Laserfiche WebLink
<br />0---------------------------------------_______________________________ <br /> <br />Person who prepared this summary notice: <br /> <br />Printed name:----------------------------------______________________ <br /> <br />0---------------------------------------_______________________________ <br /> <br />Signature:---------------------------------__________________________ <br /> <br />o Date:-----------------------------------_____________________________ <br /> <br />0----------------------------------------______________________________ <br /> <br />Organization:-------------------------------_________________________ <br /> <br />0-----------------------------------------_____________________________ <br /> <br />Street and city:---------------------------------____________________ <br /> <br />0----------------------------------------______________________________ <br /> <br />State: ZIP: Phone number: (____)--------------------------- <br /> <br />0------------------------------------------____________________________ <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 /> <br />u---------------------------------------_______________________________ <br /> <br />0------------------------------------__________________________________ <br /> <br />0------------------------------------__________________________________ <br /> <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 />common areas (for multifamily housing), bare soil locations, dust- <br />lead locations, and/or building components (including <br />or space, and the material underneath the paint), and <br />based paint hazards presumed to be present: <br /> <br />0-------------------------------_______________________________________ <br /> <br />present. <br />presumed to be <br /> <br />type of room <br />types of lead- <br /> <br />0---------------------------------_____________________________________ <br /> <br />0---------------------------------_____________________________________ <br /> <br />0------------------------------------__________________________________ <br /> <br />0--------------------------------______________________________________ <br /> <br />0------------------------------------__________________________________ <br /> <br />0-----------------------------------___________________________________ <br /> <br />0---------------------------------_____________________________________ <br /> <br />" <br />u--------------------------------______________________________________ <br /> <br />0---------------------------------_____________________________________ <br /> <br />D--------------------~-----------______________________________________ <br /> <br />0--------------------------------______________________________________ <br /> <br />0---------------------------------_____________________________________ <br /> <br />0------------------------------________________________________________ <br /> <br />0--------------------------------______________________________________ <br /> <br />0------------------------------________________________________________ <br /> <br />u----------------------------__________________________________________ <br /> <br />Contact person for more information about the presumption: <br />Attachment 3 <br />Page 3 of5 <br />