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Federal Register /Vol. 64, Appendix );—Sample Summary Risk Assessment Notice Format Note This following appendix will not appear in the Code of Federal Regulations Summary Notice of Lead -Based Paint Risk Assessment Address/location of property or structur(s) this summary notice applies tw Lead -based paint risk assessment description Date(s) of risk assessment Summary of risk assessment results (check all that apply): (a) —No lead -based paint hazards were found. (b) _ Lead -based paint hazards were found. (c) _ A brief summary, of the findings of the risk assessment is provided below (tegttired if any lead -based paint hazards were farad). Summary of types and locations of lead- .based paint hazards. List at least the housing unit numbers and common areas (for multifamily housing). bare soil locations. dust-lead locations. and/or building components (including type of room or space. and the material underneath the paint). and types of lead -based paint hazards found Contact . person for more information about the risk assessment Printed name: .8 /Wednesday, September 15. 1991 1 and Regulations 50231 Date: Organization: Street and city. State: _ ZIP: _ Phone number: Appendix C— Sample Summary Presumption Notice Format Note The following appendix will not appear in the Code of Federal Regulations Notice That Lead -Based Paint or lead -Based Paint Hazards Are Presumed to be Present Address/location of property or structure(s) this notice of presumption applies to: Type of prosimption (check all that apply): (a) _ Lead -based paint is presumed to be Present. (b) _ Lead -based paint hazard(s) hare) presumed to be present Summary of presumption. list at least the housing [uric numbers and common areas (for multifamily housing). bare soil locations, dust-lead locations. and/or building components (including type of room or space. and the material underneath the paint), and types of lead -based paint hazards Presumed to be present Contact person for more information about the presumption Printed name: Organization: Street and city. Street and city. State: ZIP: _ Phone number. (—j Appendix D— Sample Hazard Reduction Completion Notice Format Note: The following appendix will not appear in the Code of Federal Regulations. Summary Notice of Completion of Lead- Based Paint Hazard Reduction Activity Address/locatiOW-Of property or structures) this summary notice applies to: Summary of the hazard reduction activity. Start and completion date(s): Activity locations and types. list at least the housing unit numbers and common areas (for multifamily housing), bare soil locations. dust-lead locations, and/or building components (including type of room or space. and the material underneath the paint). and types of hazard reduction activities performed at the locations listed: Dates) of clearance testing and/or sail . analyses: — Locations of building components with lead - based paint remaining in the rooms, spaces or areas where activities were conducted: - Summary of results of clearance testing and soil analyses: (a) _ No clearance testing was performed. (b) _ clearance testing showed clearance was achieved. (c) _ Clearance testing showed dearance was not achieved Contact person for more information about the hazard reduction. Printed name: Organization: Street and city. State: _ ZIP: Phone number. C —_) State: _ ZIP: _ Phone number. (_ —) Person who prepared this summary notice: Organization: Printed name: Person who prepared this notice of Signature: Street and coy. presumption: Date: pni fm name' _.. Organization: State: _ ZIP: _ Phone number. (--J Person who prepared this summary notice: Printed name: 0 Signature: Signature: Date: Organization: IFR Doc 99 -23016 Filed 9- 14 -99: 8:45 aml 131 w COVE 4210-az-e Street and city. - State: _ ZIP: Phone number. ( —J AT AC tkm E"T- 3