Laserfiche WebLink
<br />. [---------------------------------------------------------------------- <br />Person who prepared this summary notice: <br />Printed name:------------------------------------____________________ <br />u----------------------------------------______________________________ <br />Signature:---------------------------------__________________________ <br />[ Date:------------------------------------____________________________ <br />[---------------------------------------------------------------------- <br />Organization:-------------------------------_________________________ <br />l-------------------------------------_________________________________ <br />Street and city:--------------------------------------_______________ <br />0---------------------------------------_______________________________ <br />State: ZIP: Phone number: (____)--------------------------- <br />c-----------------------------------------_____________________________ <br /> <br />Appendix C--Sample Summary Presumption Notice Format <br /> <br />Note: The following appendix will not appear in the Code of <br />Federal Regulations <br /> <br />Notice That Lead-Based Paint or Lead-Based Paint Hazards Are Presumed <br />to be Present <br /> <br />Address/location of property or structure(s) this notice of <br />presumption applies to: <br />J-----------------------------------------------------_________________ <br />l--------------------------------------________________________________ <br />J---------------------------------------_______________________________ <br />Type of presumption (check all that apply) : <br />(a) Lead-based paint is presumed to be present. <br />(b) Lead-based paint hazard(s) is (are) presumed to be <br />present. <br />Summary of presumption. List at least the housing unit numbers and <br />common areas (for multifamily housing), bare soil locations, dust- <br />lead locations, and/or building components (including type of room <br />or space, and the material underneath the paint), and types of lead- <br />based paint hazards presumed to be present: <br />c--------------------------------------________________________________ <br />[---------------------------------------------------------------------- <br />[---------------------------------------------------------------------- <br /> <br />---------------------------------------------------------------------- <br /> <br />J-----------------------------------------------------_________________ <br />1J-------------------------------------_________________________________ <br />J-----------------------------------___________________________________ <br />L-----------------------------------___________________________________ <br />]---------------------------------------------------------------------- <br />J-------------------------------_______________________________________ <br />lJ-------------------------------------_________________________________ <br />0-----------------------------------___________________________________ <br />1_----------------------------------------------------__________________ <br />[---------------------------------------------------------------------- <br />l----------------------------__________________________________________ <br />J-----------------------------------------------------_________________ <br />0-----------------------------_________________________________________ <br />Contact person for more information about the presumption: <br />Attachment 3 <br />Page 3 of5 <br />