11 SUMMER STREET UNIT 1L LEAD INSPECTION REPORT 10-29-2022 i
XYZ lid P Mtt Ter" Z_
� Z
46 Towertt(N St
Lowrance,MA 01841.
LaW 1��y,
XYZ Lead Paint Testing Mobile,(978)876-2054 .
Rafael Vasquez
Licensed Lead inspector Office:(978)686-3797
— mzleadpaint@imaii.com
Lead Inspection I.Risk Assessment
StA Strqet Name t p1 Street Type Unit
Gity Zip Code
Owner Name:
Number of Rooms in Unit:
Property Type:
Owner Address:
Contact Information.: t..1 S' gle Family
Client Name(if different from owner): Multi Family #of Units:
Condominium #of Units:
�
Client Address: Care C] Other:
.UaY
d Column 1!ekga hunt Golumn Delead IC Metfiail Calnm» Laundry in Basement? ElYes No.
DC Covered. F
Covered REM Removed Finished Space in Basement? Yes t�.ij�o
DC imp Ceiling Di d
IvIEf 1Vfewt Wed
REP Replaced
Encapsulated. SCR scrad Possible Pb'Water Servic ine
MR Metal Rep.Window intact .
NA Not Xccess�le SFR Storm Frame Removed Yes Na Not Tasted
Made Intact SLD Sealed. Testing Method Used
NC No Coating PRE Prepared for Enc- STP Stripped
Tile Tile(testing suggested) Component Dow Not Exist VRfMR VieryUMetal Rap Window 251aZS Expiration Bate: # #
VB Vinyl Baseboard X-flay Fluoreseenee
VR Vinyl Rep.Window del: Serial#
4 mtnents 1.Notes:.
`— n Demarcation Lines
Cl Submitted for Compliance Evaluation
Floor#' . . (level within building of unit being inspected) Floor# Property Diagram I Knit Labels
C C t
.............!
a
Z r 7
f t, t
1 e f
`--;-
A>
I
o-
.J
'
A(Street Side) Start here rL(Street Side) Start Here
Pb(lead)equal to or greater than 1.0 tng/ems with x-rdy uorescence or positive with Na2S is Dangerous,A(StteetSide) .
XRF Calibration Recorded in Log Book ,�
Address.Verified through USPS ,/ Checkoff when complete
R arch onJLFad Related History far Address Check off wheat complete.ma.ustd tPPp tar 800-531-957 Lid Ch hen fete
212,
2-
Inspector's I 'me(print} Ltcensa#
Z 2
L31RA-risoa ocrt Sigh re Date
f
Address: I I Stammer St
INSPECTION HISTORY Apt#1 Left City Salem �
Page 2 of�
Determination INTERIM CONTROL
Y Inspector Name: Lic# Visual
Risk Assessment R.A.Name: Lic#
N Signature Y
Lead Hazards? Signature
[Ur ent Pb.Hazards? N
Comprehensive
Dust Ta en for
Initial Ins,ection
y Inspector Name:R Vas uez Lie#4224 Risk Assessment Y R.A.Name: Lic#
1 0 2 9 2 2
N Signatur N Signature
Lead Hazards? Urgent Pb.Hazards? —
Comp initial Visual Portion of
Nv/Partial PCAD Inspector Name: Reinspection for P R.A.Name: Lic#
Y LIC# Interim Control
1V Signature F Signature
Lead Hazards?
Addendum(add-on Dust Taken for Risk
to Initial Ins ection P R.A.Name: LIC#
Y Inspector Name: ,Lic# Assessment Reins .
N Signature
F Signature
Lead Hazards'?
Visual Portion of
Addendum as Full Reinspection for
Interun Control P R.A.Name: Lic#
In ection
NN
Inspector Name: Lic#
F Signature
Signature
Lead Hazards?
Dust Taken for Risk �F]
R.A.Name: Lic#
Walk Through for Inspector Name: Assessment Reins .
� Ed/Consultation
Lic# Signature
Signature
REINSPECTION HISTORY 0 R.A.Name: Lic#
Visual Portion of NF
Inspector Name: Lic# N Signature
Reocc.Reins ection
Imards?
Signature
Dust Taken for P R.A.Name: LIC#
Visual Portion of Inspector Name: LIC# RA Recertification
Reece,Reins ection HF
F Signature
Signature
Dust Taken for Inspector Name: Lic#
POST COMPLIANCE ASSESSMENT DETERMINATIONS
P
Reece.Reinspection
� F Signature PCAD
Y Inspector Name: Lic#
II' Dust Taken for RFFSignature
Inspector Name: Lic# N
Signature
Reece.Reins ection Lead Hazards:
Full Inspection
Actin as PCAD Inspector Name: Lic#
v7sual Portion of P Inspector Name:
Final Reins ection ,LIC#
N Signature
F I Signature Lead Hazards?
Visual Portion of Inspector Name: Visual Po,tiou of Inspector Name: Lid
Final Reins ection P LIC# PCAD Reinspection P
F Signature BSignature
Dust Taken for F..T1 p Inspector Name: LIc# Dust Taken for P Inspector Name: Lic#
Reinsp:(No Reocc) PCAD Reins ection
F Signature iSignature
III Dust Taken for Final p Inspector Name: Dust Taken for Inspector Name:Reins No Reocc) ,LIC# ffr!T!N
P ,LIC#
F Signature F Signature
History rev 6/17
Address:I I Summer St Apt#1 Left �j
City Salem Page 3 of
REOCCUPANCY CERTIFICATE HISTORY
COMPLIANCE HISTORY(CONY.)
Certificate of
Reoccu anc• Certificate of
Inspector Name: Maintained
iLic# Con, hance Inspector Name: Lic#
Only after Signature
H;gh/Mod Risk Signature
#rooms rule No Work=No Dust
Work=7 Dust
Certificate of
Reoccu anc, Certificate of
Inspector Name: ,Lic# Restored
Com liance Inspector Name: Lic#Only after Signature
High/Mod Risk Signature
#rooms rule Dust wipes and auth.
eo le
Certificate of
Reoccu anc Certificate of
Inspector Name: Lic# Maintained
Com hance Inspector Name: Lic#
Only after Signature
High/Mod Risk Signature
#rooms rule No Work=No Dust
Work=7 Dust
COMPLIANCE HISTORY
Letter of Full Initial Certificate of
Com liance Inspector Name: Restored Inspector Name:Lic# Compliance Lic#
No pr or h;story/ Signature Signature
No signs of UD Dust wipes and auth.
people
Letter of Interim OTHER HISTORY:WAIVERS/UD
� Control Inspector Name: ,Lic#
Approved
Signature CLPPP Waiver Inspector Name:No prior Comp. ,Lic#
Ex ires in I r.
Attach to Comp Signature
Does
Recertification of
Interim Control Inspector Name;
Lic# Approved
CLPPP waiver Inspector Name: Lic#
Expires 2 vrs from Signature
original IntAttach to Comp Signature
rim
' Control
C01
DOGS
Letter of Full
Deleading Inspector Name: UD/DES Visual
Com Hance Lic# Reins ection
p� Inspector Name: Lie#
I Signature
Dust wipes if No F Signature
Reocc. No LOC Issued
F7Dust
FLUD/ ES Dust
Inspector Name: Lic# ken �p Inspector Name: Lic#No SignatureF Signature
Issued
UD/DES Dust
FCO21e
Taken pp Inspector Name: Lic#
Inspector Name: Lic# F Signature
No LOC issued
Dus Signature
UD/DES Final
Reins ection p Inspector Name: Lick
-
Signature
Signature
No LOC Issued
History rev 6/17
Page 4 of;�'Z_
EXPLANATION OF LEAD INSPECTION 1 RISK A ESSMENT REPORT FORM COLUMNS
j This page provides general in needed to understand the lead inspection/risk assessment report,How
with the inspector/risk assessor before you start to do any wank on your hams. p ever,you should speak
SIDE Refers to A,B,C,or side of the building or room.See the di
building or room is the side facing the street
thatves theagram on the cover sheet.The``A"side of the
buildin , .property its address(usually,it is the front of the.
g) Ke in ep g your back to this street,from the:"A"side move clockwise to the"B"side on your left,the«C„
side opposite you,and the"13"side to the right. Numbering is from left to right,
LOCATION/SURFACE..
Refers to.the building component(s)being tested.Some surfaces may be made up of more than one art.For
SURFACE.. example;<`Baseboard"tray refer to four separate pieces of wood(one on each wail),but is still considered one surface.
LEAD The.actual lead result.Each surface tested must have a result recorded in.the"Lead"column.
• A number shows that the surface was tested with an XRF analyzer.A number.equal.to or greater than 1.0 mg/cm'
is a dangerous level of lead. .
