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<br />Appendix A--Sample Summary Inspection Notice Format <br /> <br />Note: The following appendix will not appear in the Code of <br />Federal Regulations <br /> <br />Summary Notice of Lead-Based Paint Inspection <br /> <br />Address/location of property or structure(s) this summary notice <br />applies to: <br /> <br />0--------------------------------______________________________________ <br /> <br />0------------------------------________________________________________ <br /> <br />0--------------------------------______________________________________ <br /> <br />Lead-based paint inspection description: <br />Date(s) of inspection:--------------------------_____________________ <br /> <br />of inspection results (check all that apply) : <br />No lead-based paint was found. <br />Lead-based paint was found. <br />(c) A brief summary of the findings <br />provided below (required if lead-based paint <br /> <br />Summary <br />(a) <br />(b) <br /> <br />of the inspection is <br />found) <br /> <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 />0-----------------------------_________________________________________ <br /> <br />0-------------------------------_______________________________________ <br /> <br />D-----------------------------_____________________~--_________________ <br /> <br />0--------------------------------______________________________________ <br /> <br />0-----------------------------_________________________________________ <br /> <br />0----------------------------__________________________________________ <br /> <br />0----------------------------__________________________________________ <br /> <br />~ . <br />u------------------------------________________________________________ <br /> <br />D-----------------------------_~----------------_______________________ <br /> <br />0-----------------------------_________________________________________ <br /> <br />0----------------------------__________________________________________ <br /> <br />0-----------------------------_________________________________________ <br /> <br />0----------------------------__________________________________________ <br /> <br />0-----------------------------_________________________________________ <br /> <br />Contact person for more information about the inspection: <br /> <br />Printed name:--------------------------______________________________ <br /> <br />Organization:-----------------------_________________________________ <br /> <br />Street and city:-------------------------____________________________ <br /> <br />[[Page 50231]] <br /> <br />State: ZIP:--------------------------____________________________ <br /> <br />Phone number: (_) ----------------__________________________._______ <br /> <br />Person who prepared this summary notice: <br /> <br />Printed name:-------------------------_______________________________ <br /> <br />Signature:--------------------_______________________________________ <br /> <br />Attachment 3 <br />Page 1 of5 <br /> <br />