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11 SUMMER STREET UNIT 1 LEAD INSPECTION REPORT 10-29-2022 i XYZ Load Mint Teeft LLC Z Z— IS Toweftdtl St i Lawrim",MAOfail. LICOM LoW irmpeclar RafWlJ '4 ><Inlaadpai►ttT�1 A= i - a XYZ Lead Pa i rat Testing nnvblle: 978)$76-2054 . Rafael Vasquez Licensed Lead Inspector Office:(978)686-3797 ' WleadaaintOirnail tom Lead Inspection/Frisk Assess ent St.# St t Name`___ p Street Type Unit C.G >"ity Zip Code__Qiy Owner Nettle: Number of Rooms in Unit: Owner Address: Property Type: Contact Information: S' gle Family Client Name(if diffemat from owner): Multi Family #:of.LJnits: Condominium #of Units: Client Address: ❑ i}ay Care ❑ Other: Key Stripped d Colutatn DekxdfIC hit fiod Column . Y Dete9d/1 Method column Laundry in Basement? Yes No CCV Covered DIP Covered. REM Removed Finished Space in Basement? Yes p DC ' Dmp Coning. DIP Di d p EP Nllrld metal ENC End sulated. SCR-r: scrapReplaed Possible Pb Water Servi ine MR Metal Rep.Window INT SCR Scraped. NA Not Access�le Intact SPR Storm Pearce Removed ❑Yes No Not Tested MI ' Made Intact SLD Scaled. Testing Method.Used NC No Coating PRE Prepared far Enc. STP Tile Tile(testing suggested) Component Does Not Exist VRfMR Vi UMetal Rep Windovr Na2S Expiration Bate: VB Vinyl Baseboard X-Ray Fluorescence VR Vinyl Rep.Window del: Serial# Gatnments 1.Notes: ❑ Demarcation Lines ❑ Submitted for Compliance Evaluation Floor#' " . (level within building of unit being i Property Diagram 1 unit Labels {, g nspecxed} I'l'Ool'# . C i t r f --------------- r , r II .a .... r-.. ✓ . r 1 1 ' I r r 1 a ! f t +- 1 i Y F i r r f r • 1 f i. i f f ' . r i ' I D B -_ j i--f--- _ sV.. . 1 7--'T---C-- e A(Street Side) Start Here A(Street Side) Start Here Pb(lead)equal to or greater than 1.0 tng/cma scence or positive with Ns2S is Dangerous. with x-rdy uoreA(StreetSlde) XRF Calibration Recorded in Log Book re Address.Verified through LISPS ,- ,/ Cheek off when complete R arch on d Related History for Address ;Check offwhen complete e.ma.usfd Eppp tsr$00-53L-957 Cll hen fete Inspector's Name(print} Ltcense� ®Z Z 2 LIlRt�-revised 0 6 t1 7 Sigh re Date Address:11 Stammer St Apt#1 Left City Salem Page 2 of Z�Z/ INSPECTION HISTORY INTERIM CONTROL MIFN Y Inspector Name: INTERIM Visual Risk Assessment R.A.Name: Lic# Signature �r Signature Ur , Pb.Hazards? Comprehensive Initial lns)ection - - MPb4 102922 Y Inspector Name:R Vas uez ,Lic#4, Y R.A.Name: Lic# N Signatur N Signature Lead Hazards? ' Comp Initial LlC# Visual Portion of W/Partial PCAD inspector Name: Reinspecfion for 0 P R.A.Name: Lic# Y Interim Control Signature F Signature Lead Hazards? Addendum(add-on Dust Taken for Risk R.A.Name: to Initial his ection Inspector Name: Assessment Reins . P 8 Lic# F Signature N Signature Lead Hazards'? Visual Portion of Addendum as Full Reinspection for R.A.Name: Ins ection Y Inspector Name: interim control NF Lic# Lic# Signature N Signature — Lead Hazards? Dust Taken for Risk -D7 R.A.Name: ,Lic# Walk Through for Inspector Name: Lrc# Assessment Reins . Ed/Consultation F Signature Signature Risk Assessment REINSPECTION HISTORY Recertifcatior Y R.A.Name:_ Lic#_ j Visual Inspector Name: eocc.Reins ection P ----�Lic# N Signature R L'J Urgent Pb.Hazards? Signature Dust Taken for Inspector Name: RA Recertifica P R.A.Name: Lic# Visual Portion of P tion Lic# I Reoce.Reins ection F Signature_ F Signature ust Taken for Inspector Name: POST COMPLIANCE ASSESSMENT DEDETERMINATIONSD P Lic# Reocc_Reins ection F Signature PCAD Y Inspector Name: LIC# Dust Taken for P Inspector Name: Lic# N Signature Reocc_Reins ection Lead Hazards? F Signature Full Inspection Actin as PCAD Inspector Name-'—, Visual Portion of Inspector Name: Final Reins ection P LIc# j N Signature F Signature Lead Hazards? Visual Portion of Visual Portion of Inspector Name: Lie# Final Reins ection P Inspector Name: Lic# PCAD Reins ection P 8 Signature BSignature Dust Taken f.—rF.—Tj P Inspector Name: Lic# Dust Taken for P Inspector Name: Lic#Rein. No Reocc) PCAD Reins ection F Signature BSignature I Dust Taken for Firwl P Inspector Name: Dust Taken for Inspector Name: Reins o Reocc) Lle# . PCAD Rests ection P F Signature FP-1 Signature History rev 6/17 Address:I I Summer St Apt##1 Left City Salem Page 3 of— REOCCUPANCY CERTIFICATE HISTORY COMPLIANCE HISTORY(CONY.) Certificate of Reoccu anc Certificate of Inspector Name: Maintained Lic# Con, liance Inspector Name: ,Lic# Only after ESignature High/Mod Risk Signature #rooms rule No Work--No Dust Work=7 Dust tR cate of u aac Certiftcate ofInspector Name: Lic# RestoredCom fiance Inspector Name: Lic# after Signature od RiskSignature ff s rule Dust wipes and auth. CO le Certificate of Reoccu ane Certificate of Inspector Name: Lick Maintained Co fiance 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 CertifiAofom liance Inspector Name: RestInspector Name: LiC# Com Lie#No prior history/ Signature Signature No si ns of UD Dust wipeseo Letter of Interim Control Inspector Name: OTHER HISTORY:WAIVERS/UD LiC# Approved Signature CLPPP waiver Inspector Name:No prior Comp. ,Lic# Ex ices in 1 r. Attach to Comp Signature Does Recertification of Interim Control Inspector Name: Lic# Approved CLPPP Waiver Inspector Name: Lic# Expires 2 yrs from Signature original interim Attach to Comp Signature Control Does Letter of Full Deleading Inspector Name: UD/DES Visual Com liance Lic# Reins ection Inspector Name: Lic# Signature F Dust wipes if No Signature Reece. No LOC Issued Certificate of M:riutained UD/DES Dust Corn liance Inspector Name: Lic# Taken Inspector Name: LiC# No Work=No Dust Signature F Signature_ Work=7 Dust No Y OC Issued UD f DES Dust Fand Taken pp Inspector Name: Lic# Inspector Name: Lic# F Signature No LOC issued Dus Signature UD Final /DES Final Reins n p Inspector Name: Lic#. 