•
le"pos"or"neg shows that level of lead., the surface was tested with sodium sulfide."Pos"means that there is a dangerous
means that the inspector was not able to test.the surface.The inspector must assume the surface contains lead
and require it to be deleaded.Speak to the inspector about Possible
• "ME1 'or"MR"means:that a metal alternativ testing options.
surface was not tested.Metal handrailsemetat window sills,and metal
railing caps need to be deleaded if they test equal to or greater than 1.0 mg/cm`,or are marked"MET"or
"NWT .All other metal surfaces must be intact,
• For key to abbreviations like"Cor$ "W «
VR or"MR","NC «Tile","➢C'--',seethe cover page.
TYPE OF Not all lead paint must be deleaded:This column tells you IF and WHY a surface needs deleadingg.The deleadin
HAZARD standards below may not apply for Interim Controls.Speak to your risk assessor for more information.. g
°`M/I"circled means that the surface is-a moveable/impacted part of a Window and must be deleaded in its entirety.
' "SF"circled indicates that there is a storm frame.preserit which requires the bland stop and exterio
deleaded as interior.moveable./impacted surfaces. r sill be
• "t1/M"circled means that the surface is"accessible mouthable"and must be deleaded to a minimum of five feet
high,four inches in from.the edge or corner.
• 'T'circled means that the surface is a"friction"surface and must be deleaded at all points of potential friction.
' "L"circled Yiieans that the surface is loose and must,at a minimum,be made intact.Loose leaded floors must.v
seated with paint or similar coating and pass a due#wipe.
. `I re than one choice is circled;the rules for depending may change depending upon what method of
"M you choose.Speak to the inspector for more information.
• "N/A"means the inspector vas umable to determine if the surface was a lead hazard.The person doing the
depeading must check this surface and follow all the rules for depeading.Speak to the inspector for more
information.
• Ifrnothing is circled in the column,then it is likely the surface doe
fo s not need depending.Speak to the inspector
r more�inform�ation. Remember;this does not mean the entire surface is lead free,it just does not require _.
depeading in its current condition.
URG HAZ? This column is completed during a risk assessment,which is an evaluation of a home's sui
fbr
Control. Only a licensed risk assessor can do a risk assessment. If"Y"is circled,there this surface isterim con i.dered
an"Urgent.Lead Hazard"and depeading is required to qualify for Interim Control.
IC DAT
The date the licensed risk assessor determines the surface meets the standards for Interim Control.
IC METH e delead�ng method or structural repair.done to qualify.the surface for Inte rim Control..Refer to the depending gdes.key o n:the cover page.
DELEAD DATE E The date that the lead inspector reinspects the surface and rinds that it is in compliance.
IDEI EAI)!METH The method used to bring a surface into full compliance.Refer to codes in the Key on the report's Dover page.
EXCLUDED The amount'of loose paint on a.surface as measured by the lead inspector."N/A"means that the in was not
SURFACES able to measure the loose paint;but has determined it is more than the cut-off for moderate risk making intact.
RULED
OUT, are adhesion a hesiots only
Box are work:well if paint is in good condition.If the inspector sees that there
n problems with eligible surfaces in a roomy he/she will rule out encapsulations as a depending method.
LIRA,Exp:2017
j Rafael Vas uez U4224
pector(p cIns nt) Li f
# 1 29 22 PageOf �
Signature Date
i
Risk Assessor(print) Lic# Signature -
AddressofPr 11 Summer St Date
ROOM# A t. it: Calm
tj
SIDE LOCATION/ I LEAD TYPE OF URG IC IC JDILEADJ DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZARD 1HAZ?1 DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH
A B
p•Walls L N/A Y
Window Sill ,Z M/I AIM L NIAffYjA B LvWalls L NlA Y B Win Apron L N/Ac Baseboards L N/A YA B C Win Casing �, L NIA
Chair Rail L NIA Y
D Header Stop MA L N/A Y
Radiator L N/A Y Int Stops P MA L NIA Y
Floor / L ✓®(dust) N/A Y 1 Win IntSash
c M/I L N/A Y
",,Ceiling L NIA Y Exterior Sill
A F lA Y
A t3 Door L N/A Y 3 Part Bead M/
C ,Door Edge F L N/A Y N/ Y
4 Blind Stop SF L !A Y
2 Door Casi L N/A Y Win Ext Sash M/I L �/Ap Y
3 4 Door Jamb 7, F L N/A Y A Window Sill Mll A!M L NIA Y
Threshold L NIA Y
B Win Apron L N/A Y
AB Door L N/A Y
Win Ca
sing L NIA Y
C D DoorEdge F L N/A Y Q Header Stop M/I L N/A Y
12 Door Casing L NIA Y
Int Stops 2 M/I L N/A Y
3 4 600rJamb F L N/A' Y 1 Win lnt5ash M/I L N/A Y
Threshold L N/A Y 2 Exterior Sill
.ll SF L l Y
A B Door L N!A Y 3 Part Bead
�
C D Door Edge F L N/A Y / L Y4 Blind Stop 1N! S L Y
1 2 Door Casing L NIA Y
/I
3 4 Door Jamb F L NIA Y Win Ext Sash L /A Y
A Window Si11 Mll AIM L N/A Y
Threshold L N/A Y
B lWin Apron I L N/A Y
Closet Door L NIA Y
C Win Casing L NIA Y
A Cl Door Edge F L N/A Y D Header Stop M Int Stops M/1 L NIA YA L N/A Y
B Cl Casing L NIA Y �.
C Closet Jamb F L NIA Y 1 Win IntSash M/I L N/A Y
D Closet Walls L N/A Y 2 Exterior Sill Mil SF L N/A Y
Cl Baseboard L N/A Y 3 Part Bead F M/1 L NIA Y
1 Closet Pole L N/A Y 4 Blind Stop M11 SF L N/A Y
2 Closet Shelf L N/A Y Win Ext Sash r M/1 L NIA Y
3 Cl Supports L N/A Y A B Fireplace L NIA Y
4 Closet Floo L®(dust) N/A Y
C D Mantle L NIA Y
Closet Ce'ing L N/A Y AB
CID Win Above 5' L N/A Y
COMMENTS/STRUCTURAL DEFECTS:
Ceiling Moldin L NIA Y
F M!1 AIM L WA Y
f M/l AIM L WA Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/1 A/M L N/A Y
by a Deleader(MORE THAN 288 SQ.IN.) F Mn A/M L WA Y
SIDE LOCATION MEASURE:LOOSE PAINT IC IC F M/1 AIM L N/A Y
DATE METHOD F Mil AIM L N/A Y
Check the box if this ROOM is RULED OUT for•encapsulation
because there are 3 or more AIM surfaces with adhesion problems
Ll/RA Rep 2017 Room
i
Rafael Vas uez U4224 10 29 22 Page f�Of
Inspector(print) Lic# Signature
Date
Risk Assessor(print) Lic# Signature Date
Address of Pro erI : 11 Summer St Apt.# cijy7 Salem
ROOM#
SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD � TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH
A B �1 rp tUalls L N/A Y A Window Sill f1, M/I A/M L N/A Y
A B L-eGv Walls 0. L NIA Y B Win Apron A B L N/A Y
C D Baseboards L IA Y
A B C Win Casing , L N/A Y
Chair Rail L N/A Y A D Header Stop Mil L N/A Y
Radiator L N/A Y Int Stops M/I L N/A Y
s Floor L®✓(dust) NIA Y 1 in IntSash M/I L N/A Y
Ceiling L N/A Y
2 Exterior Sill it F L NlA Y
A B Door L N/A Y
3 Part Bead /I L /A Y
C D Door Edge F L N/A Y
4 Blind Stop M/ SF L /A Y
1 2 Door Casing L NIA Y Win Ext Sash I L N/A Y
34 Door Jamb F L NIA Y A
Threshold Window Sill �� M/I AIM L N/A Y
L N/A Y
B Win Apron L N/A Y
A B Door L N/A' Y C Win Casing L N/A Y
G D Door Edge F L NIA Y D Header Stop M/I L NIA Y
12 Door Casing L NIA Y
Int Stops M/I L N/A Y
34 Door Jamb
®� F L N/A Y 1 Win lntSash 2—M/I L N/A Y
Threshold L NIA Y 2 Exterior Sill M/ F 'L / Y
A B Door L NIA Y 3 Part Bead M L / y
C Door Edge F L N/A Y
" 4 Blind Stop M SF L /A Y
1 2 Door Casing L N/A Y Win Ext Sash M/ L /A Y
3 4 Door Jamb 0j F L N/A Y
Q
Window Sill Mil AIM L N/A Y
Threshold L N/A Y Win Apron L NIA Y
Closet Door L NIA Y C Win Casing 03 L N/A Y
A Cl Door Edge F L NIA Y D Header Stop 6. M/I L N/A Y
B Cl Casing L NIA Y Int Stops M/I L N/A Y
C- Closet Jamb . F L N/A Y 1 Win Int Sash Mil L N/A Y
D Closet Walls L NIA Y 2 Exterior Sill Mil F L / Y
CI Baseboard L NIA Y 3 Part Bead & M L /A Y
1 Closet Pole L N/A Y 4 Blind Stop MI L 1 Y
2 Closet Shelf L N/A Y Win Ext Sash M/ L /A Y
3 Cl Supports L NIA Y A B Fireplace L N/A Y
Ad
4 Closet Floor L®(dust} N/A Y
C D Mantle L N/A Y
Closet Celli g L N/A Y AB
Go Win Above 5' L N/A Y
CQMMENTS/STRUCTURAL DEFECTS:
Ceiling Moldin L N/A Y
F M/1 AIM L N/A Y
F M/I AIM L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F Mil AIM L NIA Y
by a Deleader(MORE THAN 288 SQ.IN.)
