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312 1/2 LAFAYETTE STREET - BUILDING INSPECTION =1/2STREET Certificate No: 494-10 Building Permit No.: 494-10 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the RESIDENCE located at -------------------------- -------- - Dwelling Type i 312 1/2 LAFAYETTE STREET in the CITY OF SALEM Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY OCCUPANCY PERMIT IS FOR THE WHOLE BUILDING (312 LAFAYETTE STREET) This permit is granted in confotnuty with the Statutes and ordinances relating thereto, and expires _ _ unless sooner suspended or revoked. Expiration Date -46 ------ ------ Issued On: Toe Oct 19,2010 ------ ------ - GecTMS®2010 Des Lauriers Municipal Solutions,Inc. '-'--""--"""-----"""""""""""""""""" """'------- �•�ONDIT YSOYE AO CITY OF SALEM BUILDING PERMIT 3121/2 LAFAYETTE STREET - `� _ 494-10 GIS4as9 Map:: 32 COMMONWEALTH OF MASSACHUSETTS Block: CITY OF SALEM Lor 0218 Category: REMODEL , Permit# 494-10 • BUILDING PERMIT Project# JS-2010-000781 Est. Cost.s,„ $920,000.00 Fee Charged: e' $10,125.00 Balance Due: $.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: ' . ! Contractor: License: Expires Use Group: "' ,_. Win over Construction/Michael Sarno Lot Size(sq.ft) 4984 1352 Zoning: ':` Owner: LAFAYETTE REALTY TRUST Units Gained: Applicant: Windover Construction/Michael Sarno Units Lost: ,. AT: 312 1/2 LAFAYETTE STREET Dig Safe#: ISSUED ON: 20-Jan-2010 AMENDED ON: EXPIRES ON: 20-Jun-2010 " TO PERFORM THE FOLLOWING WORK: CONVERT(2)UNITS TO ONE GROUP DWELLING. ADD TWO(2) STAIRWAYS EXTEND DORMER ADD LIFT,FIRE PROTECTION NEW PLUMBING NEW ELECTRICAL ENCLOSE PORCH&DEMOLISH ONE GARAGE jbh POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground:., Underground: Excavationijiz,7,),JV MC/ Service: Meter: /fl� / Footings: Rough: Rough: g11111,1Rough Found tion:n: FinalFina[41n v;; FinalGi�k Rough Frame:"f: /.yb C�. I / Fireplace/Chimney: D.P.W. Fire ( Health Meter: Insulation: Final: House# o pp i Water: ,� I Assessor Treasury: Sewer: ers: /%'''//0 Final: R G THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPO OLATION OF ANY OF ITS RULES AND REGULATIONS. "'a 1 - - Signatu Fee Type: Receipt No: Dat 9 aid: Check No: Amount: BUILDING RFC-2010-000908 20- -10 0797 $10,125.00 HI A : An ilnspetti0n is RE upon completion Of work, pjaase CEMa p n ' 97"19-5641 Cali KOF �`Co � �� ®CCUpy GeoTMS®2010 Des Lauriers Municipal Solutions,Inc. t a 4. N ' V Vr� • VSGVE AD CITY OF SALEM BUILDING PERMIT The Commonwealth of Massachusetts Department of Public Safety One Ashburton Place,Boston, MA 02108.1618 CERTIFICATE FOR USE OF ELEVATOR !� Chapter 143,General Laws,as amended Salem MA Loca€ion: 312 LaFayette Street, j Speed: X11 Feet per minute capacity:�� Z_0 Pounds F.T.#: 1001657 State ID#: 258-W-400 P, F. 5 Issued on: 1010512010 A. Expires: l I y 1 Goll Thomas G.Gatzunla Commissioner Appy , I for Re•inspoction 60 days Prior to Evlretion Data. j IN CASE OF ACCIDENT NOTIFY (508)820'1444 AT ONCE. I REPORT UNSAFE CONDITIONS TO BUILDING MANAGER 1 OWNER I i 3 Titg of 14�ttlem, Massur4usetts Ilublic traperttl Department Nuilbing Department (One Balem (6reen 500-745-9595 $xt. 300 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer January 15, 1997 James & Catherine McHugh 25 May Street Peabody, Mass. 01960 Dear Property Owner: .The following notice is in regard to your property located at: 4f 3121kafayette—St-:, Salem, Mass. It is your responsibility to have snow and ice removed from your sidewalk within six (6) hours after the snow ceases to fall. This is in accordance with the City of Salem Code of Ordinance, Section 26-13 and Section 26-14. Failure to remove snow from sidewalks within prescribed time will result in a fine being assessed for each day of violation. Please contact this office upon receipt of this letter as to your course of action in this matter. Thank you in advance for your anticipated cooperation in this matter. Leo E. Treml412}+ Director of Public Property NEIGHBORHOOD IMPROVEMENTTASK FORCE REFERRAL FORM Dale: Address: �`y� ���.�sve ��a /ve fo 1 � Complaint: %�c Complainant: ,�i �`� �Ff/j/ Phone#: 75 Address of Complainant: 2 2!F 4?, L DAVID SHEA, CHAIRMAN KEVIN HARVEY BUILDING INSPECTOR ELECTRICAL DEPARTMENT FIRE PREVENTION CITY SOLICITOR HEALTH DEPARTMENT SALEM HOUSING AUTHORITY ANIMAL CONTROL POLICE DEPARTMENT PLANNING DEPARTMENT ASSESS t_ it TREASURER/COLLECTOR DPW WARD COUNCILLOR DAN GEARY SHADE TREE PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE SHEA WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE. ACTION: CITY OF SALEM MASSACHUSETTS 01970 Municipal Inspections Department 780 CMR 112 CONSTRUCTION CONTROL—FINAL AFFIDAVIT To the Building Commissioner of the City of Salem Architect/Engineer Affidavit: q A I certify that I have observed the work associated with permit no. J /0 dated .JAN . SO ZC/O fors l2LAF'"inow g' MMproject name and address). To the best of my knowledge,information and belief, the work is complete and in conformance with the approved plans and provisions of the Commonwealth of Massachusetts State Building Code and all other pertinent laws,rules and regulations of the City of Salem. Arc ct r Engineer Mass.Reg. No. Name (print) Signature r Street Address to / v1 oto nn�-rraFr,�rs�a o/9¢q Date City,State, Zip Contractor Affidavit: I certify that I have observed the work associated with permit no. if9cl— /U dated ZO/O for21Z 441't+3. t6f- sW19et61 /d9lL (project name and address). To the best of my knowledge,information and belief,the work is complete and in conformance with the approved plans and provisions of the Commonwealth of Massachusetts State Building Code and all other pertinent laws, rules and regulations of the City of Salem. LIS sg a89 Mme( s. Svc Architect or Engineer Mass. Reg.No. Name (print) 0 17 13/-cswu Signature Street Address 69- V5 US y , Date /o/7/h, City,State,Zip Then personally appeared the above name J ey Pnt o t(C/us And made oath that the above statements by them are true. A Before me, 69 date My commission expires ROFFICIAL SEAL LISA R. ROBERTS NOTARY PUBLIC COMMONWEALTH OF MASSACHUSETTS My Comm.Expires Sept.9,2016 Residential Inspection Company LETTER OF FULL DELEADING COMPLIANCE October 13, 2010 John M. Hartley, Trustee 312 Lafayette Realty Trust 152 Lynnway, Suite 3A Lynn, MA 01902 To Whom It May Concern: This letter certifies that Residential Inspection Company reinspected your property located at 312�h Lafayette Stteef and relevant common areas in the City of Salem for full deleading compliance on Octot3er.i3;;201Q, and on that date those surfaces cited in the initial inspection report dated Mav112009, were found to be in full compliance with Massachusetts General Laws, Chapter 111, Section 197, and 105 CMR 460.000: Regulations for Lead Poisoning Prevention and Control. Dust samples were taken and found to be within acceptable limits. Massachusetts law does not require the abatement or containment of all residential lead paint. The residential premises or dwelling unit and relevant common areas shall remain in compliance only as long as there continues to be no peeling, chipping or flaking lead paint or other accessible leaded materials, as long as coverings and/or encapsulants forming an effective barrier over such paint or other leaded materials remain in place, and as long as surfaces reversed to correct lead hazards remain reversed and securely in place. The law grants you a 30-day maintenance period to repair deteriorated lead paint or detached coverings over such paint, and to clean up, during which time this Letter remains valid. The reverse side of this letter indicates the authorized persons who performed deleading on the property and a general summary of the methods used. A complete reinspection report is attached to this letter, which specifies how and on what date each surface was brought into compliance. Do not lose these documents. To the best of my knowledge, the cost of the legally required deleading was $15,000. Sincerely, � serKevin Nes "� License #11359 P.O. Box 309 Page i of 2 Phone & Fax: 781-942-0188 Reading, MA 01867 Email: RIC309@comcast.net ADDRESS: 3121/2 Lafayette Street, Salem, MA 01970 Inspection and Deleading History Initial inspection done on May 13, 2009, by Kevin Nestor, License #11359 Reoccupancy reinspection done on October 11. 2010, by Kevin Nestor. License#11359 Final deleading reinspection done on October 13, 2010, by Kevin Nestor, License #11359 Deleading Contractor: Brian Moore License #DC001683 Deleading methods: YA ition Power Sanding Caustics Liquid Encapsulation Work was done in the following rooms: Rooms 1 through 9, Halls 1, 2 and 4. Staircase 1. the Kitchen, Bathrooms 1, 2 and 3. the basement and exterior of the building. Work was done on the following types of components: Walls, ceilings, baseboards, chair rails, shelves, shelf supports, doors door casings door jambs, interior window trim window sashes, exterior window components, staircase, basement and exterior components. Start Date: 2 1 10 Finish Date: 10/13/10 Cost: $15,000 Lea afe Renovator: Not Applicable License #: Modera isk Owner/Agent: Not Applicable Authorization #: Moderate Risk ading Methods: Replacement Covering Liquid encapsulation Making Intact (interior) Making Intact (exterior) Work was done in the folio rooms: Work was done on the following es of components: Start Date: Finish Date: Cost: (Doesn't Include Owner's Labor) Low-Risk Owner/Agent: Not Applicable Authorization #: Deleading Methods: Covering Liquidsulation Capping Baseboards Replaceme NLV doors,cabinet doors, shutters,shelves not d,drawers,windows on hinges) Work was done in the following rooms: Work was done on the following types of components: Start Date: Finish Date: Cost: (Doesn't Include owner's Labor Should you have any questions about this letter, call the Dept. of Public Health at 800-532-9571 Page 2 of 2 ProScience Analytical Services, Inc. Telephone: 781-935-3212 12 Cummings Park, Woburn, MA 01801 Facsimile: 781-932-4857 Email: chemistry@proscience.net Laboratory Report Contact: Kevin Nestor Batch M C 262647 Client: Residential Inspection Company Date received: 10/1112010 Address: PO Box 309 Date analyzed: 10/12/2010 Reading, MA 01867 Date of report: 10/12/2010 AIHA Lab ID: 102754 Project# N/A P.O.# N/A Project Site: 312 112 Lafayette Street Salem, MA 01970 Lead Analysis In Wipes Using SW846-7420/3051 Results Inµg/ft'(Using customer-supplied data) Sample Detection Lab ID Client ID date Description Result" Limit Continents C 380254 1 10/11/10 Room 1 -A-Floor BDL 10.0 C380255 2 10/11/10 Room I.-A-Sill 14.7 11.6 ('380256 3 10/11/10 Room I -A-Well 160.3 17.8 ('380257 4 I0111110 Room 5-B-Floor BDL 10.0 C 380258 5 10/11/10 Room 5-B-Sill 23.9 11.6 C 380259 6 10/11/10 Room 5-B-Well 267.6 10.4 C 380260 7 10/11/10 Room 7-A-Floor BDL 10.0 C 380261 8 10/11/10 Room 7-A-Sill BDL 11.6 C 380262 9 10,111/10 Room 7-A-Well 28.6 17.8 C 380263 10 10/11/10 Blank BDL 10.0 Simona Peavey,Analyst Dan Pine,Deputy Adrian Stanca,Lab Director Page 1 of 1 Unless otherwise indicated,all samples were received in acceptable condition. All result apply only to the samples as received and are accurate to no more than three significant figures. Unless otherwise indicated, all the quality control criteria for the method above have been met. BDL-Below Detection Limit Blanks are reported in total micrograms; they are not used to correct sample results. The EPA 403 Final Rule(40 CFR 745.63)requires that all wipe samples of settled dust shall be collected using wipes that meet ASTM E1792. The analytical results,for wipes not meeting ASTM E1792, are not recognized by AIHNs Accreditation Program. ProScience Analytical Services, Inc. 0 Rush/<6 Hours Chemistry Chain of Custody Record/Metals TumA Around Time Requested LABORATORY/HEADQUARTERS LABORATORY SERVICES ❑ 48 H 22 Cummings Park,Woburn.MA 01801 683 North Mountain Rd.,Newington,CT 06111 Same DayU ext Day ours 72 Hours 4-5 Days 0 T:781-935-3212 F:781.932-4857 T:860-953.1022 F:SW-953-1030 Eiemem TYPE OF Client: RESIDENTIAL INSPECTION COMPANY Address: Street p,0.80X 309 ANALYSIS (Columna) pb Cd Cr As Tom READING,MA 01867 ETPTSP ou PA Se Ag Ba Hg For Laboratory Use Project Site Line 1 3121/2 LAFAYETTE STREET OOmer(please wwfy) BATCH NUMB`.SALEM,MA 01970 wA wl =OC oC b Contact: KEVIN NESTOR CELL: 761-942-1985 FAX: 781-942-0188 FOR LABORATORY USE ONLY OFC,T: 781-992-0188 rwe Air Sam Un information Wi ed area ANALYSIS Date Field OF Stan Entl Stan End volume length width Area Weigh ' AA Lab Sam led I.D. Sam le DBSCrI linn(LOCation M+ YSI Time Time Flowrate Floveate iRers) (mch) inch) in rams IDii'o i Readin RESULT r� LD. /" 10/11/10 1 Room 1 -A-Floor WI 12.0 12.0 10/11/10 2 Room 1 -A-Sill WI 10/11/10 3 Room 1 -A-Well WI 29.5 2.75 12.0 12.0 i a 10/11/10 4 Room 5-B-Floor WI 10/11/10 5 Rooms-B-Sill WI 33.0 3.75 !Q�jld ,S3 10/11/10 6 Rooms-B-Well WI 32.5 4.25 6..i33 5 10/11/10 7 Room 7-A-Floor WI 12.0 12.0 10/11(10 6 Room 7-A-Sill WI 33.0 3.75 10/11/10 9 Room 7-A-WellWI 29.5 2.75 ,3222. 10/11/10 10 Blank WI Date: 10111(2010 'Time: ? �7 Relinquished By: Kevin Nestor _ Received BY. Date: Time: Comments: PLEASE EMAIL RESULTS TO RIC309(LCOMCAST.NET. Log-out: Date PO 1 OF 1 �wipes Provided by ProScience Analytical For complete information about our services and locations please visit us at www.proscience.net or call the numbers above. V The Commonwealth of Massachusetts Executive Office of Health and Human Services = Department of Public Health Bureau of Environmental Health Childhood Lead Poisoning Prevention Program 250 Washington St., 7th floor DEVPATRICK GOVERNOR Boston, MA 02108-4619 GO TIMOTHY P.MURRAY CLPPP Toll Free: 1-800-532-9571 LIEUTENANT GOVERNOR JUDYANN BIGBY,MO SECRETARY JOHN AUERBACH Waiver Request/Response COMMISSIONER Date of Request: February 5, 2010 Address of Property: 312 Lafayette Street and 312'/-- Lafayette Street (two separate properties) Salem MA 01970 Section of Regulation to be waived, 105 CMR 460 ❑ .020 Lot Line ❑ .110 Abatement Requirements ❑ .135 Encapsulation ❑ .150 Notification El .160 Relocation El .170 Dust Monitoring ❑ .760 Reinspection & Full Compliance Ie ..1 (Other) Former Policy Statement CLP-9 Comments/ Conditions: Please see comments and conditions on Page 3 and 4. �A-t�talchments (Supporting Documents): LK Lead Inspection Report ❑ Plot Plan 216ther: Floor Plans All parties involved must complete the information below: Properly Owner/Owner's Agent,all authorized people doing the deleading(Deleading Contractor,Lead:Safe Renovator,Authorized Owner/Agent for Moderate Risk& Low Risk1 and the Occupant of the unit. If any changes are made to the original waiver request,all parties involved must sign otYon the new changes. Date: X 16 141C lO V 1 1 Name/Organization: Healing Abuse Working for Change c/o: Candace Waldron 3 p Address: 27 Congress Street L City: Salem MA 01970 y Telephone: 978-744-8552 Fax: 978-745-6886 1 Signature CLP-9 Waiver Request/respunxcXTFPP?110 1 i 3 a f Date: February 5. 2010 Lic#: 11359 `o Name/Organization: Kevin Nestor/ Residential Inspection Company i a, Address: P.O. Box 309 N City: Reading, MA 01867 Telephone: 781-439-1985 Fax: 781-942-0188 Signature c Date: 2� 17-10 Lic/Auth#: DC(A)1683 C, Name/Organization: Ideal Property Maintenance c/o: Brian Moore i y Address: 96 Lake Street N City: Tewksbury MA 01876 0 Telephone: 978-658-2211 Fax: 978-658-2211 Signature s �i-.._ Date: %; 1 :z : ; Lie/Auth#: 58289 CSL y Name/Organization: Windover Construction Inc. c/o: Charlie Mann e Address: 13 Elm Street c City: Manchester MA 01944 w 'Telephone: 617-839-p278 Fax: 978-526-9409 e v :. Signature Date: Name/Organization: VACANT 0 Address: a City: C Telephone: Fax: Signature Date: 2 a c F Name/Organization: City of Salem Dept of Planning& Community Development c —,° Address: 120 Washington Street ' C ICOLCity: Salem MA 01970 Telephone: 978-619-5683 Fax: 978-740-0404 v Signature CLP-9 Waiver Request/responsc,'UPPP 2/10 2 Signatures represent the acknowledgement,agreement and responsibility of the parties solely for the specific role (inspector,deleader, LSR,authorized owner/agent,contractor,property owner) regarding this waiver and the Lead Regulations. All other sections of 105 CMR 460.000 and 454 CMR 22.00 must be followed. Waiver remains valid only as long as the provisions and conditions are adhered to. 1 3R�z37 41 Waiver ❑ Waiver Denied Date: 2/� �40 CLPPP Waiver ## 33 z 5-93KIssuedb :46/4AVV.