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1 <br />Federal Register/Vol. 64, 178/Wednesday. September I5. 199E Iles and Regulations 50231 <br />Date: Street and city. <br />. <br />Organization: <br />State: _ ZIP: _ Phone number. L- . <br />Street and city. <br />Appendix D—Sample Hazard <br />State: _ZIP: _Phone number: U <br />Reduction Completion Notice Format <br />Note: The following appendix will not <br />Appendix C—Sample Summary <br />appear in the Code of Federal Regulations - <br />Presumption Notice Format <br />Summary Notice of Completion of Lead - <br />Appendix B—Sample Summary Risk <br />None: The following appendix will not <br />Based Paint Hazard Reduction Activity <br />Assessment Notice Format <br />appear in the Code of Federal Regulations <br />Addressnooatiolrof property or structure(s) <br />Note: This followin appendix will not <br />g ppend <br />Notice That Lead -Based Paint or <br />this summary notice applies to: <br />' <br />appear in the Code of Federal Regulations <br />Paint Hazards Are Presumed to be Present <br />Summary Notice of Lead -Based Paint Risk <br />Address/location of property or structtue(s) <br />Assessment <br />this notice of presumption applies to: <br />Summary of the heard reduction activity. <br />Addressnocetion of property or structure(s) <br />Stan and completion date(s): <br />this summary notice applies to: <br />- <br />Activity locations and types. List at least the <br />-yared paint description: e <br />Stmtmary of risk assessment results (check <br />all that apply): <br />(a) No lead -based paint hazards were <br />(b) _ Lead -based paint hazards were <br />found. <br />(c) _- A brief sum inary of the findings of <br />the risk s provided below <br />(required <br />-based paint hazards <br />were ftnn4. <br />Summary of types and locations of lead - <br />based paint hazards. List at least the housing <br />unit numbers and common areas (for <br />mulifamily housho. bare soil locations. <br />dust -lead locations, and/or building <br />components (including type of room or <br />space, and the material underneath the <br />paint). and types of lead -based paint hazards <br />fond: <br />Contact person for more inft cation about <br />the risk assessment: <br />Printed name: <br />Type of presumption (check all that apply): <br />(a) _ Lead -based paint is presumed to be <br />present. <br />(b) _ Lead -based paint hazard(s) is(are) <br />presumed to be present. <br />Summary of presumption. last at least the <br />housing unit numbers and common areas (for <br />multifamily housing). bare soil locations. <br />dust -lead locations, and/or building <br />components (including type of room or <br />spam and the material underneath the <br />paint), and types of lead -based paint hazards <br />presorted to be present <br />housing unit numbers and common areas (for <br />multifamily housing), bare soil locations. <br />dim -lead locations, and/or building <br />components (including type of room or <br />space. and the material underneath the <br />paint). and types of hazard reduction <br />activities performed at the locations listed: <br />Date(s) of clearance testing and/or soil <br />analyses — <br />Locations of building components with lead - <br />based paint remaining in the rooms. spaces <br />or areas where activities were conducted: <br />- Summary of results of clearance testing and <br />- soil analyses: <br />(a) _ No clearance testing was <br />performed. <br />(b) _ Clearance testing showed <br />clearance was achieved- <br />(C) _ Clearance testing showed clearance <br />Contact person for more information about was not achieved' <br />the presumption: <br />Printed name: . <br />Organization <br />Street and city. <br />State: _ ZIP: _ Phone number. U <br />Contact person for more information about <br />the hazard reduction: <br />Printed name: <br />Organization: <br />Street and city. <br />State: _ 23P: <br />Phone number: U <br />Person who prepared this summary notice: <br />Organization: Printed name' <br />Person who prepared this notice of Signature: <br />Street and city. presumption Date: <br />Printed name'. Organization: <br />State: _ ZIP: _ Phone number. U <br />Person who prepared this summary notice: <br />Primed name: <br />. Signature: <br />Street and city - <br />signature: State: _ ZIP: <br />Date: Phone number. U <br />Organization: (FR Doc 99-23016 Filed 9-14-99; 8:45 am) <br />BRLRJG CODE tate-a2-e - <br />AtrActtmeN5r- 3 <br />