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Appendi x A- - Sarrpl a Summar y I nspect i on Not i ce For nat <br />Not e: The f of 1 ow ng appendi x w I 1 not appear i n t he Code of <br />Federal Regul at i ons <br />Summar y Notice of Lead -Based Paint Inspection <br />Address/ I ocat i on of property or structure(s) this summr y notice <br />appl i es to: <br />❑---------------------------------------------------------------------- <br />G---------------------------------------------------------------------- <br />❑---------------------------------------------------------------------- <br />Lead- based paint inspection descr i pt i on: <br />Date(s) of inspection:----------------------------------------------- <br />Sunrrar y of inspection results ( check all that appl y) : <br />( a) No lead-based pai nt was found. <br />( b) Lead- based pal nt vies found. <br />( c) A br i of summry of the f i ndi ngs of the inspection is <br />pr ovi ded bel ow ( r equi r ed i f I ead- based pal nt f ound) . <br />Surmar y of where 1 ead- based paint vies found. List at least the <br />housing unit numbers and conn n areas ( for rrul t i f arriI y housi ng) , and <br />bui I di ng corrponent s ( i ncl udi ng t ype of r oom or space, and t he <br />mat er i al under neat h t he pal nt ) : <br />❑---------------------------------------------------------------------- <br />❑---------------------------------------------------------------------- <br />❑---------------------------------------------------------------------- <br />❑---------------------------------------------------------------------- <br />G---------------------------------------------------------------------- <br />❑---------------------------------------------------------------------- <br />❑---------------------------------------------------------------------- <br />G---------------------------------------------------------------------- <br />G---------------------------------------------------------------------- <br />❑---------------------------------------------------------------------- <br />❑---------------------------------------------------------------------- <br />G---------------------------------------------------------------------- <br />G---------------------------------------------------------------------- <br />❑---------------------------------------------------------------------- <br />Cont act person f or more i of or rmt i on about the i nspect i on: <br />Printed narre:-------------------------------------------------------- <br />Organization:-------------------------------------------------------- <br />Street and city: ----------------------------------------------------- <br />[[Page 50231]] <br />State: ZIP: ------------------------------------------------------ <br />Phone nunber: (_) ------------------------------------------------- <br />Person viho prepared this summary notice: <br />Printed narre: -------------------------------------------------------- <br />Signature: ---------------------------------------------------------- <br />Attachment 3 <br />Page 1 of 5 <br />