8 Signature_ No LOC Issued History rev 6/17 i Page 4 of 2z- E 'LAIYATI© OF I;EAD 1NSPE+CTION!RISK A ESSMENT REP©RT FORM COLUMNS This page provides general in needed to understand the lead inspection/risk assessment report.However, au sh with the in assessor before you start to do any work on your home. ,Y ould speak j SIDE Refers to A,B,C,or D side of the building or room.See the di „ building or room is the side facing the street gives the Property i a the cover sheet.The A side of the buildin .Ks in p peF►Y its address{usually,it is the front of the. g) 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"D"side to the right. Numbering is from left to right. LOCATION/. Refers to the building component(s)being tested.Some surfaces may be made up of more than one part.For SURFACE example,"Baseboard"may refer to four.separate pieces of wood{one on each wall),but but a still considered one surface. LEAD The actual lead result.Each surface tested must have a result recorded in.the"Lead"column. • A number shawl 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. . • A"pos"or"`neg-shows that the surface was tested with sodium s level of lead., ulfide."Pos"means that there is a dangerous' "N/A"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 alternative testing options. jl "MET"or"MM"means that a metal surface was not tested.Metal handrails,metal 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 "N%A".All other metal surfaces must be intact, • For key to abbreviations like"COV" "wf "" ,> "DC'_', „ ' , , _or"MR","NC","Tile", DC-,see the cover page. T`i'I'E OF Not all lead paint must be deleaded:This column tells you IF and WHY a surface needs deleading.The deleading HAZARD standards below may not apply for Interim Controls.S • "M/I"circled r more information.. means that the surface is a moveable/impacted part of a windo to Your riskassessor w and in be deleaded in its entire . "SF"circled indicates that.there is a storm f-ame.present which requires the blind stop and e tY deleaded as interior moveable/impacted surfaces. exterior sill be • "A/W circled means that the surface is"accessible rnouthable"and must be deleaded to a minimum of five feet high,four inches in from the edge or corner. • "F"circled means that the surface is a"friction"surface and must be deleaded at all points of potential friction. • "L"circled means that the surface is loose and must,at a minimum,be made intact.Loose leaded floors must be sealed with paint or similar coating and pass a dust wipe. If more than one choice is circled;the rules for deleading may change depending upon what method of -aft"Myou choose.Speak to the inspector for more information.. • "N/A"means the'inspector was unable to determine if the surface was a lead hazard.The person doing the deleading roust check this surface and follow all th information. e rules for deleading.Speak to the inspector for more • If nothing is circled in the column,then it is likely the surface does not need deleading.Speak to the inspector for more information. Remember;this does not mean the entire deleading in its current co surface is lead free,it just does not require ndition. URG HAZ? This column is completed during a risk assessment;which is an evaluation of a home's suitability erim Control. Only a licensed risk assessor can do a risk assessment. If"Y"is circled,then this surface l stconsidered an"Urgent Lead Hazard".and deleading is required to qualify for Interim Control. IC DATE The date the licensed risk assessor determines the surface meets the standards for Interim Contra). IC METH The deleading method or structural repair done to qualify.the surface for Interim C .Refer to the deleading 'codes key on:the cover page. ontrol. DELEAD DATE E The date that the lead inspector reinspects the surface and finds that it is'in compliance. DELEAD METH'The method used to bring a surface into full compliance.Refer to codes in the Key on.the report's cover page. EXCLUDED The amount of loose paint on a.surface as measured by the lead inspector."NIA"means that the in SURFACES able to measure the loose paint;but has determined it is more tha Spector was not n the cut-off for moderate risk making intact. RULED OUT Encapsulants only work well if the pa SOX int is in good condition.If the inspector sees that there are adhesion problems with eligible surfaces in it roams he/she will rule out encapsulation as a deleading method. LIRA,Exp_2017 i I Rafael Vas uez 114224 Inspector(print) Lic# 10 29 22 Page -S0f Z' Signature Date i Risk Assessor(print) Lic# Signature Address of Pr 11 Summer St Date ROOM# A ' it: Salem 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 A B HAZARD HAZ? DATE METH DATE METH p-Walls L N/A Y A B L-®wWalls L NIA Y Window Sill ,2 MA AIM L N/A Y � A B B Win Apron L N/A Y C Baseboards L NIA Y A B C Win Casing L N/A Y Chair Rail L NIA Y D Header Stop M/1 L N/A Y r Radiator L N/A Y Int Stops Floor L ✓[](dust) N/A y p M/1 L N/A Y 1, Win Int Sash M/I L N/A Y Ceiling L N/A Y Exterior Sill /1 F /A y AB Door L N/A Y 3 Part Bead M/ N/ Y ' G ,Door Edge ,�.., F L N/A Y 4 Blind Stop SF L /A Y 2 Door Casi L N/A Y Win Ext Sash Mill L /A Y 3 4 Door Jamb F L N/A Y A Window Sill M/I N/A Y Threshold L NIA Y B L N/A A B Door L N/A Y Win Apron Y f _ 9 L N/A Y I C D Door Edge F L N/A Y Win Casing Header Stop M/I L N/A Y 1 2 Boor Casing L N/A Y Int Stops 2— M/I L N/A Y 34 600rJamb F L N/A' Y 1 Win Int Sash M/1 L N/A Y Threshold L N/A Y 2 Exterior Sill Al F. L / Y A B Door L N/A Y 3 Part Bead �/ L C D Door Edge F L NIA Y Y 12 4 Blind Stop 1U/ S L Y Door Casing L NIA Y Win Ext Sash /I L /A Y 3 4 Door Jamb F L N/A Y A lwjndow Sill MA A/M L N/A Y ' Threshold L N/A' Y B .Win Apron 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/I L N/A Y B Cl Casing L N/A Y _ Int Stops M/I L NIA Y C Closet