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<br />Appendix A--Sample Summary Inspection Notice Format <br /> <br />Note: The following appendix will not appear in the Code of <br />Federal Regulations <br /> <br />Summary Notice of Lead-Based Paint Inspection <br /> <br />Address/location of property or structure(s) this summary notice <br />applies to: <br />I~--------------------------------------------------------------------- <br />[]---------------------------------------------------------------------- <br />[1---------------------------------------------------------------------- <br /> <br />Lead-based paint inspection description: <br />Date(s) of inspection:----------------------------------------------- <br /> <br />Summary of inspection results (check all that apply) : <br />(a) No lead-based paint was found. <br />(b) Lead-based paint was found. <br />(c) A brief summary of the findings of the inspection is <br />provided below (required if lead-based paint found) . <br /> <br />Summary of where lead-based paint was found. List at least the <br />housing unit numbers and common areas (for multifamily housing), and <br />building components (including type of room or space, and the <br />material underneath the paint) : <br />[J---------------------------------------------------------------------- <br />[]---------------------------------------------------------------------- <br />D---------------------------------------------------------------------- <br />[---------------------------------------------------------------------- <br />i-I-------------------------------------------------------------------___ <br />[]---------------------------------------------------------------------- <br />D---------------------------------------------------------------------- <br />[J---------------------------------------------------------------------- <br />0---------------------------------------------------------------------- <br />0---------------------------------------------------------------------- <br />U---------------------------------------------------------------------_ <br /> <br />[]---------------------------------------------------------------------- <br /> <br />[1---------------------------------------------------------------_______ <br />D---------------------------------------------------------------------_ <br /> <br />Contact person for more information about the inspection: <br />Printed name:-------------------------------------------------------- <br />Organization:-------------------------------------------------------- <br />Street and city:----------------------------------------------------- <br /> <br />[[Page 50231]] <br /> <br />State: ZIP:------------------------------------------------------ <br />Phone number: (_____)------------------------------------------------- <br /> <br />Person who prepared this summary notice: <br />Printed name:-------------------------------------------------------- <br />Signature:-----------------------------------------------____________ <br />Attachment 3 <br />Page 1 of5 <br />