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<br />D---------------------------------------------------------------------- <br />Person who prepared this summary notice: <br />Printed name:-------------------------------------------------------- <br />1 1---------------------------------------------------------------------- <br />Signature:----------------------------------------------------------- <br />U Date:---------------------------------------------------------------- <br />D---------------------------------------------------------------------- <br />Orqanization:-------------------------------------------------------- <br />D---------------------------------------------------------------------- <br />Street and city:----------------------------------------------------- <br />D---------------------------------------------------------------------- <br />state: ZIP: Phone number: (____)--------------------------- <br />-;---------------------------------------------------------------------- <br /> <br />Appendix C--Sample Summary Presumption Notice Format <br /> <br />Note: The following appendix will not appear in the Code of <br />Federal Regulations <br /> <br />Notice That Lead-Based Paint or Lead-Based Paint Hazards Are Presumed <br />to be Present <br /> <br />Address/location of property or structure(s) this notice of <br />presumption applies to: <br />D---------------------------------------------------------------------- <br />D---------------------------------------------------------------------- <br />D---------------------------------------------------------------------- <br />Type of presumption (check all that apply) : <br />(a) Lead-based paint is presumed to be <br />(b) Lead-based paint hazard(s) is (are) <br />present. <br />Summary of presumption. List at least the housing unit numbers and <br />cammon areas (for multifamily housing), bare soil locations, dust- <br />lead locations, and/or building components (including type of room <br />or space, and the material underneath the paint) I and types of lead- <br />based paint hazards presumed to be present: <br />[J--------------------------------------------------------------------__ <br />IJ---------------------------------------------------------------------- <br />D---------------------------------------------------------------------- <br />U---------------------------------------------------------------------- <br />D---------------------------------------------------------------------- <br />D--------------------------------------------------------------________ <br />U---------------------------------------------------------------------- <br />U---------------------------------------------------------------------- <br />D-----------------------------------------------------------___________ <br />D-------------------------------------------------------_______________ <br />U---------------------------------------------------------------------- <br />D--------------------------------------------------------------________ <br /> <br />present. <br />presumed <br /> <br />to be <br /> <br />u------------------------------------------------------________________ <br />D---------------------------------------------------------_____________ <br />D--------------------------------------------------------______________ <br />IJ----------------------------------------------------------____________ <br />1 1-------------------------------------------------_____________________ <br />Contact person for more information about the presumption: <br />Attachment 3 <br />Page 3 of5 <br />