Jamb . F L N/A Y 1 Win IntSash M/I L N/A Y D Closet Walls L NIA Y 2 Exterior Sill Mil SF L NIA Y CI Baseboard L N/A Y 3 Part Bead f M/I L N/A Y r 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 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 A B C, Win Above 5' L N/A Y COMMENTS/STRUCTURAL DEFECTS: Ceiling Moldin L N/A Y F M11 AIM L NIA Y F M/I AIM L WA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/1 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 MII AIM L N/A Y DATE METHOD F M/I AIM L NIA I Y Check the box if this ROOM is RULED OUT for•encapsulation because there are 3 or more AIM surfaces with adhesion problem LYRA Rep 2017 Room i Rafael Vas uez U4224 10 29 22 Page of Inspector(print) Lie# Signature Date Risk Assessor(print) Lic# Signature Date Address of Pro ert : 11 Summer St A t# : Salem ROOM# SIDE LOCATION/ LEAD TYPE OF URG IC iC DELEAD DELEAD SIDEJ LOCATION/ LEAD � TYPE OF URG IC IC IDILEADI DELEAD SURFACE HAZARD HAZ?J DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B tNallS .0 L NIA Y A Window Sill M/I A/M L N/A Y A 6 A s 6eG Walls �- L NIA Y B Win Apron L NIA Y C D Baseboards L /A Y A a C Win Casing L NIA Y Chair Rail L N/A Y D Header Stop Mil L N/A Y A Radiator L NIA Y Ini Stops � M!I L N/A Y Floor L Q(dust) NIA Y 1 in IntSash 2_M/I L N/A Y xa.Ceiling L NIA Y 2 Exterior Sill it F L N/A 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 N/A Y Win Ext Sash �. I L NJA Y 3 4 Door Jamb F L N/A Y A Window Sill M/l AIM L N/A Y Threshold L N/A Y B Win Apron L NIA Y A P Door L N/A Y C Win Casing ('. L N/A Y G Door Edge F L NIA Y D Header Stop M/I L N/A Y 12 Door Casing L NIA Y Int Stops M/I L N/A Y 34 Doorjamb F L N/A Y w /1 L N/A Y M ©� 1 WinlntSash Threshold L N/A Y 2 Exterior Sill M! F 1 / Y A B Door L N/A 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 Qcor Casing L N/A Y Win Ext Sash M/ L lA Y 34 Door Jamb , F L NIA Y A Window Sill M/I AIM L N/A Y Threshold L N/A Y Win Apron L N/A Y Closet Door L N/A Y C Win Casing 03 L N/A Y A CI Door Edge F L N/A Y D Header Stop 4 M/I L N/A Y B a Casing L NIA Y Int Stops Mil L NIA Y C- Closet Jamb F L N/A I Y 1 Win Int Sash 0. Mil L N/A Y D Closet Walls L NIA Y 2 Exterior Sill M/l F L / Y _ Cl Baseboard L N/A Y 3 Part Bead M L A Y 1 Closet Pole L N/A Y 4 Blind Stop MI L J Y 2 Closet Shelf L N/A Y Win Ext Sash M/ L !A Y 3 Cl Supports L N/A Y A B lFireplace I L NIA Y 4 Closet Floor L❑(dust) NIA Y � d C D Mange 7 1 L NA Y Closet Ceili g L NIA Y A B Bc D Win Above 5' L N/A Y COMMENTS/STRUCTURAL DEFECTS: Ceiling Moldin L N/A Y F M/1 AIM L N/A Y ' F Mll AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/1 AIM L NIA Y by a Deleader(MORE THAN 288 SO.IN.) F M/I AIM L NIA Y SIDE LOCATION MEASURE:LOOSE PAINT iC IC F M/1 AIM L N/A Y DATE METHOD F MA AIM L NIA Y 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 Rafael Vas uez U4.224 ry 10 29 22 Page Of Z Inspector(print) Lic Signatu Date I Risk Assessor(print) Lic# Signature Address r • 11 Summer St j Date L27: A t.# t i t Salem ROOM# SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC IDELEADI DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A a #ilrtNalls L N/A Y A Window Sill A AIM L N/A Y A a Low Walls L NIA Y Win Apron L NIA Y a Baseboards L N/A Y A a C Win Casing L NIA Y Chair Rail 6 L N/A Y D Header Stop M/I L NIA Y Radiator L N/A Y Int Stops� F; P MII L NIA Y Floor �. L ✓®(dust) NIA y rt Ceiling !A Y 1 Win IntSash M/I L N/A Y 2 Exterior Sill M F L (A Y A Door NIA Y 3 Part Bead MI 7 Y C D Door Edge 1 F L N/A Y 4 Blind Stop M/ SF N/ Y 12 Door Casing V. L N!A Y Win Ext Sash /I L /A Y 34 Door Jamb 3 F L NIA Y A Window Sill M/I AIM L N/A Y Threshold L N/A Y B Win Apron V' L NIA Y AB Door L NIA Y C in Casing (' L NIA Y oar Edge F L N/A Y Header Stop Mill L N/A 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 NIA Y Threshold L NIA Y 2 Exterior Sill MY SF L 1 Y AB Door L N/A Y I3 Part Bead M1/l L / Y 0 D Door Edge F L NIA Y 4 Blind Stop M SF Y 12 Door Casing L N/A Y Win Ext Sash 34 Door Jamb F L N/A 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 NIA FY C Win Casing L N/A Y A CI Door Edge F L N/A Y : D Header Stop M/l L N/A Y B Cl Casing L NIA Y Int Stops Mil L NIA Y C Closet Jamb F L NIA Y 1 Win Int Sash Mil L N/A Y D� Closet Walls �. L /A Y / 2 Exterior Sill MII SF L NIA. Y Cl Baseboard L /A Y 3 Part Bead MII L N/A Y 1 Closet Pole �. L A Y 4 Blind Stop Mil SF L N/A Y 2 Closet Shelf L N/A Y Win Ext Sash M/I L NIA Y 3 Cl Supports L NIA Y A B Fireplace L NIA Y 4 Closet Floor L®(dust) N/A Y CD Mantle L NIA Y Closet Ceiling L NiA Y C p Win Above 5' L NIA Y COMMENTS/STRUCTURAL DEFECTS: n Ceiling Moldin L N/A Y F M/I AIM L N/A Y F M/l AIM L WA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F MII AIM L N/A Y by a Deleader(MORE THAN 288 SQ.IN.) F Mll AIM L WA Y SIDE LOCATION MEASURE:LOOSE PAINT IC IC F MII AIM L WA Y DATE METHOD F M/1 AIM L N/A I Y Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problem I L1/RA Rep 2017 Room Rafael Vas uez U4224 _ Q Ins ector(print) 10 29 22 PageV Of � p (p ) Lic# �Signnature Date I Risk Assessor(print) Lic# Signature Date r ss of Pr rt : 11 Summer St Rvvivl� li A t # ) City Salem i SIDE LOCATI N/ LEAD TYPE OF URG IC IC HDELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAU DELEAD SURFACE HAZARD HAZ? DATE MET DATE METH SURFACE A g HAZARD 1HAZ?1 DATE METH DATE METH Walls 0. L NIA Y A Window Sill' M/I AIM L N/A Y A. B w Walls L NIA Y A B B Win Apron L N/A Y c D Baseboards L /A Y A g Chair Rail L N/A Y C Win Casing L NIA Y AB D Header Stop M/I L N/A Y Radiator L NIA Y Int Stops Floor L[(dust)NIA Y p Mill L N/A Y 1 Win Int Sash WI L N/A Y Ceiling L N/A Y 2 ExteriorSill M/I SF L N/A Y lil A Door L N/A Y 3 Part Bead M/1 L NIA Y C D Door Edge F L NIA Y 4 Blind Stop 1 2 Door Casing Q L N/A Y p M/I SF L NIA Y Win ExtSash M/I L N/A I Y 34 