DEQ Form 110-502 "Inspector/Risk Assessor Lead-Based Paint Activity Quarterly Report" - Oklahoma

What Is DEQ Form 110-502?

This is a legal form that was released by the Oklahoma Department of Environmental Quality - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 10, 2016;
  • The latest edition provided by the Oklahoma Department of Environmental Quality;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DEQ Form 110-502 by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Environmental Quality.

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Download DEQ Form 110-502 "Inspector/Risk Assessor Lead-Based Paint Activity Quarterly Report" - Oklahoma

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For DEQ Use Only:
Entry#:
Inspector/Risk Assessor
Date Entered:
Lead-Based Paint Activity Quarterly Report
Qtr 2 Apr-June
Qtr 3 July-Sep
☐No Lead-Based Paint Activity performed this quarter.
20
20
th
th
(Due Jul 10
)
(Due Oct 10
)
Note: Choose a report quarter. A separate report required for each quarter
Qtr 4 Oct-Dec
Qtr 1 Jan-March
20
20
th
th
(Due Jan 10
)
(Due Apr 10
)
Date/Property
Location Type (choose one)
Activity (choose one)
Methodology
LBP Results
Activity Date:
☐ Target Housing Single
☐ Inspection
☐ XRF
Interior LBP found:
Yes
No
☐ Risk Assessment
Family Dwelling
Exterior LBP found:
Yes
No
Date Built
(Do not
☐ Chip Sampling
☐ Hazard Screen
:
☐ Target Housing Multi-Unit
Dust Lead Hazard found:
use unknown)
☐ Clearance Testing:
☐ Dust Sampling
Dwelling
)
Yes
No
(# of Units
Address:
☐ Pass/ ☐ Fail
☐ Child-Occupied Facility
Soil Lead Hazard found:
☐ Soil Sampling
City:
☐ Other:
☐ Other:
Yes
No
Zip:
Activity Date:
☐ Target Housing Single
☐ Inspection
Interior LBP found:
Yes
No
☐ XRF
☐ Risk Assessment
Family Dwelling
Exterior LBP found:
Yes
No
Date Built
(Do not
☐ Chip Sampling
☐ Hazard Screen
:
☐ Target Housing Multi-Unit
Dust Lead Hazard found:
use unknown)
☐ Clearance Testing:
☐ Dust Sampling
Dwelling
)
Yes
No
(# of Units
Address:
☐ Pass/ ☐ Fail
☐ Child-Occupied Facility
Soil Lead Hazard found:
☐ Soil Sampling
City:
☐ Other:
☐ Other:
Yes
No
Zip:
Activity Date:
☐ Target Housing Single
☐ Inspection
☐ XRF
Interior LBP found:
Yes
No
☐ Risk Assessment
Family Dwelling
Exterior LBP found:
Yes
No
Date Built
(Do not
☐ Chip Sampling
☐ Hazard Screen
:
☐ Target Housing Multi-Unit
Dust Lead Hazard found:
use unknown)
☐ Clearance Testing:
☐ Dust Sampling
Dwelling
)
Yes
No
(# of Units
Address:
☐ Pass/ ☐ Fail
☐ Child-Occupied Facility
Soil Lead Hazard found:
☐ Soil Sampling
City:
☐ Other:
☐ Other:
Yes
No
Zip:
Please e-mail to
LBPReporting@DEQ.OK.GOV
or mail to Department of Environmental Quality, Attn: LBP Staff, PO Box 1677, Oklahoma City, OK 73101-1677
Inspector/Risk Assessor Name:
Certification#:
Date:
DEQ Form #110-502
Revised 10/1/16
For DEQ Use Only:
Entry#:
Inspector/Risk Assessor
Date Entered:
Lead-Based Paint Activity Quarterly Report
Qtr 2 Apr-June
Qtr 3 July-Sep
☐No Lead-Based Paint Activity performed this quarter.
20
20
th
th
(Due Jul 10
)
(Due Oct 10
)
Note: Choose a report quarter. A separate report required for each quarter
Qtr 4 Oct-Dec
Qtr 1 Jan-March
20
20
th
th
(Due Jan 10
)
(Due Apr 10
)
Date/Property
Location Type (choose one)
Activity (choose one)
Methodology
LBP Results
Activity Date:
☐ Target Housing Single
☐ Inspection
☐ XRF
Interior LBP found:
Yes
No
☐ Risk Assessment
Family Dwelling
Exterior LBP found:
Yes
No
Date Built
(Do not
☐ Chip Sampling
☐ Hazard Screen
:
☐ Target Housing Multi-Unit
Dust Lead Hazard found:
use unknown)
☐ Clearance Testing:
☐ Dust Sampling
Dwelling
)
Yes
No
(# of Units
Address:
☐ Pass/ ☐ Fail
☐ Child-Occupied Facility
Soil Lead Hazard found:
☐ Soil Sampling
City:
☐ Other:
☐ Other:
Yes
No
Zip:
Activity Date:
☐ Target Housing Single
☐ Inspection
Interior LBP found:
Yes
No
☐ XRF
☐ Risk Assessment
Family Dwelling
Exterior LBP found:
Yes
No
Date Built
(Do not
☐ Chip Sampling
☐ Hazard Screen
:
☐ Target Housing Multi-Unit
Dust Lead Hazard found:
use unknown)
☐ Clearance Testing:
☐ Dust Sampling
Dwelling
)
Yes
No
(# of Units
Address:
☐ Pass/ ☐ Fail
☐ Child-Occupied Facility
Soil Lead Hazard found:
☐ Soil Sampling
City:
☐ Other:
☐ Other:
Yes
No
Zip:
Activity Date:
☐ Target Housing Single
☐ Inspection
☐ XRF
Interior LBP found:
Yes
No
☐ Risk Assessment
Family Dwelling
Exterior LBP found:
Yes
No
Date Built
(Do not
☐ Chip Sampling
☐ Hazard Screen
:
☐ Target Housing Multi-Unit
Dust Lead Hazard found:
use unknown)
☐ Clearance Testing:
☐ Dust Sampling
Dwelling
)
Yes
No
(# of Units
Address:
☐ Pass/ ☐ Fail
☐ Child-Occupied Facility
Soil Lead Hazard found:
☐ Soil Sampling
City:
☐ Other:
☐ Other:
Yes
No
Zip:
Please e-mail to
LBPReporting@DEQ.OK.GOV
or mail to Department of Environmental Quality, Attn: LBP Staff, PO Box 1677, Oklahoma City, OK 73101-1677
Inspector/Risk Assessor Name:
Certification#:
Date:
DEQ Form #110-502
Revised 10/1/16