F M/I AIM L N/A Y
SIDE LOCATION MEASURE:LOOSE PAINT IC IC F M/1 AIM L N/A Y
DATE METHOD F MA AIM L N/A Y
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more A/M surfaces with adhesion problems
LURA Rep 2017 Room
RRafael vas ueZ U4224 —� 0 29 22 Pa Inspector(print) Lic# Signatu e Of
Page
Date
I
Risk Assessor(print) Lic# Signature
l Date
Address of Property: 11 Summer$t
ROOM# it Salem
SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDEJ LOCATIONI LEAD TYPE OF URG IC 1C DELEAD DELEAD
SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH
A B #i7tNalls L N/A Y A Window Sill 11. AIM. L NIA Y
A B Low Walls L NlA Y Win Apron L N/A Y
A B
c Baseboards L N/A Y
n B G Win Casing L NIA Y
Chair Rail 6 L N/A Y D Header Stop M/I L NIA Y
B !
Radiator O L N/A Y Int Stops P M/I L N/A I' Y
Floor . L ✓®(dust} NIA Y 1 Win IntSash M/I L N/A Y
"y :,•Ceiling lA Y
2 Exterior Sill
A Door N/A Y
3 Part Bead W/ N
y
CID Door Edge F L NIA Y 4 Blind Stop Y
12 Door Casing L N/A YWin Ext Sash Y
34 Door Jamb F L NIA Y A Window Sill Mll AIM—L NIA Y
Threshold L N/A Y B Win Apron V' L N/A Y
A B Door L NIA Y C Win Casing 61 L N/A Y
'or Edge F L N/A Y Header Stop M/l L NIA Y
1 Door Casing L NIA Y Int Stops M/I L N/A Y
34 Door Jamb F L N/A Y 1 Win Int Sash M/I L N/A Y
Threshold L NIA Y 2 Exterior Sill M/I SF L 1 Y
AB Door L NIA Y 3 Part Bead M/I L / Y
C D Door Edge F L N/A Y
4 Blind Stop M SF L, Y
12 Door Casing L NIA Y Win Ext Sash
L /A Y
34 Door Jamb F Y A Window Sill M/I AIM L N/A Y
Threshold L N/A Y B Win Apron L NIA Y
Closet Door L N/A Y
C Win Casing L NIA Y
A Cl Door Edge F L N/A Y D Header Stop M/I L N/A Y
B Cl Casing L NIA Y Int Stops p Mil L N/A Y
C Closet Jamb / F L N/A Y 4 Win Int Sash M/I L NIA Y
D� Closet Walls Gj. L /A Y
2 Exterior Sill MII SF L N/A Y
Cl Baseboard L /A Y 3 Part Bead Mil L NIA Y
1 Closet Pole L A Y 4 Blind Stop M/I SF L N/A Y
2 Closet Shelf L N/A Y
Win Ext Sash M/I L NIA Y
3 CI Supports L N/A Y A B Fireplace L N/A Y
4 Closet Floor L®(dust) NIA Y
C D Mantle L N/A Y
Closet Ceiling L NIA Y C D Win Above 5' L N/A Y
COMMENTS/STRUCTURAL DEFECTS:
Ceiling Moldin L N/A Y
F M/I AIM L N/A Y
F M/I AIM L WA Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M11 AIM L N/A Y
by a Deleader(MORE THAN 288 SQ.IN.)
F Mll AIM L NIA Y
SIDE LOCATION MEASURE:LOOSE PAINT IC IC F M/I AIM L N/A Y
DATE METHOD F M/1 AIM L NIA I Y
Check the box if this ROOM is RULED OUT for encapsulation
II
because there are 3 or more AJM surfaces with adhesion problem
LVRA Rep 2017 Room
Rafael Vas uez U4224
Inspector rint 10 29 22 Page of
P (print) Lic# Signature Date
I
i Risk Assessor(print) Lic# Signature
Date
Ad r ss of Pr rt : 11 Summer St Cit : Salem
ROOM
SIDE LOCATI N/ LEAD TYPE OF URG IG IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE
A B HAZARD HAZ? DATE METH DATE METH
o, L N/A Y A Window sill' M/I A/M L N/A Y
A BtWalls
Walls /�
v L N/A Y B Win Apron L N/A Y
A B
c p Baseboards L /A Y
A B Chair Rail L N/A Y C Win Casing L N/A Y
AS D Header Stop M/l L N/A Y
Radiator L N/A Y Int s
Sto
Floor L ✓®(dust}NIA Y p MCI L NIA Y
1 Win IntSash M/I L N/A Y
Ceiling L N/A Y 2 Exterior Sill M/1 SF L N/A Y
lil A Door L N/A Y 3 Part Bead M/I L N/A' Y
C D Door Edge F L N/A Y 4 Blind Stop
1 2 Door Casing Q L N/A Y M/I SF L N/A Y
Win Ext Sash M/I L NIA Y
34 Door Jamb F L NIA Y A IW,,dosii M/1 A/M L N/A Y
Threshold L NIA Y
� B Win Apron L N/A Y
B oor L N/A Y
C Win Casing L NIA Y
I Door Edge F L N/A Y D Header Stop M/I L N/A Y
12 Door Casing L NIA Y Int Stops M/I L NIA Y
3 4 Door Jamb F L N/A Y 1 Win Int Sash M/l L NIA Y
Threshold /�. L NIA Y 2 Exterior Sill MA SF L N/A Y
A B Door L N/A Y 3 Part Bead M/I L N/A Y
!, D Door Edge F L N/A Y 4 Blind Stop M/I SF L N/A Y
1 Door Casing L N/A Y Win Ext Sash M/I L N/A Y
34 Door Jamb d2 F L N/A Y A Window Sill MII A/M L NIA Y
Threshold L N/A Y B Win Apron L N/A Y
Closet Door L N/A Y
C Win Casing L NIA Y
CI Door Edge F L N/A Y D Header Stop M/1 L N/A Y
B CI Casing �, L N/A Y
Int Stops M/I L N/A Y
C Closet Jamb F L N/A Y 1 Win Int Sash Mil L NIA Y
D Closet Walls L /A Y 2 Exterior Sill M/I SF L N/A Y
Cl Baseboard L N/A Y 3 Part Bead M/l L NIA Y
1 Closet Pole L N/A Y 4 Blind Stop M/I SF L N/A Y
2 Closet Shelf L N/A Y Win Ext Sash M/l L N/A Y
3 .CI Supports L N/A Y A B Fireplace L N/A Y
4 Closet Floor L®(dust) NIA Y
C D Mange L NlA Y
Closet Ceiling L N/A Y AS
COMMENTS/STRUCTURAL DEFECTS: CD Win Above 5' L N/A Y
• a Ceiling Moldin L N/A Y
F M/I AIM L N/A Y
F Mil AIM L NIA Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact FM/1 A/M L N/A Y
by a Deleader(MORE THAN 288 SQ.IN.)
