Volunteer Programs

10/2003

Volunteer Programs

Property Address: _________________________________

Amount Funded: _________________

1. Surfaces being worked on were tested for lead? Yes No

If No, go to question number 4.

2. Paint test indicated that lead-based paint is present in the unit? Yes No

3. Copy of paint test results provided to homeowner or tenants? Yes No N/A

Attach copy of paint test to document.

4. Surfaces were presumed to contain LBP? Yes No

5. Copy of presumption notice provided to homeowner or tenants? Yes No N/A

Attach copy of presumption notice to document.

6. Clearance of the property was achieved? Yes No
Attach copy of clearance test to document.

7. Copy of clearance test results provided to homeowner or tenants? Yes No N/A

Check only one for questions 8 and 9.

8. HUD’s Lead-Safe Housing Rule 24 CFR Part 35 subpart J applied to this project. The cost of the work did not exceed $5,000. Volunteers followed safe work practices as appropriate.

A. No use of prohibited work methods listed below.

· Open flame burning or torching.

· Machine sanding or grinding without a high-efficient particulate air (HEPA) local exhaust control.

· Abrasive blasting or sandblasting without HEPA local exhaust control.

· Heat guns operating above 1,100 degree Fahrenheit, or those that operat high enough to char the paint.

· Dry sanding or dry scraping. (For exceptions to this rule see 24 CVFR 35.140 (e)).

· Paint stripping in a poorly ventilated space using a volatile stripper.

B. Protection of occupants and preparation of the worksite were met as described in 35.1345.

C. Specialized cleaning after hazard reduction activities including:

· Used HEPA vacuum cleaners; or other method of equivalent efficacy; and

· Lead-specific detergents or equivalents.

D. Dust was properly controlled and contained.

9. Safe work practices were not required when activities do not disturb painted surfaces below the de minimis thresholds defined below.

· Safe work practices were not required because the maintenance or hazard reduction activities did not disturb painted surfaces that totaled more than:

¨ 20 square feet on exterior surfaces;

¨ 2 square feet in any one interior room or space; or

¨ 10 percent of the total surface area on an interior or exterior type of component with a small surface area (such as windowsills, baseboards, and trim).

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City of Representative Date