Door Jamb F L N/A Y A Window Sill MII AIM L NlA Y Threshold L NIA Y r B Win Apron L N/A Y B oor L N/A Y C Win Casing L NIA Y C Door Edge F L N/A Y D Header Stop M/1 L N/A Y 12 Door Casing L NIA Y Int Stops MJI L NIA Y 3 4 Door Jamb ; F L N/A' Y 1 Win IntSash M/1 L N/A Y Threshold /�. L NIA Y 2 Exterior Sill M!I SF L NIA Y A B Door L N/A Y 3 Part Bead M/I L N/A Y 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/l L NIA Y 34 Door Jamb a�» F L N/A Y A Window Silf Mll AIM L N/A Y Threshold L N/A Y B Win Apron L N/A Y Closet Door L N/A Y C Win Casing L N/A Y Cl Door Edge F L N/A Y D Header Stop M/I L N/A Y B Cl Casing �, L N/A Y Int Stcps C Closet Jamb F L NIA Y Mll L N/A Y 1 Win lntSash M/I L NIA Y D Closet Walls L !A Y 2 Exterior Sill M/I SF L N/A Y Cl Baseboard L NIA Y 3 Part Bead Mil L N/A Y 1 Closet Pole L N/A Y 4 Blind Stop M/I SF L N/A Y 2 Closet Shelf L NIA Y 3 CI Supports L N/A Y Win Ext Sash Mll L N/A Y I A B Fir AL N/A Y 4 Closet Floor L®(dust) NIA Y Y CD Mantle L N/A Closet Ceiling L N/A Y AB AD 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 Mil AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/I AIM L N/A Y by a Deleader(MORE THAN 288 SO.IN.) F Mn AIM L NIA Y SIDE LOCATION MEASURE:LOOSE PAINT IC IC F MA AIM L NA Y DATE METHOD F M/I 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 LURA Rep 2017 Room Rafael Vasquez U4224 / 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 t.# city- Salem Common Hallway: Front Rea Floor# SIDE LOCATION! LEAD TYPE OF URG IC IC IDELEADI 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 n B Up Walls L NIA Y Closet Door L N/A Y Low Walls L N/A Y A CI Door Edg F L NIA Y A B A B Baseboards L N/A Y B Cl Casing ©� L N/A Y Chair Rail L N/A Y G Closet Jamb .2 F L N/A Y AB Radiator L N/A*YY L D Closet Walls L /A Y Floor ❑(dust) NIACI Baseboard L NIA Y L N/A Closet Pole L N/A Y A B Door L N/A Y 2 Closet Shelf L N/A Y C D Door Edge F L NIA Y 3 CI Supports L N/A Y 12 Door Casin L N/A Y 4 Closet Floor L (dust) NIA Y 3 4 Door Jamb F L NIA Y Closet Ceiling L N/A Y Threshold L N/Al Y A Window Sill 11 AIM L N/A Y A B Door L N/A Y B Win Apron L NIA Y G D Door Edge F L NIA Y C Win Casing L NIA Y 12 Door Casing L N/A Y D Header Stop mil L N/A Y 3 4 Door Jamb F L N/A Y Int Stops I'll L N/A Y Threshold L N/A Y 1 Win Int Sash M/l L N/A Y A B Door L N/A Y 2 Exterior Sill M/I SF L N/A Y G D Door Edge F L N/A Y 3 Part Bead M/1 L N/A Y 12 Door Casing L N/A Y 4 Blind Stop M/I SF L N/A Y 3 4 Door Jamb F L N/A Y Win Ext S h M!I L N/A Y Threshold L NIA Y A Window Sill M/I AIM L N/A Y A B Door L N/A Y B Win Apron L NIA Y C D Door Edge F L NIA Y C Win Casing L N/A 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 Stops p M/I L NIA Y Closet Door Y 1 Win Int Sash M/I L NIA IY A Cl Door Edge F L N/A Y 0B Exterior Sill M/I SF L N/A Y ClCI Casing L NIA Y 3 Part Bead M/I L N/A Y C Closet Jamb F L NIA Y 3 4 Blind Stop M/1 SF L N Y I D Closet Walls N/A Y Win Ext S sh M/1 L N/A Y Cl Baseboard L /A Y AB C O Win Above 5' L N/A 1 Closet Pole Y Q• L N/A Y 2 Closet Shelf a\..Ceiling Moldin L N/A Y L N/A Y 3 CI Supports D. L NIA Y F Mll AIM L N/A Y 4 Closet Floor F M/I AIM L N/A Y L®(dust) / Y Closet Ceiling L /A Y F Mil AIM L NIA Y COMMENTS/STRUCTURAL DEFECTS; EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact by a Deleader(MORE THAN 288 SO.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 Rafael Vasquez U4224 Inspector(print) 10 /29 /22 Page!Of P (P 1 Lic# Signa ure Date Risk Assessor(print) Lic# Signature Date I Ad r ss of Pro : 11 ummer t A t.# City: Salem CONTINUATION OF ROOM SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ?j DATE METH DATE METH SURFACE A B Door HAZARD HAZ? DATE METH DATE METH L NIA Y Low Cab Fram L NIA Y C D Door Edge F L N/A Y A B Low Cab Door L N/A Y 12 Door Casing L NIA Y C D Low Cab Walls L NIA Y 34 Door Jamb F L N/A Y Threshold # Low Cab Shlvs L NIA Y L N/A Y Supports L NIA Y A B Door L NIA Y Drawers C D Door Edge F L NIA Y L NIA Y A Window Sill /I AIM L N/A Y 12 Door Casing L NIA Y B WAin pron L NIA Y 3 4 Door Jamb F L NIA Y C Win Casing L NIA Y Threshold L NIA Y D Header Stop M/I L N/A Y A B Door L NIA Y Int Stops MII L NIA Y CD DoorEdge4. F L NIA Y # Win lntSash M/I L N/A' Y [34 Door Casing L N/A Y ExteriorSi11 M/I SF L NIA Y Door Jamb L NIA Y Part Bead MII L NIA Y Threshold L NIA Y V1Blind Stop Mil SF L N/A Y Closet Door L N/A Y Win Ext Sash M/I L N/A Y A CI Door Edge F L NIA Y A Window Sill M/I A/M L N/A Y B CI Casing L N1A Y B Win Apron L NIA Y C Closet Jamb F L NIA Y C Win Casing L NIA Y Closet Walls L /A Y D Header Stop MII L NIA Y Cl Baseboard L NIA Y Int Stops P MIL L NIA Y Closet Pole L NIA Y # Win Int Sash M/I L NIA Y Closet Shelf L NIA Y f� Exterior Sill M/I SF L N/A Y CI Supports L N1A Y Part Bead MAL N/A Y Cl Drawers L N/A Y Blind Stop M/I SF L N/A Y Cl Dr Frame L N/A Y Win Ext Sash Mil L NIA Y Closet Floor L (dust) NIA Y A B lFireplace I L N/A Y AB Closet Ceiling : , L /A Y C D Mantel L NIA Y CD Shlvs Above 5' L N/A Y AB A B Sidelight(L) L N/A Y C D Cab Above 5' L N/A Y C D Sidelight(R) L N/A Y AB c D Cab Above 5' L NIA Y AB CD Win Above 5 L NIA Y IDU.,PCab'Doo, L N/A Y As c D Win Above 5' L NIA Y Cab Walls EL NIA Y F M/I A/M L NIA Cab Shlvs L NIA YF M/I AIM L N/Aport L NIA Y F M/I A/M L NIA F MII A/M L N/A F M/I AIM L N/A F Mll A/M L N/A F M/1 A/M L_N/A 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 A/M surfaces with adhesion problems LURA Rep 2017 Room comd. i f iRafael Vasquez U4224 ` `/of �Inspector(print) 1Ul29 /22 Page Signature' Date Risk Assessor(�: ' rint) Sig�re Address of Pro �Summ�erSt Date PANTRY t.