F M/I A/M L N/A Y
SIDE LOCATION MEASURE:LOOSE PAINT IC IC F M/I A/M L N/A Y
DATE METHOD F MII AIM
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more A/M surfaces with adhesion problems
LA/RA Rep 2017 Room
P
Rafael Vasquez U4224 f 10/ 29 / 22 Page of Inspector(print) Lic# Signature
Date
Risk Assessor(print) Lic# Signature
Date
Ad ress of Pro ert : 11 Summer St A I.# city: Salem
Common Hallway: Front Rea Floor#
SIDE LOCATION/ LEAD TYPE OF I URG IC IC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH
C D Up Walls —4::::L NIA Y
A B Closet Door L N/A Y
Low Walls L N/A Y A CI Door Edg F L N/A Y
A B
A B Baseboards L N/A Y B CI Casing
L N/A Y
Chair Rail L N/A Y G Closet Jamb F L N/A Y
AB
Radiator L N/A Y
D Closet Walls ��L
Y
Floor L®(dust) N/A Y Cl Baseboard
t Ceiling Y
L N/A Y Closet Pole
L NIA Y
A B Door L N/A Y 2 Closet Shelf
L N/A Y
C D Door Edge F L NIA Y 3 Cl Supports
12 Door Casin L N/A Y 4 Closet Floor L❑(dust) NIA Y
34 Door Jamb F L N/A Y Closet Ceiling
Threshold L N/A Y A Window Sill /1 A/M L N/A Y
A B Door L N/A Y B Win Apron L N/A Y
G D Door Edge F L N/A Y
C Win Casing L N/A Y
12 Door Casing L N/A Y D Header Stop M/I L NIA Y
34 Door Jamb F L N/A Y Int Stops p M/I L N/A Y
Threshold L N/A Y 1 Win IntSash M/I L N/A Y
A B Door L N/A Y 2 Exterior Sill M/I SF L N/A Y
C D Door Edge F L NIA Y 3 Part Bead M/I L N/A Y
12 Door Casing L NIA Y 4 Blind Stop . M/I SF L N/A Y
34 Door Jamb F L N/A Y Win Ext S h M/I L NIA Y
Threshold L N/A Y A I Window Sill M/I A/M L N/A I Y
A B Door L N/A Y B Win Apron L N/A Y
C D Door Edge F L N/A Y
C Win Casing L N/A Y
12 Door Casing L N/A Y D Header Stop M/I L N/A Y
3 4 Door Jamb s F L N/A Y Int Stops M/I L N/A Y
Closet Door L N/A Y 1 Win Int Sash M/I L N/A Y
A Cl Door Edge F L NIA Y 2 Exterior Sill M/I SF L N/A Y
B Cl Casing L N/A Y 3 Part Bead M/I L N/A Y
C Closet Jamb F L N/A Y 4 Blind Stop M/I SF L N/A Y
D Closet Walls N/A Y
Win Ext S sh M/I L N/A Y
Cl Baseboard L /A Y AB
1 Closet Pole c D Win Above 5' L N/A Y
�• L N/A Y y�
2 Closet Shelf L N/A Y Melling Ceiling Moldin L NIA1 Y
3 CI Supports ®. L N/A Y F Mil A/M L N/A Y
4 Closet Floor L 13(dust) Y F M/I A/M L N/A Y
/
Closet Ceiling L /A Y F Mil A/M L NIA Y
COMMENTS/STRUCTURAL DEFECTS;
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact
by a Deleader(MORE THAN 288 SQ.IN.)
SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more A/M surfaces with adhesion problems
Ll/RA Rep 2017 Hall
Rafael Vasquez It42 24
Ins ector(print) 1 U /29 /22 Page Of
P (P ) Lic# Signa u re Date
Risk Assessor(print) Lic# Signature Date J
Ad r ss of Pro : 11 ummer t A t.# it : Salem
CONTINUATION OF ROOM
SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF I URG IC IC DELEAD DELEAD
SURFACE HAZARD HAZ, DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH
A B Door L NIA Y Low Cab Fram L N/A Y
C D Door Edge F L NIA Y AB Low Cab Door
L N/A Y
12 Door Casing L NIA Y CD Low Cab Walls L NIA Y
34 Door Jamb F L NIA Y
Threshold # Low Cab Shivs L N/A Y
L NIA Y Supports L NIA Y
A B Door L NIA Y Drawers
L NIA Y
-D Door Edge F L N/A Y A Window Sill M11 AIM L NIA Y
12 Door Casing L NIA Y B Win Apron L NIA Y
34 Door Jamb F L NIA Y
C Win Casing L NIA Y
Threshold L NIA Y D Header Stop Mil L NIA Y
A' Door L NIA Y Int Stops Mil L NIA Y
CD DoorEdge F L NIA Y # Win lntSash M/l L NIA Y
12 Door Casing L N/A Y
Exterior Sill M/I SF L NIA Y
34 Door Jamb F L N/A Y Part Bead M/I L NIA Y
Threshold L NIA Y Blind Stop MII SF C N/A Y
Closet Door L N/Al Y Win Ext Sash Mll L NIA Y
A CI Door Edge F L NIA Y A Window Sill M/I AIM L N/Al Y
B 'ClCasing L NIA Y B Win Apron L NIA Y
C Closet Jamb 2-aF L NIA Y
C Win Casing L NIA Y
Closet Walls L /A Y D Header Stop Mill L NIA Y
CI Baseboard L NIA Y Int Stops P MIL L NIA Y
Closet Pole L NIA Y # Win Int Sash MII L NIA Y
Closet Shelf L NIA Y
Exterior Sill MII SF L NIA Y
Cl Supports L N1A Y Part Bead M/I L N/A Y
Cl Drawers L NIA Y Blind Stop M/I SF L N/A Y
Cl Dr Frame L NIA Y Win Ext Sash Mil L NIA Y
Closet Floor L❑(dust) NIA Y
A B Fireplace L NIA Y
Closet Ceiling L /A Y
CD Mantel L NIA Y
AB
CD Shivs Above 5' L NIA Y A B Sidelight(Lj L NIA Y
AB
c o Cab Above 5' L N/A Y C D Sidelight(R) L NIA Y
AB
c o Cab Above 5' L N/A Y AB
c D Win Above 5' L NIA Y
C D Up Cab Door L N/A Y AB
CID Win Above 5' L NIA Y
Up Cab Walls L NIA Y F M/I AIM L NIA
# Up Cab Shlvs L N/A Y F M/I AIM L NIA
Supports L NIA Y
F M/I AIM L NIA
F M/I AIM L N/A F M/I AIM L N/A
F M/1 A/M L N/A F M/l AIM L_N/A
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS I STRUCTURAL DEFECTS:
by a Deleader(MORE THAN 288 SQ.IN.)
]SIDE 2gg5 LOOSE PAINT IC IC
DATE. METHOD
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more AIM surfaces with adhesion problems
L1/RA Rep 2017 Room contd.
i
r'
Rafael Vas uez
U4224 > 10/ 29 /22 Page//Of' �
Inspector(print) Lic# Signature
Date
Risk Assessor(print) Signature
Address of Pro eri : 11 Summilar St Date
PANTRY A t.# Cit : Salem
SIDE LOCATION( LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE L=llsL
TYPE OF URG IC IC IDELEADI DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SHAZARD HAZ? DATE METH DATE METH.
6
D Walls L NIA Y A B Up L N/A Y
-w Walls L NIA Y CD Up L N/A Y A B
a B Baseboards L N/A Y Up L N/A YChair Rail12 Up L N/A Y
ABCD Radiator L NIA Yor 34 Su
L®(dust) N/A Y AB Up Cab Frame L NIA Y
zN, Ceiling f . L NIA Y C D Up Cab Door L N/A Y
A Door L N/A Y
D Door Edge F L N/A Y
Up Cab Walls L N/A Y 1 2 Up Cab Shlvs L NIA Y
1 2 Door Casing L NIA Y 34 Supports l L NIA Y
34 Door Jamb F L N/A Y
Threshold Low Cab Fram L N/A Y
L N/A Y A B Low Cab Door .� L N/A Y
A B Door L NIA Y D Low Cab Walls
- L IA Y
C D Door Edge F L N/A Y
9Low Cab Shlvs 0. L N/A Y
12 Door Casing L NIA Y
12 Supports L N/A Y
3 4 Door Jamb ,� F L N/A Y 34 Drawers
Threshold L N/A Y
L N/A Y Low Cab FramMNIA
Closet Door L NIA Y A B Low Cab Door
A CI Door Edge F L NIA Y
C D Low Cab Walls
B Cl Casing L NIA Y Low Cab Shlvs
C Closet Jamb
F L NIA Y 12 Supports D Closet Walls L NIA Y34 Drawers
Cl Baseboard L N/A Y Low Cab Fram ,
1 Closet Pole L NIA Y
L NIA Y A B Low Cab Door L NIA Y
2 Closet Shelf L NIA Y
C D Low Cab Walls L N/A Y
3 CI Supports L N/A Y kD
Cab Shlvs
4 Closet Floor L❑(dust) N/A Y L N/A Y
1 2 ports L NIA Y
Closet Ceilin. L N/A Y 34 wers
L NIA Y
A B Up Cab Frame L NIA Y
C A Windowsill M/I AIM L N/A Y
p Cab Door L NIA Y Win Apron L N/A Y
Up Gab Walls L NIA Y tHeader
asing , L NIA Y
12 Up Cab Shlvs L N/A Y D Stop M/I L NIA Y
3 4 Supports L NIA Y ps �: M/I L N/A Y
F M/I A/M L NIA Y 1 Win Int Sash /I L /A Y
COMMENTS/STRUCTURAL DEFECTS:
2 Exterior Sill SF L /A Y
3 Part Bead M/ L / Y
4 Blind Stop M/I F Y
Win Ext Sash M/I L /A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/1 AIM L N/A Y 1
by a Deleader(MORE THAN 288 SQ,IN.)
F Mll A/Nl L N/A Y
SIDE LOCATION MEASURE:LOOSE PAINT IC - IC r FM/I A/M L wA Y
DATE METHOD F Mll A!M L N/A Y
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more A/M surfaces with adhesion problems
LYRA Rep 2017 Pantry
Rafael Vasquez U4224 ,
Inspector(print) Lic# 10/ 29/ 22 Pagr of_�?
