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<br />Appendix A--Sample Summary Inspection Notice Format <br /> <br />Note: The followinq 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 /> <br />!l------------__________________________________________________________ <br /> <br />J------------------------------________________________________________ <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 findinqs 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 />housinq unit numbers and common areas (for multifamily housinq), and <br />buildinq components (includinq type of room or space, and the <br />material underneath the paint) : <br /> <br />Q---------------------------------------------------------------------- <br /> <br />0--------------------------____________________________________________ <br /> <br />0---------------------------___________________________________________ <br /> <br />---------------------------------------------------------------------- <br /> <br />u------------------------______________________________________________ <br /> <br />!~---------------------------------------------------------------------~ <br /> <br />---------------------------------------------------------------------- <br /> <br />'---------------------------------------------------------------------- <br /> <br />'---------------------------------------------------------------------- <br /> <br />---------------------------------------------------------------------- <br /> <br />~l______________________________________________________________________ <br /> <br />:---------------------------------------------------------------------- <br /> <br />~---------------------------------------------------------------------- <br /> <br />, <br />~---------------------------------------------------------------------- <br /> <br />Contact person for more information about the inspection: <br /> <br />Printed name:------------------______________________________________ <br /> <br />Orqanization:----------------________________________________________ <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 />Siqnature:----------------___________________________________________ <br /> <br />Attachment 3 <br />Page 1 of5 <br />