DELHI CENTER - 2006 CDBG - Laserfiche WebLink

Home Browse Search

Printed name: -------------------------------------------------------- Organization: -------------------------------------------------------- ---------------------------------------------------------------------- Street and city:______________________ _________ ____________ ______ _ _ __ ____ ________ ______ - - - - - -_ State: ZIP: Phone number: () - - - - - -- ___ ______ _____ __ ----------------------------------------------- ____ ________ ____ ____________ _ _ _ _ __ Person who prepared this notice of presumption: Printed name:__________________________ _____________ ___________ ______ F-- ______ ____________________ _____________ ___________ _______ Signature: ----------------------------------------------------------- Date: ----------------------------- ______________________________________________________________________ Organization:------------------------------------------------------- -- - - -- -- ---------- -------------- ----------- --- -------- Street and city: ---------------- t--------------------------- State: ZIP: Phone number: () - - - - - -- ___ _ _____ _ _ _____ ___ ___________ _ __ ______________ __ __________ __ 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 /location of property or structure(s) 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: Date(s) of clearance testing and /or soil analyses: _ Locations of building components with lead -based paint remaining in the rooms, spaces or areas where activities were conducted: _ ______ _______ ______ ______ _ _____ ---- _____-------- ____ - - - -__ Attachment 3 Page 4 of 5