# Cit : Salem SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF I URGI IC I IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH B o Walls L NIA Y A B Up Cab Frame L N/A Y w Walls L NIA Y C D Up Cab Door L N/A Y A B n 6 Baseboards L NIA Y Up Cab Walls / L NIA Y AB Chair Rail L NIA Y 12 Up Cab Shlvs c o Radiator L N/A Y 34 Supports L NlA Y Floor A B Up Cab Frame i L NIA Y (J L®(dust) N/A Y zr� I— C iling t N/A Y C D Up Cab Door L N/A Y A Door L NIA Y Up Cab Walls L N/A Y D Door Edge F L NIA Y 12 Up Cab Shlvs L NIA Y 12 Door Casing L NIA Y 34 Supports e L NIA Y 34 Door Jamb F L NIA Y Low Cab Fram Threshold L L N/A Y A B Low Cab Door l.� L N(A Y A B Door L NIA Y L /A Y C D Door Edge F L N/A Y D Low Cab Walls Low Cab Shlvs 0 L NIA Y 12 Door Casing L NIA Y 12 Supports L NIA Y 3 4 Door Jamb F L N/A Y 3 4 Drawers Threshold L N/A Y L N/A Y Low Cab Fram L NIA Y I, Closet Door L NIA Y A �IDA B .Low Cab Door oor Edge F L NIA Y L N/A Y C D Low Cab Walls L NIA Y B sing L NIA Y Low Cab Shlvs L N/A Y C Closet Jamb F L NIA Y 1 2 Supports L NlA Y D Closet Walls L NIA Y 3 4 Drawers L NIA Y CI Baseboard L N/A Y Low Cab Fram 1 Closet Pole L NIA Y L NIA Y A B Low Cab Door L N/A Y 2 Closet Shelf L NIA Y C D Low Cab Walls 3 Cl Supports L N/A Y L NIA Y 4 Closet Floor Low Cab Shlvs L NIA Y L®(dust) NIA Y 12 Supports i NIA Y Closet Ceilin L N/A I Y 34 Drawers L NIA Y A B Up Cab Frame L NIA Y A Windowsill M/I A/M L N/A Y C r p Cab Door L N/A Y (BB)Win Apron L N/A Y Up Cab Walls L NIA Y �'e Win Casing L N/A Y 12 Up Cab Shlvs L N/A Y D .Header Stop Pr1lI L NIA Y 3 4 Supports L NIA Y Int Stops M/I L N/A Y F M/I A/M L NIA Y i COMMENTS/STRUCTURAL1 Win Int Sash /I L /A Y` DEFECTS: 2 Exterior Sill SF L /A Y 3 Part Bead M/ L / Y 4 Blind Stop M/1 F Y Win Ext Sash MA L /A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M11 AIM L NIA Y 1 by a Deleader(MORE THAN 288 SQ,IN.) F Mil A/Nl L N/A Y SIDE LOCATION MEASURE:LOOSE PAINT IC IC ' FM/f A/M L N/A Y DATE METHOD F Mll 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 LURA Rep 2017 Pantry i Rafael Vasquez U4224 U �, Inspector(print) Lic# / 29/ 22 Pag Of Sig attire Date k (print)� Risk A ) Lic# Signature Date I Address of Pr a 11 Summer St A t.# ` j KITCHEN city.- 3alem 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 A e Up Walls Walls y L lA Y 0.3 Window SillM/I AIM L NIA Y Low A A e B A IL IA Y B Win Apron 0( L N/A Y p 1 Baseboards L /A Y A B C Win Casing 03 L N/A Y As Chair Rail L N! Y D Header Stop 05 M/I L NIA Y CD Radiator L NIA Y In Stops M/I L N/A Y Floor L (dust) N/A Y 1 Win Int Sash 0. M/I L NIA Y Ceiling L NIA Y 2 Exterior Sill /1' NIA Y A` Door L NIA Y 3 Part Bead M N/A Y C D Door Edge F L N/A Y 4 Blind Stop M/ SF L IA Y 12 Door Casing L NIA Y Win Ext Sash /1 L NIA Y 34 Door Jamb F L NIA Y A Window Sill M/I AIM L NIA j Y Threshold L NIA Y (_�)Win Apron L /A Y A B Door ®' 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 0. F L NIA Y 1 Win Int Sash I L /A Y Threshold L N/A, Y ?I F L 1A Y 2 Exterior Sill li A B Door L N/A Y 3 Part Bead M/ L / Y D Door Edge F L N/A Y 4 Blind Stop SF L ( Y 1 oor Casing L N/A Y Win Ext Sash Ml L FjAb Y 34 Door Jamb F L NIA Y A B Up Cab Frame L y Threshold L NIA Y C D Up Cab Door L NIA Y Closet Door L NIA Y Up Cab Walls L N/A Y �• A CI Door Edge �, F L N/A Y 12 Up Cab Shlvs L NIA Y B CI Casing L NIA Y 3 4 Supports L N/A Y C Closet Jamb �. F L N/A Y - Low Cab Fram Closet Walls L NIA Y L NIA Y A B Low Cab Door L NIA Y Cl Baseboard L N/A Y C D Low Cab Walls L N/A Y 1 Closet Pole L NIA Y Low Cab Shlvs L N/A Y 2 Closet Shelf L NIA Y 12 Supports L NIA Y 3 Cl Supports L NIA Y 34 Drawers • L NIA Y 4 Closet Floor L®(dust) NIA Y AB CD Win Above 5' L NIA Y li Closet Ceiling L /A Y Ceiling Moldin L NIA Y COMMENTS/STRUCTURAL DEFECTS: F Mil AIM L N/A Y F MII AIM L NIA 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/1 AIM L N/A Y by a Deleader(MORE THAN 288 SQ,IN.) FMn AIM L wa Y SIDE LOCATION MEASURE:LOOSE PAINT IC IC F M/I AIM L NIA Y DATE METHOD F M/I AIM L NIA 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 Kitchen 11 i Rafael Vasquez U4224 � 10 /29 /22 ��of_ Pag _ ,�2j Inspector(print) Lic# Signature i Date Risk Assessor(print) Lic# Signature Date Address of Pro pert : 11 S mm C A t.# Ci : Salem CONTINUATION OF ROOM( ) SIDE LOCATION! LEAD TYPE OF URG IC IC DELEAD DELEAD SIDEJ LOCATION! LEAD TYPE OF URG IC IC IDELEADI 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 NIA Y CD Low Cab Walls L NIA Y 3 Door Jamb F L NIA Y # Low Cab Shlvs L NIA Y Threshold L N/A Y Supports pp L NIA Y A B Door L NIA Y Drawers L NIA Y oorCasi 0 f L N/A Y A Window Sill M/I AIM L N/A Y 12 Door Casing L NIA Y B Win Apron L NIA Y 34 Door Jamb ®. F L N/A Y C Win Casing L NIA Y Threshold L N/A Y D Header Stop M/l L NIA Y A B Door L NIA Y C D Door Edge Int Stops M/I L NIA Y F L NIA Y # Win Int Sash M/I L NIA Y 12 Door Casing L NIA Y Exterior Sill Mll SF L NIA Y 34 Door Jamb F L NIA Y Part Bead Mll L NIA Y Threshold L N/A Y Blind Stop M/I SF L NIA Y Closet Door L N/A Y Win Ext Sash M/I L N/A Y A Cl Door Edge F L N/A Y A Window Sill Mll A/M L NIA Y B CI Casing L NIA Y C Closet Jamb F L N/A Y B Win Apron L N/A Y C Win Casing L NIA Y C Closet Walls L N/A Y D Header Stop Mil L NIA Y CI Baseboard L NIA Y Int Stops P M/I L NIA Y Closet Pole L N/A Y # Win Int Sash M/I L N/A Y # Closet Shelf 0 L N/A Y Exterior Sill M/I SF L N/A Y Cl Supports L N/A Y Part Bead. / Mll L N/A Y Cl Drawers L NIA Y Blind Stop M/I SF L NIA Y j Cl Dr Frame L N/A Y Win Exl Sash; Mil L N/A Y Closet Floor L®(dust) N/A Y AB Fireplace L NIA Y Closet Ceiling L N/A Y C D Mantel L N/A Y AS C D Shlvs Above 5' L N/A Y AB Sidelight(L) L N/A Y AS C p Cab Above 5' L N/A Y C D Sidelight(R) L NIA Y AS c D Fab Above '. L NIA Y AS CD Win Above 5' C NIA Y C D Up Cab Door T AS CD Win Above 5' L N/A Y Up Cab Walls 2LNIAR F,M/1 A/M L N/A Up Cab Shlvs Supports F M/I AiM L NIA F M/l A/M L N/A F M/1 A/M L NIA F M/I A/M L N/A F M/I AIM L N/A F M/I AIM L NIA EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS/STRUCTURAL DEFECTS: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 LURA Rep 2017 Room contd. Rafael Vasquez U4224 10 /29 /22 Page+_l Inspector(print) Lic#' of Signa ure bate Risk Assessor (print) Lic# Signature Date Address of Pro ert : 11 Swimmer St A t.