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El ---------------------------------------------------------------------- Person vino prepared this sumtary notice: Printed naffe: -------------------------------------------------------- ---------------------------------------------------------------------- Signature: ---------------------------------------------------------- ❑ Date: ---------------------------------------------------------------- ---------------------------------------------------------------------- Organization: ------------------------------------------------------- ❑---------------------------------------------------------------------- Street and city: ---------------------------------------------------- ❑---------------------------------------------------------------------- State: ZI P: Phone number: (_) --------------------------- ---------------------------------------------------------------------- Appendi )--------------------------- ---------------------------------------------------------------------- Appendi x C- - Sarrpl a Sumrar y Pr esunpt i on Notice For nat Note: The f of I ow ng appendix W 1 I not appear in the Code of Federal Regul at i ons Not ce That Lead -Based Pai nt or Lead -Based Pal nt Hazards Are Presuned to be Present Addr ess/ I ocat i on of pr oper t y or st r uct ur e( s) t hi s not i ce of pr esunpt i on appl i es t o: ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- Type of presunpt i on ( check all that apply): ( a) Lead- based pal nt i s pr esuned t o be pr esent . ( b) Lead-based paint hazard(s) is(are) pr esuned to be present. Summary of pr esurrpt i on. List at least the housing unit numbers and common areas ( for nul t i f arriI y housi ng) , bare soil I ocat i ons, dust- lead ust- Iead I ocat i ons, and/or bui I di ng components ( i ncl udi ng type of room or space, and the nat er i al underneath the paint), and types of lead- based paint hazards pr esuned to be present: ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- El---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑-------------------------------------------------- ------------------ Cont act person for nor e i of or mat i on about the pr esunpt i on: Attachment 3 Page 3 of 5