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pdfU. S. E NVIRONMENTAL P ROTECTION A GENCY
L EAD -B ASED P AINT A CTIVITIES
TRAINING NOTIFICATION
Important: The training program manager may complete this sample form or a similar form when notifying EPA.
Consult the Instructions for Notifying EPA of Lead-Based Paint Abatement Activities Courses when preparing t r a i n i n g
notification. Please type or print responses in black or blue ink only.
A. Type of Notification
Original
Updated
Cancellation
(choose one)
B. Description of Training
Course Discipline:
Worker
(choose one)
Course Type:
Supervisor
(choose one)
Initial
Refresher
Inspector
Language
Presented:
English
(choose one)
Other:
Spanish
Risk Assessor
Project Designer
Date(s)
Start Time
End Time
Month/Day/Year
am/
pm
am/
pm
am/
pm
am/
pm
am/
pm
am/
pm
am/
pm
am/
pm
Principal Instructor:
Training Location Name (if applicable):
Training Location Address:
Street Address
City
State
Zip Code
Training Location Phone Number:
C. Training Program
Name:
Accreditation Number:
Address:
Street Address
City
State
Zip Code
Phone Number:
D. Training Managers Information
(Please note that this form is incomplete without a signature)
I hereby attest and affirm that the information included on this notification form is true and accurate to the best of
my belief and knowledge. I acknowledge that any approval authorized pursuant to this notification will be subject
to revocation if issuance was based on incorrect or inadequate information that materially affected the decision to
issue the approval.
Name
Signature
Date Signed
For information on EPA and other lead programs, see the web site:
http://www.epa.gov/lead
File Type | application/pdf |
File Title | F:\notificationc\forms\pre-trainingmodified3.wpd |
Author | mwilson |
File Modified | 2004-07-16 |
File Created | 2003-01-23 |