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The document is a certification from the Philadelphia Department of Public Health confirming that a dwelling has been visually inspected and tested for lead contamination. It states that there is no deteriorated paint and that dust wipe samples comply with EPA standards, ensuring the property is lead-safe for 24 months. The certificate must be provided to the tenant and submitted to the Department of Public Health.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the apartment number and street name in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill in the zip code and specify the floor number if applicable. This helps in locating the dwelling accurately.
In the certifying company or individual section, print your name clearly along with your PA License number or EPA LDS Tech Certificate Number.
The inspector or risk assessor must sign and date the verification section, confirming that a visual inspection has been conducted.
Complete the owner’s name and address fields, along with their housing inspection license number for compliance.
For tenant acknowledgment, have them sign and date where indicated to confirm receipt of the Lead Safe Certification.

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philadelphia status

Office of Administrative Review Philadelphia 100 S Broad St Suite 400 Philadelphia, PA 19110 Philadelphia Bureau of Administrative Adjudication 100 S Broad St Philadelphia, PA 19110 Bureau of Administrative Adjudication 48 N 8th Street Philadelphia PA 19107 Administrative permit philadelphia 100 South Broad Street 5th Floor Philadelphia PA 19110 Phila admin