✓14SWC Signature Lic#f Q37S7 DOS Waiver# If Re uired : Issued b : Lie#: Comments/Conditions This Waiver Request is for the properties located at 312 Lafayette Street and 3121h Lafayette Street in Salem, MA 01970. At the time of the initial lead-based paint (LBP) inspection, this property was two, attached single family homes. After the renovation work, it will become one single family home. The buildings were inspected by Kevin Nestor(License #I1359) on May 13 and 18, 2009. Copies of the inspection reports are enclosed. The property is owned by Healing Abuse Working for Change (HAWC). The City of Salem, Department of Planning &Community Development is funding the deleading work. This is a waiver request to have a licensed deteader remove leaded components and delead ALL other LBP hazards and then have the installation of new components as well as plumbing, electrical, sheetrock, floors, etc. completed by non-authorized contractors. HAWC and the City of Salem has hired Ideal Property Maintenance (License #DC001683) to delead Rooms 1 through 13, the kitchen, pantry, bathrooms 1 and 2, interior hallways 1, 2, 4, 5 and 7, and staircases 1,4 and 5 at 312 Lafayette Street. The licensed deleader will also delead Rooms l throueh 9, the kitchen, bathrooms 1, 2 and 3, interior hallways 2 and 4, staircase 1 and the basement staircase at 3121/2 Lafayette Street. All lead hazards inside both buildings/apartments will be deleaded. The entire building is unoccupied and will not be reoccupied until the reoccupancy reinspection has been performed and the dust wipe samples have passed the clearance criteria. The licensed deleader will remove all leaded components and complete all other required deleading work(the only thing left to be done is the actual installation of new surfaces). The deleader will perform a clean-up to pass a visual reinspection by a licensed lead inspector in order to clear the site for non- licensed workers to begin the installation of new components. Absolutely no workers without authorization are permitted on-site until after the lead inspector has approved the site. Also, during the time that non-authorized workers are on-site for replacement, there can be no other deleading work occurring by authorized people. (This even includes no deleaders working on the exterior while interior replacement is occurring.) Private lead inspector, (Kevin Nestor, License #11359),must determine that the property meets ALL requirements for passing a reoccupancy reinspection except the installation of new components and dust sampling. The inspector will document the removal of each component in the "IC Date" and "IC Method" columns (or Comments Column). A brief summary will also be provided on the Report Cover Page. The "delead date"/"delead method" column will be filled in when the actual installation of components is completed and/or complying any other abatement methods used for final deleading(such as a door jamb that has been scraped to achieve compliance). CLP-9 Waiver Request/response/CLPPP 2/10 3 Comments/Conditions (continued) If any demolition on walls,ceilings or floors is to be done following clearance by the private inspector for non-authorized workers, it is crucial that all ­NA­components are tested and all coverings are removed sufficient to test surfaces under coverings. Sheetrock walls and ceilings which test negative must not be covering"old" plaster, which may be positive. The private inspector must verify this. If any surfaces containing a dangerous level of lead are identified, the licensed deleader must do demolition and the site cleared by the private inspector. Under no circumstances is demolition of leaded or potentially leaded surfaces to be done by non-authorized workers. After the replacement work by non authorized contractors (following safe work practices as required by 454 CMR 22.11) is completed, the licensed deleader will return to the property to do the final clean- up. The private lead inspector,(Kevin Nestor. License#11359), will return and confirm that all interior surfaces that were replaced were done so in a workmanlike manner. None of the replaced components will be painted before the final reinspection and dust sample collection. The inspector must also carefully check other surfaces in the area in which replacement work occurred to determine if any new lead hazards were created by the work and re-check all previously complied contiwnents to make sure they have not fallen out of compliance (all paint intact, coverings secured. etc.). 1f any new hazards exist, they must be corrected by authorized people. If no new hazards exist and the property passes all other reoccupancy requirements, the mandatory dust wipe samples must be taken. If the dust samples fail, the licensed deleader is responsible for clean-up until a passing sel of dust samples is achieved. NOTE: the inspector MUST follow the dust sampling protocol policy for all sets of dust samples. If the dust samples pass, the inspector may approve reoccupancy and/or full compliance. If the owner decides NOT to hire the original lead inspector that applied for this waiver, Kevin Nestor, License #11359), for all reinspections, the owner MUST request a new waiver from the Department of Public Health (DPH), Childhood Uad Poisoning Prevention Program (CLPPP). In the waiver request. the owner will need to provide the name and license number of the inspector who will perform the reinspections. DPH/CLPPP will contact the new inspector to review the waiver stipulations and have the new inspector sign off on the terms o the new waiver. PA -J!RA Owner Prop. MgK._ Deleadcr lnspector Tenant Contractor CI-P-9 Waiver Rcyuest responsc,'(TPPP2rin 4 _ - The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health Bureau of Environmental Health Childhood Lead Poisoning Prevention Program DEVAL L.PATRICKth GOVERNOR 250 Washington St. 7 floor TIMOTHY P.MURRAY Boston, MA 02108-4619 LIEUTENANT GOVERNOR CLPPP Toll Free: 1-800-532-9571 JUDYANN BIGBY,MO SECRETARY JOHN AUERBACH COMMISSIONER Fact Sheet on Maintaining Full Compliance Massachusetts law does not require the deleading of all paint,plaster or putty containing dangerous levels of lead. After a Letter of Full Initial or Full Deleading Compliance has been issued, there may still be paint or other material containing dangerous levels of lead present. For example,walls,exterior siding and surfaces above five feet may still have intact lead paint remaining on them. The owner of any residential property is not strictly liable for damages associated with a case of childhood lead poisoning as long as the dwelling unit and any associated common areas has a valid Letter of Full Compliance. The owner remains under it duty of reasonable care to avoid liability.In other words,owners must keep their properties in good repair, free of defective lead paint, plaster,or putty,to protect themselves from liability. Letters of Compliance do not"expire"after any given period of time,and the Childhood Lead Poisoning Prevention Program(CI_PPP)does not require letters of compliance to be routinely updated. However,property owners should visually assess the property for compliance on a regular basis, and any time occupants report loose paint, plaster or putty, and/or detached coverings. In addition,owners may choose to update their letters of compliance to certify that the property is still free of lead hazards. In order to do this, the owner must hire a lead inspector to perform a Post- Compliance Assessment Determination,or"PCAD." Directions for performing a post-compliance assessment and for correcting hazards are contained in Appendices A and B of the document CLP-10A,Maintenance of Full or Interim Control Compliance Status, available from CLPPP upon request at(800)532-9571. The directions in these documents must be strictly followed, to protect the person doing the work and any occupants from lead exposure, and to protect the owner from liability. It is critical [hat the property owner maintain all documents associated with the compliance status of the property together in a safe place.The owner will need these documents in order to perform routine maintenance or post-compliance work, as well as to fulfill the reporting requirements associated with the Property Transfer Notification and Tenant Notification regulations.These documents include: ✓ The comprehensive initial inspection report ✓ The Letter of Full Compliance ✓ A reinspection report,completed on the initial lead inspection report,when deleading was done. Do not loose this document it is your guide to how each surface was deleaded ✓ Dust sample results,when deleading was done ✓ Deleading notifications,when deleading was done ✓ Deleading invoices from the authorized persons who did deleading work,when deleading was done ✓ Any post-compliance assessment determination reports ✓ Any Certification of Maintained Compliance or Certification of Restored Compliance ✓ Any waivers issued by CLPPP or by the Division of Occupational Safety pertaining to the property CLP-1013 Revised 1/09,7/1/04 Page I of I LEAD INSPECTION / RISK ASSESSMENT REPORT ' Page 1 or 6j,- RESIDENTIAL INSPECTION COMPANY P.O. Box 309 Reading, MA 01867 781-942-0188 St.# Address Apt. 000r Deeeo City Zip Code Owner's Name: Michael 8 Emily Quinones Number of Rooms in Unit Property Type: Owner's Address: 3121/2 Lafayette Street Salem MA 01970 Single Family Contact Information: JenniferKolodzie• 978.619.5685 MuniFamilyi #Units_ Client Name if different from owner : City of Salem Condominium—, #Units--_ Client Address: 120 Washington Street Salem MA 01970 Day care _ other: Key: Lead Column Key: Deleadl IC Method Column Laundry in Basement? Yes o0 COV Covered CAP Capped SCR Scraped Finished Soace in Basement? VB Vinyl Baseboard Cov Covered DIP Dipped Yes orlo MET Metal ENC Encapsulated REM Removed VR Vinyl Rep.Window MI Made Intact REP Replaced Testing Method Used: MR Metal Rep.Window PRE Prepared for Enc REV Reversed NazS Exp.Date NA Not Accessible VR/MR Vinyl/Metal Rep Window INT Intact X-RFluorescence NC No Coating SFR Storm Frame - ay Removed y Tile Tile(testing suggested) f7;,l Component does not exist Model RMD Serial#2400 DC Dropped Ceiling Comments/Notes 77/1s /S 3iZ �itF e� 5r. 7�P" L.r�rir% .Skoc_v w.¢-s /.✓... 75'fe CGoS6T /N�Pco.+� A—Tf/f' /�9Se��/tn' G✓�S 5 yHi/ 1//SHS /3it�_-- A4-r-7P-W2. -w.�S -- — Floor# (this is the level within building of unit being inspected) Floor# Z_i(this is the level within building of unit being inspected) - 9 T f . A f Street Side Start Here ' ( J ,� A(Street Side) _-� Start Here�(� Pin(lead)equal to or greater than 1.0 mg/cm'with X-rav Fluorescence or positive with Na,S is Dangerous. XRF Calibration Recorded in Log Book ✓ -Check off when complete Address verified through USPS ✓ -Check off when complete Research on Lead-Related History for Address ✓ -Check off when complete ww_walww.ma.usid,dlpI)orSOO-532.9571 Inspector Name: Kevin Nestor Lic#11359 Signatur • Date: -5--13-0 LURA rev 8,'118 LEAD INSPECTION / RISK ASSESSMENT REPORT / Page rPr of `f3 RESIDENTIAL INSPECTION COMPANY P.O. Box 309 Reading, MA 01867 781-942-0188 St.# Address Apt. �O�®C ©®�®C7©©©®❑s❑©® Zip�❑❑❑❑ �8�1 Number of Rooms in Unit Owner's Name: Michael&Emily Quinones Property Type: Owner's Address: 3121/2 Lafayette Street Salem MA 01970 Single Family Contact Information: JenniferKolodzie• 978.619.5685 Multi Family_ #Units_ Client Name if different from owner): City of Salem Condominium_ #Units_ Client Address: 120 Washington Street Salem MA 01970 Day care __ other: Key: Lead Column Key: Deleadl IC Method Column Laundry in Basement? Yes or COV Covered CAP Capped SCR Scraped Finished SDace in Basement? Yes o VB Vinyl Baseboard COV Covered DIP Dipped MET Metal ENC Encapsulated REM Removed VR Vinyl Rep.Window MI Made Intact REP - Replaced Testing Method Used: MR Metal Rep.Window PRE Prepared for Enc REV Reversed Na2S Exp.Date NA Not Accessible VR/MR VinyllMetal Rep Window INT Intact X-Ray Fluorescence NC No Coating SFR Storm Frame Removed Model RMD Serial#2400 Tile Tile(testing suggested) � Component does not exist DC Dropped Ceiling Comments I Notes Floorq-3—(this is the level within building of unit being inspected) Floor#_(this is the level within building of unit being inspected) B --1---` �o. I-- -- - - --- -- -- — D 9 — --- - - -- -- - - D i - - -'-� '� �--- -- -- — -7'- --- - -- -- -- - --- -- -- -- - -- -- - ----- A(Street Side) Start Here A(Street Side) Start Here Ph(lead)equal to or greater than 1.0 mg/cm2 with X-ray flitniescence or positive with Na;S is Dangerous. XRF Calibration Recorded in Log Book ✓ -Check off when complete Address verified through USPS ✓ -Check off when complete Research on Lead-Related History for Address ✓ -Check off when complete www.si;n_.ma.0 %.Inhlclnr+n or 800-532-9571 Inspector Name: Kevin Nestor Lic#11359 Signatur Date: -67:'1-07 LI/RA rev 8/08 ADDRESS:9/Z� e! ?f �le�e 5TCee7- .SP/ew eV 9`70 Page 2 of �3 INSPECTION HISTORY INTE M CONTROL Determination Risk Assessment l Inspector Name: Lic#_ Y R.A.Name: Lic#_ N Signature 8 Signature_ Lead Hazards? Urgent Ph.Hazards? Comprehensive Inspector Name* 7T1 ,LIC#/ Dust Taken for Risk Initial Ins ection rAssessment 8 R.A.Ndme: ,Lle#_ O / 3 6 Signature F Signature Lead Hazards? Visual Portion of P RA Name: ,Lick_ Comp Initial Reinspection for Inspector Name: Lic#_ w/Partial PCAD Interim Control 8N Signature F Signature Lead Hazards? Dust Taken for Risk [qF R.A.Name:_ ,Lit#_ Addendum(add-on Inspector Name: ie#� Assessment FTTTReins . V Initial Ins coon Signature / O / / / Signatured�� Lead Hazards? —Iii�e l Portion of R.A.Name: ,Licit— Addendum Reinspection[or — IInterim Control Addendum as Full P Signature— Insp. l osl Docs Y Inspector Name: .Lid_ F Lead Hazards? N Signature Dust Taken for Risk P RA.Name:_.. _. ,LIC#_.__ Assessment Reins P.walk Throughfor F Signature Ed/ConsultationInspector Name: ,Lic#__ Signature R sk Assessment Recertification REINSPECTION HISTORY ey R.A.Name:_.. __.__,Lic#�.. Visual Portion of N Renee.Reins coon Inspector Name: 7D ,Lle#/ Ur ent Ph.Hazards? Signature___.______,_ O D Signature v Dust Taken for RA P RA.Name: Lic#_ Recertification Visual Portion of 8F Signature__.__..__ Reece.Reins ction PI � Inspector Name: ,Lh:#_ F Signature POST COMPLIANCE ASSESSMENT DETERMINATIONS DusPCAD Inspector Name:____, t Taken for Reocc.Reins coon P Inspector Name• LIC# Y Signature__ Signature ..— txad Hazards? Dust Taken for p Full Ins ection Renee.Reins ection 8 Inspector Name: ,Lic#__ P F Actin as PCAD Signature ey Inspector Name:_. Lick— Signature Taken for Lead Hazards? N Signature _ Reocc.Reins ction 8 P Inspector Name: .Lick— Visual Portion of p Inspector Name: _—,Lic#__ $lgnature PCAD Reins coon F Signature Visual Portion of Final Rmns ction Inspector Na ,LIC#/35 7 / O 3 / 1611 F /` Dust Taken for [qF Inspector Name: ,Lic#_ Signature uzo PCAD Reins ction Visual Portion of NF Ins ector Name: ,Lic#_ Signature Final Reinspection p Signature Dust Taken for PCAD Rems ction Inspector Name:—,1.10 Dust Taken for Final F Reins Ne Reocc 8 Inspector Name: .Lid— Signature F Signature ADDRESS:A?z Zd st erre Page 3 of� REOCCUPANCY CERTIFIGerrISTORY ' COMPLIANCE HISTORY (CONT.) Certificate of e� Certificate of Reoccu ane Inspector Name• 4 ,Lie#�i Maintained Inspector Name:_,Lie# / O / , Q Com liance Only after Signature v Signature High/Mod Risk No Work=No Dust #rooms rule Work=7 Dust Certificate of Certificate of 'T ,,upajcy Inspector Name: ,Lle# Restored P com Nance Inspector Name:_,Lic# Only after Signature Signature High/Mod Risk Dust wipes and auth. #rooms rule pe0ple Certificate of Inspector Name: LIe#_ Certificate of Reoccu ane Maintained Inspector Name: .Lic#_ Signature Com Bance Only after Signature High/Mod Risk No Work=No Dust #rooms rule Work=7 Dust COMPLIANCE HISTORY Certificate of Letter of Full Initial Restored Coliance Inspector Name: ,Lick_ Co lance Inspector Name: ,Lic# m Noprior history/ Signature_ Signature_ P ry Dust wipes and auth. No signs of UD people Letter of Interim OTHER HISTORY: WAIVERS/UD Control Inspector Name: ,Lick_ Approved CLPPP Waiver ^J/�� No prior comp. Signature / D Inspector Name:�S�,Lic#3 Expires in 1 r. ?!Do! omp Signature_ Recertification of 31,$a 3 fl Interim Control Inspector Name: Lic#_ Approved P CLPPP waiver Inspector Name:_... .Lic#_- Expires 2 yrs from SignatureSi nature original Interim Attach to Comp g -------- Control Docs Letter of Full Deleading Inspector Name, L�$ Lle#/. UD/DES Visual Com liance P � Reins coon Inspector Name:___,Lic#_ O / 3 / Signatures ` P Signature Dust wipes if No No I,OC Issued 8 peace. Certificate of iJD/DES Dust Maintained Inspector Name: .Lic#_ Taken Inspector Name: ,Lic#_, 7m! '.nm liance SignatureSignature No Work=No Dust No LOC Issued F Work=7 Dust UD/DES Dust Taken Certificate of P Inspector Name: Lic#— Restored Compliance Inspector Name: .Lic#_ F Signature No I.00 Issued Signature UD j DES Final Dust wipes and auth. Rens coon people Inspector Name: ,Lid P No LOC Issued F Signature . Page 4 of EXPLANATION OF LEAD INSPECTION/RISK ASSESSMENT REPORT FORM COLUMNS This page provides general information needed to understand the lead inspection/risk assessment report.However,you should speak with the inspector/risk assessor before you start to do any work on your home. SIDE Refers to A,B,C,or D side of the building or room.See the diagram on the cover sheet.The"A"side of the building or room is the side facing the street that gives the property its address(usually,it is the front of the building).Keeping 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 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(or average number)equal to or greater than 1.0 mg/cm2 is a dangerous level of lead. • A"pos"or"neg"shows that the surface was tested with sodium sulfide."Pos"means that there is a dangerous level of lead. • "N/A"means that the inspector was not able to test the surface.Unless the owner can get a sample to test,the inspector must assume the surface contains lead and require it to be deleaded,if necessary. • "MET"or"MR"means that a metal surface was not tested and only needs to be intact,even if it is a leaded surface. However,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 is marked"N/A." • For key to abbreviations like"COV","VB","VR"or"MR","NC","Tile","DC",see the cover page. • When a component box is slashed and there are test results above and below the diagonal line,the result on the "bottom"represents results below 5 ft.and the"top"result indicates the test result above 5 ft. TYPE 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. Speak to your risk assessor for more information. • "M/I"circled means that the surface is a moveable/impacted surface and must be deleaded in its entirety. • "SF"circled indicates that there is a storm frame present which requires the blind stop and exterior sill be deleaded as interior moveable/impacted surfaces. • "A/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 comer. • "L"circled means that the surface is loose and must,at minimum,be made intact. + If more than one choice is circled,the rules for deleading may change depending upon what method of deleading you 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 must check this surface and follow all the rules for deleading.Speak to the inspector for more information. • 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 surface is lead free, it just does not require deleading in its current condition. URG HAZ? This column is only completed during a risk assessment.A risk assessment is an evaluation of a home's suitability for Interim Control. Only a licensed risk assessor can do a risk assessment,not all inspectors are risk assessors. If"Y"is circled,then this surface is considered an"Urgent Lead Hazard"and some type of deleading work is required to qualify for Interim Control. IC DATE The date the licensed risk assessor determines the surface meets the standards for Interim Control. IC METH The deleading method or structural repair done to qualify the surface for interim Control. Refer to the deleading codes key on the cover page. DELEAD The date that the lead inspector reinspects the surface and finds that it has been successfully brought back into DATE compliance. DELEAD The method used to bring a surface into full compliance.Refer to codes in the Key on the cover page of the PCAD METH EXCLUDED The amount of loose paint on a surface as measured by the lead inspector."N/A"means that the inspector was not SURFACES able to measure the loose paint,but has determined it is more than the cut-off for moderate risk making intact. LIRA Exp.8108 Kevin Nestor 11359 / '�v .S-i3-O S Page 5-01 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# ��gnature Date Address of Property 3/Z/IL C S/ Apt # City �i4�eiys ROOM / SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIONI tLEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B Up Walls .