Elevated Blood Lead (EBL) Environmental Investigation Report For the Property at: STREET ADDRESS CITY, STATE AND ZIP Property Owner: OWNER’S NAME STREET ADDRESS CITY, AND ZIP PHONE # Prepared for: Parent’s Name Parent’s PHONE Parent’s address Report prepared and submitted by: EBL Investigator’s Name Michigan Certification Number P-XXXX If a second investigator, list also Agency Street Address City, State and ZIP EBL Investigator’s Phone Number EBL Investigator’s Email Address Day Month Year Day Month Year Date of Investigation Date of Report
Elevated Blood Lead (EBL) Environmental Investigation Report For the Property at: STREET ADDRESS CITY, STATE AND ZIP Property Owner: OWNER’S NAME STREET ADDRESS CITY, AND ZIP PHONE # Prepared for: Parent’s Name Parent’s PHONE Parent’s address Report prepared and submitted by: EBL Investigator’s Name Michigan Certification Number P-XXXX If a second investigator, list also Agency Street Address City, State and ZIP EBL Investigator’s Phone Number EBL Investigator’s Email Address Day Month Year Day Month Year Date of Investigation Date of Report
EBL_EI_Report_Template_2.12.15_484582_7.docx