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<br />Appendix A--Samp1e 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 />i 1---------------------------------------------------------------------- <br /> <br />Lead-based paint inspection description: <br />Oate(s) of inspection:----------------------------------------------- <br /> <br />of inspection results (check all that apply) <br />No lead-based paint was found. <br />(b) Lead-based paint was found. <br />(c) A brief summary of the findinqs <br />provided below (required if lead-based paint <br /> <br />Summary <br />(a) <br /> <br />of the inspection is <br />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 />0---------------------------------------------------------------------- <br /> <br />cJ____________________________________________________--________________ <br /> <br />J---------------------------------------------------------------------- <br /> <br />~---------------------------------------------------------------------- <br /> <br />~J---------------------------------------------------------------------- <br /> <br />~---------------------------------------------------------------------- <br /> <br />]---------------------------------------------------------------------- <br /> <br />~J---------------------------------------------------------------------- <br /> <br />u---------------------------------------------------------------------- <br /> <br />_J---------------------------------------------------------------------- <br /> <br />:l---------------------------------------------------------------------- <br /> <br />-]---------------------------------------------------------------------- <br /> <br />il---------------------------------------------------------------------- <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 />[[paqe 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 />