Example of a Completed Clearance Report The following report is an example of a completed clearance report from a paint stabilization job in a one-bedroom unit that houses a HCVP family. , ST 12345; 123-123-1235 (phone); Home Environmental Inspection Services, Inc., (fax) Firm's risk assessment certification number: ST 78787 CLEARANCE REPORT General Information Date of clearance 2/25/2008 examination: Clearance Examiner: Bob Jones Certification Category: Risk Assessor : ST Certification Number: R77777 Property address: , Apt. A Ourtown, ST 89898 Client name: Sally Smith Client address: . Hammond, ST 89898 Laboratory: Analysis Services, Inc. Address: Bigtown, ST 88999 Telephone number: 222-222-2222 NLLAP number: ST L99999 Summary of Clearance Results The project area passed visual inspection. Dust at or above Federal standards was found in the following area, so the project failed clearance. Location Surface μg lead/ft2 Bathroom Floor under C-1 window 200 Signature: Bob Jones Date: 2/25/2008 Example of a Completed Clearance Report (page 2) Summary of Hazard Reduction Activities Name of firm ABC Renovations Address of Firm , ST 87654
Example of a Completed Clearance Report The following report is an example of a completed clearance report from a paint stabilization job in a one-bedroom unit that houses a HCVP family. Home Environmental Inspection Services, Inc., , ST 12345; 123-123-1235 (phone); (fax) Firm's risk assessment certification number: ST 78787 CLEARANCE REPORT General Information Date of clearance examination: 2/25/2008 Clearance Examiner: Bob Jones Certification Category: Risk Assessor : ST Certification Number: R77777 Property address: , Apt. A Ourtown, ST 89898 Client name: Sally Smith Client address: . Hammond, ST 89898 Laboratory: Analysis Services, Inc. Address: Bigtown, ST 88999 Telephone number: 222-222-2222 NLLAP number: ST L99999 Summary of Clearance Results The project area passed visual inspection. Dust at or above Federal standards was found in the following area, so the project failed clearance. Location Surface μg lead/ft2 Bathroom Floor under C-1 window 200 Signature: Bob Jones Date: 2/25/2008 Example of a Completed Clearance Report (page 2) Summary of Hazard Reduction Activities Name of firm ABC Renovations Address of Firm , ST 87654
HCVLeadHazardTool.docx