Request for a lead paint inspection of my apartment

Date: ______________________________
To (owner or managing agent): ______________________________
Owner or agent address: ______________________________
From (your name): ______________________________
Building address: ______________________________
Apartment: ______________________________

A child under 6 lives in my apartment or spends 10 or more hours a week here. Child's age (optional): ________

The building was built before 1960. Section 27-2056.4 of the New York City Administrative Code requires the owner to investigate apartments where a young child lives for lead paint hazards at least once a year, including peeling paint and paint on doors and windows that rub.

Please arrange the lead paint inspection of my apartment and tell me in writing the date and time. Please also send me a copy of the results and of any lead paint test of the apartment.

[ ] I returned the annual notice that asks about young children.   [ ] I have not received an annual notice this year.

If the inspection is not done, I will contact HPD by calling 311.

Signature: ______________________________
Phone or email: ______________________________

Keep a copy. Send it by certified mail with return receipt, or hand it over and ask for a dated receipt.