—O. AIM L NIA Y ® Window Sill CM L N/A Yr. nr]/ra Aip— A9 Low Walls AIM L NIA Y ,, B Win Apron QA L N/A YBBaseboards 9. AM1 L NIA V r7 ro '/,p r•� M C Win Casing Q11 L N/A Y 11ABChair Rail A/M L NIA Y D Header StopM11 LY e•7� As Radiator — O, AIM L NIA Y /y, Int Stops g �'1 L NIA Y r 7 rJ Floor —. 0.0 AIM L NIA Y W [Exterior in Int Sash ON L NIA Y r7 ra Ceiling ,� 0.3 A/M L N/A Y 2 Sill 99 SF L N/A YA B Door AJM L N/A Y 3 art Bead .7 m NIA Y r7/, VLIVDoor Casing ,Qp�L N/A Y r7fro �� 4 ind Stop 01 SF ® N/A Y r7 m2 DoorJamb 9. ®L NIA Y 7 r /, in Ext Sash 9 L NIA Y /7/4 Vic- 34 Threshold AIM L N/A I Y Window Sill Qq L NIA Y ,7 y A B Door AIM L NIA Y B Win Apron (11D1 L NIA Y /n n/ C D Door Casing AIM L N/A Y C Win Casing .q L N/A Y ,7 ra 12 jJa'bmb AIM L NIA Y D Header Stop 9. 1 L NIA Y r9 W 3 4 ld AIM l NIA Y Int Stops �d 4jJ11 L NIA Y �(,o/Q 1,102 A B AIM L NIA Y 1 Win Int Sash q. ®rt L NIA Y r�/ao C D sing AMM L NIA Y © Exterior Sill .� SF L N/A Y12 mb AIM L N/A Y 3 Pan Bead Z. mN/A Y r�r034 old AIML NIA Y 4 Blind Stop O SF �N/A Y rVia A B AIM L NIA Y Win Ext Sash .9 10 L NIA Y r7/roKzC D asing AMM L N/A Y ® Window Sill 0 ADA L N/A Y p .12 mb AIM L NIA Y B Win Apron 9. 0 L pNIA Y �y��/ro34 ld AM L N/A Y C Win Casing ` & L NIA Y A Closet Door AIM L NIA Y D Header Stop M11 L Ck Y r7/ ® CI Casing .3AIM L NIA YInt Stops 4).9 L N/A Y q/ C Closet Jamb- .3 AMM L NIA Y 1 Win Int Sash 9.41 Q(D 4x91 L N/A Y D Closet Walls—Q. AIM L N/A Y 2 Exterior Sill C/. 0 SF L NIA Y q/ Cl Baseboard A/M L NIA Y ® Part Bead 677 0 m NIA Y q/rJ {/ O Closet Pole AMM L NIA Y 4 Blind Stop 10 SF 0 N/A Y A/d x 2 Closet Shelf—0.3 A/M L N/A Y Win Ext Sash g. Q1111 L N/A Y 17// 3 CI Suppons 0.3 AIM L NIA Y AB Fireplace AMM L N/A Y /3,2/<�•S 4 Closet Floor AIM L N/A Y CD Mantle ® L NIA Y 1 Closet Ceilirg.Q.3 AMM L NIA Y Win Above 5' AIM L N 1 Y Ceiling Moldi .; A/M L N/A Y V?,,bf,4 Alf w o /,IOJz AIM L NIA Y A/M L N/A Y AMt L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE.LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Revin Nestor 11359 S'/„3-ps Page 6 Of—at � Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# nature Date Address of Property: .14444 S�� e ST Apt.# City: Z:%; �! CONTINUATION OF ROOM —,,4`440 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 Door A/M L NIA Y A Window Sill Mil A/M L N/A Y C D Door Casing A M L NIA Y B Win Apron AIM L NIA Y # Door Jamb ARML NIA Y C Win Casing AIM L NIA Y Threshold AIM L Ni Y D Header Stop WI L NIA Y A B Door AIM L N/A Y Int Stops Mil A/M L NIA Y C D Door Casing AIM L NIA Y # Win Int Sash M11 AIM L NIA Y # Door Jamb AIM L N/A Y Exterior Sill MR SF L NIA Y Threshold AIM L NIA Y Part Bead Mil L N/A Y A B Door A/M L N/A Y Blind Stop Mill SF L N/A Y C D Door Casing AIM L N/A Y Win Ext Sash MR L NIA Y # Door Jamb AIM L NIA Y A Window Sill Mil ARM L N/A Y Threshold AIM L NIA Y B Win Apron AIM L N/A Y Closet Door AIM L N/A Y C Win Casing ARM L NIA Y A CI Casing 0.$ AIM L N/A Y D Header Stop Mil L N/A Y ® Closet Jamb,.0.3 AIM L NIA Y Int Stops Mll ARM L NIA Y C Closet Walls—p.3 AIM L N/A Y # Win Int Sash Mil A/M L N/A Y D Cl Baseboard �/ A/M L NIA Y Exterior Sill MII SF L N/A Y Closet Pole ARM L NIA Y Part Bead MA L NIA Y # Closet Shelf O•3 ARM L NIA Y Blind Stop M/1 SF L NIA Y Cl Supports,. p. AIM L NIAj Y Win Ext Sash WI L NIA Y ( Cl Drawers AIM L N/A Y A B Up Cab Frame AIM L N/A Y � Cl Or Frame ARM L NIA Y C D Up Cab Door AIM L NIA Y f Closet Floor O.2, ARM L NIA Y Up Cab Walls AIM L NIA Y Closet Ceiling-0.3 AIM L NIA Y # Up Cab Shlvs AIM L NIA Y Closet Door AIM L NIA Y Supports AIM L Ni Y A Cl AIM L N/A Y Low Cab Fra O ARM L NIA Y B B AIM L N/A Y A Low Cab Dov 0. AIM L N/A Y C AIM L NIA Y C D Low Cab W ,3 _3NM L N/A Y D Clrd AIM L N/A Y # + Low Cab Sh ,alJAIM L NIA Y AIM L NIA Y 4 Supports AIM L NIA Y # f AIM L NIA Y Z Drawers AIM L NIA Y As Cl Supports AIM L NIA Y Ce Shlvs Above 5ARM L N/A Y AB CI Drawers AIM L N/A Y CD Cab Above 5' ARM L N/A Y AB CI Dr Frame AIM NIA4Y _ co, Cab Above 5' \ AIM LI Y Closet Floor AIM L N/A AB Fireplace AIM L NIA Y AIM L NIA CD Mantle A/M L NIA Y AB Sidelight(L) ARA L NIA Y C D Sidelight(R) A/M L N/A Y As "D Win Above 5' \ AIM L NIA Y EXCLUDED SURFACES: Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT ICIC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ.IN.) DATE METHOD (MORE THAN 288 SQ,IN.) DATE METHOD LI/RA RepRoomCont,8/08 Kevin Nestor 11359 a Page-101! Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of ProoeM:3/27 e5L,4 7/C ST AM.# City: !P/droo, HALLWAY: Interior # / or Common Hallway: Front Rear 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 A B Upper Walls AIM L N/A Y A Closet Door AIM L NIA Y A B Lower Walls ,e AIM L NIA Y B Cl Casing AIM L N/A Y A B Baseboards ( AIt00N/A Y �� y�I' �„rp C Closet Jamb AIM L NIA Y A B Chair Rail AIM L NIA Y D Closet Walls AIM L NIA Y As OD Radiator AIM L NIA Y Cl Baseboard AIM L N/A Y Floor — 0-1 AIM L NIA Y 1 Closet Pole AIM L NIA Y Ceiling 0. 1 AIM L NIA Y 2 Closet Shelf AIM L NIA Y B Door — 0.3 AIM L NIA Y 3 CI Supports AIM L NIA Y CD Door Casing 9.9 OA N/A Y tf ep �"„/, t� 4 Closet FloorAIM LN/A Y 2 DoorJamb q. L NIA Y ��to -� , �' Closet Ceiling AIM L NIA Y 34 Threshold 0.3 AIM L NIA Y A Window Sill M/I AIM L NIA Y A B Door 0-z AIM L N/A Y B Win Apron AIM L NIA Y D Door Casing do N/A Y C Win Casing AIM L NIA Y i 2 Door Jamb 9. NIA Y A^Iioj D Header Stop MA L N/A Y 34 Threshold — 0.1 AIM L NIA Y Int Stops M/I AIM L NIA Y 775 Door AIM L N/A Y 1 Win Ind Sash MA AIM L N/A Y C D Door Casing AIM L NIA Y 2 Exterior Sill M/I SF L N/A Y 12 Door Jamb AIM L N/A Y 3 Part Bead MIA L N/A Y 34 IThreshold AIM L NIA Y 4 Blind Stop Mil SF L NIA Y [AB Door AIM L NIA Y Win Ext Sash M/I L NIA Y Door Casing AIM L NIA Y A Window Sit MA AIM L N/A Y Door Jamb AIM L N/A Y B Win Apron AIM L NIA Y Threshold AIM L N/A Y C Win Casing AIM L NIA Y Door A/M L NIA Y D Header Stop MA L NIA Y DoarCasing A M L NIA Y Int Slops M/l Amt L NIA Y Door Jamb AIM L NIA Y 1 Win int Sash MA AIM L N/A Y Threshold AIM L NIA Y 2 Exterior Sill M11 SF L N/A Y A Closet Door AIM L N/A Y 3 Pad Bead M/I L NIA Y B Cl Casing AIM L NIA Y 4 Blind Stop M/I SF L NIA Y C Closet Jamb AIM L N/A Y lWinExtSash M/I L N/A Y All D Closet Walls Amt L NIA Y CD Win Above 5' MA AIM L N/A Y AB CI Baseboard AIM L NIA Y CD Ceiling Moldin M/I AIM L NIA Y 1 Closet Pole AIM L NIA Y 2 Closet Shelf AIM L NIA Y 3 CI Supports AIM L NIA Y 4 Closet Floor AIM L N/A Y Closet Ceiling AIM L NIA Y EXCLUDED SURFACES: Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ.IN.) DATE METHOD (MORE THAN 288 SQ.IN.) DATE METHOD Kevin Nestor 11359 . S-i3-D 9 Page g 0143 Inspector(print) Lie If Signature Date Risk Assessor(print) Lie# / Signature Dale Address of Property:3/2 VL !_.9 . �e' ST Apt# City: �BH7 HALLWAY: Interior #a- or Common Hallway: Front Rear Floortit 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 Upper Walls—Q.3 AIM L N/A Y A Closet Door AIM L N/A Y A B Lower Walls G AIM L N/A Y B Cl Casing AIM L NIA Y A e Baseboards .( A/NoNIA Y ,p !r� ��. vis C Closet Jamb AIM L NIA Y A BI Chair Rail AIM L NIA Y D Closet Walls AIM L NIA Y AB C o Radiator Q. AIM L NIA Y Cl Baseboard AIM L NIA Y Floor _ Q. 1 AIM L NIA Y 1 Closet Pole AIM L N/A Y Ceiling _ Q. AIM L N/A Y 2 Closet Shelf AIM LNIA Y B Door A1M L NIA Y 3 CI Supports AIM L NIA Y C D Door Casing_ L NIA Y �,)J,a 4 Closet Floor AIM LNIA Y I m2 Door Jamb 9. (®L NIA Y y- , Closet Ceiling AIM L NIA Y 3 4 IThreshold AIM L NIA Y A Window Sill Mil (VQ N/A Y , ro ®B Door —0. 1 AIM L NIA Y Win Apron �. AIM L NIA Y CC) Door Casing 9.1 00 NIA Y ,g a ,« C Win Casing L N/A Y • 10 Door Jamb N/A Y ,y ra yNr D Header Stop 9. Mll LNIA Y 1/.0 34 Threshold _ 0. 1 AIM N/A Y Int Slops M/I &m NIA Y ,7/4 A B Door AIM L N/Al Y I 1 O Win Int Sash M/I Oag N/A Y r!/r ' D Door Casing 9. 0 L NIA Y 2 Exterior Sill /. Mil SF L NIA V 2T 72- 62 Door Jamb &L N/A Y ,1 „ ,o e 3 Part Bead MII L NIA Y 34 Threshold AIM L NIA Y 4 Blind Slop /. Mill SF L N/A Y A B Door AIM L NIA Y Win Ext Sash M11 L NIA Y OD Door Casing 9. L N/A Y �/rO yr, ro A Window Sill .9 M/I ®L NIA Y 10 Door Jamb eL NIA Y ,7 p ,Q( r7u(.o ® wm Apron AIM LNIA Y 34 Threshold 0.24 AIM L NIA I Y C Win Casing 9. QI L NIA Y A B Door (D L N/A Y , «/,r, D Header Slop L N/A Y r$ ,o p ra t- CC Door Casing 9. �I I L NIA Y ro ker, %/,o Int Stops L NIA Y q ,o ( # 1 Doorjamb III L NIA Y r so gemrla.g gem 1 Win Int Sash &m N/A Y 11 Threshold .p.1 AIM L NIA Y ® Exledor Sill MA SF L 701. Y 7/,o � A Closet Door L NIA Y q/ro ', r 3 Part Bead JVA M/I L®A Y B Cl Casing O L NIA Y q/yo ( rr/r 4 Blind Stop Jrt MIA SF L Y r(J w C Closet Jamb LNIA Y �lsqftj I Win Ext Sash MA L Y ,7/10 AS Closet Walls.-Q 3 AIM L NIA Y I Go Win Above 5' I"--�M11 AIM L N/A Y As CI Baseboard . l AIM L& Y J1 ,�/,y C �r ,p CC Ceiling Moldin O,O MII AIM L NIA Y Closet Pole G AIM L N/A Y 2 Closet Shelf Q.0 AIM N/A Y 3 CI Supports C�m N/A Y ,T ,o N1 4 ,• 4 Closet Floor .J AIM L N/A Y Closet Ceilin Q. AIML N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC I IC I SIDE LOCATION MEASURE:LOOSE PAINT C IC (MORE THAN 288 SQ,IN.) DATE METHOD (MORE THAN 288 SQ.IN.) DATE METHOD Kevin Nestbr 11359 _ 5-�3-c5ij' Page ! Of q3 • Inspector(print) Uc# Signature Date Risk Assessor(print) Lic If Signature Date Address of Property: 3IZ'/L 04zCAte e Sl Apt# City CONTINUATION OF ROOM — LG �fZ 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 I HAZARD HAZ? DATE METH DATE METH 7-8 Door A/M L NIA Y A Window Sill $. MY L NIA Y /,yr„ CD Door Casing AML NIA Y ® Win Apron q. AIM L NIA Y �7/,r, # Door Jamb AIM L N/A Y C Win Casing Q(al L NIA Y /7/ro Threshold A/M L NIA Y D Header Stop •r Mil L N/A Y /,7/,0 A B Door A/M L-N/A Y Int Stops .g M/I ON L NIA Y /,7/,o CD Door Casing AIM L N/A Y #2 Win lrn Sash MA AM N/A Y rt/iu # Door Jamb AIM L NIA Y 7 Exterior Sill M/l SF L N/A Y Threshold AIM L N/A Y Part Bead Mll L N/A Y A B Door AIM L N/A Y Blind Stop MII SF L N/A Y C D Door Casing AIM L N/A Y Win Ext Sash MII L NIA Y # Door Jamb A/M L NIA Y A Window Sill MA AIM L N/A Y Threshold A/M L NIA Y B Win Apron A/M L NIA Y Closet Door AIM L N/A Y C Win Casing AIM L NIA Y A Cl Casing A/M L N/A Y D Header Stop MA L N/A Y B Closet Jamb A/M L N/A Y Int Stops Mill AIM L NIA Y C Close(Walls A/M L N/A Y # Win Int Sash MA AIM L N/A Y D Cl Baseboard AIM L NIA Y Exterior Sill M/I SF L NIA Y Closet Pole A/M L NIA Y Pan Bead MA L N/A Y # Closet Shelf AIM L NIA Y Blind Stop M/I SF L N/A Y Cl Supports A/ML N/A Y Win Ext Sash M/I L NIA Y Cl Drawers AIM L N/A Y A B Up Cab Fmme AIM L NIA Y CI Or Frame A/M L N/A Y C D Up Cab Door AIM L N/A Y Closet Floor AIM L N/A Y Up Cab Walls AIM L N/A Y Closet Ceiling AIM L N/A Y # Up Cab Shlvs AIM L N/A Y Closet Door AIM L N/A Y Supports A/M L N/A Y A Cl Casing AIM L N/A Y Low Cab Fram AIM L NIA Y B Closet Jamb A/M L NIA Y AB Low Cab Door A/M L NIA Y C Closet Walls AIM L NIA Y C D Low Cab Wall AIM L N/A V D Cl Baseboard AIM L NIA Y # Low Cab Shl AIM L N/A Y Closet Pale AIM L N/A Y Supports A/M L NIA Y # Closet Shelf A/M L N/A Y Drawers AIM L N/A Y AD Cl Supports A/ML NIA Y co Shlvs Above S' AIM L N/A Y ClAS Drawers AIM L N/A Y co Cab Above 5' AIM L N/A Y AB Cl Or Frame A/M L N/A Y co Cab Above 5' AIM L NIA Y Closet Floor AIM L NIA Y A B Fireplace AIM L N/A Y Closet Ceiling A/M L NIA Y C D Mantle AIM L NIA Y B Sidelight(L) AIM L NIA Y C D Sidelight(R) A/M L NIA Y Aa co Win Above 5' A/M L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SQ.IN DATE METHOD LI/RA RepRoomCont,8108 ZA2 Kevin Nestor 11359 �/y� 3-O rJ Page 10 or7 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# ignature Date Address of Pro e :331Z�V2. .l4LA C C sr A t.# Ci ;xlkowl STAIRCASE /AST 70 f ed^or 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 I DATE METH A B Upper Walls— O.Z AIM L NIA Y A Window Sill i MII AIM L N/A Y A B Lower Walls /. AIM L N/A Y d B Win Apron AIM L NIA Y A B Baseboards 9. 1 AIM ON/A Y ��.a /ql� C win Casing AIM L N/A Y A B Chair Rail ARM L NIA Y D Header Slop MR L NIA Y AB CD Radiator /. AIM L NIA Y Int Stops MA AIM L N/A Y Floor 0.0 AIM L N/A Y 1 Win IM Sash MR AIM L N/A Y Ceiling —0- 1 AIM L NIA Y 2 Exterior Sill MR SF L NIA Y A B Door AIM L NIA Y 3 Pad Bead MB L N/A Y C D Door Casing AIM L N/A Y 4 Blind Stop MA SF L N/A Y 1 2 Door Jamb AIM L NIA Y Win Ext Sash MA L N/A Y 3 4 Threshold AIM L NIA Y A Window Sill MR AIM L N/A Y A B Door AIM L N/A Y B Win Apron AIM L NIA Y C D Door Casing AIM L N/A Y C Win Casing AIM L N/A Y 12 Door Jamb ARM L NIA Y D Header Stop MR L NIA Y 3 4 Threshold AIM L NIA Y Int Stops MR ARM L N/A Y A B Door AIM L NIA Y 1 Win Int Sash MR AIM L N/A Y C D Door Casing AM L NIA Y 2 Exterior Sill MO SF L NIA Y 12 Door Jamb AIM L NIA Y 3 Pad Bead MR L NIA Y 3 4 Threshold AIM L NIA Y 4 Blind Stop MA SF L N/A Y A B Door AIM L N/A Y 17,Ext Sash MII L NIA Y C D Door Casing AIM L N/A Y Newel Post A/M L NIA Y 12 Door Jamb AM L NIA Y Railing Cap O O L N/A Y 3 4 Threshold AIM L N/A Y Handrail c AIM L N/A Y A B Door AIM L N/A Y Balusters ` 61 L NIA Y .o ..1. C D Door Casing AIM L N/A Y Lower Rail /. AIM L N/A Y # Door Jamb AIM L NIA Y Stair Treads AIM L NIA Y Threshold AIM L N/A Y Stair Risers .9 L N/A Y * Res* '44 A Closet Door AIM L NIA Y Stringer L NIA Y .7/.o k.o B CI Casing AIML NIA Y Floor Edge 9.q AIM L NIA Y r7 w oro C Closet Jamb Atter L NIA Y Floor Casings A1M L NIA Y r7/.o e q D Closet Walls AM L NIA Y r-�13-o9 Cl Baseboard AIM NIA I Y fLOd�. G�S��y(�S Ani 0°'LOo/L ,E�Gre- 1 Closet Pole aLNIA j 2 Closet Shelf �Re �d� 7''�i4N ?WO fCBT f�d�tt 3 CI Suppods Ri4i�iivC/ 4 Closet Floor .JJ Closet CeilingA EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. _ SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 ?f � � ,>'/�-p Page11 Qr� Inspector(print) LIC# Signature Date Risk Assessor(print) Lic# Signature Date` Address of Property34Z �2 LAffJG/C7' P ST Apt# Ciri iir 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 n Up Walls0.3 AIM L NIA Y A Window Sill ON L N/A Y C nho r. 0A B Low Walls AIM L NIA Y ® Win Apron L NIA Y n/ro A B Baseboards AIM L N/A Y ,7/,p ~ / rr/, C Win Casing /•i �j I L N/A Y /,7/10 A B Chair Rail AIM L NIA Y D Header Stop 4).719 L N/A Y /i7/,o As Radiator 6.0 AIM L NIA Y Int Stops /y 0 L NIA Y Floor _ Q, AIM L N/A Y m Win Int Sash 9.47101 C*m NIA Y Ceiling 0.0 AIM L N/A Y 2 Exterior Sill y.1t SF m N/A Y v 0B Door AIM L N/A Y 3 Part Bead /.OIC m N/A Y /7,0 VR C D Door Casing .9 L NIA Y , ,p ,0 4 Blind Stop SF m N/A Y r�/,o 02 Door Jamb 9. L NIA Y � 10 p/, , Win Ext Sash /.001 NIA Y ,7/,o V 34 Threshold � AIM L NIA Y A Window Sill 9 L N/A Y A B Door9 ®t L NIA Y ,jV u 1 ( .� L N/A Y ��! • ® Win Apron , o ODD Casing 9. �1 L N/A Y ,7/4o M C Win Casing ®A L NIA Y ' ,7/ro 02 Door Jamb L N/A Y p a L NIA Y �:7/,a I Alp) ,p D HeaderSto 3 4 Threshold AIM L N/A Y Int Stops at CM L N/A Y A B Door ,I AIM L N/A Y 1 Win Int Sash felt L NIA Y OD Door Casing 9 OA L NIA Y q p h ,� (� Exterior sill /4 MA SF L P(f7 V .7 ro 10 Door Jamb ®L NIA Y 7/rU ,�,o t 3 Part Bead M/1 L Y ,7/(0 34 Threshold aQ AIMLN/A Y 4 Blind Stop 41,4M/I SF L � Y ,7/,0 2 A B Door AIM L NIA Y Win Ext Sash /MT M/1 L to Y ,7/10 57,e - C D Door Casing AIM L NIA Y A Window Sill i9>0 L N/A Y 7110 12 Door Jamb A/M L N/A Y Win Apron r1.7 611 L NIA Y .7/10 34 Threshold AIM L N/A Y C Win Casing rel L NIA V A Closet Doo 69L N/A Y p b/ D Header Stop L NIA Y B Cl Casing AIM L NIA Y Int Stops L N/A Y r7 rp ©Closet Jamb 4210 NIA Y , y 1 Win Int Sash 40 L NIA Y ,7 N D Closet Walls AIMONIA Y 071to • , 2 lExteriorSill a SF 0)N/A Y Cl Baseboard AIM L NIA Y 1 ® Part Bead /.0 ® O N/A Y 1 Closet Pole AIM L N/A Y 4 Blind Slop 0 SF OWA Y 2 Closet Shelf 104 AIM L N/A Y IWinExtSash I/.0 IV ®NIA Y 3 Cl Supports0 jq AIM L N/Afy f •, , AB Fireplace AIM L NIA Y 4 Closet Floor 9 p/N/A ,p CD Mange AIM L N/A Y Closet Ceilin d. AIM L NIAi A o Win Above 5' \• AIM L NIA Y s-/a os S/Di C jw Ceiling Moldin /. AIM L NIA Y y 9 /D/ri'IJ AIM L NIA Y qj17/10 kti AIM L N/A Y 17 ICS aR/!ke✓ar2 5/11105 a 0.c7 AIM L NIA Y I## EXCLUDED SURFACES:Su aces listed in these boxes can be made intact only by a licensed delBader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ.IN.) DATE METHOD (MORE THAN 288 SQ.IN.) DATE METHOD Kevin Nestbr 11359 S/3 0 Page l yof#3 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property:.3�Z SIL �AFAHcr7� ST Apt.# City KITCHEN 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 Upper Walls. p.3 AIM L N/A Y A Window Sill— 0.0 MII AIM L N/A Y A B Lower Walls AIM L NIA Y ® Win Apron 0.3 AIM L NIA Y A BSLLL Baseboards—d, AIM L NIA Y C Win Casing 0.1 AIM L NIA Y A B Chair Rail AIM L NIA Y D Header Stop 0,74MA AIM L N/A Y AB co Radiator 0.0 AIM L NIA Y Int Stops 0.1 MII AIM L NIA Y Floor „O. AIM L NIA Y ® Win IM Sash O t Mil AIM L NIA Y 07,u Ceiling ... 0. AIM NIA Y 2 Exterior SBl Q1 SF NIA Y 71,k) V ®B Door — 0. 1 AIM L N/A Y 3 Part Bead O ® m N/A Y 7104 V9 C D Door Casing AIM L N/A Y 4 Blind Slop q. all SF C)NIA V 02 Door Jamb 0A AIM NIA Y Win Ext Sash q aI ON/A Y 07,4 t 3 4 Threshold O.d AIM L NIA Y A Window Sill 0.0 Ntll AIM L NIA Y g B Door � AIM L NIA Y B Win Apron AIM L N/A Y .. AIM L NIA Y C D Door Casing 0.1 AIM L N/A V Win Casing Q 1m Doorjamb 0.1 AIM L NIA Y D Header Stop-O MII AIM L N/A Y 3 4 Threshold 0.0 AIM L NIA Y Int Stops 0.0 MII AIM L N/A Y ®B Door AIM L N/A Y 1 Win Int Sash V M/I AIM L NIA Y CID Door Casing O. AIM L N/A Y 2 Exterior Sill MA SF L N/A Y 1 2 Door Jamb O.D AIM L N/A Y 3 Pan Bead M!I L NIA Y ®4 Threshold 0.0 AIM L NIA Y 4 Blind Stop V2 MII SF L NIA Y ®B Door — 0. AIM L N/A Y Win Ext Sash MA L NIA Y C D Door Casing- .3 AIM L NIA Y B Up Cab Frame O• AIM L N/A Y 12 Doorjamb .