# BATHROOM# Cit Salem 1;E:: SIDE LOCATION/ LEAD TYPE OF [HAZ,G IC IC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF URG IC IC IDELEAD—FDELEAD SURFACE HAZARD DATE METH DATE METH SURFACE I HAZARD HAZ? DATE METH DATE METH C D Up Walls L N/A Y �B p Cab Frame L N/A Y A B Low Walls L NlA Y C D Up Cab Door L NIA Y p Baseboards L NIA Y A 8 Up Cab Walls �. L NIA Y Chair Rail L NIA Y 1 2 Up Cab Shhv1 011L NIA Y A8 Radiator L N1A Y 34 Supports L N!A Y Floor L�0(du.t�N YLow Cab Fram L N/A Y g Y B Door A B Low Cab Door L N/A Y L N/A Y G Door Edge F L NIA Y C D Low Cab Walls L NIA Y D 2 Door Casing L NIA Y Low Cab Shlvs L NIA Y 'I 1 2 Supports 34 Door Jamb F L N/A Y L NIA Y 3 4 Drawers L NIA Y Threshold L NIA Y A Window Sill 1ZZ M/I AIM L A Y A oor L NIA Y B Win Apron L NIA Y C D Door Edge F L N/A Y G Win Casing L NIA Y 12 Door Casing ,:• L NIA Y D Header Stop � MA L NIA Y 3 4 Door Jamb �jZ F L N/A Y Threshol Int Stops /I L NIA Y L NIA Y 1 Win Int Sash A B Door L N/A Y L NIA Y 2 Exterior Sill /1 1 % Y C D Door Edge F L NIA Y 3 Part Bead 12 Door Casing L N/A Y M6 I L / Y 4 Blind Stop / SF L / Y 34 Door Jamb F L N/A Y Win Ext Sash If /A Y Threshold L NIA Y AB Win Above 5' Closet Door L N!A Y CD L NA Y —g Ceiling Moldin L NA Y A Cl Door Edge F L N/A Y A --alb j C �s B CI Casing; L N/A Y Medicine C L NAY C ClosetJamb F f� FM/I AIMS WA Y L N/A Y F MII AIM L N/A Y D Closet Walls L N/A Y Cl Baseboard L N/A Y F M/I AIM L NIA Y 1 Closet Pole F M/I AIM L NIA Y L NIA Y r 2 Closet Shelf L N F M/I AIM L NIA Y IA Y 3 CI Supports L N/A Y F Mill AIM L NIA Y 4 Closet Floor L F M/1 A/M L NIA Y I ❑(dust) N/A Y �.Ceilinj L NIA Y F M/I AIM L N/A Y Closet ° F M/I AIM L N/A Y F Mli A/M L N/A Y F M/I AIM L N/A Y F M/I A/M L NIA Y F M/I AIM 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 1C IC DATE METHOD 1 Check the box if this ROOM is RULED OUT for encapsulation I because there are 3 or more AIM surfaces with adhesion problems li LI YRA Rep 2017 Bath i Rafael Vasquez q U4224 10[29 /22 Page Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature J l Address P o e : 11 Summer St Date A # C' : Salem HALLWAY:Interior #� or Common Hallway: Front #tea Floor EAB LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC IDILEADI DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE a HAZARD HAZ? DATE METH DATE METH alls L NIA Y Closet Door L NIA Y I L4;,w AB Walls a. L NIA Y A CI Door Edge F L N/A Y C D Baseboards 0L NIA Y A B B CI Casing L N/A Y Chair Rail L NIA Y C Closet Jamb F A e L N/A Y u Radiator L N/A Y D Closet Walls L NIA Y _.E Floor L 0Qdust N/A Y CI Baseboard s Ceiling L /A Y L N/A Y 1 Closet Pole L N/A Y B Door L N/A Y 2 Closet Shelf L N/A Y CID 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 Closet Ceilin L Threshold Q. L N/A Y Window Sill MA AIM L NIA 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 3 4 Door Jamb F L N/A Y Int Stops 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/A Y 2 Exterior Sill / D Door Edge F L N/A Y L / Y 3 Part Bead L /T Y Door Casing L N/A Y 4 Blind Stop L /A Y 3 4 Door Jamb O. F L NIA Y Threshold Win Ext Sash L /A Y Q L N/A Y A Window Sill M/I A/M L N/A Y A B Door L NIA 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 NIA Y 3 4 Door Jamb F L N/A Y M/I L N/A YCloset Door L N/A Y Int Stops Win 1.t Sash M/I L N/A Y A CI Door Edge F L NIA Y 2 Exterior Sill MII SF L N/A Y B Cl Casing L N/A Y 3 M/I Part Bead L N/A Y - C Closet Jamb F L N/A Y 4 Blind Sto p M/I SF L NIA 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 N/A Y 2 Closet Shelf L N/A Y 3 CI Supports I. N/A Y F M/I A/M L WA Y F M/I AIM L N/A Y 4 C losetFloor L❑(dust) N/A Y F M/1 A/M L N/A Y Closet Ceilin L N/A Y COMMENTS IS 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 L1/RA Rep 2017 Hall i Rafael Vasquez: U4224 .�7 � 10/ 29 /22 Pag,/60fz �' Inspector(print} Lic# Signa# re Date Risk Assessor(print) Lic# Signature Date Address f Pro e 11 Summer St A t. i : Salem HALLWAY:Interior # or Common Hallway: rout Re Floor#� SIDE LOCATION/ LEAD TYPE OF 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 B jA alls L /A Y Closet Door L N/A Y ?LowWalls L N1A Y A Cl Door Edge F L N/A Y A B c Q Baseboards L 61iA Y B CI Casing L N/A Y A 6 Chair Rail L N/A Y C Closet Jamb F L N/A Y AS Radiator L N/A Y Floor D Closet Walls L N/A Y L®(dust) N/A Y Cl Baseboard Ceiling L N/A Y L N/A Y " 1 Closet Pole L N/A Y A DoorWNA 2 Closet Shelf L N/A Y C D Door Edge 3 Cl Supports L N/A Y 12 Door Casing 4 Closet Floor L ®(dust) N/A Y 3 4 Door JambNIA Closet Ceiling L N!A Y Threshold A Window Sill M/I AIM L N/A Y A oor s L N/A Y B Win Apron L NIA Y C Door Edge F L N/A Y C Win Casing L N/A Y % 1 2 Door Casing L N/A Y D Header Stop M/I L N/A Y 3 4 Door Jamb F L NIA Y Int Stops p M/1 L N/A Y Threshold L N/A Y 1, Win lntSash M/I L N/A Y A B Door L N/A Y 2 Exterior Sill MA SF L N/A Y C D Door Edge F L NIA Y 3 Part Bead MA L N/A Y 1 2 Door Casing L N/A Y 4 Blind Stop M/I SF L N/A Y 3 4 D oor Jamb F L N/A AY Win Ext Sash M/I L Threshold L N/A Y A Window Sill 1A AIM L A B Door L NIA Y B Win Apron_ L N!A Y C D Door Edge F L NIA Y C Win Casing L NIA Y 12 Door Casing L N/A Y D Header Stop Mill N/A Y 3 4 Door Jamb F L N/A Y Int StopsM/1 L NIA Y Closet Door L N/A Y 1 Win Int Sash M/I L NIA Y A [CID..,Edge F L NIA Y 2 Exterior Sill M/I SF L N/A Y B Cl Casing L N/A Y 3 Pact Bead Ivl/I L N/A Y � C Closet Jamb F L N/A Y 4 Blind Stop M/1 SF L NIA Y D Closet Walls L N/A Y Win Ext Sash M/I L N/A Y Cl Baseboard L N/A Y AS C D Win Above 5' L NIA Y i 1 Closet Pole L N/A Y ��Ceiling Moldin L N/A Y 2 Closet Shelf L NIA Y F M/I AIM L NIA 3 CI Supports L NIA Y Y F M/I AIM L N/A Y 4 Closet Floor L®(dusf) N/A Y F M/I AIM L WA Y Closet Ceili 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 is DATE 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 L1/RA Rep 2017 Hall i Rafael Vasquez U4224 ! 