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Appendix A-- Sample Summary Inspection Notice Format <br />Note: The following appendix will not appear in the Code of <br />Federal Regulations <br />Summary Notice of Lead -Based Paint Inspection <br />Address /location of property or structure(s) this summary notice <br />applies to: <br />---------------------------------------------------------------------- <br />---------------------------------------------------------------------- <br />---------------------------------------------------------------------- <br />Lead -based paint inspection description: <br />Date(s) of inspection:----------------------------------------- - - - - -- <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 findings of the inspection is <br />provided below (required if lead -based paint found). <br />Summary of where lead -based paint was found. List at least the <br />housing unit numbers and common areas (for multifamily housing), and <br />building components (including type of room or space, and the <br />material underneath the paint): <br />---------------------------------------------------------------------- <br />---------------------------------------------------------------------- <br />---------------------------------------------------------------------- <br />---------------------------------------------------------------------- <br />---------------------------------------------------------------------- <br />---------------------------------------------------------------------- <br />---------------------------------------------------------------------- <br />---------------------------------------------------------------------- <br />---------------------------------------------------------------------- <br />---------------------------------------------------------------------- <br />---------------------------------------------------------------------- <br />---------------------------------------------------------------------- <br />Contact person for more information about the inspection: <br />Printed name:-------------------------------------------------------- <br />Organization:-------------------------------------------------------- <br />Street and city:----------------------------------------------- - - - - -- <br />[[Page 50231]] <br />State: ZIP:------------------------------------------------------ <br />Phone number: ( ) ------------------------------------------- - - - - -- <br />Person who prepared this summary notice: <br />Printed name: -------------------------------------------------------- <br />Signature: ----------------------------------------------------------- <br />Attachment 3 <br />Page 1 of 5 <br />