- AIM L NIA Y C Up Cab Door O. AIM L N/A Y 30 Threshold .O AIM L N/A Y Up Cab Wall O.3 AIM L N/A Y A Closet Door AIM L NIA Y 12 Up Cab Shly .tj AIM L N/A Y Cl Casing AIM L NIA Y 34 Supports 0.3 AIM L NIA Y C Closet Jamb A/M L Y , 0, Low Cab F 0.3 AIM L NIA Y D Closet Walls AIM L 0 Y q/ 0. ow Cab Do C AIM L N/A Y Cl Baseboard AIM L Y 00 Low Cab W .If AIM L N/A Y j a) Closet Pole AIM L N/A Y Low Cab Shl A/M L NIA Y 2 Closet Shelf /. AIM L NIA Y 1 2 Supports AIM L N/A Y 3 Ci Suppods AIM L NIA Y 34 Drawers .-0. AIM L NIA Y r 4 Closet Floor A M L IQA Y ,�,4 O. 3 A D Win Above 5' MII AIM L MIA Y Closet Ceiling A/M L Y 5-/3-09 eeA"0.W,C 77tF" wa/1s= -0•S EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 S0.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 ,� S—i3-OS Page 3Of ' Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property:3/2 SIL .4AtAt e�e .V7' Apt# City - !��/e9 CONTINUATION OF ROOM —K/TG t71/ 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 Door AIM L N/A Y A Window Sill Mll AIM L NIA Y C D Door Casing p.1 AIM L NIA Y B Win Apron AN L NIA Y # 1 Door Jamb AIM L 0 Y r ry.p, 3 C Win Casing AMM L NIA Y Threshold � AIM L N/A Y D Header Stop M/I L N/A Y A B Door —10.31 AIM L N/A Y Int Stops M/I AIM L N/A Y IDD Door Casing AIM L N/A Y # Win Int Sash M/I AMM L NIA Y # Door Jamb .. O. AIM L N/A Y Exterior Sill MP SF L NIA Y Threshold 0. 1 AMM L N/A Y Part Bead Mil L N/A Y A B Door AIM L NIA Y Blind Slop Mil SF L N/A Y C D Door Casing AIM L N/A Y Win Ext Sash MII L NIA Y # Door Jamb AIM L N/A Y A Window Sill IMA AIM L N/A Y Threshold AIM L NIA Y B Win Apron AIM L NIA Y Closet Door AIM L N/A Y C Win Casing AMM L N/A Y A Cl Casing AIM L N/A Y D Header Stop MII L NIA Y B Closet Jamb AIM L N/A Y Int Stops M/I A/M L N/A Y C Close(Walls AIM L NIA Y # Win Int Sash MII AIM L N/A Y D Cl Baseboard AIM L NIA Y Exlerior Sill MII SF L N/A Y Closet Pole AIM L N/A Y Ifind d M/I L N/A Y # Closet Shelf AIM L N/A Y p M/I SF L N/A Y Cl Supports AIM L NIA Y Sash M/I L NIA Y CI Drawers AMM L NIA Y AO Fram AIM L NIA Y G je •1 _..._....` _.. Cl Or Frame AIM L NIA Y C D ➢ec>r d. AIM L NIA Y � Closet Floor AIM L NIA Y Wall 0. 1 AIM L N/A Y Closet Ceiling AIM L N/A Y # t ,$pI' p.j AIM L NIA Y li�i Closet Door AIM L N/A Y s AMM L N/A Y A Cl Casing AIM L N/A Y b Fram _ AIM L N/A Y B Closet Jamb AMM L N/A Y A B Low Cab Door AIM L N/A Y C Closet Walls AIM L N/A Y C D Low Cab Wall AIM L NIA Y D Cl Baseboard AIM L NIA Y # Low Cab Shl AIM L N/A Y Closet Pole AIM L NIA Y Supports AIM L N/A Y # Closet Shelf AIM L NIA Y Drawers AIM L NIA Y AS Cl Supports AIM NIA Y CD Shlvs Above 5' AIM L NIA Y Cl Drawers AIM L NIA Y AS Cab Above 5AIM L N/A Y AS EClo,etF AMiL N/A Y DD Cab Above 5' AIM L NIA Y AIM L N/A Y A 8 Fireplace AIM L N/A Y JA AIM L N/A Y C D Mantle AIM L N/A Y B Sidelight(L) AIM L NIA Y C D Sidelight(R) AIM L NIA Y AB 11 CD 'Nin Above 5' � AIM L N/A Y EXCLUDED SURFACES: Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE'.LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO,IN.) DATE METHOD LIRA RepRoomCont.8/08 KEvin Nestor 11359 JY� 6'��-o S Page lof3 Inspector(print) Lic# Signature Date Risk Assessor (print) Lic# �/ Signature Date Address of Pro a :3/Z;L ��4 e110 s7 Apt.# Ci : sr4 �C BATHROOM / f/ RST ogc-�-LOa/Z SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ, DATE METH DATE METH A B Upper Walls—0.3 AIM L NIA Y Low Cab Fram AIM L N/A Y A B Lower Walls 0.0 AIM L NIA Y AB Low Cab Door AIM L N/A Y A B Baseboards-0.3 AIM L NIA Y C D Low Cab Walls AIM L N/A Y A B Chair Rail 0.0 AIM L N/A Y Low Cab ShIvs AIM L NIA Y AB Co Radiator AIM L NIA Y 12 Supports AIM L NIA Y Floor 0.3 AIM L NIA Y 7744 34 lorawers AIM L NIA Y Ceiling — 0.3 AIM L N/A Y A Window Sill .0 MA AIM L NIA Y A B Door — 0.3 AIM L N/A Y ® Win Apron — 0.2 AIM L N/A Y D Door Casing—O.Z, AIM L N/A Y C Win Casing 0.if AIM L NIA Y 62 Door Jamb _0.3 AIM L NIA Y D Header Stop 0. ( MA L NIA Y 34 Threshold 0.0 AIM L NIA Y Int Stops _O.ZMII AIM L NIA Y A BKDoor . AMM L NIA Y ® Win Int Sash 0MA AIM L NIA Y ,�/�o C DAIM L NIA Y 2 ExterorSJl 0 SF 0 N/A Y ghro R N ,o 12 AMM L NIA Y 3 Part Bead f.pO0 m N/A Y ,�1,o p,E+ „,p 34 AIM L N/A Y 4 Blind Stop 41.51 SF O NIA Y (1,0 4,, O A Closet Door AMM L N/A Y Win Ext Sash /.I 01 (1)NIA Y ,-11,0 �— B Cl Casing AIM L NIA Y AsCDWin Above5' -�' MA AIM L NA Y As C Closet Jamb AIM L N/A Y c Ceiling Moldirg 0.3 Mil AIM L NA Y As D Closet Walls AIM L NIA Y D Medicine Cab M/1 AIM L NA Y AB Cl Baseboard AIM L N/A Y CD Wall OIC M/I AIM L NA Y 1 Closet Pole AIM L NIA Y M/l AIM L NA Y 2 Closet Shelf AIM L N/A Y M/1 AIM L NA I Y 3 CI Supports AN L N/A Y fM/1 AIM L NA Y 4 ICloset Floor AIM L NIA Y MIA AIM L NA Y Closet Ceiling ARM L NIA Y Mil AIM L NA Y A B Up Cab Frame AIM L N/A Y Mil AIM L NA Y C D Up Cab Door AIM L N/A Y M/I AIM L NA Y Up Cab Walls A/M L NIA Y Mill AIM L NA Y 12 Up Cab Shlvs AIM L NIA Y Mill AMM L NA Y 34 Supports AIM L NIA Y MA AIM L NA Y /o-thio /20OrYt ore,"a14-e) lv�til.�OGJ IS /v4hJ iii/ .�/Tty�jt/, EXCLUDED SURFACES: Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kovin Nestor 11359 � � �"—i O jp Page L•'of-iilI3 Inspector(print) Lic# Signature Date Risk Assessor(print) Uc# gnature Date Address of Prot)a :.3/Z"A FAB e ST A t.# City: �A�Birr STAIRCASEWLL 3 IVB T!A//�C�Se d2 f/�2$j' 70 StzoaD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH A B Upper Walls O. AIM L N/A Y A Window$ill MA AIM L NIA Y A B Lower Walls / AIM L NIA Y B Win Apron AIM L N/A Y A e Baseboards 40.0 AIM L N/A Y C Win Casing AIM L NIA Y A B Chair Rail /. ' AIM L NIA Y D Header Stop Mil L N/A Y AB co Radiator 0.0, AIM L NIA Y e R Int Stops MA AIM L NIA Y Floor — 0.1 AIM L NIA Y 1 Win Int Sash Mil AAM L NIA Y Ceiling 0.3 AIM L N/A Y 2 Exterior Sill MII SF L NIA Y B Door AIM L NIA Y 3 Part Bead MA L NIA Y CD Door Casing 0.0 AIM L NIA Y 4 Blind Stop M/1 SF L NIA Y 02 Door Jamb 0.6- AIM L N/A Y Win Ext Sash M/I L NIA Y 34 Threshold Q. AIM L N/A Y A Window Sal Mn AIM L NIA Y AB Door AIM L NIA Y B Win Apron AIM L NIA Y . 0D Door Casing O• AIM L NIA Y C Win Casing AIM L NIA Y 02 Door Jamb .O AIM L N/A Y D Header Stop Mll L NIA Y 34 Threshold _ 0.� AIM L NIA Y Int Stops M/I AIM L N/A Y AB Door AIM L NIA Y 1 Win Int Sash MII AIM L NIA Y CD Door Casing AIM L NIA Y 2 Extedor Sa Mil SF L NIA Y 12 Door Jamb AIM L N/A Y 3 Pad Bead MA L N/A Y 3 4 Threshold AIM L NIA Y 4 Blind Stop Mil SF L NIA Y A B Door AAM L NIA Y Win Ext Sash MII L NIA Y CD Door Casing AIM L NIA Y Newel Post Q AIM L NIA Y 12 Door Jamb AIM L NIA Y Railing Cap AIM L NIA Y 3 4 Threshold AIM L NIA Y Handrail AIM L N/A Y A B Door AIM L N/A Y Balusters O• AIM L NIA Y CID Door Casing AIM L NIA Y Lower Rail AAM L NIA Y # Door Jamb AIM L N/A Y StairTreads 0.2. AIM L NIA Y Threshold AIM L NIA Y Stair Risers 0.0 AIM L NIA Y A Closet Door AIM L N/A Y Stringer AIM L NIA Y B Cl Casing AIM L NIA Y Floor Edge —O. 1 AIM L NIA Y C Closet Jamb AIM L NIA Y Floor Casi 0. AIM L N/A Y D Closet Walls AIM L NIA Y Cl Baseboard AIM L N/A Y 1 Closet Pole AIM NIA Y O' 3 2 Closet Shelf AIM L NIA Y 3 Cl Supports AIM L NIA Y 4 Closet Floor AIM L NIA Y Closet Ceiling A/ML NIA Y _ EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE.LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestbr 11359 Page/60f'a Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property:.1Z yZ '14'r# a Ile ST Apt.# City' Si4�Bnp HALLWAY:Interior ## or ommon Hallway: Front Rear 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 A a Upper Walls 03 AIM L NIA Y A Closet Door_ AIM L N/A Y A B Lower Walls /. AIM L NIA Y B Cl Casing AIM L N!A Y A B Baseboards 9. L NIA Y jr 7f r:. ilP. /a t8 M C Closet Jamb AIM L NIA Y A B Chair Rail AIM L NIA Y D Closet Walls AIM L NIA Y AB CD Radiator /, AIM L N/A Y Cl Baseboard AIM L NIA Y Floor 0.1 AIM L NIA Y 1 Closet Pole AIM L NIA Y Ceiling _ 0. ( AIM L N/A Y 2 Closet Shelf ARM L NIA Y ®B Door L N/A Y to ' r Y,,7; 3 AWL Cl Supports AIM L NIA Y C D Door Casing L N/A Y !6&2 4 Closet Floor AIM L NIA Y m2 Door Jamb L NIA Y ,eke an y re Closet Ceiling AIM L NIA Y 34 Threshold — 0-2, AIM L NIA Y A Window Sill MA A/M L N/A Y OB Door 9. L NIA Y rJ ro fZ p B Win Apron AMM L N/A Y C D Door Casing 9. AS L NIA Y � C Win Casing AMM L NIA Y 10 Door Jamb 0 L NIA Y D Header Stop M/I L NIA Y 34 Threshold _p.( AIM L NIA Y Ind Stops Mn AIM L NIA Y Ae Door _ C1,9 L N/A Y i)p (,y 'r rr ,e 1 Win Int Sash Mil AIM L N/A Y OVID Door Casing 9. N/A Y 7/A )124" to p 2 Exterior Sill MII SF L N/A Y 02 Door Jamb L N/A Y /r)/,o w a 3 Part Bead Mil L N/A Y 34 Threshold O•( AIM L NIA Y 4 Blind Slop Mn SF L NIA Y A B Door AIM L N/A Y Win Ext Sash M/I L N/A Y D Door Casing 00 N/A Y rr ,p A Window Sill Mn AIM L NIA Y 62 Door Jamb AM L NIA Y ri/,pe1,, ee B Win Apron AIM L N/A Y 34 Threshold 10.0 AIM L N/A Y C Win Casing AIM L NIA Y A B Door AIM L NIA Y D Header Slop MAI L NIA Y C D Door Casing AIM L NIA Y Int Stops M/I ARM L N/A Y # Door Jamb AIM NIA Y 1 Win Int Sash Mn AIM L NIA Y Threshold AW L N/A Y 2 Extenor Sill M/I SF L NIA Y A Closet Door AIM L NIA Y 3 Pan Bead Mil L N/A Y B Cl Casing AIM L N/A Y 4 Blind Stop M/I SF L N/A Y C Closet Jamb AIM L NIA Y Win Ext Sash Mn L NIA Y AB D Closet Walls AIM L NIA Y C, Win Above 5' Mil AMM L NIA Y AB Cl Baseboard AIM L NIA Y C D Ceiling Moldm M/I AIM L NIA Y 1 Closet Pole AIM L NIA Y 2 Closet Shelf AIM L NIA Y 3 CI SuDDorts AIM L N/A V 4 Closet Floor AIM L NIA Y Closet Ceiling AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 S0.IN.) DATE METHOD S�3-0 y 7h0r- Cd-,",oveV75 we,te RccdAbf oti yne Eaeoy �OiC STlS'iic.c�43� �/• 43 KevinNestar 11359 �y/�� �j/�-OS PageL[of — Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: 3/Z/�L ,CAFi4yCly 5r Apt.d City:�i eg? Y! ROOM •3 SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD I TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B Up Walls 0.Z AIM L NIA Y ® Window Sill 7.60 /0 L N/A Y O/ro A B Low Walls 1. AIM L NIA Y B Win Apron 9. oo L NIA Y r►/ro A B Baseboards '?. 7 L 0 Y r 7 � d!a a C Win Casing g.c/ �(G� L NIA Y /r7/rD A B Chair Rail AIM L N/A Y D Header Stop &I AIM C)NIA Y ,J WAI AB Radiator AIM L NIA Y Int Stops /. t® Arm/ L N/A Y r7/r4 Rc Floor Q. AIM L N/A Y Win Int Sash O. MIA AIM L NIA Y e r Ceiling —40.0 AIM NIA Y 2 Exterior Sill SF NIA Y ,7�0 • A B Door L NIA Y 0,7,0 e ,, 3 Part Beade4 0. I LNIA Y L. D Door Casing L NIA Y 1,7�rp f y��, 4 Blind Stop q SF �NtA Y o • �2 Door Jamb �.q Q L N/A Y r7/rO q �, ,o Win Ext Sash O.O MII LNIA Y 34 Threshold �. AIM L NIA Y A Window Sill M/I AIM L NIA Y A B Door L NIA Y w ,d u B Win Apron AIM L N/A Y Door Casing I L NIA Y r7/ ea► '7N ra C Win Casing AIM L NIA Y 02 Door Jamb CJ.CJ ( iiL NIA Y n/r ej v ,e D Header Stop Mil AIM L NIA Y 34 Threshold 0. AIM L NIA Y Int Slops M/1 AIM L NIA Y A B Door AIM L N/A Y 1 Win Int Sash MII AIM L NIA Y C D Door Casing AIM L NIA Y 2 Exterior Sill MII SF L N/A Y 12 Door Jamb AIM L NIA Y 3 Part Bead Mil L NIA Y 34 Threshold AIM L NIA Y 4 Blind Stop Mill SF L N/A Y A B Door AIM L NIA Y Win Ext Sash Mill L N/A Y C D Door Casing AIM L NIA Y A Window Sill MA AIM L NIA Y _ 12 Door Jamb AIM L NIA Y B Win Apron AAM L NIA Y 34 Threshold AIM L NIA Y C Win Casing AIM L NIA Y A Closet Door &L NIA Y ,7/ M.- 4 D Header Stop M/I AIM L N/A Y B CI Casing ON LLN/A Y r)/Zo y/ Int Stops MII AIM L NIA Y C Closet Jamb �I®N/A Y r7/W 1 Win lrit Sash MII A/M LNIA Y m Closet Walls AIM L NIA Y 2 Exterior Sill Mil SF L NIA Y CI Baseboard y.q AIM L Y /.O r, e 3 Part Bead Mil L NIA Y Closet Pole 1V AIM L N/A Y 4 Blind Stop MII SF L NIA Y 2 Closet Shell AIM L NIA Y iT4 R 1 4 0 WinExtSash MII L NIA Y 3 CI supports AIM L NIA Y q r !N ,. A B Fireplace AIM L NIA Y Closet Floor_0.0 AIM L N/A Y CD Mantle AIM L NIA Y AB Closet Ceilinqj 0. AIM NIA Y CD Win Above S' AIM L NIA Y Ceiling MoldiN AIM L N/A Y AIM L N/A Y AIM L NIA Y AIM L NIA Y EXCLUDED SURFACES: Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT ICIC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO,IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Nevin Nestor 11359 Page Leor64-; Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property:3/2//f- 49VClye ST Apt.# City: fie ROOM SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIONt I LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B Up Walls — 0. AIM L NIA Y ® Window Sill �'j_cj 10 Q& L NIA Y A B Low Walls /. AIM L N/A Y B Win Apron q.`( �I t L N/A Y 7/10 Zeob A a Baseboards AIM L NIA Y .7/,0 �Ow�r C Win Casing 9.9 BDA L NIA Y A B Chair Rail AIM L NIA Y D Header Slop 9.5 ID L NIA Y AB Radiator O,O AIM L N/A Y Int Slops 0.0 Mil AIM L N/A Y Floor (j. A/M L N/A Y Win Int Sash tJ.40 Mll A/M L N/A Y Ceiling o.3 AIM L NIA Y 2 Exterior Sill Y AB Door L N/A Y ,7/,0 3 Part Bead Y fjSJ D Door Casing ®1 L NIA Y ,Itho 4 Blind Stop SF NIA Y j 02 Door Jamb 147.1 L NIA Y afro Win Ext Sash .Q M/I L NIA Y 34 Threshold 10.1 A/M L N/A Y ® Window Sill 0 ®Q L NIA Y , ,o A B Door 47. L N/A Y _ ,? ro B Win Apron QUI L NIA Y OD Door Casing J!gi L NIA Y 7(,o C Win Casing OI L N/A Y ,7/ 10 Door Jamb IGN/A Y D Header Stop Y 34 Threshold p.1 AIM L NIA Y Int Stops MA AIM L NIA Y A B Door A/M L N/A Y 1 Win Int Sash 0.0 Mill A/M L NIA Y C D Door Casing AIM L NIA Y m Extenor Sill 9.1 SF m NIA Y N •7/NAs V 12 Door Jamb A/M L N/A Y 3 Pad Bed Q.D Mill L NIA Y 34 Threshold AIM L NIA Y 4 Blind StopYY SF m NIA Y A-13 Door AIM L N/A Y Win Ext Sash 0.0 Mil L N/A Y C D Door Casing AIM L N/A Y 6) Window Sill 9. 4D A& L N/A Y ,7/, 12 Door Jamb AIM L NIA Y B Win Apron 9.9 f0A7 L NIA Y 47�i KWmExtSash . N,A 34 Threshold AIM L NIA Y C i 9' Y ,7,G A Closet Door ®L NIA Y ,7/,p D Stop 9•y ®1 mNIA YB CI Casing (9 L NIA Y ,7JN ,ry — O. M/I AIM L NIA Y ClosetJamb . ®Dl L N/A Y ?/ m 1 ash— O A M/l AIM L NIA Y D Closet Walls O• AIM L NIA Y r 2 Sill `'J ® SF m N/A YCI Baseboard . AIM L ID Y ,7/.0 /y72 „ *fL 6) g`p S j 'i L NIA Ym Closet Pole G AIM L N/A Y 4 p 9.9 do SF 0 NIA Y2 ClosetShelf 9 p AIM L N/A Y 7 ,q T °, A /fjt Sash G•o Mn L N/A Y 3 Cl Supportsd a AIM N/A Y ,7 ,p /j'1 �p f, B IFireplace I AtM LNIA Y 4 Closet Floor �.� A/M L NIA Y C D Mamle A/M L N/A Y AB Closet Ceilin Q.3 AIM L N/A Y Co Win Above 5' AIM L NIA Y Ceiling Moldin Z. AIM L NIA Y AIM L N/A Y AIM L NIA Y AIM L N/A Y EXCLUDED SURF CES: Surfaces listed in these boxes can be made Intact on y by a licensed deleader. SIDE LOCATION MEASURE.LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT •• IC IC (MORE THAN 288 SQ.IN.) DATE METHOD (MORE THAN 288 SQ.IN.) DATE METHOD Kevin Nestor 11359 �y� S—/3-O cj Page 1Of`13 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property, Z�Z '44AWIle ,57" Apt# City Si4�C�ry CONTINUATION OF ROOM -474 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 Door AIM L NIA Y A Window Sill ?..3 Q) & L N/A Y C D Door Casing AIM L NIA Y (� Win Apron 9.9 OA L NIA Y # Door Jamb AIM L NIA Y C Win Casing GI L N/A Y r7�io Threshold AIM L NIA Y D Header Stop L N/A Y A B Door AIM L N/A Y Int Stops 0.0 MII AIM L N/Al Y C D Door Casing AIM L NIA Y # / Win Int Sash M/I AIM L N/A Y # Door Jamb AIM NIA YExledor Sill SF a)N/A Y Threshold AIM L N/A Y Pad Bea ,j L N/A Y A B Door AIM L NIA Y Blind Slop •! SF O N/A Y o C D Door Casing AIM L NIA Y Win Ext Sash O.O M/I L NIA Y # Door Jamb AIM L NIA Y A Window Sill Mn AIM L NIA Y Threshold AIM L NIA Y B Win Apron AIM L NIA Y Closet Door AIM L NIA Y C Win Casing AIM L NIA Y A Cl Casing AIM L N/A Y D Header Stop Mfl L NIA Y B Closet Jamb AIM L NIA Y Int Stops M/1 A/M L N/A Y C Closet Walls AIM L NIA Y # Win Int Sash M11 AIM L NIA Y D Cl Baseboard AIM L N/A Y Exterior Sill M11 SF L N/A Y Closet Pole AIM L NIA Y Pad Bead Mll L NIA Y # Closet Shelf AIM L NIA Y Blind Stop MA SF L N/A Y "'u " AIM L NIA Y Win Ext Sash MAL N)A Y CI Drawers AIM L N/A Y A B Up Cab Frame AIM L WA Y CIDr Frame AIM N/A Y CD Up Cab Door AIM L NIA Y Closet Floor AIM L NIA Y Up Cab Walls AIM L N/A Y Closet Ceiling AIM L N/A Y # Up Cab Shlvs AIM L NIA Y Closet Door AIM L N/A Y Supports A1M L N/A Y A CI Casing AIM L N/A Y Low Cab Fram AIM L N/A Y B Closet Jamb AIM L N/A Y A B Low Cab Door AIM L NIA Y C Closet Walls AIM L N/A Y C D Low Cab Walls AIM L NIA Y D CI Baseboard AIM L N/A Y # Low Cab Shl, AIM L NIA Y Closet Pole AIM L NIA Y Supports AIM L NIA Y # Closet Shelf AMM L NIA Y Drawers AIM L N/A Y Cl SupportsABs AIM L NIA Y DD ShNs Above 5' AIM L NIA Y AS Cl Drawers AIM L N/A Y CD Cab Above 5' AIM L NIA Y AS Cl Dr Frame AIM L NIA Y CD Cab Above 5' AIM L NIA Y Closet Floor AIM L NIA Y A B Fireplace A/M L NIA Y Closet Ceiling AAIM L N/A Y C D Mantle AIM L NIA Y A B Sidelight(L) AIM L NIA Y ESidelight,R) AIM L NIA Y Win Above 5' \ AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINTIC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO,IN.) DATE METHOD (MORE THAN 288 S0.IN.) DATE METHOD LI1RA RepRoomCnnt,8/08 Kevin Nestor 11359 .. S'/3 d s Page POf � Inspector(print) Lic# Signature Date Risk Assessor(print) Lie# Signature Date Address of Property:-3/2/z 06¢F e 'e ST Apt.# City: 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?J DATE METH I DATE METH A B Up Walls O• AIM L NIA Y A Window Sill Cf.5110 ®1 L NIA Y n/r0 A e Low Walls /. AIM L NIA Y (W Win Apron L NIA Y A BC 11 Baseboards 9. AIM L NIA Y Y#&* /jt p�«/,o C Win Casing �'f ;ml L N/A Y ,710 A B Chair Rail AIM L NIA Y D Header Stop N% MII L® Y8 a Cilli . o AB Radiator 0.0 AIM L N/A Y Int Stops 99 0 04>N/A Y 7/to Floor 0-0 AIM L NIA Y m Win Int Sash p.i MA AIM L NIA Y Ceiling 0. 1 AIM L N/A Y 2 Exterior Sill .9 Mil SF L NIA Y @B Door 9.19 0L N/A Y 3 Part Bead(A Ml L(Sk Y C D Door Casing 9•q L NIA Y r ro ,« 4 Blind Stop SF (D N/A Y r Cis 02 Door Jamb L N/A Y , Win Ext Sash O.OMII L NIA Y 34 IThreshold 10.1 AIM L N/A Y A Window Sill 9D L NIA 9 � Y_ it a AB Door 6LC� O. AIM L NIA Y (� Win Apron �1 L NIA Y q/ro OD Door Casing�O• AIM L NIA Y C Win Casing 9� � L NIA Y ,7/w r 02 Door Jamb AIM L NIA Y D Header Stop qq L N/A Y ( ,� Cjry~,,,e 34 Threshold D. AIM L N/A Y Int Stops q �I L N/A Y 7/10 A B Door 40 L NIA Y ,7 ,e 10„ a 1 Win Int Sash Mll AIM L NIA Y CD Door Casing L N/A Y ,7/0 rQjpt r, o ® Exte or Sill j .Q SF m NIA Y 7/iu • 62 Door Jamb �1. O L NIA Y .7//0 �! N�« .0 3 Part Bea GL I L NIA Y 3 4 Threshold .� AIM L NA Y 4 Blind Stop :g SF (DNIA Y r rp A B Door A/M L NIA Y Win Ext Sash �.d M/I L NIA Y C D Door Casing AIM L NIA Y A Window Sill M11 AIM L NIA Y 12 Door Jamb AIM L NIA Y B Win Apron AIM L N/A Y 3 4 Threshold AIM L NIA Y C Win Casing AIM L NIA Y ® Closet Door ADL NIA Y q,p D Header Stop M/I L N/A Y B Cl Casing ! NIA Y 7jw Int Stops M11 AIM L NIA Y C Closet Jamb 49.11 0 L NIA Y ,7/to 1 Win Int Sash Mil A/M L NIA1 Y D Closet Walls 0.3 AIM L NIA Y 2 Exterior SIB M/I SF L N/A Y ��ww Cl Baseboard AIM L Y r7/iy /j}'I- w rp 3 Part Bead Mil L NIA Y (D Closet Pole AIM L NIA Y 4 Blind Stop M/l SF LNIA Y 2 Closet ShelfO 41f,Q1 AIM L NIA Y 6r/.7/,0/1?.