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<br />---------------------------------------------------------------------- <br /> <br />Person who prepared this summary notice: <br /> <br />Printed name:--------------------------------------------------______ <br /> <br />1-----------------------------------------------------_________________ <br /> <br />Signature:----------------------------------------------_____________ <br /> <br />1 Date:-------------------------------------------------_______________ <br /> <br />---------------------------------------------------------------------- <br /> <br />Organization:----------------------------------------------__________ <br /> <br />1------------------------------------------------------________________ <br /> <br />Street and city:-------------------------------------------------____ <br /> <br />1--------------------------------------------__________________________ <br /> <br />State: ZIP: Phone number: (____)--------------------------- <br /> <br />1-----------------------------------------------------_________________ <br /> <br />Appendix C--Samp1e 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 /> <br />1-----------------------------------------------------_________________ <br /> <br />1-----------------------------------------------------_________________ <br /> <br />J-------------------------------------------------------_______________ <br /> <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 /> <br />]---------------------------------------------------------------------- <br /> <br />1-----------------------------------------------------_________________ <br /> <br />1-----------------------------------------------------_________________ <br /> <br />1______-----------------------------------------------_________________ <br /> <br />1-----------------------------------------------------_________________ <br /> <br />1-------------------------------------------___________________________ <br /> <br />---------------------------------------------------------------------- <br /> <br />1-----------------------------------------------------_________________ <br /> <br />1-----------------------------------------------------_________________ <br /> <br />I <br />,---------------------------------------------------------------------- <br /> <br />1-----------------------------------------------------_________________ <br /> <br />1-----------------------------------------------------_________________ <br /> <br />---------------------------------------------------------------------- <br /> <br />]---------------------------------------------------------------------- <br /> <br />'---------------------------------------------------------------------- <br /> <br />I <br />I 1------------__________________________________________________________ <br /> <br />1-----------------------------------------------------_________________ <br /> <br />Contact person for more information about the presumption: <br />Attachment 3 <br />Page 3 of 5 <br />