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<br />Appendix A--Sample Summary Inspection Notice Format <br /> <br />Note: The fo11owing appendix wi11 not appear in the Code of <br />Federa1 Regu1ations <br /> <br />Summary Notice of Lead-Based Paint Inspection <br /> <br />Address/1ocation of property or structure(s) this summary notice <br />app1ies to: <br /> <br />D---------------------------------------------------------------------- <br /> <br />D---------------------------------------------------------------------- <br /> <br />D---------------------------------------------------------------------- <br /> <br />Lead-based paint inspection description: <br />Date(s) of inspection:----------------------------------------------- <br /> <br />Summary of inspection resu1ts (check a11 that app1y) : <br />(a) No 1ead-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 be10w (required if 1ead-based paint found) . <br /> <br />Summary of where lead-based paint was found. List at 1east the <br />housing unit numbers and common areas (for mu1tifami1y housing), and <br />bui1ding components (inc1uding type of room or space, and the <br />materia1 underneath the paint) : <br /> <br />D---------------------------------------------------------------------- <br /> <br />D---------------------------------------------------------------------- <br /> <br />0---------------------------------------------------------------------- <br /> <br />D---------------------------------------------------------------------- <br /> <br />c---------------------------------------------------------------------- <br /> <br />D---------------------------------------------------------------------- <br /> <br />D---------------------------------------------------------------------- <br /> <br />D---------------------------------------------------------------------- <br /> <br />[J---------------------------------------------------------------------- <br /> <br />D---------------------------------------------------------------------- <br /> <br />D---------------------------------------------------------------------- <br /> <br />D---------------------------------------------------------------------- <br /> <br />D---------------------------------------------------------------------- <br /> <br />D---------------------------------------------------------------------- <br /> <br />Contact person for more information about the inspection: <br /> <br />Printed name:-------------------------------------------------------- <br /> <br />Organization:-------------------------------------------------------- <br /> <br />Street and city:----------------------------------------------------- <br /> <br />[[Page 50231]] <br /> <br />State: ZIP:------------------------------------------------------ <br /> <br />Phone number: (____)------------------------------------------------- <br /> <br />Person who prepared this summary notice: <br /> <br />Printed name:-------------------------------------------------------- <br /> <br />Signature:----------------------------------------------------------- <br /> <br />Attachment 3 <br />Page 1 of5 <br />