� °Ir/ro Win Ext Sash MII LNIA Y 3 Cl Supports(JO AIM NIA Y ",7 , ryr rr •o RCeifing place AIM LNIA Y 4 Closet Floor Q. A/M L NIA Y nge AIM L N/A Y AIM L NIA Y n Above 5' AIM L N/A Y Moldin (� AIM L NlA Y AIM L NIA Y AIM L NIA Y AIM LNIA Y EXCLUDED SURFACES: Surfaces listed in these boxes can be made intact only by a licensed eleader. SIDE LOCATION MEASURE:LOOSE PAINT ICIC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 /3-0 S Page 01113 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature�/ Date Address ofPropertv:.1ZIZ .�f/Fi4l►CJIe ST ADt.# City: CONTINUATION OF ROOM —)I?00 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 7—B Door AIM L NIA Y Low Cab Fram AIM L NIA Y C D Door Casing AIM L NIA Y AB Low Cab Door AMM L NIA Y # Door Jamb AIM L N/A Y C D Low Cab Wal's Y Threshold AIM L N/A Y # Low Cab ShIvs Y 77B Door AIM L NIA1 Y Supports AIM L NIA Y C D Door Casing AIM L NIA I Y Drawers A1M L NIA Y # Door Jamb AIM L NIA Y A Window$OI IMII AIM L NIA Y Threshold AIM L N/A Y B Win Apron AIM L NIA Y A B Door AIM L N/A Y C Win Casing AIM L NIA Y C D Door Casing AIM L NIA Y D Header Stop M/I L NIA Y # Door Jamb AIM L NIA Y Int Stops M/I AIM L NIA Y Threshold AMM L NIA Y # Win Int Sash M11 AIM L NIA Y Closet Doord ()/6 ,O AIM L NIA Y CF Extenor Sill Mill SF L NIA Y A CI Casing —0.1 AIM L NIA Y Part Bead Mil L NIA Y B Closet Jamb.0.7 AIM NIA Y Blind Stop Mn SF L NIA Y 6> Closet Walls AIM L NIA Y lWin Ext Sash Mil L N/A Y D Cl Baseboard AIM L NIA Y A Window Sill MA AIM L N/A Y Closet Pole /. AIM L NIA Y B Win Apron AIM L N/A Y #1 Closet Shelf .e AIM L NIA Y C Win Casing AIM L NIA Y Cl Suppods i/ AIM L NIA Y D Header Stop M/I L N/A Y Cl Drawers AIM L NIA Y Int Stops M11 AIM L N/A Y Cl Dr Frame / AIM L NIA Y # Win Int Sash M/I AIM L N/A Y Closet Floor (7. AIM L N/A Y /(C Exterior Sill Mil SF L N/A Y Closet Ceiling p. AIM L N/A Y I Pan Bead M11 L NIA Y AB c D Sli Above 5'1 AIM L NIA Y Blind Slop Mll SF L WAI Y As cc Cab Above 5' A/ML N/A Y Win Ext Sash MA L N/A Y AB C D Cab Above 5' AIM L N/A Y A B Fireplace AIM L NIA Y A B Up Cab Frame AIM L NIA Y C D Mantle AIM L NIA Y C D Up Cab Door AIM L NIA Y A B Sidelight(L) AIM L NIA Y Up Cab Walls AIM L NIA Y C D Sidelight(R) AMi L NIA Y Aa # Up Cab Shlvs AIM L NIA Y CD Win Above 5' AIM L N/Al Y Supports AIM L NIA Y ABD D Win Above 5' \ AIM L NIA I Y Pipe cNAse /,✓ S/D� C CGoS�i = —o• Z EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION I MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 S0.IN.) DATE METHOD (MORE THAN 288 S0.IN.) DATE METHOD IJ/RA RepRoomConi,8/08 Kevin Nestor 11359 73. . + i�•d^ Page9or�.J inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: 3lZ/Z .0 i 1976l/t Ss Ant# CIN S9/ens HALLWAY:Interior # S or " Common Hallway: Front Rear Floor# SIDE LOCATION/ LEAD TYPE OF URG IC I IC DELEAD DELEAD SIDE LOCATION/ I LEAD TYPE OF URG IC I IC DELEAD DELEAD A B SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH C 13 Upper Walls—. AIM L NIA Y ACloset Door AIM L NIA Y A B Lower Walls AIM L NIA Y B Cl Casing AIM L N/A Y A B Baseboards .1 AIM L NIA Y C Closet Jamb AIM L NIA Y A B Chair Rail AIM L NIA Y D Closet Walls AIM L N/A Y AB CD Radiator AIM L NIA Y Cl Baseboard AMM L N/A Y Floor _ AIM L NIA Y 1 Closet Pole AIM L N/A Y Ceiling 0.3 AIM L N/A I Y 2 Closet Shelf AIM L N/A Y B Door 1� AIM L NIA Y 3 Cl Supports AIM L NIA Y C D Door Casing Q AIM L NIA Y 4 Closet Floor AIM L NIA Y m2 Door Jamb O.Z. AIM L NIA Y Closet Ceiling AIM L NIA Y • 34 Threshold .0 AIM L N/A Y A Window Sill M/I AIM L NIA Y A®Door 0.0 AIM L N/A Y B Win Apron AIM L NA Y �C1D, Door Casing CJ. AIM L NIA Y C Win Casing AJM L NIA Y We Door Jamb �0. AMM L NIA Y D Header Stop M/I L N/A Y 34 Threshold O AIM L NIA Y Int Slops M/I AIM L N/A Y AB Door AIM L N/A Y 1 Win Int Sash M/I AIM L N/A Y I OD Door Casing AIM L NIA Y 2 Exterior Sill MII SF L N/A Y m2 Door Jamb AMM L NIA Y 3 Part Bead MM L N/A Y 3 4 Threshold AIM L NIA Y 4 Blind Stop M/I SF L NIA Y A BkThres*ho1d0,07i AIM L NIA Y Win Ext Sash Mll L N/A Y C(D AIM L NIA Y __ A Window Sill MA AIM L NIA Y 1 02 AIM L NIA Y B Win Apron AMM L NIA Y 34 AIM L N/A Y (jG C Win Casing AIM L NIA Y A BoDoor AIM L NIA Y D Header Stop MH L N/A Y C Dng AIM L N/A Y Int Stops M11 ARM L N/A Y # b A1M L N/A Y 1 Win Int Sash M/I AIM L NIA Y AIM L NIA Y 2 Exterior Sill M/I SF L N/A Y A Closet Door AIM L N/A Y_ 3 Part Bead M/I L N!A Y B Cl Casing AIM L NIA Y 4 Blind Stop M11 SF L NIA Y C Closet Jamb AIM L N/A I Y Win Ext Sash MAI L NIA Y D Closet Walls AIM L N/A Y CD Win Above 5' M/1 AIM L N/A Y Ae Cl Baseboard AIM L N/A Y AD Ceiling Moldin \ M11 AIM L NIA Y 1 Closet Pole AIM L NIA Y S/3 -0 rj 2 Closet Shelf AIM L N/A Y 7jeAA/$OI+N—S Q 3 Cl Supports AIM L N/A Y C = 0• Z 4 Closet Floor AIM L N/A Y Closet Ceiling iAMM L NIA Y EXCLUDED SURFACE :Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 S0.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD 3-O% Tfhr S7W,'Xg:;,� Cavxlr®o-OVpNTS G+Je.tC RecoA.�ei> oni 793*r- Sn�'i�t.Cr432 Fo.t.►*S. Kevin Ill 11359 � ,3'i.�OS PageZ3ot Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# �/ Signature Date Address of Prooerbr:_%V2%G 45W4tel e sT Apt.# City: ROOM 6 SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HA2? DATE METH DATE METH SURFACE HAZARD HAZ, DATE METH DATE METH A B Up Walls — D. AIM L NIA Y A Window Sill Q7♦ .AM L NIA Y ry Io A B Low Walls AIM L NIA Y ® Win Apron ®I L NIA Y ,7/14 A B Baseboards 4 L N/A Y ,Z �; �r/, C Win Casing OM L NIA Y 77/io A B Chair Rail AIM L NIA Y D Header Stop .0 10 L NIA Y jZ ,0 a rl�b AB Radiator .O AIM L NIA Y Int Stops ,M L NIA Y .?/io Floor — O•Z A/M L N/A Y Win Int Sash .3 M/1 A/M L N/A Y Ceiling AIM L NIA Y 2 Exterior Sill Cf. 12 SF ON/A Y B Door 60L N/A Y 9VA 3 Part Beay:' 1 (® L N/A Y gQ�J s/ C D Door Casing jo L NIA Y 01,7/,* 4 Blind Stop 9.5SF ()NIA Y r ,v 02 Door Jamb L N/A Y / ., Win E#Sas .( M11 L NIA Y 34 Threshold A/M L NIA Y A Window Sill MA A/M L NIA Y A B DoorI .3 AIM L NIA Y B Win Apron AIM L N/A Y 0D Door Cj, •9 AM L NIA Y S, °, C Win Casing A/M L NIA Y m2 Door JaA/M L N/A Y D Header Stop Mil L NIA Y 34 Thresh . AIM L NIA Y Int Stops Mill AIM L NIA Y A B Door g. 01 L N/A Y FIWo , 1 Win Int Sash Mill A/M L NIA Y Co Door Casing T. I L NIA Y q s 2 Exterior SillMill SF L N/A Y ®2 Door Jamb QL NIA Y ,7/,o Q�0" r 3 Pad Bead Mil L N/A Y 34 Threshold —0. AMM L N/A Y 4 Blind Stop MII SF L NIA Y A B Door AIM L NIA Y Win Ext Sash Mil L NIA Y C D Door Casing AIM L NIA Y A Window Sill MA A/M L N/A Y 12 Door Jamb AIM L N/A Y B Win Apron AIM L NIA Y 34 Threshold AIM L NIA Y C Win Casing AIM L N/A Y 6> Closet Door Q L N/A Y 7/,p �+ D Header Stop Mill L NIA Y B Cl Casing AM L NIA Y ,0/,n Int Stops Mll A/M L N/A Y C Closet Jamb �j.� 0 L NIA Y 7/,p 1 Win int Sash Mill AIM L N/A Y D Closet Walls O. AIM L NIA Y 2 Exterior Sill M/I SF L NIA Y Cl Baseboard A/M L N/A Y 57.7/to 3 Pad Bead M/1 L N/A Y 6> Closet Pole G AIM L NIA Y 4 Blind Stop MII SF L NIA Y 2 Closet Shelf AIM L NIA Y n w "p a a Win Ext Sash MA L NIA Y 3 Cl Supports AIM L NIA Y ',7 , {'Z`� ' y U A B Fireplace AIM L NIA Y 4 Closet Floor O.Z. A/M L NIA Y C D Mantle AIM L N/A Y J-1 IAB Closet Ceili 0.3 AIM L WA Y CB Win Above 5' AIM L N/A Y S-/3 '0 5 S/.a t G Ceiling Moidin O AIM L NIA1 Y p///V7;v akcxS 0•( AIM L NIA IY AIM L N/A Y AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO,IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Keflin Nestor 11359 S/3-O^j Page— Inspector(print) age—Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Prwertv:3/1�L 1i*=AkK ee ST Apt.# City %Y4/wo-ji PORCH A B Q D (circle one) 1st fl nd 13rd fl 4th fl (circle one) OFF 6 —.77wlbe— /�5117/ 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 I HAZARD HAV DATE METH DATE METH AB Siding NIA Y ,o Y.& m Support Clmns/ AIM L NIA Y CD Comer Boards L N/A Y Newel Post 0.0AAA L NIA Y X Upper Tdm p m N/A Y g ,p A4.r7 oll Railing Cap 0.( AIM L NIA Y Ceiling L NIA Y Handrail /. AIM L N/A Y Joists L NIA Y Balusters 0.0 AIM L N/A Y ® Storm Door A/M L NIA Y Lower Rail 0,0 AIM L N/A Y B Door —O.Z. AIM L NIA Y Stair Treads it A/M L NIA Y C Door Casing—O. AIM L NIA Y Stair Risers / AIM L N/A Y D Door Jamb A/M L N/A Y Stringer AIM L NIA Y 2 Threshold O. A/M L NIA Y Lower Walls AIM L NIA Y 34 Kickplate �/ AIM L NIA Y Lattice AIM L N/A Y A Storm Door AIM L N/A Y Lower Tnm A/M L NIA Y B Door AIM L NIA Y Floor �. AIM L NIA Y C Door Casing AIM L NIA Y AB Window Sill A/M L NIA Y D Door Jamb AIM L NIA Y C D Win Casing A/M L NIA Y 12 Threshold AIM L NIA Y 12 Window Sash AIM L N/A Y 3 4 Kickplate AIM L NIA Y 34 Mullions AIM L N/A Y B Window Sill 6.1y 00 N/A Y S7,7/r / jJ ' 41` A B Window Sill AIM L NIA Y C D Win Casing WiZ. N/A Y q�.0 AM,r Nee /17y CID Win Casing AIM L NIA Y ndow Sash AIM L N/A Y 12 Window Sash AIM L NIA Y 3 4 Mullions AIM L NIA Y 34 Mullions AIM L NIA Y A B Window Sill AIM L N/A Y _ A B Window Sill AIM L N/A Y C D Win Casing AIM L NIA Y C D Win Casing A/M L NIA Y 12 Window Sash AIM L NIA Y 12 Window Sash AIM L NIA Y 3 4 Mullions AIM L N/A Y 3 4 Mullions A/M L NIA Y A B Window Sill A/M L N/A Y A B Window Sill AIM L NIA Y C D Win Casing AIM L NIA Y C D Win Casing AIM L N/A Y 12 Window Sash A/M L N/A Y 12 Window Sash AIM L NIA Y 3 4 Mullions A/M L NIA Y 3 4 Mullions AJM L NIA Y A B Window Sill A/M L NIA Y A B Window Sill A/M L NIA Y C D Win Casing AIM L NIA Y C D Win Casing A/M L NIA Y 1 2 Window Sash AIM L NIA Y 12 Window Sash AIM L N/A Y 34 Mullions AIM L N/A Y 34 Mullions AIM L N/A Y /D//-/0 771r— ;;1OX4X Gvj95 .�eslaVeA, 7*3f r—sc-fAlor?� 16'72 Aew on/ epwe rive- t=e?7-. 11 EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC METH (MORE THAN 1440 SQ.IN.) DATE 0D (MORE THAN 288 SO,IN.) DATE METHOD Kevin Neatbr 11359 � � S-i3-O 5; PagezSf Inspector(print) Lic# Signature Date Risk Assessor (print) Lic# Signature Date Address of Pro a J?/Z�L �i5ffi9 !/C ✓`r Apt# C' �dr-w BATHROOM , TeC;0Njj F440,Z SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIONI LEAD TYPE OF fG IC IC DELEAD DELEAD SURFACE HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD DATE METH DATE METH A B Upper Walls .c( AIM L NIA Y !�rp f. '� 4 ,� Low Cab Fra A/M L NIAA B Lower Walls �. AIM L NIA Y '/tv M� w d/0 t f(� Low Cab Door AIM L N/AA B Baseboards .�j "N/A Y S - �� /o 41r1/R�YtILow Cab Wall p .ZAIM L NIAA B Chair Rad ®L NIA Y ,*,* R Low Cab Shly p LAIM L NIA AB CD Radiator AIM L NIA Y 1 Supports AIM L NIA Y Floor AIM L NIA Y 34 Drawers 10.0 AIM L NIA Y Ceiling .Q AIM L NIA Y A Window Sill 2,6 0 00 L NIA Y B Door ®1 L NIA Y �!� B VExtenor 9. I L NIA Y q/,p /Zap CD Door Casing L NIA Y q/p g .4' L NIA V ,T/,a R 1 02 Doorjamb OL NIA Y ,�/,p op L NIA Y ,-*a 34 Threshold D.? AIML NIA Y .� L NIA Y ,i/,o Ap A B Door AIM L N/A Y //f sh 'J t®1 NIA Y T C Door Casing 0. 1 A/M L NIA Y 2 ill 'J.Ie1 SF C9NIA Y ,7 , VRI 2 Door Jamb — .I AIML NIA Y 3 9.90 OWA Y 57,71 v 34 Threshold AIM L NIA Y 4 Blind Stop SF 0 NIA Y57,7/,, A Closet Door A/ML NIA Y Win Ext Sash 9. ©NIA Y AB B Cl Casing A/M L NIA YC D Win Above 5' MII AIM L NA Y C Closet Jamb A/M L NIA I Y " Ceiling Moldin a.3 Mil AIM L NA Y D Closet Walls AIM L NIA Y CD Medicine Cab MII AMM L NA Y 44,* s- AS CI Baseboard AMM L NIA Y CD Wall OIC O M11 AIM L NA Y 1 Closet Pole AIM L N/A Y M11 A!M L NA Y 2 Closet Shelf AIM L N/A Y M11 AIM L NA Y 3 Cl Supports AIM L N/A Y M/I AIM L NA Y 4 Closet Floor AIM L N/A Y MA AIM L NA Y Closet Ceiling AIM L N/A Y Mil AIM L NA Y A B Up Cab Frama D. ( AIM L NIA Y M11 AIM L NA Y C®Up Cab Door Q. A/M L NIA Y MII AIM L NA Y Up Cab Wall 0.2 M11 AIM L NA Y 2 Up Cab Shly 10.3 AIM L NIA Y MA AIM L NA Y 34 Supports AMt L NIA Y Mil AIM L NA Y Si3•o9 5-�3 -� 9 svDe � ,e3gse,3v� ou rs sae co,uve�cS TiCAn/so.�•+ = 5. 9 s/,�iw n,1 �a�n/io �'! zs�iDe Cn �i•9 s/�/�� scR SNfzX"-T je = - O. 1 o.o EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 S0.IN.) DATE METHOD KevinNestDr 11359 9C2/—/"— � ✓4--/.3.0�j Pagez6Of�f3 Inspector(print) Lic# Signature Date Risk Assessor(print) Signature Date Address of Propert3%?Y2 10A4ge sr Apt.# C., /en, STAIRCASE 3 - SKaA /b M 77//,x.Z yc=�4 o 0/Z, 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 I HAZARD HA2? DATE METH DATE METH A e Upper Walls— O. A/M L N/A Y A Window Sol MA AIM L NIA Y A B Lower Walls /. AIM L NIA Y B Win Apron AIM L NIA Y A B Baseboards 0.3 A/M L N/A Y C Win Casing AIM L NIA Y A BI Chair Rap /rte AIM L NIA Y D Header Stop Mil L N/A Y f c. D1CD IRadiator A/M L N/A Y Int Stops M/I AIM L NIA Y Floor /. AIM L N/A Y 1 Win Int Sash MA AIM L NIA Y Ceiling —p.I AMI L NIA Y 2 Exterior Sill Mil SF L NIA Y A Door .� AIM L NIA Y 3 Pad Bead MA L N/A Y C D Door Casing Q. AIM L NIA Y 4 Blind Slop M/I SF L N/A Y Door Jamb_p.3 AIM L N/A Y Win Ext Sash M11 L N/A Y 34 Threshold / AIM L NIA Y A Window Sill Mil AIM L NIA Y A B Door AIM L N/A Y B Win Apron AIM L N/A Y C D Door Casing AIM L NIA Y C Win Casing AIM L NIA Y 12 Door Jamb AIM L NIA Y D Header Stop MB L NIA Y 34 Threshold A/M L NIA Y Int Stops MB AIM L NIA Y A B Door A/M L NIA Y 1 Win Int Sash MB AIM L NIA Y C D Door Casing AIM L NIA Y 2 Exterior Sill Mil SF L N/A Y 12 Door Jamb AIM L NIA Y 3 Part Bead MA L NIA Y 3 4 Threshold AIM L N/A Y 4 Blind Slop Mll SF L N/A Y [AS Door AIM L NIA Y Win Ext Sash M/l L NIA Y Door Casing AIM L NIA Y Newel Post Q.( AIM L NIA Y Door Jamb AIM L N/A Y Railing Cap .O AIM L N/A Y Threshold A/M L NIA Y Handrail AIM L NIA Y Door AIM L N/A Y Balusters .—O. AIM L NIA Y Door Casing A/M L N/A Y Lower Rail A/M L NIA Y Door Jamb AIM L N/A Y Stair Treads 0.1 AIM L NIA Y Threshold A/M L NIA Y Stair Risers—O. AIM L N/A Y A Closet Door AIM L NIA Y Stringer AIM L NIA Y B Cl Casing AIM L NIA Y Floor Edge —O.Z AIM L N/A Y C Closet Jamb AIM L N/A Y Floor Casings A/M L N/A Y D Closet Walls AIM L NIA Y -4,-13-42 Cl Baseboard AiM L NIA Y CAMAJAI OVMelb4o� _ O. 11' 1 Closet Pole AIM L NIA Y 2 Closet Shelf AIM L NIA Y 3 Cl Supports AIM L NIA Y 4 Closet Floor AIM L N/A Y Closet Ceiling AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 50.IN.) DATE METHOD (MORE THAN 288 S0.IN.) DATE METHOD ROM Nestor 11359 �--+ S/3-O 9 Pagel` of44-3 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property:-312�/t 1AFir CA ST Apt.# City: Bolles, HALLWAY: Interior #6 or ommonHalfway: Front Rear Floor# //CA FI-OO/2 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 Upper Walls A/M L NIA Y A Closet Door A/M L NIA Y A B Lower Walls / AIM L N/A Y B Cl Casing AIM L NIA Y A e Baseboards .f AIM L N/A Y C Closet Jamb AIM L NIA Y A B Chair Rail ,r' AIM L N/A Y D Closet Walls AMM L NIA Y AB co Radiator 0.0 AIM L NIA Y f Cl Baseboard AIM L NIA Y Floor 0.( AIM L NIA Y 1 Closet Pole AIM L NIA Y Ceiling — 0. 1 A/M L NIA Y 2 Closet Shelf AIM L NIA Y B Door .1 AIM L NIA Y 3 CI Supports AIM L NIA Y • C D Door Casing O.Z A/M L NIA Y 4 Cioset Floor AIM L NIA Y 1 02 Door Jamb .;O.Z AlM L NIA Y Closet Ceiling AIM L NIA Y 3 4 Threshold —0.( AIM L N/Al Y A Window Sill If MA AIM L NIA Y A0 Door _ .3 AIM L NIA Y B Win Apron AIM L N/A Y C D Door Casing 0.1 AMM L NIA Y C Win Casing AIM L NIA Y 1 02 Door Jamb 0.7,. AIM L NIA Y D Header Stop MA L NIA Y 34 Threshold �t AIM L NIA Y Int Stops M/I AIM L N/A Y A Q Door 0.3 AIM L NIA Y 1 Win Int Sash Mil AIM L NIA Y AFDDoorCasing—O. AIM L N/A Y 2 Exterior Sill MN SF L N/A Y I 10 Door Jamb — .f AIM L NIA Y 3 PaR Bead M/I L NIA Y 3 4 Threshold0.0 AIM L NIA Y 4 Blind Stop MA SF L N/A Y A B Door 0-3 AIM L NIA Y twin Ext Sash M11 L N/Al Y 1 DD Door casing O.C AIM L N/A Y A Window Sill M11 A/M L N/A Y (D2 Door Jamb.—0. 1 AIM L NIA Y B Win Apron AMM L N/A Y 3 4 Threshold 0.0 A/M L NIA Y C Win Casing AIM L NIA Y 7-B —Door— 0.3 AIM L N/A Y D Header Stop M/I L NIA Y C D Door Casing—0.3 A/M L N/A Y Int Stops MA AIM L N/A Y # Door Jamb /. AIM L NIA Y 1 Win Int Sash MA AIM L N/A Y Threshold 1/.' AMI L NIA Y 2 Exterior Sill Mill SF L NIA Y A Closet Door -A/M L N/A Y 3 Pad Bead mil L NIA Y B Cl Casing AMM L NIA Y 4 Blind Slop M/I SF L NIA Y C Closet Jamb AIM L N/A Y Win Ext Sash Mil L NIA Y A8 D Closet Walls AIM L NIA Y CD Win Above 5' M/1 AIM L NIA Y A6 Cl Baseboard AMM L N/Al Y Co Ceiling Moldin 0. M/I AIM L NIA Y 1 Closet Pole AIM L N/A I Y s/3 -O 1! 2 Closet Shelf A/M L N/A Y C&-vxtC/9t_ Hew 3 Cl Supports AIM L NIA Y 4 Closet Floor AMM L N/A Y Closet Ceiling A/ML N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE I METHOD (MORE THAN 288 S0.IN.) DATE METHOD Keain Nestbr 11359 OS Page Za Of#7—? Inspector(print) Lie# Signature Date Risk Assessor(print) Lie# �/ Signature Date Address of Prop erty-yz lz "w;PteA sT Apt.# City: 1-%;9lGirr 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 Up WallsO•'3 AIM L N/A Y ® Window Sill O:1 MA AIM L N/A Y A 8 Low Walls AIM L NIA Y B Win Apron —O.Z AIM L NIA Y A B Baseboards .O A/M L NIA Y C Win Casing—O. AIM L NIA Y A B Chair Rail ARM L NIA Y D Header Stop O.( MA L N/A Y AS Radiator /. A/M L NIA Y IM Stops . ( IW AIM L NIA Y Floor Q AAM L NIA Y O Win Int Sash 0.0 M/I AIM L NIA Y a Ceiling AIM L N/A Y 2 Exterior Sill SF ONIA Y �7/xo - A oorO. ARM L N/A Y _ 3 Part Bead 0 NIA Y ,�/x p VR— CD Door Casing O_Z. AIM L NIA Y 4 Blind Stop SF m NIA Y r7/11) VX 2 Door Jamb o.3 AIM L NIA Y Win EM Sash $. mN/A Y 1 34 Threshold O.O AIM L NIA Y A Window Sill MA A/M L N/A Y A B Door 0.0 ARM.L N/A Y __ _ B Win Apron _ A/M L NIA Y ©D Door Casing a AAM L NIA Y C Win Casing AIM L NIA Y 1 (52 Door Jamb AIM L NIA Y D Header Stop M/I L N/A Y 34 Threshold p.► ARM L NIA Y Int Stops M/I AIM L N/A Y AB Door A/M L NIA Y 1 Win Int Sash MA A/M L N/A Y C D Door Casing AIM L N/A Y 2 Exterior Sill MA SF L NIA Y 12 Door Jamb AIM L NIA Y 3 Pad Bead M/I L NIA Y 3 4 Threshold AIM L N/A Y 4 Blind Stop M1I SF L NIA Y AB Door AIM L N/A Y lWn Ext Sash NUI L N/A Y C D Door Casing AIM L N/A Y A Window Sill Mil AIM L N/A Y 12 Door Jamb ARM L NIA Y B Win Apron A/M L N/A Y 34 Threshold A/M L N/A Y C Win Casing AIM L N/A Y A Closet Door O.Z ARM L N/A Y D Header Stop M/I L N/A Y ® CI Casing AIM L NIA Y Int Slops M/I AIM L NIA Y C Closet Jamb 0.1 AIM L N/A Y 1 Win Int Sash MA ARM L N/Al Y D Closet Walls 0.31 AIM NIA Y 2 Exterior Sill MII SF L N/A Y Cl Baseboard.O. AIM L NIA Y 3 Part Bead M11 L NIA Y Closet Pole ARM L N/A Y 4 Blind Stop MA SF L NIA Y 2 Closet Shelf_ A/M L NIA Y Win Ext Sash MR L N/A Y 3 CI Supports U.0 ARM L NIA Y K 3 A B lFireplace AIM L N/A Y 4 1cioset Floor 0.0. AIM L N/A Y C D Mantle AIM L N/A Y A9 Closet Ceilin 0.3 ARM L NIA Y 1Co Win Above b' ,-" ARM L NIA Y Ceiling Moldi 0. AIM L N/Al Y ARM L N/A Y AIM L NIAJ Y I E A M L NIA1 Y EXCLUDED URFACE : urfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 281 SQ.IN.) DATE METHOD Kevin Nestor 11359 ,�/3.Orj Page At�3 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# L Signature Date Address of Prooertv:3/l%L .44C,9tf e 5T Apt.