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February 17, 2016 <br />Based upon the review of your license application, the Indiana Lead and Healthy Homes Program has determined that you have fulfilled the <br />requirements of 410 IAC 32 and are eligible for licensing in the following lead -based discipline: Lead Inspector <br />Enclosed is your Lead Inspector license card. This card must be available for review at all times while you are implementing a lead -based <br />project. <br />This license may be revoked, pursuant to 410 IAC 32-2-8, if you: <br />(1) Violate any requirements of th6se rules (410 IAC 32), or any other federal, state, or local regulation pertaining to lead -based paint <br />activities. <br />(2) Falsify information on Your appfication, for licensing. <br />(3) Fail to meet any qualifications specified in 410 IAC 32, <br />(4) Conduct a Iead-based paint project, or related lead -based activity, in a manner that is hazardous to the public health. <br />Your license is valid effective 0312912010, and will expire on 03129/2019, as indicated on your card. We suggest that you attend the <br />required training and submit an application for license renewal early to insure your license does not lapse. In order to avoid re -taking the <br />Initial training course, you must attend a refresher in the discipline you are seeking a license within three (3) years from the date of issuance <br />of your last training course certificate. <br />Indiana state Department of, Health <br />Jason Ganser <br />Lead Inspector License # I ND000501 <br />Effective: 03/29/2010 Expirati©m 03/29/2019 <br />Birth Date: 01/10/1974 Gender: M <br />Height: 6-00, Eye Collor: BLU <br />`Weight: 200 Hair Color: BRO <br />Indiana State Department of Health <br />100 N. Seinate Avenue, N855 <br />Indianapolis, Indiana 46264 <br />Lead Inspector <br />Certificate Number Expira,tien iDate,' <br />IND000501 03129/2019 <br />Jason A.,jGa,nse:l <br />Jerome M. Adams, MD, MPH <br />State Health Commissioner <br />Indiana State Department: bf Health <br />SYATE FORM 49122 �9 <br />