10-Exhibit D-633775 LIRA-EBL Report Checklist.pdf

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Lead Inspection / Risk Assessment

Report Checklist

This checklist is not intended to be an all-inclusive list. Complying with this list does not guarantee that a certified Lead Inspector/Risk Assessor will not receive a violation as a result of an enforcement inspection. Inspections will utilize Michigan’s Act, corresponding Rules, ASTM standards and interpretive guidance from the U.S. Department of Housing of Urban

Development (HUD), the Environmental Protection Agency (EPA), and the Michigan Department of Health and Human Services (MDHHS) to determine compliance. MDHHS reserves the right to modify this compliance checklist without prior notice.

TITLE PAGE / TABLE OF CONTENTS

R325.99403 LI; R325.99404 RA; HUD 2012; 5-90, 7-33

Property address and if applicable, apartment number(s) Property owner(s) name, address and phone number Date of inspection / assessment Date of report Inspector / risk assessor name and certification number XRF serial number Company employing the inspector / risk assessor name, address and phone number Table of contents

PURPOSE OF ENVIRONMENTAL INVESTIGATION

Key definitions for identifying and describing location of lead hazards and surfaces tested

LEAD TESTING

R325.99403 LI; R325.99404 RA; HUD 2012; 5-111; 5-112, 7-33

Plain language conclusion section (“results and recommendations”) is designed to provide easy identification of all lead hazards (or lead paint).

All lead hazards (component/location, severity/priority, abatement/interim options) Positive lead based paint results (sample number, floor, wall/side, room and number, component, substrate, visual condition, color, result, PbC mg/cm2) Dust wipe sample results (sample number, room/wipe location, surface tested, lead hazard, lab result) Soil sample results (sample number, location of bare soil area, approximate area in square feet, lead hazard, lab result) Other surface sample results (surface/item description, location, material, result) Surfaces unable to be tested (room, component, reason not tested) Potential hazards (sample number, floor, wall/side, room and number, component, substrate, visual condition, color, result, PbC mg/cm2)

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WATER TESTING

N/A

INSPECTOR CERTIFICATION

(R325.99403 LI; R325.99404 RA; HUD 2012; 5-90, 7-33)

Name, signature, certification number, and email address of inspector / risk assessor conducting testing

APPENDICES

Appendix A (Resident Interview)

Occupant use patterns (R325.99404 RA; HUD 2012; 5-99, 5-100, 5-101)

Appendix B (Site Information)

Date of construction of subject building(s) (R325.99403 LI; R325.99404 RA; HUD 2012; 5-90, 7-33)

Results of the visual inspection (R325.99404 RA) Background information regarding the physical characteristics of residential dwelling or facility (building condition survey) (R325.99404 RA; HUD 2012; 5-94) Results of previous inspection or analyses for lead paint or previous assessment for lead hazards (R325.99404 RA; HUD 2012; 5-94) If multi-family, describe unit selection process and common area sampling (HUD 2012; 5-94) Site plan and floor plans included; north direction arrow (HUD 2012; 5-94, 5-20, 7-33 Floor plan includes sides, walls, large components (doors/windows) (HUD 2012; 5-94) Floor plan includes location where dust wipes were taken (HUD 2012; 5-104) Floor plan identifies rooms by number and function, (e.g., Room #4 – living room) (HUD

2012; 5-23, 7-23) Site plan shows all detached outbuildings, fences, areas of bare soil in excess of 9 sq. ft., children play areas, soil sample locations (HUD 2012; 5-21 – 5-23) Representative pictures (recommended)

Appendix C (Lead: Education, Testing Resources & Laws)

Definition of a risk assessment and why it was performed (HUD 2012; 5-90) Owner responsibility regarding the Federal Lead-Based Paint Disclosure Rule and lessees and potential buyers (HUD 2012; 7-34, 7-35, 5-86) Lead poisoning prevention education (HUD 2012; 5-86) Testing method, sampling procedure and results of on-site paint analysis, including quality control data (R325.99403 LI; R325.99404 RA; HUD 2012; 7-33) Ongoing monitoring and re-evaluation schedule/protocol (HUD 2012; 5-93 – 5-98)

Appendix D (All XRF Results & Device Used)

Specific location of each painted component tested (R325.99403 LI; R325.99404 RA; HUD 2012; 7-33)

Paint condition listed as intact or deteriorated (HUD 2012; 5-49) Report includes the XRF Performance Characteristic Sheets (HUD 2012 Appendix 8.1-24)

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Appendix E (Laboratories Used & Original Laboratory Reports)

Name, address, and phone number of each NLLAP recognized laboratory conducting analyses of collected samples (R325.99404 RA; HUD 2012; 5-90, 7-33)

Any other sampling results (R325.99404 RA; HUD 2012; 5-94)

OTHER

Chain of custody for samples completed accurately (HUD 2012; 5-104, 5-106) Glossary of lead-related terms used in the report (HUD 2012; 5-91)

REPORTING REQUIREMENTS

Report was provided no later than 20 business days after completion of the lead inspection and/or risk assessment (when all field data has been received) (R325.99103 Recordkeeping)

Copy to building owner; copy to person who contracted for (R325.99103 Recordkeeping) Reported lead identification activity by 15th of following month (R325.99408 Notifications) Written disclosure of any affiliation between the inspector/assessor and the person(s) who conduct lead abatement on subject property, if abatement is scheduled (R325.99404 RA)