# City: ROOM g SIDE LOCATIONI I 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 8 Up Walls _ O.Z AIM L NIA Y A Window Sill—0.0 M/1 AIM L NIA Y A B Low Walls AIM L N/A Y ® Win Apron —0. AIM L NIA Y A 8 Baseboards 0.7 A/M L NIA Y C Win Casing— O. AIM L NIA Y A 8 Chair Rail ,/ AIM L N/A Y D Header Stop O.O MII L NIA Y AB Radiator —Q. AIM L N/A Y Int Stops — 11 AIM L NIA Y Floor Q./ AIM L NIA Y 6 Win Int Sash 0. Mil AIM L NIA Y ,.7/1 Ceiling AIM LNIA Y 2 Exterior Sill C.A SF QN/A Y elha OB Door — . 1 AIM L N/A Y 3 Part Bead '].3 NIA Y b71041 i CD Door Casing..0.1 AIM L N/A Y 4 Blind Stop 10 SF m NIA Y /n/r 02 Door Jamb Q. AIM L N/A Y Win Ext Sash 9. 19 NIA Y r74 3 4 Threshold — O O AIM L NIA Y A Window Sill MA AIM L N/A Y AB Door .. AIM L NIA Y 0 Win Apron AIM L N/A Y 4)D Door Casing O.1 AIM L NIA Y C Win Casing AIM L N/A Y 02 Door Jamb _0.O AIM L N/A Y D Header Slop M1I L N/A Y j 34 Threshold AIM L N/A Y Int Slops Mll AIM L NIA Y A B Door AIM L N/A Y 1 Win Int Sash MA AIM L NIA Y Door Casing 0-24 AIM L N/A Y _ 2 Exterior Sill M/1 SF L N/A Y 02 Door Jamb .3 AIM L N/A Y 3 Part Bead MA L NIA Y 34 Threshold AIM L N/A Y 4 Blind Stop M/I SF L NIA Y A B Door —0.1 AIM L N/A Y S 2>e C — Win Ext Sash M/1 L N/A Y ®D Door—Casing_Q. I AML NIA Y ,�� A Window Sill MIA AM L N/A Y 12 Door Jamb —0.2 AIM L NIA Y B Win Apron AIM L NIA Y 3 4 Threshold —10. 1 AIM L N/A Y C Win Casing AIM L NIA Y Closet Door 0. 11 AIM L NIA Y D Header Stop M11 L NIA Y CI Casing /. MAN Y Int Stops Mli AIM L NIA Y C Closet Jamb .0A Y 1 Win Int Sash M/I AIM L NIA Y D Closet Walls C_ Y /�y 2 Exterior Sill M/I SF L NIA Y Cl Baseboard /. ' AIMA Y 3 Part Bead M/l L N/A Y 1 Q Closet Pole /. A Y 4 Blind Slap M/I SF L N/A Y 2 Closet Shelf A Y Win Ext Sash MA L NIA Y 3 Cl Supports / A Y A B Fireplace AIM L NIA Y 4 Closet Floor Q. AIM L NIA Y C D Mantle AIM L N/A Y Aa Closet Ceiling AIM L N/A I Y Win Above S' ` AIM L NIA Y Ceiling MoldinE Q. AIM L NIA Y AIM L NIA Y AIM L NIA Y AIM L NIA Y EXCLUDED SURFACES:Su aces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ,IN.) DATE METHOD (MORE THAN 288 SQ.IN.) DATE METHOD S i3_as -X-4172Mac401t o,e ,c]PvE S117/10 - Afd 7"f}i --tZ� 56/Qo` ceS -!r/s i DQ ZWV-e Kevin Nestor 11359 � Page 3Oof/3 Inspector(print) Lic# Signature Date Risk Assessor(print) /_LIC# Signature Date Address of Properly: 3IZIt ,i9FAyC//C ST Apt.# City:✓'�i9�Giy CONTINUATION OF ROOM -ROO.y 8 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 Hi DATE METH DATE METH AB Door AIM L N/A Y A Window Sill M11 AIM L NIA Y CD Door Casing AIM L N/A Y B Win Apron AIM L NIA Y # Door Jamb AIM L N/A Y C Win Casing AIM L N/A Y Threshold AIM L N/A Y D Header Stop Mil L NIA Y AB Door AIM L N/A Y Int Stops Mil AIM L NIA Y C D Door Casing AIM L NIA Y # Win Int Sash M/1 AIM L NIA Y # DoorJamb AIM L NIA Y Exterior Sill MII SF L N/A Y Threshold AIM L NIA Y Part Bead Mn L N/A Y A B Door AIM L N/A Y Blind Stop MJI SF L NIA Y C D Door Casing AIM L NIA Y Win Ext Sash Mil L NIA Y # Door Jamb AIM L N/A Y A Window Sill Ma AIM L N/A Y Threshold AIM L NIA Y B Win Apron AIM L NIA Y Closet Door �/ AIM L N/A Y C Win Casing AIM L N/A Y A Cl Casing AIM L NIA Y D Header Stop Mil L NIA Y B Closet Jamb 0.0 AIM L N/A Y Int Stops Mil AIM L NIA Y (C� Closet Walls O.1 AIM L NIA Y # Win Int Sash M/I AIM L NIA Y 0 Cl Baseboard 0.6 AIM L NIA Y Exterior Sill MA SF L NIA Y Closet Pole 4 AIM L WA Y Pan Bead MA L N/A Y # r Closet Shelf O. AIM L NIA Y Blind Stop MAI SF L NIA Y Cl Supports Q AIM L NIA Y Win Ext Sash Mll L N/A Y Cl Drawers /. AIM L NIA Y A B Up Cab Frame AIM L NIA Y CI Dr Frame AIM L NIA Y C D Up Cab Door AIM L NIA Y _ Closet Floor O.1 AIM L NIA Y Up Cab Walls AIM L N/A Y Closet Ceiling 00 AIM L NIA Y # Up Cab Shlvs AIM L N/A Y LIBaseboard or AIM L NIA Y Supports AIM L NIA Y A Cl A/M L NIA Y Low Cab From AIM L N/A Y B b AIM L NIA Y AS Low Cab Door AIM L NIA Y C lls AIM L N/A Y C D Low Cab Walls AIM L NIA Y D Clard AIM L NIA Y # Low Cab Sh AIM L N/A Y le AIM L NIA Y Supports AIM L N/A Y # elf AIM L NIAI Y Drawers Ii AIM L NIA Y AS Cl Supports AIM NIA Y c Shlvs Above 5' AIM L N/A Y AS Cl Drawers AIM L NIA Y CD Cab Above 5' AJM L N/A Y AB Cl Dr Frame AIM L N/A Y 71D Cab Above 5' AIM L NIA Y Closet Floor AIM L NIA Y B Fireplace AIM L NIA Y Closet Ceiling AIM L NIA Y C D Mantle AIM L N/A Y B Sidelight(L) AIM L NIA Y C D Sidelight(R) AIM L N/A Y AB Co Win Above 5' AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SQ.IN.) DATE METHOD LI/RA RepRoomCont.8/08 Kevin Nestor 11359 4/1•u/!p A-- f=/,�O/ Page Rof#J Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Ignature Date Address of Pro a :.3/Z VZ ,C e Ae S Apt.# City: 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 HA2. DATE METH DATE METH AB Up Walls — O.O AIM L N/A Y A Window Sill— O.J MII A/M L N/A Y A B Low Walls A/M L NIA Y B Win Apron ter' A/M L NIA Y A B Baseboards a. AAM L N/A Y Q`� Win Casing A/M L NIA Y A B Chair Rail A/M L NIA Y D Header Stop OJ Mn L NIA Y ne Radiator AIM L NIA YG!', Int Stops Q.Q MA AIM L N/A Y W Floor Q.J AIM L NIA Y Win Int Sash G Mil AIM L NIA Y Ceiling —p.i AIM L N/A Y 2 Exterior Sill MA SF L Y A�Door — AAM L N/A Y 3 Part Bead MII L Y 7/ro �r yu co C D Door Casing O• J AIM L NIA Y 4 Blind Stop M/I SF L410 Y �-)/,4 w ro Door Jamb 10. 1 AIM L N/A Y Win Ext Sash ^/ MA L(Ply Y 3 4 Threshold O.J A/M L NIA Y A Window SJI MII AIM L NIA Y A B 4Door — AIM L NIA Y B Win Apron AIM L NIA Y C 41 AIM L N/A Y C Win Casing AIM L NIA Y 02 .O AIM L N/A Y D Header Stop MII L N/A Y 34 — A/M L NIA Y Int Stops MA A/M L N/A Y A B AIM L NIA Y 1 Win Int Sash MII A/M L NIA Y C D AIM L N/A Y 2 Exterior Sill M/1 SF L N/A Y 12 AIM L N/A Y 3 Pad Bead MA L NIA Y 3 4 IThreshold I N RAN Y 4 Blind Slop M/I SF L N/A Y AB Door Y Win Ext Sash MII L NIA Y CID Door Casing Y A Window Sill MA AIM L N/A Y 12 Door Jamb Y B Win Apron AIM L N/A Y 34 Threshold Y C Win Casing AIM L NIA Y A Closet Door Y D Header Stop MII L N/A Y ( Cl Casing .O I Y Int Stops MA ARM L NIA Y C Closet Jamb O.J AAM L NIA Y 1 Win Int Sash M/I A/M L NIA Y D Closet Walls O•J ARM L NIA Y 2 Exterior Sill Mil SF L NIA Y Cl Baseboard.Q. A/M L NIA Y 3 Pad Bead M/I L NIA Y C) Closet Pole AIM L N/A Y 4 Blind Stop M/I SF L NIA Y 2 Closet SheA/M L N/A Y X 3 Win Ext Sash MA L N/A Y 3 Cl Suppodsp /-O $ AIM L NIA Y AS Fireplace A/M L N/A Y 4 jCloset Floor p( AMI L NIA Y CD Mantle AIM L N/A Y AB Closet Ceilin O.f AIM L N/A Y co Win Above 5' A/M L NIA Y —011 E Ceiling Moldi U.( A/M L NIA Y P/p e cN005 e. -s a t C % 'O• ( AAM L NIA Y /4CCeSS ?ANG Imo/ O. 3 AIM L NIA Y itIAIM L N/A Y EXCLUDED SURFACES: Surfaces listed in these boxes can be ma a intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 S0.IN.) DATE METHOD (MORE THAN 288 SO.IN.) FATE METHOD Kevin Nestor 11359 �� S-/3 a�j PageeOf -7 Inspector(print) Lic# Signature Date Risk Assessor (print) Lic# Signature Date Address of Prooertv:.3/2z- .�FAy�//C S7 Ant# City: l Zew? BATHROOM 3 SIDE LOCATIONI I LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B Upper Walls 0.3 AIM L N/A Y Low Cab Fram 0.0 AIM L NIA Y A 8 Lower Walls AIM L NIA Y A B Low Cab Door 0.0 AIM L NIA Y A B Baseboards-6.1 AIM L NIA Y IV Low Cab Walls 0.0 AIM L N/A Y A a Chair Rail /. AIM L N/A YLow Cab Shlv 0 4 AIM L NIA Y AS CD Radiator 0.0 AIM L N/A Y Supports AIM L N/A Y Floor — 0.24 AIM L NIA Y JK jDrawers 0. AIM L NIA Y Ceiling —0.3 AIM L NIA Y A Window Sill — .7.M/I AIM L NIA Y Door — 0.3 AIM L NIA Y _ B Win Apron —77, AIM L NIA Y C D Door Casing 0. ( AIM L N/A Y 4f) Win Casing p.Z AIM L N/A Y X92 Door Jamb .1 AIM NIA Y D Header Stop QMB L N/A Y 34 Threshold .- AIM L NIA Y Int Stops _O.� MII AIM L NIA Y AB Door AIM L NIA Y Q Win Int Sash— MJI AIM L N/A Y ,o CD Door Casing AIM L NIA Y 2 Exterior Sill /.a SF NIA Y , qVe 12 Door Jamb AIM L NIA Y 3 Part Bead �N/A Y ,�/p V/ 34 Threshold AIM L NIA Y 4 Blind Stop 8 SF ONIA Y ,7/ro A Closet Door AIM L N/A Y Win Ext Sash 9. NIA Y w'. Vie' I AS B Cl Casing AIM L NIA Y c Win Above 5' 11 M/I AIM L NA Y C Closet Jamb AIM L NIA Y �p Ceiling Moldin . t Mil AIM L NA Y AS D V�ab s AIM L N/A Y DD Medicine Cab /.� Mil AIM L NA Y AB Clrd AJM L N/A Y CD Wall OIC M/I AIM L NA Y 1 AIM L N/A Y M/I AIM L NA Y 2 lf AIM L NIA Y M/I AIM L NA Y 3 Cl AIM L NIA Y MII AMM L NA Y 4 r AIM L NIA Y Mll AIM L NA Y Closet Ceiling AIM L N/AY M/I AIM L NA Y B Up Cab Frame 0.0 AIM L NIA Y M/1 AIM L NA Y CO Up Cab Door 0.0 AIM L NIA Y WI AIM L NA Y Up Cab Walls a.0 ARd L NIA Y M/I AIM L NA Y Up Cab Shlvs 0.0 AIM L N/A Y Mll AIM L NA Y 34 Isuppons AIM L N/A Y MII AMM L NA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. _ SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SQ.IN.) DATE METHOD kkn Nestor 11359 � � S/3-O CF � 7 Page Of_ Inspector(print) Llc# Signature Date Risk Assessor(print) Lic# �1Signature Date Address of Property: 312 VL 114r74WGT/e ST Aot# STAIRCASE 3i9,$«n/j 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 I DATE METH SURFACE I HAZARD HAZ. DATE METH DATE METH A a Upper Wells 6. ®I L N/A Y �/41&14 Oh rp �jy A Window Sll M/I AIM L NIA Y A e Lower Wall .o ,0 AIM L NIA Y B Win Apron AIM L NIA Y A B Baseboards �/. AIM L N/A Y C Win Casing AIM L NIA Y A e Chair Rail AIM L NIA Y D Header Stop Mil L N/A I Y AB CD Radiator / AIM L NIA Y Int Stops MII AIM L NIAFY Floor AIM L N/A Y 1 Win Int Sash MA AIM L NIA Y Ceiling AIM L N/A Y /�/oAll xa C 2 Exterior Sill M11 SF L NIA Y A B Door —0.1 AIM L NIA Y 3 Pad Bead MA L NIA Y VD Door Casing L N/A Y Ya,.�fippLp /d 4 Blind Stop M/I SF L N/A Y V Doorjamb AIM L NlA Y lWin Ext Sash Mil L NIA Y 34 Threshold O.Z. AIM L NIA Y A Window Sill M/I AIM L N/A Y A B Door AIM L NIA Y B Win Apron AIM L N/A Y C D Door Casing AIM L NIA Y C Win Casing AIM L N/A Y 12 Door Jamb AIM L NIA Y D Header Stop I IM/I L NIA Y 34 Threshold AIM L N/A Y Int Stops M/I AIM L NIA Y A B Door AIM L NIA Y 1 Win Int Sash I M/I AIM L NIA Y C D Door Casing AIM L NIA Y 2 Exterior Sill Mll SF L NIA Y 1 2 Door Jamb AIM L NIA Y 3 rBI1,nd Bead Mll L NIA Y 34 Threshold AML NIA Y 4 Stop M/I SF L NIA Y A B Door AIM L NIA Y Ext SashMll L NIA Y C D Door Casing AIM L N/A Y Newel Post AIM L N/A Y 12 Doorjamb AIM L N/A Y Railing Cap AIM L NIA Y 34 Threshold AIM L N/A Y Handrail p, AIM L N/A Y A BKDoor , AIM L N/A Y Balusters r' AIM L NIAY C DAIM L NIA Y LowerRail AIM L N/A Y # AIM L NIA Y StairTreads Q. AIM L NIA Y AIM L N/A Y Stair Risers Q. AIM L N/A Y A Closet Door AIM L NIA Y Stringer 0. 11 AIM L N/A Y B Cl Casing AIM L N/A Y Floor Edge 42 �(lp L N/A Y i0 h �p C Closet Jamb AIM L NIA Y Floor Casings AIM L N/A I Y D Closet Walls AIM NIA Y s�3.4;e9 ?j/.�.- N'/45E'�I�n.� wRs Cl Baseboard AIM L NIA Y y/V.Gj,eWj 1 Closet Pole AIM L NIA Y 2 Closet Shelf AIM L NIA Y RdrWNCs7e-a 7ow&— �W- 1X5 TD 472 3 1 Cl Supports AIM LN/A Y /20s1T'a, 4 ICloset Floor A7M L N/A Y [/q�(� NMN - +/De a r7 /o Closet Ceiling AIM L NIA Y G/NdGC6/be of . �/CCA� .= O. 3 EXCLUDED SURFACES: Surfaces listed in these boxes can be made intact only by a licensed deleader. /o , iv edoor SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 S0,IN.) DATE METHOD Kevin Nestor 11359, _ .�/3—O�j Page 34Of Inspector(print) Llc# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: 312% Lafayette Street Aot.# City: Salem PORCH® B C D (circle one) do 2nd fl 3rd t1 4th fl (circle one) ,CCFT Si De 7>7 .3/Z �t 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 HAZ7 DATE METH DATE METH AB Siding ®N/A Y ,7/,a Mrry,r Support Clinris ,Q M L NIA Y CO Comer BoaMs mNlA Y ,7 N /y1,y" o,r ro Newel Post p AIM 'L NIA Y C Upper Trim L N/A Y .7/,p 4111110, ou r♦ Rating Cap D. AIM L NIA Y Ceding mNIA Yr7/rq ;7t e11 rr ro Handrail Q. AIM LN/A Y C Joists / L NfA Y Balusters.,� G AIM L NIA Y tl A Sloan Door AIM L NIA Y Lower Rail ,5-AIM L NIA Y B Door AIM L NIA Y r7 rJ ,£'CrJ n/rd. �/j? Stair Treads AIM L NIA Y B/P! It> Door Casing N/A Y r7 ro Re- q,, !G i�E'O:t9 Stair Risers eA/M L NIA Y D Door Jamb 1101 L NIA Y r7 to nw A; �,' Stringer AIM L NIA Y 6 Theshold L N/A Y h,p 9111/10 lower Walls Q. A/M L NIA Y 2r IV 34 Klckplate ,- AIM L N/A Y Lattice AIM L N/A Y A Storm Door Ii, AIM L N/A Y Lower Trim A1M L NIA Y B Door AQA L NIA Y Floor 0. AIM L NIA Y C Door Casing AIM N/A Y AB Window Sill AIM L NIA Y D Door Jamb AIM L N/A Y C D Win Casing AIM L NIA Y 12 Threshold AMM L N/A Y 12 Window Sash AIM L N/A Y 34 Kickplate AIM L N/A Y 1 34 Mullions AIM L N/A Y A B Window Sill ®I L NIA Y .7/ra A B Window Sill A/M L NIA Y D Win Casing 69L N/A Y /714 M CD Win Casing AIM L N/A Y 2 Window Sash AIM L NIA Y 5M q to 12 Window Sash AIM L NIA1 Y .,,,__,. .,"..- •_.�.... 34 Mullions A/M L N/A Y 1 34 Mullions AIM L NIA Y A B Window Sill 9.Cy to L NIA Y A B Window Sill AIM L NIA Y r D Win Casing 9.5 *1 L N/A Y C D Win Casing AIM L N/A Y 16 Window Sash AWL NIA Y 12 Window Sash AIM L NIA Y 34 Mullions f' AIM L N/A Y 34 Mullions A/M L N/A Y A B Window Sill 4V L N/Al Y AB Window Sill A M L NIA Y D Win Casing 9. AOL NIA Y .7/.J5W.7 C D Win Casing A!M L NIA Y 12 Window Sash AIML N/A Y )'f) �y7 r7 reVX12 Window Sash AIM L N!A Y 4 Mullions AMM L N/A Y 34 Mullions AIM l NIA Y A B Window Sill AIM L N/A Y A B Window Sill AIM L NIA Y C D Win Casing AIM L NIA Y C D Win Casing AIM L N/A Y 12 Window Sash AIM L NIA Y 12 Window Sash AIM L NIA Y 34 Mullions AIM L N/A Y 34 Mullions A/M L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 1440 SQ.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Vvin Nestor 11359 �._ /3.6 g Page 7J'014—"3 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: 312 Lafavette Street Apt# City Salem �/ PORCH ® B C D (circle one) (0 2nd fl 3rd III 4th 11 (circle one) /lsf�TS/Pe— 70 -3/Z ,4gFi71f Q77C 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 AB Siding L N/A Y .7/,p „, Support CIM ,pA1M L WA Y s C D Comer Boards L NIA Y .�/,� JT a ru t' Newel Post O• AIM�L NIA Y � Upper Trim L WA Y ,7/.0 10.17 10/41., lq Railing Cap Q. AIM L N/A Y [JOO Ceding ,.Fj (DN/A Y /,7/,o /Ns e p p Handrail 0.1 AIM L WA Y Joists L NIA Y Balusterso A / AIM L NIA Y V plir— A Ston Door /.O ®11L NIA Y .7/,e e i is C Lower Rail 04 O ,S AIM LNIA Y .1I B Dow O• AIM L NIA Y Stair Treads AIM L NIA Y / 4 Door Casing �1 L NIA Y ST.�/.o Stair Raers ARM L NIA Y D Door Jamb ON L WA Y 471. Stringer ARM L NIA Y (�2 Threshold 00 NIA Y 7�, $p(( Lower Walls / AIM L NIA Y l 1 3 4 Mckplate A/ AIM L Y ,�/ (,�j ��, t Ladi Q. AIM L NIA Y A Storm Door AIM L NIA Y Lower Trim Q. f ARM L NIA Y B Door AIM L NIA Y Floor AIM L N/A Y C Door Casing AIM N/A Y AB Window Sid ARM LNIA Y D Door Jamb A/M L NIA Y C D Win Casing AIM L N/A Y 12 Threshold AIM L NIA Y 12 Window Sash AIM L WA Y 34 Kickplate ARM L NIA Y 34 Mullions ARM L NIA Y A B Window SRI L N/A Y �/ro A B Window Sill A M LNIA Y D Win Casing jtj.Cj ON L NIA Y i G D Win Casio ARM L NIA Y 2 Window Sash AIM L NIA Y r7,y 12 Window Sash AIM L N/A Y 34 Mullions ARM L NIA Y 34 Mullions AIM L NIA Y A B Windowsill 121.91 ®M L N/A Y %7/10 A B Window SRI AIM L NIA Y OD Win Casing /0LN/A Y N/ Qti D Win Casing AIM LNIA Y 10 Window Sash AMI L N/A Y ,t t0 12 Window Sash AIM L NIA Y 34 Mullions ARM L NIA Y 34 Mullions AIM L NIA Y A B Window Sill 00 L NIA Y 7/4 A B Window Shc A/M L NIA Y D Win Casing OR L N/A Y V gati eD Win Casing AIM L NIA Y 12 lWindow SasN AIM L NIA Y 12 Window Sash ARM L N/A Y _ Mullions AIM L NIA Y 34 Mullions A!M L NIA Y A B jWmdowsRI AIM L NIA Y A B Window Sill ARM L NIA Y C DW-in Casing AIM L N/A Y C D Win Casing AIM L NIA Y 12 Window Sash AIM L N/A Y 12 Window Sash A/M L NIA Y 34 IMullions I A/M L NfAl Y 1 34 Mullions ARM L NIA Y I EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 1440 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 k�y ,S%/3-Q s Page�k of 3 • Inspector(print) Lic# Signature Date Risk Assessor (print) lac# Signature Date Address of Property: 312.312%Lafayette Street Ant.# City: Salem EXTERIOR A Side SIDE LOCATION/ LEA TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD A SURFACE HAZARD HAZ. DATE METH DATE METH A SURFACE HAZARD HAZ. DATE METH DATE METH Siding 6)N/A Y L • Atir •Dw to Window Sig AIM L NIA Y Comer Boards Al &WA Y 51.7 p Asr it ,e /y/s' A Win Casing A/M 'L NIA Y A Lower Trim L WA Y ,1/ /fir �r�p �' Window Sash AIM L NIA Y Upper Trim djN/A Y977/w IMPS Mi♦MAC Cellar On SIR AIM LNIA Y _ Win Above 5' (D N/A I Y 71A*#Ir o A Cel Win Sash ARM L NIA Y Porch Above 5' L NIA Y CH Win Frame ARM L NIA Y Storm Door AIM L N/A Y Screen Frame Xj AIM L N/A Y Door AMM L NIA Y Cellar Win Sit AIM L NIA Y A Door Casing AIM L WA Y A cel Wm Sash AIM L WA Y 1 2 Door Jamb A/M L WA Y tojeC YC5 N Cel Win Frame ARM L NIA Y 3 4 Threshold ARM L WA Y Screen Frame AIM L N/A Y Klckplate ARM L NIAI Y Cellar Win Sill AIM L N/A Y Storm Door AIM L_N/A Y A Cat Win Sash AIM L WA Y DoorL AIM NIA Y Cel Win Frame ARM L NIA Y A Door Casing ARM L WA Y Screen Frame ARM L N/A Y 1 2 Door Jamb AIM L N/A Y Cellar Win SIR AIM L NIA Y 3 4 Threshold AIM L N/A Y A Cel Win Sash A/M L NIA Y Kickplate ARM L WA Y Cel Win Frame AIM L N/A Y Door AIM L NIA Y Screen Frame NJ AIM L N/A Y A Door Casing AIM L NIA Y Foundation L NIA Y 1 2 Door Jamb AN L N/A Y A Bulkhead AN L NIA Y 3 4 Threshold ARM L N/A Y Fences ARM L N/A Y Window Sill ARM L NIA Y Shutters ARM L NIA Y A Win Casing AIM L N/A Y Newel Post AMM L N/A Y # Window Sash AIM L NIA Y Railing Cap ARM L NIA Y Window Sill AIM L N/A Y Handrail AIM L N/A Y A Win Casing AIM L NIA Y A Balusters AMM L NIA Y # Window Sash AIM L N/A Y Lower Rail AIM L N/A Y Window Sit AIM L N/A Y Stair Treads AIM L NIA Y A Win Casing A1M L N/A Y Stair Risersk. AtM NIA Y # Window Sash AIM L NIA Y Sltinger WA Y A LampPost L WA Y Porch Floor N/A Y Drain Pipes NIA Y A Elec Conduit NIA Y Oil Fill Pipe NIA Y Overhang Trim N/A Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area 11200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED A (MORE THAN 1440 SO.IN.) DATE METH (Square Feet) (PPM) DATE METH A Play Area A Bare soil A Comments: A Kevin Nestor 11359 Page Vol, ' Inspector(print) Lic# Signature Date Risk Assessor (print) Lic# Signature Date Address of Property: 312-312%Lafayette Street Ant.