Cherokee Nation
Environmental Programs
Lead Based Paint Inspection Application
Name: _____________________________________________
Phone: _____________________________________________
Email: ______________________________________________
Physical Address: _______________________________________________________________
City: ______________________ County: ____________________ Zip: _______________
Mailing Address (if different from above):
The following requirements must be met in order to be eligible for an inspection. The inspection
locates positive surfaces with lead based paint and lead dust hazards that may be in your home.
No abatement services are available at this time.
I am a Cherokee Nation tribal citizen.
I live in a home constructed before 1978.
Children under 6 years old live in or visit the home frequently.
The home is not a rental property.
I am not receiving any other housing services offered by Cherokee Nation.
Signature: Date:
____________________________________________ ________________________
For Cherokee Nation Use Only
Received by:
Mail Form: Cherokee Nation Environmental Programs
PO Box 948
Tahlequah, OK 74465
mail Form:
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