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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 />'--1______________________________________________________________________ <br /> <br />lJ---------------------------------------------------------------------- <br /> <br />[i______________________________________________________________________ <br /> <br />Lead-based paint inspection description: <br /> <br />Date(s) of inspection:----------------------------------------------- <br /> <br />Summary <br />(a) <br />(b) <br />(c) A <br />provided below <br /> <br />of inspection results <br /> <br />(check all that <br />No lead-based paint was found. <br />Lead-based paint was found. <br />brief summary of the findinqs <br />(required if lead-based paint <br /> <br />apply) <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 />n--------------------------------------------------------------________ <br /> <br />~---------------------------------------------------------------------- <br /> <br />'---------------------------------------------------------------------- <br /> <br />,---------------------------------------------------------------------- <br /> <br />[j---------------------------------------------------------------------- <br /> <br />Q---------------------------------------------------------------------- <br /> <br />[---------------------------------------------------------------------- <br /> <br />[---------------------------------------------------------------------- <br /> <br />D------------------------------------------------______________________ <br /> <br />D-------------------------------------------___________________________ <br /> <br />iJ----------------------------------------------________________________ <br /> <br />~---------------------------------------------------------------------- <br /> <br />ri-----------------------------------------_____________________________ <br /> <br />[J-------------------------------------------___________________________ <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 of 5 <br />