# 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 9.9 4)WA Y . W /Jq t ro r Window SBI AIM L NIA Y pDoorl rds , 6 NIA Y /.v_/ro IHS n r0 B Win Casing AN L NIA Y B LowerTrim a N/A Y .-i/r /Y7r •rr it ff�' Window Sash AIM L N/A Y N m N/A Y /.�/r ,� ^'• tJ /f'�t' 4Swh Sill & L NIA Y ' 6 WA Y .1/ro#JOr p rc 8 Sash,, AIM L NIA Y -r/.7/,a r a [J e 5' L NIA Y �F Frame AIM L N/A Y AIM L NIA Y ame AIM L NIA Y ry e!'1T tJa AFM L N/A Y _ _ — - _ Shc �.0 41 L NIA Y Or7/r $ B Door Casing A/M L N/A Y B ash AIM L N/A Y ,11ir0 „ rJ VA I 1 2 Door Jamb AIM L N/A Y t� ram AIM L NIA Y 3 4 Threshold ARM L NIA Y 4 Screen Frame CO L N/A Y ,� ,J [ p[o Kickplate ARM L NIA V Cellar Win Stll ,Q L NIA Y Storm Door ARM L N/A Y _ B Get Win Sash ARM L NIA Y Door AIM L NIA Y #5 CeI Win Fra . AIM L NIA Y 071ha B Door Casing A/M L N/A Y Screen Frame ARM d)N/A Y 1 ,n ,0 2:�oy1 r, , 1 2 Door Jamb AIM L N/A Y Cellar Win Sill AIM L N/A Y 3 4 Threshold A/M L N/A Y B Cel Win Sash ARM L N/A Y Kickplate AIM L N/A Y # Cel Win Frame ARM L N/A Y Door AIM L NIA Y Screen Frame AIM L NIA Y B Door Casing AIM L N/A Y Foundation L N/A Y 1 2 Door Jamb A/M L NIA Y B Bulkhead A/M L NIA Y 3 4 Threshold AIM L N/A Y Fancesd„0 p. AIM L N/A Y /� Window Sill AIM L NIA Y Sh: AIM L NIA Y B Win Casing AIM L NIA Y Newel Post ARM L N/A Y # Window Sash AIM L N/A Y Railing Cap AIM L NIA Y Window S01 A/M L N/A Y Handrail AIM L NIA Y B Win Casing AIM L N/A Y B Balusters AIM L NIA Y # Window Sash AIM L NIA Y Lauver Rad AIM L NIA Y Window Sill AIM L NIA Y StairTreads AIM L NIA Y B Win Casing AIM L NIA Y Stair Risers Alt L NIA Y # Window Sash AIM L N/A Y Stdnger AIM L NFA Y 8 Lamb Post L N/A Y jPomh Floor I I AIM L NFA Y Drain Pipes 0. L NFA Y ,*c Ld/Awojs Dice ,Ovdve F/I/E B Elec Conduit L NIA Y Od Fill Pipe L NIAJ Y Overhang Trim AIM L NIA I Y Excluded Surfaces: Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area 11200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED B (MORE THAN 1440 S0.IN.) DATE METH (Square Feel) (PPM) DATE METH B Play Area B Bare sod B Comments: B tor Kevin Nestor 11359 4::7 S�/3-6 JPage.3N Or Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: 312 Lafayette Street Ant.# City: Salem PORCH A B ® D (circle one) gb 2nd fl 3rd fl 4th fl (circle one) ,CCfT 5/D2 3/L �C,4Xelle VSiding N/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIONI LEAD TYPE OF URG IC I DELEAD DELEAD CE HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH 0 N/A Y ,� ,o r Hf [Q Support Cknn ,p ,J A/M L NIA Y ards ONIA Y /1�w MS o f( f Newel Post 0. AIM L NIA Y O. L NIA Y Railing Cap Q. AIM L NIA Y 0.0 L N/A Y Handrail 0.0 AIM L NIA Y / L N/A Y Balusters O AIM L NIA Y ® Storm Door /. AIM L NIA Y Lower Rail .O AN L N/A Y B Door O. AIM L NIA Y Stair Treads , AIM L N/A Y C Door Casing O• A/M L NIA Y Stair Risers 0.1 AW L NIA Y D Door Jamb O.1 AIM L NIA Y Stringer 0.0 AIM L NIA Y 02 Threshold A/M L N/A Y Lower Walls AIM 4DNIA Y 7 Zt' /f fo 34 Kickplate 0.1 AIM L NIA Y Lattice 0. AIM L N/A Y A Storm Door AIM L NIA Y LowerTdm 0.) AIM L NIA Y B Door A/M L N/A Y Floor O. AIM L NIA Y C Door Casing AIM L N/A Y A B Window Sill A/M L NIA Y D Door Jamb AIM L NIA Y C D Win Casing AIM L NIA Y 1 2 Threshold AIM L N/A Y 12 Window Sash A/M L NIA Y 3 4 Kickplate AIM L N/A Y 34 Mullions AIM L NIA Y Window Sill 1.0 N/A Y ,7 10f, AB Window Sill A/M L N/A Y r C D Win Casing 3.1 ,0NIA Y ,Z ,p EF �0p a ,� CD Win Casing AIM L NIA Y Window Sash AIM L NIA Y , ,o yf p ,y e 12 Window Sash AIM L NIA Y 34 Mullions AIM L NIA Y 34 Mullions AIM L NIA Y B Window Sill _ �N/A Y ,f,� H�p ,o AB Window Sill A/M L N/A Y r C D Win Casing 3.3 � NIA Y q,O �, W CD Win Casing A/M L N/A Y 1 Window Sash AIM L NIA Y , ,0 7p/,V 12 Window Sash Artt L NIA Y _ 34 Mullions AIM L N/A Y 34 Mullions AIM L N/A Y A B Window Sill AIM L NIA Y A B Window Sill AIM L NIA Y C D Win Casing A/M L N/A Y C D Win Casing AIM L N/A Y 12 Window Sash A/M L N/A Y 12 Window Sash AIM L NIA Y 34 Mullions A/M L NIA Y 34 Mullions AIM L NIA Y A B Window Sill 11, AIM L N/A Y A B Window Sill AIM L N/A Y C D Win Casing A/M L NIA Y C D Win Casing AIM L NIA Y 1 2 Window Sash AIM L N/A Y 12 Window Sash AIM L NIA Y 34 Mullions AIM L NIA Y 34 Mullions AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 1440 SO,IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 �y�� S/,�—O�J Paged l 017 3 Inspector(print) Uc# Signature We Risk Assessor(print) Uc# Signature Date Address of Property: 312%Lafayette Street Apt.# City: Salem PORCH A B© D (circle one) to 2nd fl 3rd fl 4th fl (circle one) 5/De 7t 3/Z �fZ �Fi9 C7/C VCeHN NI LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC EAD DELEAD E HAZARD HAZ DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH L NIA Y ,7 u Support Clmn (J. AIM L NIA Y rds ,e L NIA Y Newel Post O, AIM 'L N/A Y O. L N/A Y Rating Cap O. AIM L NIA Y ro, L N/A Y Q Handrail O. AIM L N/A Y L NIA Y Balusters p.t AIM L N/A Y ® Storm Door /. A/M L NIA Y Lower Rat Q ARA L NIA Y B Door O. AIM L NIA Y Stair Treads,. A/M L NIA Y C Door Casing A/M L NIA .Y Stair Risers 0.1 AIM L NIA Y D Door Jamb .3 ARM L NIA Y Stringer O. A/M L NIA Y 2 Threshold „O. f AIM L NIA Y Lower Walls AIM L N/A Y 34 Kickplate ARA L N/A Y Lattice AIM L N/A Y A Storm Door AIM L N/A Y LowerTrim 0.74 AIM L N/A Y B Door AIM L NIA Y Floor Q. ARA L N/A Y C Door Casing AIM L N/A Y Window SRI O.4 AtM L NIA Y _ D Door Jamb A/M L NIA Y C D Win Casing AIM L N/A Y &" 12 Threshold AIM L NIA Y 12 Window Sash V AIM L NIA Y 34 Kickplate AIM L N/A Y 34 Mullions 1/ AIM L NIA Y A B Window Sill AIM L N/A Y A B Window Sill AIM L N/A Y C D Win Casing AMM L N/A Y C D Wm Casing AIM L NIA Y 12 Window Sash AIM L N/A Y 12 lWindow Sash AIM L NIA Y 3 4 Mullions AIM L NIA Y 3 4 IMullions A/M L N/A Y AB Window Sill ARM L N/A Y A B Window Sill AIM L NIA Y C D Win Casing ARM L NIA _ ---- -- „Y C D Win Casing AIM L NIA Y 12 Window Sash AIM N/A Y 12 Window Sash A/M L NIA Y 3 4 Mullions AiM L NIA Y 34 Mullions AIM L NIA Y A B Window Sill ARM L NIA Y A B Window Sill AIM L NIA Y C D Win Casing AIM L NIA Y C D Win Casing AIM L NIA Y 12 Window Sash AIM L NIA Y 12 Window Sash AIM L NIA Y 3 4 Mullions _AIM L NIA Y - 34 Mullions AIM L NIA Y AB Window Sill AIM L NIA Y I A B Window SRI ARM L NIA Y C D Win Casing AIM L NIA Y C D Win Casing AIM L NIA Y 12 Window Sash AIM L N/A Y 12 Window Sash ARM L NIA Y 3 4 Mullions A/M L NIA Y 3 4 Mullions A/M L N/A I Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 1440 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 �e-74 .-. .S/3-a F Page 0?6!�3 + Inspector(print) Uc# Signature Date Risk Assessor (print) Lic# Signature Date Address of Property: 312-312'/ Lafayette Street Apt # City' Salem EXTERIOR C Side SIDE LOCATION/ LEAD TYPEOF URG IC IC DELEAD DELEAD SIDE LOCATION/ 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 43)N/A Y 0,7/,o „ M Window SM AIM L NIA Y Comer Boards g. m N/A Y ,) urs AVr C Win Casing A/M L N/A Y C Lower Trim N/A Y , �" ,7 so � Window Sash AIM L NIA Y Upper Trim NIA Y V,71,j „ ro �yy Cellar Win Sill BD+0 WA Y -.7/,� Win Above 5' d)N/A I Y , ro /yJC G Cat Win Sash 1 01) N/A I Y /ZZ! ron ! V Porch Above 5' L NIA Y N Cel Win Fram &AMCQ N/Al YSiG/t- Sion Door AIM NIA Y ,7Jre /1i,/rc &." Screen Frame AIM L NIA Y Door I.q 6V L NIA Y qJ,o A'7„ CellarWin Sis rf. AWO N/A Y •7 W © Door Casing 47.CA 00 N/A YlB,J //u ro C Cel Win Sash AIM L NIA Y 1 Door Jamb 6 0111L N/A Y r7.o p!!r 't� Cal Win Fra AIM L a Y 9A! 3 4 Threshold Q. AIM L NIA Y Screen frame A/M m NIA Y b 17/ mt '%5/0 Kickplate Q. AIM L N/A Y Cellar Win Sill A/M L NIA Y Storm Door AIM L WA Y C Cel Win Sash AIM L N/A Y Door A/M L NIA Y # Cel Win Fram A/M L N/A Y © Door Casing L N/A Y ,7/,0I Screen Frame AIM L N/A Y 1 2 Door Jamb 1.4 L NIA Y /7/N SC4,Ll Cellar Win Sill AIM L NIA Y 4 Threshold 0.1 AIM L NIA Y C Cel Win Sash AIM L NIA Y Kickplate AIM L N/A Y # Tel Win Frame AIM L N/A Y Door p. AMM L NIA Y Screen Frame A/M L N/A Y ® Door Casing AIM L NIA Y Foundation N/A Y /,7/,,; 1./04 /yJ 1 2 Door Jamb A/M L N/A Y C Bulkhead i� A/M L NIA Y 3 Threshold AIM L N/Al Y I Fences AMM L NIA Y Window Sill AIM L NIA Y Shutters AJM L N/A Y C Win Casing AIM L NIA Y Newel Post g2. A/M L N/A Y # Window Sash AIM L NIA Y Railing Cap AIM L NIA Y 014sse e Window Sill AIM L N/A Y Handed AIM L NIA Y Do, rS C Win Casing A/M L N/A Y C Balusters 0.0 A/M L N/A Y # Window Sash A/ML NIA Y Lower Rail 0.0 AIM L NIA Y Window Sill A/M L NIA Y Slair Treads 41C, A/M L N/A Y C Win Casing AIM L N/A Y Stair Risers AIM L INA Y # Window Sash AIM L NIA Y Stringer AIM L NIA Y C Lamp Post L N/A Y Porch Floor 0,9 A/M L NIA Y Drain Pipes 0 0 L N/A Y �oltGNCS Foo Dam G S /-t S, C Elec Conduit L N/A Y Woad 41M? 2 *r- b0 Q,4- Z Q 01 Fill Pipe /. L N/A Y Wei/,N 07- Zt eAS 'd3* `/ = -a•3 Overhang T' A/M L N/A Y E c uded Surfaces:Surfaces listed in this box can be made ��o/rr/rJ AIJrJ rAl A;,.rT- Soil Test Results intact only by a licensed deleader. 3"/r 7l.-u /y7r (Must be less than 400 ppm for play area 11200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED C (MORE THAN 1440 SO.IN.) DATE METH (Square Feet) (PPM) DATE METH C Play Area C Bare soil C Comments: C 7t/Y-0 9 F/e'ZASTdAVC 40bNnD*11`70N OVO tcS 4r �rf/lM' �� : 40,00rq s4,v¢tcs a O.S- io/ir/ru VOW io! iT S/i7/tv rHs Kevin Nestor 11359 JS—/3'O Page-//6 Of!O Inspector(print) tic# Signature Date Risk Assessor (print) Lic# Signature Date Address of Property: 312.312%Lafayette Street Aot # City Salem EXTERIOR D Side SIDE LOCATION! LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIOPU LEAD TYPE OF URG IC IC DELEAD DELEAD D SURFACE HAZARD HAZ? DATE METH DATE METH D SURFACE HAZARD HAZ. DATE METH DATE METH Siding &NIA Y :?,;/so » ion ro 1AW Window Sill A/M L N/A Y Corner Boards m NIA Y '?/so j" AY4114 1"rD Win Casing AIM L N/A Y D Lower Trim N/A Y n,C r iy o Window Sash AIM L NIA Y Upper Trim NIA Y ,� ,o AO�p w Cellar Win Sill L NIA Y , ,° —.V—x Win Above 5' �y�WA Y '71,0 s' A��„ ,p D Cel Win Sash I V AIM L NIA Y q rU A w ,o 1/t Porch Above 5' i L NIA V #e ' Cel Win Fra C/. �p L NIA Y 1 61,7104 Stone Door A/M L WA Y Screen Frame s"M ARA L NIA Y 67,71s.; WeltZcrm Door AOA L N/A Y Cellar Win Sill 4I L NIA Y , ra s D Door Casing AIM L WA Y D Cel Win Sash AIM AIM L NIA V , ro A,6q� y 0 ✓It. 1 2 Door Jamb AIM L N/A Y Del WinFrame 6) L NIA Y 3 4 Threshold AtM L NIA Y Screen Frame AIM L WA YW,zq.; ni Kickplate AIM L NIA Y Cellar Win Sill L N/A Y VrX,o 10%,114 Stone Door A/M L NIA Y D Cel Win Sash AIM L NIA Y ro r o rm Door A/M L N/A Y 3 CeI Win Frame 9.rf L NIA Y r cm N, w D Door Casing A/M L NIA Y J Bcreen FrameAIM L N/A Y , rU y w 1 2 Door Jamb AIM L NIA Y Geller Win Sill AIM L NIA Y 3 4 Threshold AIM L NIA Y D Cel Win Sash AM L NIA Y _ Kickplate AIM L N/A Y # Cal Win Frame AIM L NIA Y Door A/M L NIA Y Screen Frame AOA L MIA Y D Door Casing AIM L NIA Y Foundation L NIA Y 1 2 Door Jamb AIM L WA Y D Bulkhead AIM L N/A Y 3 4 Threshold AIM L NIA Y Fences �e- A/M L NIA Y Window Sill AIM L N/A Y Shutters / AIM L NIA Y D Win Casing A/M L NIA Y Newel Post A/M L WA Y # Window Sash AIM L N/A Y Railing Cap AIM L NIA Y Window Sill AIM L N/A Y Handrails AIM L NIA Y D Win Casing AMM L N/A Y D Balusters AIM L NIA Y # Window Sash AIM L WA Y Lower Rail AIM L NIA Y Window Sill AIM L NIA Y Stair Treads ARA L WA Y D Win Casing AIM L NIA Y Stair Risers AOA L WA Y # Window Sash AIM L N/A Y Stringer AIM L NIA Y D Lamp Post L NIA Y Porde Floor ARA L N/A Y .J C Drain Pipes LNiA Y _ Acc jr Drain AQe �3ave ��7, D Efec Conduit 3. L NIA I 'Y Oil Fill Pipe it L WA Y Overhang Tri m�/ AIM L NIA I Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESULREMED REMED D (MORE THAN 1440 SO.IN.) DATE METH (Square Feet) (PPM) DATE METH D Play Area D Bare soil D Comments: D > �_Kevin Nestor 11359 �/ c Inspector(pool) Llc g 5; PageT�Dr�3 Signature Date Risk Assessor(print) Licit Signature Date Address of Pro e : 312312%Lafa ette Street A t.# V Salem GARAGE / S / D4? C 1eFT Fi4(C/NG GfirCAGE-S SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION] LEAD PE OF URG IC IC DELEAD DELEAI A SURFACE HAZARD H . DATE METH DATE I METH C SURFACE HAZARD H DATE METH DATE METH Siding O L NIA Y A Comer Boards Siding WA Y WA Y ,�/ro /jam u . � lv- C Comer Boards Lower TrimL WA Y �WA Y Lower TO 41N/A Y u r0 Upper TrimL WA Y ,710� �.. N Upper Tdm �N/A Y r)/,0/ox- 4/4'a jw Door S .O AIM L WA Y Door AIM L N/A Y A Door Casing Qr AIM L N/AFY C poor Casing AIM L NIA Y Door Jamb Q,f AiM L WA Y Door Jamb AIM L NIA Y Threshold AIM L WA Ytu ThresholdWindow STN &ON]A Y Wdow Si4 00rN Y 37.7/1. 5jcA_A Win Casing N A YWCasi &VmWA YWin Sash ��WA Y (>WSash (AtmWA YL NIA YC Foundation C L NIA Y s-13-og cv= ee,-r/2r __ EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. _ SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC A (MORE THAN 1440 SQ.IN.) DATE METHOD C (MORE THAN 1440 SQ.IN.) DATE METHOt A C A C A 7- SIDE LOCATION/ LEAD TYPE OF JRG IC DELEAD DELEAD SIDE LOCATION] LEAD TYPE OF URG IC IC DELEAD DELEAC B SURFACE HAZARD METH DATE METH D SURFACE HAZARD HAZ. DATE METH DATE METH Siding L WA 41 r• , y� Siding WA Y n ,p a � r e B Comer Boards L WA g?,y" r �y� D Comer Boards ON/A Y .�/p /alb- /°,r s AM- Lower Trim /, L N/A Lower Tdm L NIA Y Upper Trim L WA %!L Upper Trim L N/A Y ,�/r0 /j►l ��ir ro �S Door Q. AIM L NIA Door O. A!M L NIA Y ,B� Door Casing p. AIM L NIA D Door Casing �r L NlA Y A Door Jamb 0.1 AIM L N/A Door Jamb , Qal L WA YThreshold 00 A/M L NIA Threshold /j,,G AIM L WAWindow Sill �N/A w"s Window Sill A!M L NIA Y B Win Casing NIA q/10 D Wm Casing ARA L WA Y Win Sash N/A r Wn Sash AIM L NIA Y B Foundation L N/A Y D Foundation L N/A Y S-/S-O 5; .S-/3-o9/ (i 51wXin t Sf/Gb -/9jGG T L O.O EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC B (MORE THAN 1440 SQ.IN.) DATE METHOD D (MORE THAN 1440 SQ.IN.) DATE METHOD B D B D B D IdevinNestor 11359 . _ 5�,3-pcJ Pager-'0&3 A Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: 312-312%Lafa ette Street Apt.# Ci1y: Salem GARAGE,2 671.De C elallr- ArCi9G�5 SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LCCATIONJ LEAD TYPE OF URGI IC IC DELEAD DELEAL A SURFACE HAZARD HAZ DATE METH DATE METH C SURFACE HAZARD HAZ? DATE METH DATE METH Siding L NIA Y Siding ./ L NIA Y A Comer Boards L NIA Y C Corner Boards /. L NIA Y Lower Trim L WA Y Lower Tdm L N/A Y Upper Trim L WA Y .1 ,e Rfiry Upper Trim619 ON/A Y Door _ AIM L WA Y Door AIM L NIA Y A Door Caaing AIM L WA Y C Door Caging AIM L NIA Y Door Jamb AIM L WA Y Door Jamb AIM L WA Y Threshold AMI L NIA Y Threstwtd AIM L NIA Y Window Sill AM1 L WA Y lWindow Sill AMI L WA Y A Win Casing AINt L WA Y C lWin Casing AIM L NIA Y Win Sash AIM L WA Y lWin Sash AIM L N/A Y A Foundation L WA Y C lFoundation L WA Y S i? o�j aawn/3oowr n O.O EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. _ SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC A (MORE THAN 1440 SQ.IN.) DATE METHOD C (MORE THAN 1440 SQ.IN.) DATE METHOC A C A C I CATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD RFACE HAZARD HAZ. DATE METH DATE METH D SURFACE HAZARD HAZ. DATE METH DATE METH g —O• L WA Y Siding L NIA Y er Boards L WA Y D Comer Boards ,,i L NIA Y r Trim L WA Y Lower Trim L NIA Y er Trim 0NIA Y %l,o N Upper Tdm 3. �lIA Y �1 44'" ier,e gewn r AIM L NIA Y Door AMM L WA Y Casing AMM L WA Y D Door Casing AMM L N/A Y Jamb AIM L NIA Y Door Jamb �. AIM L WA Y p shold AMM L NIA Y TAleehetd S/ AIM L NIA Y ��.,� geo" ow Sill AIM L WA Y Window Sill AIM L NIA Y ,7 y Casing AIM L N/A Y Ding AMM L WA Y Sash AIM L WA Y Win Sash AIM L NIA Y dation L NIA Y D IFoundation L N/At Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC B (MORE THAN 1440 SO.IN.) DATE METHOD D (MORE THAN 1440 SQ IN.) DATE METHOD B D B D B D OW— 9195V��C wi75 Re. oyes /.v /!5 fdW/7 I(win Nestor 11359 /�/ October 11 2010 Page Of L Inspector(print) Lic# Signature Date IA Risk Assessor (print) Lic# Signature Date Address of Property: 312.312%Lafayette Street Apt.# City: Salem BASEMENTILAUNDRY AREA SIDE LOCATIONI I LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH AB Wall AN L N/A Y 7r Pipet/ 4C AIM L NIA Y AB Wall AIM L NIA Y Sink AIM L NIA Y AB Walls AN L N/A Y AB Drainpipe AN L NIA Y on AB WallsAIM L NIA Y AB Serviceboard AN L N/A Y AB CD Baseboards AN L N/A Y A B Shelves I AIM L NIA Y AB CD Chair rails AIM L NIA Y C D Supports AN L NIA Y Floor AN L NIA Y A B Shelves AIM L NIA Y Ceiling .Or g AN L NIA Y C D Supports AN L NIA Y AB Chimney p./ AIM L N/A Y A B Shelves AN L N/A Y A cc uP ARA L NIA Y , C D Supports AN L N/A Y B Do AIM L N/A Y Window Frame 1.0 Mil ARA IA Y C D Door Casing 0.0 AN L NIA Y A B Wndow Sash NUI NIA Y p _� 2 Door Jamb 0.0 AN L N/A Y [Ex,�ttenor Sill N MII AN L NIA Y 34 Threshold /.'' AIM L N/A Y 2aBeadMII AIM L N/A Y A Doo AIM L NIA Y 3 4 Ext Sash Mil AN L NIA Y Cn/�D.,� Door Casing .p AIM L NIA Y Window Frain Mil AIM L NiA V (92 Door Jamb 0.0 AN L NIA Y A B Window Sash Mil AN L NIA Y 3 4 ThresholdC D E AN L NIA Y xterior So MI7 AM L NIA Y A B DoorC/os 1W, AN L NIA Y 1 2 Part Bead M11 AIM L N/A V DO Door Casing 1. MN/A Y / M 34 Win Ext Sash MA AIM L NIA Y 02 Door Jamb 1 0 AIM L NIA Y Window Frain M/I AIM L N/A Y 34 Threshold .1 AN L NIA Y A B Window sash Mil AN L NIA Y As .. Cabinets AN L N/A Y C D Exterior Shc Mil AN L INA Y A B Benches AN L NIA Y 12 Part Bead Mil AIM L NIA Y C D Supports AN L NIA Y 34 Win Ext Sash M4 AIM L NIA Y A Closet Door AIM L N/A Y Window Frame M4 AIM L NiA Y B Cl Casing AN L N/A Y A B Window Sash . MII AN L NIA Y C Closet Jamb AN L NIA Y C D Exterior Sill MII AIM L NIA Y D Closet Walls AN L N/A Y 12 Part Bead MII AN L NIA Y Cl Baseboard AN L NIA Y 34 Win Ext Sash Mll AN L NIA Y 1 Closet Pule AIM L NIA Y Newel Posts AN L NIA Y AFloor AM1 L NIA Y A B Handrail AIM L NIA Y ClAIM L NIA Y CD Balusters AIM L NA Y AIM L NIA Y 12 Lower rail AIM L N!A Y g AIM L NIA Yf, 3 4 Treads AIM L NIA Y +/�J�V� >F/✓!t .0rT 1/ 919 AN L NIA V i30�JfLDS �3p/fn,A aur jr O..s/O.,S� AIM L N/A Y / G/y 0ts s 2.7 L NIA1 V EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE I METHOD 1 (MORE THAN 288 S0.IN.) DATE METHOD -„ ,rte- �n rw," ,�,�,T� M �-.