10 /29 /22 pa Inspector(print) Li c# gee"—� ur w Signature Date Risk Assessor(print) Lic# Signature / Addre f P ert : 11 Sul mer St 3 Date R Aat. ! city: Salem SIDE ATION/ LEA TYPE OF I URG IC IC IDELEADI DELEAD SIDE LOCATION/I LEAD TYPE OF I URG IC IC �DELEADCELEAD i SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH A B Up Walls fall L /A Y A Window Silt A B Low Walls M/I AIM L N/A Y A a L NIA Y B Win Apron L NIA Y c o Baseboards L NIA Y A B C Win Casing L N/A Y AB Chair Rail L NIA Y D Header Stop M/1 L NIA Y CD Radiator L NIA Y Floor Int Stops M/1 L N/A Y � L❑'(dust) NIA Y 1 Win Int Sash M/I L NIA Y Ceiling L IA Y 2 Exterior Sill M/I SF L N/A Y A B Door L NIA Y 3 Part Bead M/I L NIA Y C D Door Edge F L N/A Y 12 Door Casing L NIA Y 4 Blind Stop M/I SF L NIA Y Win Ext Sash M/I L N/A Y 34 Door Jamb F L NIA Y A Window Sill Mil AIM L N/A Y Threshold L NIA Y B Win Apron L N/A Y A 8 Door L N/A Y C Win Casing L NIA Y D Door Edge F L NIA Y D Header Stop M/I L N/A Y 1 oor Casing L N/A Y 34 Door Jamb F L N/A Y Int Stops Mil L NIA Y 1 Win Int Sash M/I L NIA Y Threshold L NIA Y 2 Exterior sill M/1 SF L NIA Y A B Door L NIA Y 3 Part Bead D Door Ede MA L NIA Y Y 4 Blind Stop M/I SF L NIA Y 2 Door Cass ® F ing �; L L NI N/A A, Y Win Ext 5as M/I L NIA Y 3 4 Door Jamb F L N/A Y Newel Post L N1A Y Threshold L /A Y Railing Cap AIM L NIA Y A B Door L N1A Y Handrail AIM L N/A Y C D Door Edge F L NIA Y Balusters L N/A Y 12 Door Casing L NIA Y "Lower rail 34 Door Jamb F � L N/A Y L N!A Y „ Treads F L N/A Y Closet Door L NIA Y „ `Risers L NIA Y A CI Door Edge F L NIA Y „Stringer L NIA Y B CI Casing L NIA Y Tread edge>5 L NIA Y C Closet Jamb F L NIA Y D Closet Walls L NIA Y Landing floor L ❑(dust)NIA Y 40, Floor Edge L N/A Y Cl Baseboard L N/A Y Floor Casing L NIA Y 1 Closet Pole L N/A Y F M/l AIM L NIA Y 2 Closet Shelf IL NIA Y 3 Cl Supports L N/A Y F M/I AIM LNIA1 Y 4 Closet Floor L®(dust) NIA Y F M/I AIM L N/A I Y Closet Ceiling L N/A Y F M/I AIM L NIA Y —VA . F M/I AIM 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 or more AIM surfaces with adhesion problems LYRA Rep 2017 Stair Rafael Vasquez U4224 t 10 f 29/22 PageNO Of Inspector(print) Lic# Signature' Date Risk Assessor(print) Lic# Signature f Date ' Address of Prop xtg 11 Summer St Ant # / D� city Salem PORCH (side) _ (floor) 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 AB Siding L NIA Y A B Window Sill '� AIMM L IA Y CID Corner Boards L A Y CD Win Casing L N/A Y ri Upper Trim L N/A Y 12 Window Sash L NIA Y Ceiling �- L IA Y 3 4 Mullions L NIA Y Joists L A Y A B Window Sill ` Al L IA Y Storm Door �(� L N/A Y C D Win Casing L NIA Y LAB Sirm Door Edge v F L NIA Y 12 Window Sash L N/A Y Door 'N/A Y 3 4 Mullions L NIA Y Door Edge F /A Y 1111, Support Clmns 0. L NIA Y Door Casing q L N/A Y Newel post A) L N/A Y 3 4 Door Jamb /� F L IA Y '/ � Railing Cap AIM L N/A Y Threshold �, (_L)q/A Y Handrail A/ L N/A Y Kickplate L /A Y '.,Balusters L N/A Y Storm Door L NIA Y tft Lower Rail L N/Al Y A B Strm Door Edge Y ,.,Treads F L NIA Y C D Door /A Y Risers L NIA Y ,ra. F000',:E" eF L NIA Y Stinger L N/A Y �2 Casing L lA Y Tread Edge L N/A Y 3 2r poor Jamb F L /A Y Lower Walls L N/A Y Threshold L NIA Y ',a Lattice L N/A Y Kickplate L /A Y Y A,x•LowerTrim L N/A Y A B Window Sill AI L N/A Y Floor LQ(dusty N/A Y C D Win Casing L N/A Y F M/1 AIM L NIA Y 1� Window Sash L NIA Y F MA AIM L N/A Y 3 4 Mullions L NIA Y F M/l AIM L NIA Y A B Window Sill AIM L N/A Y F M/I AIM L N/A Y C D Win Casing L NIA Y F M/f AIM L N/A Y 12 Window Sash L NIA Y F M/I AIM L N/A Y 34 Mullions L N/A YI F M/I AIM L NIA Y A B Window Sill AlM L iA Y F Mil AIM L N/A Y C D Win Casing L NIA Y F M/1 AIM L NIA Y 12 indow Sash L NIA Y F M/I AIM L NIA Y 3 4 Mullions L NIA Y F M/I AIM L NIA 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 AIM surfaces with adhesion problems LI/FA Rep 2017 Porch Rafael Vas uez' 114224 ~� Inspector(print) Lic# 1U/29122 PageofG_ Sign ure Date Risk Assessor (print) Lic# Signature Address of Pro rt : 11 Summer St Date t.# c.ity.Salem 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 ' L N/A Y _HAZARD HAZ? DATE METH I DATE METH Window Sill A/M L N/A Y Corner Boards L N/A Y A Lower Trim L N/A Y Win Casing L N/A Y # Window Sash 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 CeI Win Frame Porch Above 5' L N/A Y L /A Y # Cel Win Sash L NIA Y Storm Door - L N/A Y ' Screen Frame L N/A Y Simi Door Edge F L N/A Y Cellar Win Sill AAIM L N/A Y A Door L NIA Y A CeI Win Frame 2 Door Edge 2— F L N/A' Y L N/A Y # L 3 4 Door Casing L /A Y CeI Win Sash . N/A Y Screen Frame L NIA Y Door Jamb F L /A Y Cellar Win Sill A/M L NIA Y Threshold N/A Y A Gel Win Frame L N/A Y Kickplate L /A Y # CeI Win Sash L N/A Y r Stnrm Door L N/A Y Screen Frame L N/A Y Slrm Door Edge F L N/A Y -- Foundation L N/A Y A Door L NIA Y A Bulkhead L N/A Y 1 2 Door Edge F L N/A Y Fences 3 4 Door Casing L (A Y L N/A Y Shutters L N/A Y Door Jamb Threshold F L N/A Y Newel post '0 L N/A Y Kickplate L /A Y Railing Cap AIM L NIA Y Door Handrail A/M L NIA Y L NIA Y A Door Edge F L N/A Y A Balusters L N/A Y 1 2 Door Casing L NIA Y Lower Rail L NA Y 3 4 Door Jamb F L N/A Y Treads F L N/A Y Risers L N/A Y Threshold L N/A Y Tread edge L NIA Y Kickplate / L NIA Y 3 Landing floor L NIA Y Window Sill � A/M L N/A Y Stringer L N/A Y A Win Casing iL NIA Y Lattice L N/A Y Window Sash L N/A Y Drain Pipes L NIA Y Window Sill A/M L N/A Y A Elec Conduit L A N/A Y Win Casing I. N/A Y Qil Fill Pipe L# Window Sash L N/A Y NIA, Y Overhang Trim L /A Y COMMENTS/STRUCTURAL DEFECTS: A Lamp Post L N/A Y A I f A F M/l A/ L /A Y A F M/I A/M 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.) LOCATION ppm for play area/t200 ppm for bare soil} 4REAMEASUREMENT RESULT REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT rconre ICMETHOD A (Square Feet) (PPM) DATE METH A Play Area A Bare Soil A Comments: L1/RA Rep 2017 Ext A Rafael Vasquez U4224 101 29/22 Pag of�Z Inspector(print) Lic# Signature Date Risk Assessor (print) Lic# Signature Date Address of Property:I I Summer St Apt.