FORMPage 1 of__ Customer NamO e:Address: Co Telephone:(Home) E E-mail:Renovation Information:Fill out all of the following information that isavailable about the Renovation Site, Firm, and Certified Renovator. Renovation Address: ____________________________________________________Unit# ______ City: ________________State: ______Zip code: ____________Certified Firm Name: __________________________________________________________________ Address: ___________________________________________________________________________ City: ________________State: ______Zip code: ____________ Contact #: (____)____- _____ Email: ______________________________________ Certified Renovator Name: Date Certified:/ /Test Kit InformationTest Kit Information:Use the following blanks to identify the test kit or test kits used in testing components. Test Kit #1Manufacturer: _______________________________________ Manufacture Date: _____/_____/_____ Model: _____________________________________Serial #: _______________________________ Expiration Date: _______________________________ Test Kit #2Manufacturer: _______________________________________ Manufacture Date: _____/_____/_____ Model: _____________________________________Serial #: _______________________________ Expiration Date: _______________________________ Test Kit #3Manufacturer: _______________________________________ Manufacture Date: _____/_____/_____ Model: _____________________________________Serial #: _______________________________ Expiration Date: _______________________________ EPA Certified Renovator:Certification No. 2010-2014 AWDI, LLC.- All Rights Reserved. May be copied without changes for personal use but not resold in any form.'