Sig att� / x Date
Risk Assessor(print)) Lic# Signature Date
I Address of Pro e : 11 S,mmer St A t.# �— city., Salmi
j KITCHEN
SIDE LOCATION/ LEAD TYPE OF I URG IC IC JDELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZARD HAZ,. DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH
A B Low WWinddow .A B A L lA Y 1.� M/I AtM L N/A Y
c P L lA YU Wallsw Walls B 0.0 L N/A Y
A BoBaseboards L /A YA B C �> L NIA Y
Chair Rail L NIA Y D eaerSto
A B p 0;5 M/I L N/A Y
c p Radiator L NIA Y
Int Stops M/I L NIA Y
�H Floor L Dow) N/A Y
� 1 Win Int Sash �. M/I L NIA Y
a Ceiling L NIA Y 2 MSI[[ /I' N1A Y
A` Door L NIA Y 3 M L NIAC D Door Edge F L N/A Y 4 M/ SF L /Al2 Door Casing L NIA Y /I L NIA Y
3 4 Door Jamb ` F L NIA Y A Window Sill M/I A/M L NIA Y
Threshold L NIA Y Win Apron L /A Y
A B Door Q' L N/A Y
C Win Casing L N/ Y
C; Door Edge F . L N/A Y
D Header Stop M/I L ]A Y
1 Door Casing ® L N/A Y Int Stops M/I L / Y
34 Door Jamb F L N/A Y 1 Win Int Sash ( L /A Y
Threshold L NIA, Y ' Exterior Sill ?I F L 1A Y
A B Door L NIA Y 3 Part Bead M/ L / Y
D Door Edge F L NIA Y 4 Blind Stop SF L ( Y
1 oor Casing L NIA Y Win Ext Sash Ml L /A Y
34 Door Jamb F L NIA Y A B Up Cab Frame L Y
Threshold L N/A Y C D Up Cab Door L N/A Y
Closet Door Y Up Cab Walls L N/A Y
A Cl Door Edge 0. F L NIA Y 12 Up Cab Shlvs L NIA Y
B Cl Casing 0. L NIA Y 34 Supports L NIA Y
C Closet Jamb �. F L N(A Y - Low Cab Fram
• L N/A Y
Closet Walls L NIA Y A B Low Cab Door
L NIA Y
Cl Baseboard L NIA Y C D Low Cab Walls
L N/A Y
1 Closet Pole L N/A Y
Low Cab Shlvs L N/A Y
2 Closet Shelf L N/A Y 12 Supports L NIA Y
3 Cl Supports L N/A Y .
3 4 Drawers L N/A Y
4 Closet Floor L❑(dust) N/A Y A B
c o Win Above 5'
IL L NIA Y
Closet Ceiling L /A Y Ceiling Moldin L N/A Y
=
COMMENTS STRUCTURAL DEFECTS:
F Mil A/M L N/A Y
F Mil AIM L N/A Y
F M/I AIM L N/A Y
F M/I AIM L NIA Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/I A/M L N/A Y
by a Deleader(MORE THAN 288 SQ.IN.) FMn AIM L N/A Y
SIDE LOCATION MEASURE:LOOSE PAINT IC IC F M/I A/M L N/A Y
DATE METHOD ! F M/I A/M L N/A Y
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more A/M surfaces with adhesion problems
Ll/RA Rep 2017 Kitchen
i
i Rafael Vasquez U4224
Inspector(print) Lic# 10 /29 /22 Pag _of_
Signature Date
j Risk Assessor(print) Lic# Signature s Date
Address of Property: 11 S rrlm C A t.# / Ci : SaletTt
CONTINUATION OF ROOM
SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION! LEAD TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE ?
HAZARD HAZ. DATE METH DATE METH
A B Door L NIA Y Low Cab Fram
• L NIA Y
C Door Edge F L NIA Y A B Low Cab Door
1 2 Door Casing L NIA Y L NlA Y
C D Low Cab Walls L N/A Y
3 Door Jamb F L NIA Y # Low Cab Shlvs
L NIA Y
Threshold L N/A Y Supports L N/A Y
PP
A B Door '.' L NIA Y Su
L NIA
oor Edge F L N Y
12 Door Cass A Y Drawers A Window Sill M11 AIM L NIA Y
ing L NI/A Y B Win Apron L N/A Y
34 Door Jamb �. F L N1A Y
C Win Casing L NIA Y
Threshold t NIA Y D Header Stop M/1 L NIA Y
A B Door L NIA' Y Int Stops p M/I L N/A Y
C D Door Edge F L NIA Y # Win Int Sash M/I L N/A Y
12 Door Casing L NIA Y Exterior Sill MII SF L N/A Y
3 4 Door Jamb F L NIA Y Part Bead M/I L NIA Y
Threshold L NIA Y Blind Stop M/I SF L NIA Y
Closet Door L NIA Y Win Ext Sash M/I L N/A Y
A CI Door Edge F L NIA Y A Window Sill M/I AIM L N/A Y
B Cl Casing L N/A Y B in Apron L NIA Y
C Closet Jamb F L N/A Y
C Win Casing L N/A Y
C Closet Walls L N/A Y D Header Stop M/I L NIA Y
CI baseboard L NIA Y Int Stops P M/I L NIA Y
Closet Pole L NIA Y # Win Int Sash �. M/1 L NIA Y
# Closet Shelf � L NIA Y Exterior Sill M/l SF L NIA Y
Cl Supports L N/A Y Part Bead Mil ' L N/A Y
CI Drawers L NIA Y Blind Stop M/I SF L N/A Y
Cl Dr Frame L N/A Y Win Ext Sash;' MII L NIA Y
Closet Floor To(dust) N/A Y AB Fireplace L NIA Y
Closet Ceiling L NIA Y CD Mantel L NIA Y
AS
c D Shlvs Above 5' . L NIA Y AS AB Sidelight(L) L NIA Y
c D fCab Above 5' L N/A Y C AS D Sidelight(R) L NIA Y
CD Cab Above '. L NIA Y AS
CD Win Above 5' L NIA Y
C D Up Cab Door L NIA Y A o Win Above 5' L N/A Y
Up Cab Walls L NIA Y F,M/l AIM L N/A
# Up Cab Shlvs L NIA Y
Supports L NIA Y F M/1 AIM L NIA
F Mil AIM L N/A
F M/1 A/M L NIA
F M/I AIM L N/A
F M/I AIM L N/A
F MII AIM L NIA
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS/STRUCTURAL DEFECTS:
by a Deleader(MORE THAN 288 SQ.IN.)
SIDE LOCATION MEASURE:LOOSE PAINT IC IC
DATE METHOD
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more AIM surfaces with adhesion problems
LYRA Rep 2017 Room contd.
Rafael Vas uez U4224 10 /29 122 Page+f�of��
Inspector(print) Lic#' ,
Signa ure bate
Risk Assessor (print) Lic#
Signature
Address of Pro ert- 11 Summer St A t.# Date
BATHROOM# City:: Salem
SIDE LOCATION/ LEAD TYPE OF I URG IC IC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH
A 8
C
D Up Walls L N1A Y �B p Cab Frame L NIA Y
A a Low Walls L N/A Y C D Up Cab Door L NIA Y
p Baseboards L N!A Y
A 8 Up Cab Walls �. L NIA Y
Chair Rail L NIA Y 1 2 Up Cab Shlvs 0.� L NIA Y A8
Radiator L NIA Y 3 4 Supports L N/A Y
Floor L❑'(dust�N/A Y
Low Cab Frarr
Ceiling L /A Y L N/A Y
AB Law Cab Door
L N/A Y
B Door L N/A Y CID Low Cab Walls
C Q Door Edge F L N/A Y L NIA Y
1 2 Door Casing L NIA Y Low Cab Shlvs L NIA Y
12 Supports L N/A Y
34 Door Jamb F L NIA Y
34 Drawers L NIA Y
Threshold L NIA Y A Window Sill /0 Mlt A1M L A Y
A oor L NIA. Y I .
B Win Apron L N/A Y
C D Door Edge F L N/A Y
G Win Casing L NIA Y
122 Door Casing L NIA Y D Header Stop MA L NIA Y
34 Door Jamb j2— F L N/A Y
Int Stops /l L NIA Y
ThreshoI L NIA Y Y 1 Win Int Sash
A B Door L N/A Y
: L NIA Y 2 Exterior Sill /l - L %
C D Door Edge F L NIA Y 3 Part Bead
12 Door Casing L N/A Y MI L /^ Y
4 Blind Stop 1 SF L / Y
34 Door Jamb F L NIA Y
Win Ext Sash
Threshold L N/A Y AB
L
C p Win Above 5' NA Y
Closet Door L N/A Y
'MICeiling Moldinq L NA Y
A Cl Door Edge F L N/A Y Ay
Medicine Cab L NA Y
B Cl Casing; L NIA Y r
C Closet Jamb F f` F M/I A/M N/A Y
L NIA Y F M/l AIM L NIA Y
D Closet Walls L N/A Y
F M/1 AIM L NIA Y
� Cl Baseboard L N/A Y
1 Closet Pole L NIA Y F Mil AIM L NIA Y
/
2 Closet Shelf L N/A Y F M/I AIM L NIA Y
•
3 Cl Supports L N/A Y F Mill AIM L NIA Y
4 Closet Floor L F M/1 AIM L N/A Y
l ❑(dust) NIA Y
Closet Ceilinj L NIA Y F M/I AIM L NIA Y j
Mll AIM L N/A Y F M/I AIM L NIA Y
F M/I AIM L NIA Y
F M/I AIM'L NIA Y
F Mil AIM L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Intact COMMENTS/STRUCTURAL DEFECTS:
by a Deleader(MORE THAN 288 SQ.IN.)
