Objectives. To evaluate the focused surveillance of blood lead results of 20 micrograms per deciliter (µg/dL) of venous blood and higher received by the California Occupational Blood Lead Registry (Registry) because of new legislation concerning occupational lead poisoning. Methods. We used occupational blood lead results reported to the Registry from January 1, 2020, to December 31, 2021, to describe the current industries with workers having the highest levels of lead poisoning. Results. The Registry received 239 blood lead levels (BLLs) of 20 µg/dL or higher for 151 adults with occupational lead exposure in 28 industries over the study period. Worker BLLs ranged from 20 µg/dL to 55 µg/dL. The industries with the greatest number of workers were storage battery manufacturing, painting contractors, and shooting ranges. Conclusions. Occupational lead poisoning is a health concern across numerous industries in California. The current outdated state and federal occupational lead standards would not require removal from lead work for any of the workers in this study despite extensive evidence of harm at lower BLLs. Strengthened standards could support public health initiatives for worker protection and reduce take-home lead to family members. (Am J Public Health. 2022;112(S7):S690–S694. https://doi.org/10.2105/AJPH.2022.307002 )