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<br />Appendix A--Sample Summary Inspection Notice Format <br /> <br />Note: The folJ.owing appendix wilJ. not appear in the Code of <br />FederaJ. ReguJ.ations <br /> <br />Summary Notice of Lead-Based Paint Inspection <br /> <br />Address/location of property or structure(s) this summary notice <br />appJ.ies to: <br />G---------------------------------------------------------------------- <br />u---------------------------------------------------------------------- <br />0---------------------------------------------------------------------- <br /> <br />Lead-based paint inspection description: <br />Date(s) of inspection:----------------------------------------------- <br /> <br />Summary of inspection resuJ.ts (check alJ. that appJ.y): <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 beJ.ow (required if J.ead-based paint found) . <br /> <br />Summary of where J.ead-based paint was found. List at J.east the <br />housing unit numbers and common areas (for lIlUJ.tifaDtiJ.y housing), and <br />buiJ.ding components (incJ.uding type of room or space, and the <br />materiaJ. underneath the paint) : <br /> <br />u---------------------------------------------------------------------- <br /> <br />0---------------------------------------------------------------------- <br />~---------------------------------------------------------------------- <br />C---------------------------------------------------------------------- <br />0----------------------------------------------------------------------- <br />0---------------------------------------------------------------------- <br />0---------------------------------------------------------------------- <br />0---------------------------------------------------------------------- <br />0---------------------------------------------------------------------- <br />0---------------------------------------------------------------------- <br />0---------------------------------------------------------------------- <br />~---------------------------------------------------------------------- <br />0---------------------------------------------------------------------- <br />Q---------------------------------------------------------------------- <br /> <br />Contact person for more information about the inspection: <br />Printed name:-------------------------------------------------------- <br />Organization:-------------------------------------------------------- <br />Street and city:----------------------------------------------------- <br /> <br />[[Page 50231]] <br /> <br />state: ZIP:------------------------------------------------------ <br />Phone number: (____)------------------------------------------------- <br /> <br />Person who prepared this summary notice: <br />Printed name:-------------------------------------------------------- <br />Signature:----------------------------------------------------------- <br />Attachment 3 <br />Page 1 of5 <br />