Harris County Public Health & Environmental Services Home page

Environmental Public Health Division

Lead Hazard Control Program Referral Form

Type the first word in the line above:.

Date:
Name: Address:

City:

Phone: Alt. Phone:

Email Address:

Names and ages of children living at the property

Name: Age
Name Age

Name Age

Name Age

Name Age

Dwelling Owner's Name:

Dwelling Owner's Phone:

Year Dwelling was built:

Comments:

Every effort will be made to keep applicant information confidential

Disclaimer

Last updated: November 03, 2009
Harris County Public Health & Environmental Services
2223 West Loop South
Houston, TX 77027
Tel: (713) 439-6000
Webmaster