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Lead-Safe Form <br />DBA: RENEWAL BY ANDERSEN OF INDIANA, OHIO & TENNESSEE <br />Legal Name: Windows, LLC <br />1320 City Center Dr. Suite 350 | Carmel, IN 46032 <br />Phone: (317) 428-2054 | Fax: (null) | info@windowsbyrba.com <br />Marlene Nowak <br />1709 Wayne Street <br />South Bend, IN 46615 <br />Year Built: 1927 <br />H: (574)288-7490 <br />C: (574)261-7797 <br />SIGNATURE OF SALES PERSON: <br />PRINT NAME OF SALES PERSON <br />Nicholas Ritchie <br />SIGNATURE OF CUSTOMER 1: <br />PRINT NAME <br />Marlene Nowak <br />SIGNATURE OF CUSTOMER 2: <br />PRINT NAME <br />02/02/25 Page 26 / 35 <br />Lead Safe Work Pamphlet Receipt and Lead Testing Permission Form <br />Pamphlet Receipt <br />I have received a copy of the lead hazard information pamphlet informing me of the <br />potential risk of the lead hazard exposure from renovation activity to be performed in my <br />dwelling.  I received this pamphlet before the work began.  <br />Permission to Test <br />I  confirm  if  my house was built pre 1978, I understand and give permission to have my <br />house tested for Lead Paint at time the measure technician comes  out  to take final <br />measurements.  I  understand  that  the  if  the  test  does  show  the  presence  of <br /> lead  paint, that the firm performing the renovation  will be required to use the lead-safe <br /> work practices  required  by  EPA’s  Lead-Based  Paint  Renovation,  Repair,  and <br /> Painting  Rule.  I also understand that there is no added charge for using the lead safe <br />work practices.  <br /> <br />By signing below, I hereby agree to the terms and conditions above.