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_ s <br />It <br />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 following lead-based discipline: Lead Worker <br />;losed is your Lead Worker license card. This card must be available for review at all times while you are implementing a lead-based <br />,ect. <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 federali 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 01/06/2024, 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 />Jose L. Solis <br />Lead Worker License # IND001890 <br />Effective: 01/06/2021 Expiration: 01/06/2024 <br />Birth Date: 06/06/1982 Gender: M <br />Height: 5'5" Eye Color: Brown <br />Weight: 170 Hair Color: Black <br />Indiana State Department of Health <br />-sa 100 N. Senate Avenue, N855 <br />Indianapolis, Indiana 46204 <br />Lead Worker <br />Jose L. Solis <br />Kristina Box, MD, FACOG <br />Kristina Box, MD, FACOG <br />State Health Commissioner <br />Indiana State Department of Health <br />STATE FORM 49,22 IR2 10-1e, <br />