# Cit : 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 Win 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 �} M L /A Y Win Above 5' L /A Y B Gel Win Frame "� L /A Y Porch Above 5 . L N/A Y # l Cal Win Sash L N/A Y Storm Door L N/A Y Screen Frame /A Y Stmn Door Edge F L N/A Y Cellar Win Sill M L /A Y B Door L NIA Y B Cel Win Frame 1 2 Door Edge F L NIA Y #� Gel Win Sash 0 '1A y 3 4 Door Casing L N/A Y Screen Frame lA y Door Jamb F L N/A Y Cellar Win Sill AIM L /A Y Threshold . L N/A Y B Gel Win Frame L /A Y Kickplate L N/A Y # Cel Wm Sash L N/A Y ] ��]_-- __1 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 N/A Y Railing Cap A/M L N/A Y Kickplate L N/A Y Handrail AIM L N/A Y Door L NIA Y B Baluste1_q rs L N/A Y B Door Edge F L N/A Y tower Rail L N/A Y 1 2 Door Casing L NIA . Y Treads F L N/A Y 3 4 Door Jamb F L N/A Y Risers L N/A Y Threshold L NIA Y Tread edge L N/A Y Kickpiate. L N/A Y Landing floor L_NIA 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 N/A Y Oil Fill Pipe L N/A Y # Window Sash L N/A Y Overhang Trij L N/A Y COMMENTS/STRUCTURAL DEFECTS: B Support C Imns L N/A Y B F M/I A/M L N/A Y ' B 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 Deleader(MORE THAN 2880 SQ.IN.) LOCATION AREA MEASUREMENT RESULT REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD (Square Feet) (RPM) DATE METH BPlay Area Bare Soil B Comments: B Ll/RA Rep 2017 Ext B Rafael Vasquez U4224 10/ 29 /22 Page 2�of Inspector(print) 22 Lic# Sigrikure g Date Risk Assessor (print) Lic# Signature Date Address of Property: $UtT m ar'$t Ant # � city Salem EXTERIOR C Side p4 � SIDE LOCATION/ LEAD TYPE OF URG IC IC ID,ELEADI DELEAD SIDEJ LOCATIONI LEAD TYPE OF URG IC IC DELEAD DE LEAD C SURFACE HAZARD HAZ? DATE METH DATE METH C SURFACE HAZARD HAZ? DATE METH DATE METHSiding L N/A Y oftdow ill A/M L N/A Y Corner Boards L /A Y C gL N/A YLowerTrim L N/A Y # ash L N/A Y Upper Trim L /A Y Cellar Win Sill A/M L N/A Y Win Above 5' L /A Y C Cel Win Frame L N/A Y Porch Above 5' L A Y # Cell 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 C Door L N/A Y C Gel Win Frame L N/A Y 1 2 Door Edge F L N/A Y # 3 4 Door Casing L N/A Y Gel Win Sash L N/A Y Screen Frame L N/A Y Door Jamb F L WA Y Cellar Win Sill A/M L N/A Y Threshold L N/A Y C FCen L N/A Y Kickplate L NIA Y # L N/A Y Storm Door L N/A Y L N/A Y Strm Door Edge F L N/A Y C Door L NIA Y Foundation L N/A Y C Bulkhead L NIA Y 1 2 Door Edge F L N/A Y 3 4 Door Casing L N/A Y Fences 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 N/A Y Kickplate L N/A Y Handrail A/M L N/A Y Door L N/A Y C Balusters L N/A Y C Door Edge F iL 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/A Y Tread edge L N/A Y Kickplate L N/A Y Landing flo r L N/A 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 I Y # Window Sash L N/A Y Drain Pipes v L N/A Y Window Sill A/M L N/A Y C Elec Conduit L N/A Y C Win Casing L N/A Y 1 Fill Pipe ` L /A Y # Window Sash L N/A Y Overhang Trim, L N/A Y COMMENTS/ST UCTURAL DEFECTS: C Support Clmn 9 L /A Y C F M!I AIM L N/A Y C F M/1 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 porn for bare soil) intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION AREA MEASUREMENT RESULT REMED RENTED !1DE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD (Square Feet) (PPM) DATE METH Play Area Bare Soil Comments: C aI i LYRA Rep 2017 Ext C Rafael Vas uez U4224 10 /29 /22 Page_Zf f Inspector(print) Lic# Signature Date Risk Assessor (print) Lic# Signature Date Ad r ss of Property: Summer St t.# cit : Salem EXTERIOR D Side v SIDE LOCATION/ LEAD TYPE OF I URG IC IC DELEAD DELEAD FD J LOCATION( LEAD TYPE OF URG IC IC DELEAD DELEAD D SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH Siding L N/A' Y Window Sill A/M L NIA Y Corner Boards L NIA Y Win Casing L N/A Y D Lower Trim L N/A Y Window Sash Upper Trim, L /A Y L N/A Y kCellarin Sill A/M L N/A YWin Above 5' L /A' Y Frame (':� L N/A YPorch Above 5' L N/A Y SashL N/A YStorm Door L NlA Yirame L N(A Y Strm Door Edge F L N/A Y Cellar Win Sill • AIM L N/A Y D Door �, L N/A Y D I Cal Win Frame 1 2 Door Edge F L N/A Y L N1A Y # Cel Win Sash L NIA Y 3 4 Door Casing L N(A' Y Screen Frame L NIA Y Door Jamb F L NIA Y Cellar Win Sill A/M L NIA I Y Threshold L N/A Y D Cal Win Frame Kickplate L N/A Y L N/A Y # Cel Win Sash L NIA Y Storm Door L N/A Y Screen Frame Sirm Door Edge F L N/A Y L NIA Y D Door 7- L N/A Y L N/A Y Foundation D Bulkhead L NIA Y 1 2 Door Edge 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 N/A Y Threshold L NA Y Railing Cap A/M L NIA Y Kickplate L N/A Y Handrail A/M L NIA Y W L N/A Y D Balusters DL NIA Y L N/A Y Lower Rail L N/A Y 1 2L N/A Y Treads F 3 4 L N/A Y L N/A Y Risers L N/A Y L N/A Y Tread edge L NIA Y N/A Y Landing Floor L N/A 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 Drain Pipes L N/A Y Window Sill AIME L NIA Y D Elec Conduit L N/A Y LDjWindowSash in Casing L N/A Y Oil Fill Pipe L N/A Y L N/A Y Overhang Tri L N/A Y COMMENTS 15TRUCTURAL DEFECTS: D Support Clmns L N/A Y D F MA AIM L NIA Y D F Mll WM L N/A intact by a Deleader(MORE THAN 2880 SQ.IN.) 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) LOCATION AREA MEASUREMENT RESULT REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT IODATE ICMETHOD D (Square Feet) (PPM) DATE METH D May Area Bare Soil D �i D Comments: Lt/RA Rep 2017 Ext D