SIDE LOCATION MEASURE:LOOSE PAINT IC IC
DATE METHOD
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more AIM surfaces with adhesion problems
L.JRA Rep 2017 Bath
Rafael Vasquez
1J4224 10[29 /22 Page Of (/
Inspector(print) Lic# Signature
Date
Risk Assessor(print) Lic# Signature ! J
Address of Property: 11 Summer St Date
A .# Ci : Salem
HALLWAY:Interior #� or Common Hallway: Front Rea Floor#
SIDE LOCATION/ LEAD TYPE OF URG IC IC IDELEADI DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC IDILEADI DELEAD
SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE
A B a HAZARD HAZ? DATE METH DATE METH
C D ails L N/A Y
A B Closet Door L N/A Y
Walls �. L N/A Y A CI Door Edge F L NIA Y
A B
C D Baseboards 0 L N/A Y
A B B Cl Casing L N/A Y
Chair Rail L N/A Y C Closet Jamb F
A B L N/A Y
Radiator L NIA Y D Closet Walls
L N/A Y
. Floor L❑Qdust N[A Y CI Baseboard
st Ceiling L /A Y 1 Closet Pole L N/A Y
t�:: L N/A Y
B Door L N/A Y 2 Closet Shelf
L N/A Y
C D Door Edge F L N/A Y 3 CI Supports L N/A Y
1 2 Door Casing �. L N/A Y 4 Closet Floor L®(dust) N/A Y
34 Door Jamb F L N/A Y
�t Closet Ceilin L N/A Y
Threshold A L N/A Y Window Sill I M/I A/M L N/A Y
A B door L N/A Y B Win Apron L N/A Y
C Door Edge F L N/A Y
C Win Casing L N/A Y
2 Door Casing L N/A Y D Header Stop M/I L N/A Y
34 Door Jamb F L N/A Y Int tops p � M/I L N/A Y
Threshold L N/A Y 1 Win Int Sash M/I L N/A Y
A B Door �. L N/Al Y I2 ExterorSill
D Door Edge F L N/A Y L [ Y
3 Part Bead L IT Y
"�2 Door Casing L N/A Y 4 Blind Stop L /A Y
34 Door Jamb Q. F L NIA Y
Threshold Win Ext Sash L /A Y
Q L N/A Y A Window Silt M/I A/M L N/A Y
A B Door L N/A Y B Win Apron L N/A Y
C D Door Edge F L N/A Y
C Win Casing L N/A Y
12 Door Casing L N/A Y D Header Stop M/I L N/A Y
3 4 Door Jamb F L N/A Y Int Stops M/I L N/A
p YCloset Door L N/A Y 1 Win IntSash M/I L N/A Y
A CI Door Edge F L NIA Y 2 Exterior Sill M/I SF L N/A Y
B CI Casing L N/A Y 3 Part Bead
M/I L N/A Y
C Closet Jamb F L NIA Y
4 Blind Stop M/I SF L N/A Y
D Closet Walls L N/A Y Win Ext Sash M/I L N/A Y
Cl Baseboard L N/A Y AB
c D Win Above 5' IL
L N/A Y
1 Closet Pole L N/A Y Ceiling Moldin L NlA Y
2 Closet Shelf L N/A Y
3 CI Supports I. N/A Y F M/1 A/M L WA Y
4 Closet Floor F M/I AIM L N/A Y
L❑(dust) NIA V
F M/1 A/M L N/A Y
Closet Ceilin L N/A Y COMMENTS/S RUCTURAL DEFECTS:
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact
by a Deleader,(MORE THAN 288 SQ.IN.)
SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more AIM surfaces with adhesion problems
Ll/RA Rep 2017 Hall
i
Rafael Vasquez' U4224 10/ 29 / 22 -'
Inspector(print) Lic# PageOf
Signa# re Date
Risk Assessor(print) Lic# Signature
Address'ofPro e 11 Summer StApt-4 �° Date i : Salem
HALLWAY:Interior # or Common Hallway: ut R�Fl j
SIDE LOCATION/ LEAD TYPE OF URG IC I IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH
J�A
B
o al L /A Y
Closet Door L N/A Y
Low Walls L N/A Y A CI Door Edge F L N/A Y
A B
c Baseboards L /A Y B CI Casing L N/A Y
A B Chair Rail L NIA Y C Closet Jamb F
AB L N/A Y
Radiator L N/A Y
Floor D Closet Walls L N/A Y
L®(dust) N/A Y Cl Baseboard
L N/A Y
Ceiling L N/A Y 1 Closet Pole L N/A Y
A Door L NIA Y 2 Closet Shelf
C D Door Edge F L NIA Y L N/A Y
3 Cl Supports L N/A Y
12 Door Casing L N/A Y 4 Closet Floor L®(dust) N/A Y
3 4 Door Jamb F L NIA Y Closet Ceiling L N/A Y
Threshold L N/A Y A Window Sill M/I AIM L NIA Y
A oor s L N/A Y
Door Edge
B Win Apron L NIA Y
F L N/A Y
C
C Win Casing L N/A Y
12 Door Casing L N/A Y D Header Stop M/I L N/A Y
3 4 Door Jamb F L N/A Y s Int Stops M/1 L NIA Y
Threshold L N/A Y 1, Win IntSash M/I L N/A Y
A B Door L NIA Y 2 Exterior Sill M/I SF L N/A Y
C D Door Edge F L NIA Y 3 Part Bead M/I L N/A Y
12 Door Casing L N/A Y 4 Blind Stop M/I SF L N/A Y
34 Door Jamb F L N/A Y Win Ext Sash M/I L N/A Y
Thr
eshold L NIA Y A 1window,Sill p/I A/M L N/A Y
A B Door L N/A Y B Win Apron L N/A Y
C D Door Edge F L N/A Y C Win Casing L NIA Y
12 Door Casing L N/A Y D Header Stop Mll L N/A Y
3 4 Door Jamb F L N/A Y s Sto
Int p Mill N/A Y
Closet Door L NIA Y 1 Win Int Sash M/I L N/A Y
A Cl Door Edge F L N/A Y 2 Exterior Sill MA SF L N/A Y
B Cl Casing L N/A Y 3 Part Bead Ivl/I L N/A Y
C Closet Jamb F L NIA Y 4 Blind Stop M/1 SF L N/A Y
D Closet Walls L N/A Y Win Ext Sash M/I L N/A Y
Cl Baseboard L N/A Y AB
CD Win Above 5' L N/A Y
1 Closet Pole L N/A Y Ceiling Moldin L NIA Y
2 Closet Shelf L N/A Y F M/I AIM L NIA Y
3 CI Supports . L N/A Y F M/1 AIM L N/A Y
4 Closet Floor L®(dust') N/A Y
F M/I A/M L N/A Y
—4—
Closet Ceili L N/A Y COMMENTS/STRUCTURAL DEFECTS:
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact LIE
by a Deleader(MORE THAN 288 SQ.IN.)
