b'Registration for RRP and Pre-Education REGISTRATIONFORRRP LEAD SAFE WORKPRACTICESand Brochure Receipt - 1A PRE EDUCATION RECEIPTCustomer Name:If a home is pre-1978 and meets Target HousingAddress: definitions, the in-home sale must include the Telephone: FAX:proper Pre-Renovation education, i.e., delivery (Home)E-mail:Telephone: and receipt of the Renovate Right brochure. (Cell)Type of Home: Frame Masonry OtherIn order to effectively quote a project that may Age of Home:Year Built Original Windows:YES NOcontain lead in the areas to be disturbed, there Age Confirmation: Deed Tax Rolls Owner Otherneeds to be a preliminary test to establish whether Renovation Project:Windows Doors Conservatories/Sunrooms Roofing Siding Otherlead exists or not.To help plan the containment, sketch a simple floor plan showing the approximate position of the areas that wil ected by Leadcontainment compliancethe RRPRules. Use be af than one shetThere are two pieces of documentation that the Safe Work Practices to help determine how to layout theinwithmore Floor Plan LayoutReceipt of Renovation Right Brochure:if necesary. AWDI Registration Form completes: I have received a copy of the lead hazard information pamphlet Renovate Right informing me of the potential risk of the leadhazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before the work began.1. Acknowledgement of the delivery of thePermission Received for Initial Lead Test: Renovate Right BrochureI understood that my residence may contain lead coatings on the future renovations I am investigating with the firm noted above.As such, I gave my permission for their representative (signature below) to score a sample component with a razor knife and use2, Permission from the resident for the renovator an approved EPA Test) to determine if lead is present.I fully understand that this is a preliminary test, and if I decide to proceedwith the renovations, and lead was detected in this preliminary, an official test will need to be done by a Certified Renovator (orto perform a preliminary test for quotation other Certified EPA test conductor) to establish official results. The representative will provide me a copy of this form. I understandthere will be slight damage to the component but am aware that the EPA RRP Final Rule require this test for all renovations to beperformed after April 22, 2010 on target homes and child occupied facilities built prior to 1978.The result shown was obtained bypurposes a good faith test using EPAaccepted test kits in accordance with EPA instructions for in-home tests.In addition, the back of the form can contain aPreliminary Test Result:Lead Detected Lead Not Detected Proof of Previous Abatementlayout of areas to be renovated, or even the Interior Homeowner Signature: Additional Comments: withoutpersonal use but not resold in any form. Date:2010 AWDI, LC.- Al Rights Reserved. May be copiedchanges for and/or Exterior Layout Forms. EPA Certified Firm:Certification No.RepresentativeSignature: Date: 2010- 2014 AWDI, LLC Al Rights Reserved Do not Reproduce without PermissionSelf-Certification Form - RENOVATOR RRPSELF1G Owner-Occupant: CERTIFICATION OPTION Address: If the Renovate-Right Brochure cannot be deliveredto the owner and/or the occupant, the CertifiedRenovators Self Certification Option (for tenant-occupied dwellings only)Declined I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unitFirm must make the required attempt to deliver itlisted below at the date and time indicated and that the occupant declined to sign the con?rmation of receipt. I further certify that Ihave left a copy of the pamphlet at the unit with the occupant.or certify that the attempt was made, and what 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 inattempt was used. This is the form to be filled out how pamphlet was left).Note Regarding Mailing OptionAs an alternative to delivery in person, you may mail the lead hazard information pamphletand saved with the other documentation. to the owner and/or tenant.Pamphlet must be mailed at least seven days before renovation. Mailing must be documented by acerti?cate of mailing from the post office.Printed Name of Person Certifying DeliveryAttempted Deliver Date::Signature of Person Certifying Lead Pamphlet DeliveryEPACertified Firm:Certification No.Address: RepresentativeSignature: Date:Additional Comments:2010-AWDI, LLC - All Rights Reserved. May be Reproduced without changes. TLC Logo used with permission.'