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childhood lead poisoning prevention branch

Line-by-line guidelines for filling out CDPH form 8551 and 8552​

​The Abatement of Lead Hazards Notification (CDPH form 8551) Form

SECTION 1: Enter the street number, street name and apartment number when applicable. Enter the City, County and Zip Code accurately in the space provided. 
  • Type of structure​: Check the appropriate box. If “Other” is checked, please specify the type of structure in the space provided.
SECTION 2: Please provide a summary of the work and the location of abatement activity that will be conducted on the structure.
  • Description of work to be performed: Check the appropriate box.
  • Type  of Abatement​: Check the box that applies to your abatement activity. If conducting both temporary (designed to last less than twenty years) and permanent (designed to last a minimum of twenty years) abatement, check both boxes.
  • Do any children reside on the premises? Check the box that is applicable.
SECTION 3: Enter the start date and end date of the abatement project in the space provided. Enter the month, day and full (four digit) year.
SECTION 4: List specific times and dates when residents are not allowed to enter the work areas when applicable.
SECTION 5: Enter the name and telephone number, with area code, of the property owner or the manager. In the space provided, enter the street number, street name, apartment number when applicable, city, state and zip code of the property owner or manger.
SECTION 6: Enter the name of the individual and, if applicable, the company, along with the telephone number with the area code. In the space provided, enter the street number, street name, apartment number when applicable, city, state and zip code of the individual conducting the abatement. 
  • CDPH certification number​: Enter the individual’s Lead-Related Construction certification number issued by the California Department of Public Health when applicable. If no CDPH certification number is entered on the form, CDPH may contact the individual to indicate that there is an error with the filing and request the certification number.
SECTION 7: Enter the telephone number of the city or county local Environmental Health Agency, this can be found online in the A-Z Indez of Childhood Lead Poisoning Prevention Programs​.

The Lead Hazard Evaluation Report (CDPH form 8552) Form

SECTION 1: Enter the date when the individual conducting the Lead Hazard Evaluation was on-site collecting samples or taking readings. Enter the month, day, and full (four digits) year. If multiple types of evaluations are conducted on a property over a period of time, please submit separate forms for individual dates.
SECTION 2: Please check the box that applies to the type of Lead Hazard Evaluation conducted. If the box “Other” is checked, please specify the type of inspection in the space provided.
SECTION 3: Structure Where Lead Hazard Was Conducted​: Enter the street number, street name, and apartment number when applicable. Enter the City, County and Zip Code accurately in the space provided.
  • Construction date (year) of structure​: Enter the (four digit) year the structure was constructed. 
  • Type of structure: Check the appropriate box. If “Other” is checked, please specify the type of structure in the space provided.
  • Children living in structure​: Check the box that is applicable. Check the box “Yes” even if children are present for a short period of time and do not necessarily live in that structure full time.
SECTION 4: Enter the name, telephone number, street number, street name, and apartment number when applicable, city, state, and zip code of the individual or business/agency who owns the structure.
SECTION 5: Check all boxes that apply. The box “Other” should be checked if there are any other hazards identified other than the options provided under section 5 and please describe the other hazard. 
SECTION 6: Enter the name, telephone number, street number, street name, apartment number when applicable, city, state, and zip code of the individual conducting the Lead Hazard Evaluation. 
  • CDPH certification number: Enter the individual’s Lead-Related Construction certification number issued by the California Department of Public Health.
  • Signature​:  For purposes of Title 17, California Code of Regulations, §36000, the certified Inspector/Assessor (or Project Monitor for clearance inspection) is required to sign the form and submit it to the California Department of Public Health. If the certified Inspector/Assessor (or Project Monitor for clearance inspection) does not sign a form, CDPH will contact the individual and will indicate that there is an error with the filing.
  • Date: Enter the date when the Lead Hazard Evaluation Report was signed.
  • Name and​ CDPH certification number of any other individuals ​conducting sampling or testing​​​: If additional individuals were involved in sampling or testing at the same location, including Sampling Technicians working under the direction of a CDPH certified Inspector/Assessor, please enter those individuals’ names and CDPH certification numbers.
SECTION 7: The attachments mentioned in Section 7 shall be maintained for a minimum of 3 years by the CDPH certified Inspector/Assessor who conducted the Lead Hazard Evaluation. A copy of these attachments and of the Lead Hazard Evaluation Report form must be submitted to the person who ordered the Lead Hazard Evaluation. Copies of these attachments should not be submitted to CDPH with the form. Attachments should be submitted only if requested by CDPH.
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Attaching Additional Pages: All attachments mentioned under Section 7 should not be sent to the California Department of Public Health. Attachments should be submitted only if requested by CDPH. 



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