SIDE LOCATION MEASURE:LOOSE PAINT IC RATE IC METHOD
i
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more AIM surfaces with adhesion problems
Ll/RA Rep 2017 Hall
Rafael Vasquez 1 J4224 �
Inspector(print) 10 (29 /22 Pag _G Of
Lic# Signature Date
Risk Assessor(p ) Lic#
j (print) Signature Date
Address of P ert . 11 Sumer St A t. f
city: Salem#
SIDE ATION/ LE PE OF URG IC IC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
A T
SURFACE AZARD HAZ? DATE METH DATE METH
SURFACE HAZARD HAZ. DATE METH DATE METH
� B Up Walls L /A Y
A Window Sill M/I AIM L N/A Y
A B Low Walls L NIA Y
A a B Win Apron L NIA Y
C D Baseboards L N/A Y
A B Chair Rail L NIA Y C Win Casing L N/A Y
A B D Header Stop M/l L NIA Y
-CD Radiator L NIA Y
Int Stops MA L NIA Y
� Floor L O(dust) N/A Y
z 1 Win Int Sash Mill L N/A Y
Ceiling L IA Y 2 Exterior Sill M/I SF L NIA Y
A B Door L NIA Y 3 Part Bead
C D Door Edge F L NIA Y M/I L NIA Y
� 1 2 Door Casing L NIA Y 4 Blind Stop M/I SF L NIA Y,
Win Ext Sash M/I L NIA Y
34 Doorjamb ,(�. F L NIA Y A Window Sill Mil AIM L NIA Y
Threshold L NIA Y B Win Apron L N/A Y
A B Door L N/A Y
C Win Casing L NIA Y
D Door Edge F L NIA Y
D Header Stop M/I L NIA Y
1 oor Casing L N/A' Y
Int Stops Mil L NIA Y
34 Door Jamb F L NIA Y 1 thin Int Sash M/I L N/A Y
Threshold L NIA Y 2 Exterior Sill M/I SF L NIA Y
A"Door
L N/A Y
3 Part Bead M/I L NIA Y
D Door Edge �. F L NIA Y 4 Blind Stop
2 Door Casing �; L NIA, Y M/I SF L N/A Y
A Y
34 Door Jamb F L NIA Y Win Ext Sas milli L N/
Newel Post L NIA Y
Threshold L !A Y
Railing Cap AIM L NIA Y
A$ Door L NIA Y
Handrail AIM L NIA Y
C D Door Edge F L NIA Y
12 Door Casing. L NIA Y Balusters
Lower rail L N/A Y
34 Door Jamb L N/A Y
F L N/A Y �"�=
Treads F L N/A Y
Closet Door L N/A Y
A CI Door Edge F L NIA Y Risers L NIA Y
Stringer L N/A Y
B Cl Casing L N/A Y Tread edge>S L N/A Y
C Closet Jamb
F L NIA Y Landing floor L (dust)N/A Y
D Closet Walls L N1A Y
� Cl Baseboard L N/A Y Floor Edge L NIA Y �
Floor Casing L NIA Y
� 1 Closet Pole L NIA Y
F ANI AIM L N/A Y
2 Closet Shelf iL N/A Y
3 CISupports L N/A Y F M/I AIM L N/A Y
4 Closet Floor L F M/I AIM L NIA Y
El(dust) NIA Y
F M/I A/M L Closet Ceiling L NIA Y NIA Y
F M/I A/M L NIA Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS/STRUCTURAL DEFECTS:
by a Deleader(MORE THAN 288 SQ.IN.)
SIDE LOCATION MEASURE:LOOSE PAINT IC IC
j DATE METHOD
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 Of more NM surfaces with adhesion problems
L1/RA Rep 2017 Stair
Rafael Vasquez U4224 °( 10/ 29/22 Page/0 Of'
Inspector(print) Lic# Signature Date
Risk Assessor(print) Lie# Signature Date
Ad r ss fPr : 11 Summer St A t.# City Salem
PORCH C (side) _ (floor)
SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ JEAD TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZARD HAZ, DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH
AB Siding L NIA Y AB Window Sill � AIM L /A Y
C D Corner Boards L A Y C D Win Casing L NIA Y
Upper Trim L N/A Y
12 Window Sash L N/A Y
Ceiling L lA Y 3 4 Mullions L N/A Y
Joists L A Y
�- A B Window Sill AI L /A Y
Storm Door (14 L N/A Y
C D Win Casing L NIA Y
A B Strm Door Edge F L NIA Y 12 Window Sash L NIA Y
C D Door )41A Y 34 Mullions L NIA Y
Door Edge F /A Y yr Support Clmns 0. L NIA Y
1 or Casing L NIA Y Newel post A) L NIA Y
3 4[Threshold
oor Jamb /� F L IA' Y
'/ Railing Cap A/M L N/A Y
' /A Y
Handrail A! L NIA Y
r.•
Kickplate L /A Y Balusters L N/A Y
Storm Door L NIA Y Lower Rail L N/Al Y
A B Strm Door Edge t1 F L NIA Y Treads F L N/A Y
C D Door
/A Y �a
Risers L NIA Y
Door Edge F L N/A Y °° Stringer L N/A Y
" 22- oor Casing L IA Y ",, Tread Edge L NIA Y
3 2r Door Jamb F L /A Y Lower Walls L N/A Y
Threshold} L N!A Y '
Lattice L N/A Y
Kickplate 0L IA Y Lower Trim L N/A Y
A B Window Sill A! L N/A Y '
Floor L®(dust)` NIA Y
C D Win Casing L N/A Y
-. F M/I AIM L N/A Y
1 Window Sash L NIA Y F M/t AIM L N/A Y
34 Mullions L NIA Y F M/l AIM L NIA Y
A B Window Sill A/M L N/A Y F M/1 AIM L N/A Y
CID Win Casing L N/A Y F MA.AIM L N/A Y
12 Window Sash L N/A Y F M/1 A/M L NIA Y
3$ Mullions L NIA Y F M/l AIM L NIA Y
A B Window Sill AIM L /A Y F M/l AIM L NIA Y
C D Win Casing L NIA Y F M/I AIM L NIA Y
12 hdow Sash I L N/A Y F M/I AIM L N/A Y
34 Mullions L NIA Y F M/I A/M L N/A Y
COMMENTS/STRUC-URAL DEFECTS: (dust)*-Applies only to porches used as interior space
COMMENTS/STRUCTURAL DEFECTS:
EXCLUDED,SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader.
SIDE LOCATION MEASURE:LOOSE PAINT IC IC
(MORE THAN 2880 SO.IN.) DATE METHOD Check the box if this ROOM is RULED OUT for encapsulation because there
are 3 or more A/M surfaces with adhesion problems
LI/FA Rep 2017 Porch
'Rafael Vas iuez
U4224 10/29 t22 Page Of
Inspector(print) Lic# Sign ure
Date.
i
Risk Assessor (print) Lic# Signature '
Date
Address of Pmn,,rtir 11 Summer St
A t.# Ci : Salim
I EXTERIOR A Side
SIDE .LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
A SURFACE HAZARD JHAZ? DATE METH DATE METH A SURFACE
Siding r L N/A Y HAZARD HAZ? DATE METH DATE METH
WindowA/M L N/ACorner Boards L NIA YWin C L N/AA LowerTrim L N/A Y Wind
L N/A Y
Upper Trim L /A Y Cellar Win Sill A/M -L NIA Y
Win Above 5' _ L N/A Y A Cal Win Frame
Porch Above 5' L N/A Y
L IA Y # Cel Win Sash L N/A Y
Storm or -
L N/A Y �' Screen Frame L N/A Y
Stmi Door Edge F L N/A Y
Cellar Win Sill A/M L N/A Y
A Door L NIA Y A Get Win Frame
2 L N/A Y
Door Edge 2— F L N/A' Y
#3 4 Door Casing L '/A Y 'Gel Win Sash L N/A Y
Screen Frame L N/A Y
Door Jamb F L /A Y
reshol N/A Y Cellar Win Sill A/M L N/A Y
Thd
A Cel Win Frame L N/A Y
Kickplate I L /A Y
# CeI Win Sash L N/A Y
!Storm Door L N/A Y
Screen Frame L N/A Stan poor Edge F L N/A Y Y
A L N/A Y
Foundation L N/A Y
Docr �
A Bulkhead L N/A Y
1 2 Qoar Edge F L N/A Y
Fences
' 3 4 Daor Gasing � L (A Y L N/A Y
Shutters i Door Jamb ,
Threshold F L IA Y L N/A Y
Newel post '( L N/A Y
N/A Y Railing Cap A/M L N/A Y
Kickplate L /A Y
Handrail 41 A/M L NIA Y
Door L NIA Y
' A Door Edge F L N/A Y A Balusters L N/A Y
Lower Rail L N/A Y
1 2 Door Casing L N/A Y
Treads F L N/A Y
3 4 Door Jamb F L N/A Y
Risers L N/A Y
Threshold L N/ATread edge L N/A Y
Kickplate L N
Landing floor L N/A Y
Window Sill A/M L N/A Y
Stringer L N/A Y
A Win Casing � iL NIA Y
# Window Sash L N/A Y Lattice L NIA Y
Drain Pipes L N/A Y
Window Sill A/M L N/A Y
A Elec Conduit L N/A Y
A Win Casing L N/A Y
#
oil Fill Pipe L NIA. Y Window Sash L N/A Y
Overhang Trim L /A Y
COMMENTS/STRUCTURAL DEFECTS: A Lamp Post L NIA Y
A I f F M/t A/ L /A Y
A F M/I AIM L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area/1200 ppm for bare soil)
