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January 6, 2021 <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 foliowing lead-based discipline: Lead Project Supervisor <br />:iosed is your Lead Project Supervisor license card. This card must be availaole for review at all times while you are implementing a <br />i -based project. <br />This license may be revoked, pursuant to 410 IAC 32-2-8, if you: <br />(1) Violate any requirements of these 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 application for licensing. <br />(3) Fail to meet any qualifications specified in 410 IAC 32. <br />(4) Conduct a lead-based paint project. or related lead-based activity, in a manner that is hazardous to the public health. <br />Your license is valid effective 01/06/2021, and will expire on 01i06/2024: 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 />Edna Lomeli <br />Lead Project Supervisor License # IND001891 <br />Effective: 01/06/2021 <br />Birth Date: 02/08/1982 <br />Height: 5-08 <br />Weight: 200 <br />Expiration: 01/06/2024 <br />Gender: F <br />Eye Color: Brown <br />Hair Color: Brown <br />ErF. Indiana State Department of Health <br />100 N. Senate Avenue, N855 <br />Indianapolis, Indiana 46204 <br />late <br />Lead Project Supervisor <br />Certlticate Number Explratlon Date <br />INDO 1 91 01/06/2024 <br />Edna Lomeli <br />Kristina Box, MD, FACOG <br />Kristina Box, MD, FACOG <br />State Health Commissioner <br />Indiana State Department of Health <br />