intact by a Deleade,r(MORE THAN 2880 SQ.IN.) LOCATION AREAMEASUItEMENT RESULT11111 REMED REMED
SIDE LOCATION MEASURE:LOOSE PAINT IGDATE IGMETHOD
A {Square Feet) (PPM) DATE METH
A Play Area
A Bare Soil -�
A Comments:
f
LYRA Rep 2017 Ext A
Rafael Vasquez U4224 � 1'0/ 29l 22 Pag -of�2
Inspector(print) Lic# Signature Date
Risk Assessor (print) Lic# Signature Date
Address of Pro ert :11 Summer Sit Apt.# Z city:Salem
EXTERIOR B Side
SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
B SURFACE HAZARD HAZ? DATE METH: DATE METH B SURFACE HAZARD HAZ? DATE METH DATE METH
Siding L N/A Y Window Sill A/M L N/A Y
Corner Boards L N/A Y B Wm Casing L N/A Y
B Lower Trim L N/A Y # Window Sash L N/A Y
Upper Trim L /A Y
Cellar Win Sill (L,)VA Y
Win Above 5' L /A Y B Cel Win Frame "0 �� /A Y
Porch Above 5 L N/A Y # r Cel Win Sash L N/A Y
Storm Door L N/A Y Screen Frame /A Y
Strm Door Edge F L N/A Y cellar Win Sill M (--L)WA Y
B or
L NIA Y B Cel Win frame ( L /A Y
1 2 Door Edge F L N/A Y ff Gel Win Sash YyA Y
3 4 Door Casing 7 L N/A Y Screen Frame L Y
Door Jamb F L N/A Y Cellar Win Sill AIM L 1A Y
Threshold L N/A Y B Gel Win Frame L /A Y
Kickplate L N/A Y # Gel Win Sash L N/A Y
Storm Door L N/A Y Screen Frame L /A Y
Strm Door Edge F L N/A Y Foundation L N/A Y
B Door L N/A Y B Bulkhead L N/A Y
1 2 Door Edge F L N/A Y Fences L N/A Y
3 4 Door Casing L N/A Y Shutters L N/A Y
Door Jamb F L N/A Y Newel post L N/A Y
Threshold L NIA Y Railing Cap A/M L N/A Y
Kickplate L NIA Y Handrail AIM L N/A Y
Door L N/A Y B Balusters L N/A Y
B Door Edge F L N/A Y Lower Rail L N/A Y
1 2 Door Casing L N/A . Y
Treads F L NIA Y
3 4 Door Jamb F L N/A Y Risers L N/A Y
Threshold L NIA Y Tread edge L NIA Y
Kickplate. L N/A Y Landing floor L N/A Y
Window Sill /M L NIA Y Stringer L N/A Y
B Win Casing L N/A Y
Lattice L N/A Y
# Window Sash L N/A Y , drain Pipes L N/A Y
Window Sill A/M L N/A Y B Elec Conduit L N/A Y
B Win Casing L NIA Y
Oil:Fill Pipe L N/A Y
# Window Sash L NIA Y Overhang Tri L N!A Y
COMMENTS/STRU TURAL DEFECTS: B Support Clmns L NIA Y
B IL�
Y
B Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results{Must be less than 400 ppm for play_area/1200 ppm for bare soil)
intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION ,AREA MEASUREMENT RESULT REMED REMED
JB
LOCATION MEASURE:LOOSE PAINT IC DATE IC METHoo (Square Feet) (PPM) DATE METH
Play Area
Bare Soil
Comments:
B
LI/RA Rep 2017 Ext B
Rafael Vasquez j'
U4224r-?, 10/ 29 /22 Page &/of 22
Inspector(print) Lic# Signa`fure
Date
Risk Assessor (print) Lic# Signature
Date
Address of Property: Summer'St A t.# Cit... Salem
EXTERIOR C Side
SIDE LOCATION/ LEAD TYPE R URG IC IC DELEAD DELEAD SIDEJ LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD
C SURFACE HAZARD HAZ? DATE METH DATE METH C SURFACE HAZARD HAZ? DATE METH DATE METH
Siding L N/A Y
Window Silt A/M L N/A Y
Corner Boards L /A Y C Win Casing L NIA Y
C Lower Trim L N/A Y
# Window Sash L NIA Y
Upper Trim L /A Y
Cellar Win Sill A/M L N/A Y
Win Above 5' L /A Y C Get Win Frame L N/A Y
Porch Above 5' L A Y # Cel Win Sash L N1A Y
Storm DoorSWAY
Screen Frame L N/A Y
Strm Door Edge Cellar Win Sill A/M L N/A Y
C Door C Cel Win Frame L N/A Y
1 2 Door Edge # Gel Win Sash L N/A Y
3 4 Door Casing Screen Frame L N/A Y
Door Jamb Cellar Win Sill A M L N/A Y
Threshold C Cel Win Frame L N/A Y
Kickplate # Get Win Sash L N/A Y
Storm Door L N/A Y Screen Frame L N/A Y
Strm Door Edge F L N/A Y Foundation L NIA Y
C Door L NIA Y C Bulkhead L N/A Y
1 2 DcorEdge F L NIA Y Fences L N/A Y
3 4 Door Casing L N/A Y Shutters L N/A Y
Door Jamb F L N/A Y Newel post L NIA Y
Threshold L N/A Y Railing Cap A/M L N/A Y
Kickplate L N/A Y
qE� Handrail A/M L N/A Y
Door L N/A Y C Balusters L N/A Y
C Door Edge F L N/A Y Lower Rail L N/A Y
1 2 Door Casing L NIA Y Treads F L N/A Y
3 4 Door Jamb F L NIA Y Risers L N/A Y
Threshold L N/A Y
Tread edge L NIA Y
Kickplate L N/A Y Landing flo r L NIA Y
Window Sill A/M L N/A Y Stringer L N/A Y
C Win Casing L N/A Y
Lattice L N/A Y
# Window Sash L N/A Y Drain Pipes .0 L N/A Y
Window Sill A/M L N/A Y C Elec Conduit L N/A Y
C Win Casing N/A Y '1 Fill Pipe L /A Y
# Window Sash I, N/A Y Overhang Trim, L N/A Y
COMMENTS/ST UCTURAL DEFECTS: C Support Clmn 9 FFT
L /A Y
C
F Mil A/M L N/A Y44:1
C F M/I A/M L NIA Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area/1200 ppm for bare soil)
Intact by a Deleader(MORE THAN 2880 SQ.IN.) OLOCAONAREA MEASUREMENT RESULT REMED RENTED
SIDE LOCATION MEASURE:LOiOSEPAINT IODATE ICMETHOD
(Square Feet) (PPM) DATE METH
C it C
I� c aJ
i
LURA Rep 2017 Ext C
i
Rafael Vas uez U4224 10 /29 /22 f_ '
Inspector(print) Lic# Signature
Pag
Date
Risk Assessor (print) Lic# Signature
Date
ss of Property: 11 Summer St
Adr
A t.# cit : Salem
.EXTERIOR D Side
SIDE LOCATION/ LEAD TYPE OF URG IC IG DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
D SURFACE HAZARD 1HAZ?j DATE METH DATE METH D SURFACE
HAZARD HAZ? DATE METH DATE METH
WSidinNAL N/A' Y Window Silt AIM L NIA Y
ds L N/A YD Win CasingD L N/A Y # Wintlow SashL /A Y L NIACellar Win Sill A/M L N/A Y
' L lA' D Cel Win Frame (�:� L N/A Y
5' L N/A Y # Cel Win Sash
L N/A Y
Storm Door L N/A Y Screen Frame
L N/A Y
Strm Door Edge F L N/A Y Cellar Win Sill A/M L N/A Y
D Door 2— L N/A Y D Cal Win Frame
1 2 Door Edge F L N/A Y L NIA Y
# Cel Win Sash L N/A Y
3 4 Door Casing L N/A Y
' Screen Frame L N/A Y
Door Jamb F L N/A Y Cellar Win Sill A/M L N/A Y
Threshold L N/A Y Q Cel Win Frame
Kickplate L N/A Y L N/A Y
Cal Win Sash L N/A Y
Storm Door L NIA Y Screen Frame
Strm Door Edge F L N/A Y L N/A YFoundation
D Door L N/A Y
L N/A Y D Bulkhead L N/A Y
1 2 Door Edge F L N/A Y
Fences L N/A Y
3 4 Door Casing L N/A Y
Shutters L N/A Y
Door Jamb F L N/A Y Newel post L N/A Y
Threshold L N/A Y Railing Cap A/M L NIA Y
' Kickplate L N/A Y Handrail A/M L N/A Y
Door L N/A Y D Balusters
D Door Edge F L NIA Y L N/A Y
Lower Rail L N/A Y
1 2 Door Casing L N/A Y Treads
3 4 Door Jamb F L N/A Y F L N/A Y
Risers L N/A Y
Threshold L N/A Y Tread edge L N/A Y
Kickplate Landing floor L NIA Y
Window Sill A/M L N/A Y Stringer L N/A Y
D Win Casing L NIA Y
Lattice L N/A Y
# Window Sash L N/A Y
gDain L N/A Y
Window Sill AIM L NIA Y D t
L N/A Y
D Win Casing L N/A Y L N/A Y
# Window Sash L N/A Y i L N/A Y
COMMENTS/STRUCTURAL DEFECTS: D Support !
L N/A Y
D F M/I A/M L NIA Y
D F M/I AIM L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400
intact by a Deleader(MORE THAN 2880 SQ.IN. Ppm for play area/1200 ppm for bare soil)
} LOCATION AREA MEASUREMENT RESULT REMED REMED
SIDE LOCATION MEASURE:LOOSE PAINT ICDATE ICMETHOD
D (Square Feet) (PPM) DATE METH
D Play Area
Bare Soil
II D
Comments:
L1/RA Rep 2017 Ext D