<Ovv2ML/ /A" 4- Residential Inspection company LETTER OF FULL DELEADING COMPLIANCE October 13, 2010 John M. Hartley, Trustee 312 Lafayette Realty Trust 152 Lynnway, Suite 3A Lynn, MA 01902 To Whom It May Concern: This letter certifies that Residential Inspection Company reinspected your property located at 51'2:La a ette Strut and relevant common areas in the dif�Mefti for full deleading compliance on Obtober 11"9610, and on that date those surfaces cited in the initial inspection report dated May 1k 2000, were found to be in full compliance with Massachusetts General Laws, Chapter 111, Section 197, and 105 CMR 460.000: Regulations for Lead Poisoning Prevention and Control. Dust samples were taken and found to be within acceptable limits. Massachusetts law does not require the abatement or containment of all residential lead paint. The residential premises or dwelling unit and relevant common areas shall remain in compliance only as long as there continues to be no peeling, chipping or flaking lead paint or other accessible leaded materials, as long as coverings and/or encapsulants forming an effective barrier over such paint or other leaded materials remain in place, and as long as surfaces reversed to correct lead hazards remain reversed and securely in place. The law grants you a 30-day maintenance period to repair deteriorated lead paint or detached coverings over such paint, and to clean up, during which time this Letter remains valid. The reverse side of this letter indicates the authorized persons who performed deleading on the property and a general summary of the methods used. A complete reinspection report is attached to this letter, which specifies how and on what date each surface was brought into compliance. Do not lose these documents. To the best of my knowledge, the cost of the legally required deleading was $15,000. Sincerely, J'eKevin Nestor License #11359 P.O. Box 309 Page 1 of 2 Phone & Fax: 781-942-0188 Reading, MA 01867 Email: RIC309@comcast.net ADDRESS: 312 Lafayette Street, Salem, MA 01970 Inspection and Deleadina History Initial inspection done on May 18, 2009, by Kevin Nestor, License #11359 Reoccupancy reinspection done on October 11, 2010, by Kevin Nestor. License #11359 Final deleading reinspection done on October 13. 2010, by Kevin Nestor. License #11359 Deleading Contractor: Brian Moore License #DC001683 Deleading methods: FeaG emoli on Power Sanding Caustics Re lacement Covering Liquid Encapsulation de Intact Work was done in the following rooms: Rooms 1 through 9, Halls 1, 2, 4 and 5, Staircase 1. the kitchen, oantry, bathroom, basement and exterior of the building. Work was done on the following types of components: Walls, ceilings, baseboards. chair rails, shelves, shelf supports, doors, door casings, door iambs interior window trim window sashes, exterior window components, staircase, basement and exterior components. Start Date: 2 1 10 Finish Date: 10/13/10 Cost: $15,000 Le afe Renovator: Not Applicable License #: Modera isk Owner/Agent: Not Applicable Authorization #: Moderate Risk ading Methods: Replacement Covering Liquid encapsulation Making Intact (interior) Making Intact (exterior) Work was done in the folio rooms: Work was done on the following s of components: Start Date: Finish Date: Cost: (Doesn't Include Owners Labor) Low-Risk Owner/Agent: Not Applicable Authorization #: Deleading Methods: Covering Liquid E sulation Capping Baseboards Replacemen LV doors,cabinet doors, shutters,shelves not a drawers,windows on hinges) Work was done in the following rooms: Work was done on the following types of components: Start Date: Finish Date: Cost: (Doesn't Include Owner's Labor) Should you have any questions about this letter, call the Dept. of Public Health at 800-532-9571 Page 2 of 2 ProScience Analytical Services, Inc. Telephone: 781-935-3212 22 Cummings Park, Woburn,MA 01801 Facsimile: 781-932.4857 Email: chemistry@proscience.net Laboratory Report Contact: Kevin Nestor Batch#: C 262648 Client: Residential Inspection Company Date received: 10/11/2010 Address: PO Box 309 Date analyzed: 10/12/2010 Reading, MA 01867 Date of report: 10/12/2010 AIHA Lab ID: 102754 Project# N/A P.O.# N/A Project Site: 312 Lafayette Street Salem, MA 01970 Lead Analysis In Wipes Using SW846-7420/3051 Results in pg/ft'(using customer-supplied data) Sample Detection Lab ID Client ID date Description Result* Limit Comments C 380264 11 10111/10 Room 1 -A-Floor BDL 10.0 ('380265 12 t0/11/10 Room 1 -A-Sill BDL 11.7 C 380266 13 10/11110 Room 1 -A-Well 195.5 17.6 C 380267 14 10/11/10 Room 6-D-Floor BDL 10.0 C 380268 15 10/I1110 Room 6-D-Sill BDL 12.5 C 380269 16 10/11/10 Room 6-D-Well 248.0 17.8 C 380270 17 10/11/10 Room 8-D-Floor BDL 10.0 C 380271 18 10/11/10 Room 8-D-Sill BDL 11.6 C 380272 19 10/11/10 Room 8-D-Well 185.4 17.8 C 380273 20 10/11/10 Blank BDL 10.0 Sinnoni Peavey,Analyst Dan Pine, Deputy Adrian Stanca,Lab Director Page 1 of 1 Unless otherwise indicated, all samples were received in acceptable condition. All result apply only to the samples as received and are accurate to no more than three significant figures. Unless otherwise indicated, all the quality control criteria for the method above have been met. BDL- Below Detection Limit Blanks are reported in total micrograms; they are not used to correct sample results. The EPA 403 Final Rule(40 CFR 745.63)requires that all wipe samples of settled dust shall be collected using wipes that meet ASTM El 792. The analytical results,for wipes not meeting ASTM E1792,are not recognized by AIHA's Accreditation Program. ProScience Analytical Services, Inc. Di Rush/<6 Hours Chemistry Chain of Custody Record/Metals Tum Around Time Requested LABORATORY/HEADQUARTERS LABORATORY SERVICES 22 Cummings Park,Woburn,MA 01801 683 North Mountain Rd.,Newington,CT 06111 ❑ Same Day Next Day 48 Hours Ej 72 Hours 4-5 Days T:781A35-3212 F:781-9324857 T:860A53-1022 F:860-953-1030 Client: RESIDENTIAL INSPECTION COMPANYElement TYPE OF 1 O Address. Street P.O.BOX 309 ANALYSIS (Co'umn 4) Pb Cd Cr As Town READING,MA 01867 AIR bDUT PAINT g Laboratory N DU PA Be A Beea H For Laborato Use Project Site Line 1 312 LAFAYETTE STREET PMte sea I TCLP spo OBATCH NUMBER PM So T SALEM,MA 01970Otherr(please Specify) ne 2 TSP WATER IPES /^ Ts WA WE C C Contact: KEVIN NESTOR CELL: 781-439-1985 L FAX: 781.942-0188 FOR LABORATORY LABORATORY USE ONLY OFC.T: 781-942-0188 TYPE Air Sam 1 11 Wiped area ANALYSIS Date Feld OF Stan End Slart End Volume length widlh Area Weig t 7 I AA Lab Sam led I.D. Sam le Description/Location .wu s Time Time FlOwrale Fbwmte (liters) (inch) (inch) in tams :Dien i ReadingRESULT LD. 10/11/10 11 Room 1 -A-Floor WI 12.0 12.0 �j ! 3B02E�i 10/11/10 12 Room 1 -A-Sill WI 32.75 3.75 i i L 10/11/10 13 Room 1 -A-Well WI 29.75 2.75 10/11/10 14 Room 6-D-Floor WI 12.0 12.0 10/11/10 15 Room 6-D-Sill WI 33.0 3.5 !VI 10/11/10 16 Room 6-D-Well 1WI 29.5 2.75 10/11/10 17 Room 8-D-Floor 12.0 12.0 i i 10/11/10 18 Room 8-D-Sill WI 33.0 3.75 Ell 19 Room 8-D-Well WI 29.5 2.752—20 Blank WI Relinquished By: Kevin Nesto Date: 10/11/2010 Time: t Received By: Date: i��t l�1 (� Time: Comments: PLEASE EMAIL RESULTS TO RIC309@COMCAST.NET. Log-out: = Date OWipes provided by ProScience Analytical PG 1 OF 1 For complete Information about our services and locations please visit us at www.proscience.net or call the numbers above. The Commonwealth of Massachusetts _ Executive Office of Health and Human Services Department of Public Health j Bureau of Environmental Health _ Childhood Lead Poisoning Prevention Program { 250 Washington St., 7t" floor DEVAL L.PATRICK Boston, MA 02108-4619 GOVERNOR TIMOTHY P.MURRAY CLPPP Toll Free; 1-800-532-9571 LIEUTENANT GOVERNOR JUDYANN BIOBY,MO SECRETARY ---� I JOHN AUERBACH Waiver Request/Response i COMMISSIONER t Date of Request: February 5. 2010 jAddress of Property: 312 Lafayette Street and 312'1/- L.afa 'e to $tr"tt(Isco separate Rroys tics i Salem. MA 01970 Section of Regulation to be waived, 105 CMR 460 ❑ .024 lot line ❑ .110 Abatement Requirements ❑ .135 Encapsulation ❑ .150 Notification 1 ❑❑.1160 Relocation ❑ .170 Dust Monitoring ❑ .760 Reinspection & Full Compliance i� (Other) Former Policy Statement CLP-9 I Comments i Conditions: Please see comments and conditions on Pam 3 and 4. Attachments (Supporting Documents): i 7� �L.ead Inspection Report [1 [9 Plot Plan Ether: Floor Plans _ 3 S 3 All parties involved must complete the information below: Property OwnerlOwner's Agent,all authorized people doing the deleading(Deleading Contractor,Lead•Safe Renovator,Authorized Owner+Agent rur Malerale Risk K l,ow Risk)and the Occupant of the unit. If any changes arc made to the original waiver request,all parties involved ; must sign off on the new changes. I L Date: _ } 16 pm0 Name/Organization: Healing Abuse Working for Change cim Candace Waldron 9 ^3 Address: 27 Congress Street t City: Salem MA 01970 d u Telephone: (Q8.744-8552 Fax: 978-745-6880 Signature (1.11-9 Waiver Requc.Nvresponw(*.PPP 2/111 t d Z 1 . q i Date: February 5.2011) Lie#: 11359 = Name/Organization: Kevin Nestor% Residential Inspection Com any CL Address: P.O. Box 309 —° City: Reading, MA 01867 Telephone: 781-439-1985 Fax: 781-942-0188 — Signature .r Date: / -/D Lic/Auth#: DCIk)1683 Name/Organization: Ideal Property Maintenance do: Brian Moore Address: 96 Lake Street C City: Tewksbury, MA 01876 0 Telephone: 978-658.2211 Fax: 978-658-2211 Signature 3 Date: _5 / 2, > Lic/Auth#: 58289('SL J 9 Name/Organization. Windover Construction Inc cio: Charlie Mann r_ Address: 13 Elm Street City: Manchester. MA 01944 S Telephone: 617-839-6.178 Fax: 978-i26-9409 Signature Date: Name/Organization: VACANT aAddress: u City: _ Telephone: Fax: Signature Date: 27Z41 0 c NamelOrganization: CLy of Salem Mot of Planning K Community lkvelopment ii °, .Address: 120 Washington Street b x City: Salem. MA 01970 q Telephone: 978-b 19-5683 Fax: 978-740-04!i4 Signature — CLP-9 Waiver Reyuadrcspon:;c%CLPI'P 21[0 2 Signatures represent the acknowledgement,agreement and responsibility of the parties solely for the specific role (inspector,deleader,LSR,authorized owner/agent,contractor,property owner) regarding this waiver and the Lead Regulations. All other sections of 105 CMR 460.000 and 454 CMR 22.00 must be followed. Waiver remains valid only as long as the provisions and conditions are adhered to. f 3X0237 Waiver,A`poroved E) Waiver Denied Date: 2/� q/ /O CLPPP Waivers#/32 sZ3r Issued b :td/Io?4/IffrwC Signature Lic#f 3757 DOS Waiver# if Required): Issued by: Lic#: Comments /Conditions This Waiver Request is for the properties located at 31.2 Lafayette Street and 3121/2U, fayette Street in Salem, MA 01970. At the time of the initial lead-based paint(LBP) inspection, this property was two, attached single family homes. After the renovation work, it will become one single family home. The buildings were inspected by Kevin Nestor(License#11359) on May 13 and "18, 2009. Copies of the . inspection reports are enclosed. The property is owned by Healing Abuse Working for Change (HAWC). The City of Salem, Department of Planning & Community Development is funding the deleading work. This is a waiver request to have a licensed deleader remove leaded components and delead ALL other LBP hazards and then have the installation of new components as well as plumbing, electrical, sheetrock, floors, etc. completed by non-authorized contractors. HAWC and the City of Salem has hired Ideal Property Maintenance (License#DC001683) to delead Rooms 1 through 13, the kitchen, pantry, bathrooms 1 and 2, interior hallways 1. 2, 4, 5 and 7 and staircases 1. 4 and 5 at 312 Lafavette Street. The licensed deleader will also delead Rooms l through 9, the kitchen. bathrooms 1. 2 and 3, interior hallways 2 and 4, staircase 1 and the basement staircase at 3121/2 Lafayette Street. All lead hazards inside both buildings/apartments will be deleaded. The entire building is unoccupied and will not be reoccupied until the reoccupancy reinspection has been performed and the dust wipe samples have passed the clearance criteria. The licensed deleader will remove all leaded components and complete all other required deleading work(the only thing left to be done is the actual installation of new surfaces). The deleader will perform a clean-up to pass a visual reinspection by a licensed lead inspector in order to clear the site for non- licensed workers to begin the installation of new components. Absolutely no workers without authorization are permitted on-site until after the lead inspector has approved the site. Also, during the time that non-authorized workers are on-site for replacement, there can be no other deleading work occurring by authorized people. (This even includes no deleaders working on the exterior while interior replacement is occurring.) Private lead inspector, (Kevin Nestor, License#I1359),must determine that the property meets ALL requirements for passing a reoccupancy reinspection except the installation of new components and dust sampling. The inspector will document the removal of each component in the "IC Date" and"IC Method" columns(or Comments Column). A brief summary will also be provided on the Report Cover Page. The "delead date"/"delead method" column will be filled in when the actual installation of components is completed and/or complying any other abatement methods used for final deleading(such as a doorjamb that has been scraped to achieve compliance). CLP-9 Waiver Request/response/CLPPP 2/10 3 s Comments/Conditions (continued) If any demolition on walls,ceilings or floors is to be done following clearance by the private inspector i for non-authorized workers, it is crucial that all "NA"components are tested and all coverings are removed sufficient to test surfaces under coverings. Shectrock walls and ceilings which test negative must not be covering "old"plaster, which may he positive. The private inspector must verify this. f If any surfaces containing a dangerous levet of lead are identified, the licensed deleader must do demolition and the site cleared by the private inspector. Under no circumstances is demolition of leaded or potentially leaded surfaces to be done by non-authorized workers. E After the replacement work by non-authorized contractors(following safe work practices as required by 454 CMR 22.11) is completed. the licensed deleader will return to the property to do the final clean- tip. The private lead inspector, Kevin Neswr�L,ic nse{7I13.5yj,will return and confirm that all interior jsurfaces that were replaced were done so in a workmanlike manner. None of the replaced components will be painted before the final reinspection and dust sample collection. The inspector must also carefully check other surfaces in the area in which replacement work occurred it) determine if any new lead hazards were created by the work and re-eheck all previously complied components to make sure they have not fallen out of compliance (all paint intact, coverings secured. etc.). If any new hazards exist, they must be corrected by authorized people. If no new hazards exist and the property passes all other reoccupancy requirements, the mandatory dust wipe samples must be taken. If the dust samples fail, the licensed deleader is responsible for clean-up until a passing set of dust samples is achieved. NOTE: the inspector MUST follow the dust sampling protocol policy tint all sets of dust samples. If the dust samples pass,the inspector may approve rcoccupancy andor full compliance. c if the owner decides NOT to hire the original lead inspector that applied for this waiver.(hcd in Nc-sGit, j License #113591, for all reinspeclions, the owner MUST request it new waiver from the Department (it Public Health(DPH), Childhood lead Poisoning Prevention Program (CLPPP). In the waiver request. the owner will need to provide the name and license number of the inspector who will perform the reinspections. DPHiCLPPP will contact the new inspector to review the waiver stipulations and have the new inspector sign off on the terms o the new waiver, r� F.RA Owner Prop. Me . Deleader Inspector Tenant Contractor ('I.P-o Waicor Reyuost,responsei(A.PPP110 -t The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health Bureau of Environmental Health Childhood Lead Poisoning Prevention Program DEVAL L.PATRICK GOVERNOR 250 Washington St. 7th floor TIMOTHY P.MURRAY Boston, MA 02108-4619 LIEUTENANT GOVERNOR CLPPP Toll Free: 1-800-532-9571 JUDYANN BIGBY,MD SECRETARY JOHN AUERBACH COMMISSIONER Fact Sheet on Maintaining Full Compliance Massachusetts law does not require the deleading of all paint,plaster or putty containing dangerous levels of lead. After a Letter of Full Initial or Full Deleading Compliance has been issued, there may still be paint or other material containing dangerous levels of lead present. For example,walls,exterior siding and surfaces above five feet may still have intact lead paint remaining on them. The owner of any residential property is not strictly liable for damages associated with a case of childhood lead poisoning as long as the dwelling unit and any associated common areas has a valid Letter of Full Compliance. The owner remains under a duty of reasonable care to avoid liability. In other words,owners must keep their properties in good repair, free of defective lead paint, plaster,or putty, to protect themselves from liability. Letters of Compliance do not"expire" after any given period of time, and the Childhood Lead Poisoning Prevention Program(CLPPP)does not require letters of compliance to be routinely updated.However,property owners should visually assess the property for compliance on a regular basis, and any time occupants report loose paint, plaster or putty, and/or detached coverings. In addition,owners may choose to update their letters of compliance to certify that the property is still free of lead hazards. In order to do this, the owner must hire a lead inspector to perform a Post- Compliance Assessment Determination, or"PCAD." Directions for performing a post-compliance assessment and for correcting hazards are contained in Appendices A and B of the document CLP-10A, Maintenance of Full or Interim Control Compliance Status,available from CLPPP upon request at(800)532-9571. The directions in these documents must be strictly followed, to protect the person doing the work and any occupants from lead exposure,and to protect the owner from liability. It is critical that the property owner maintain all documents associated with the compliance status of the property together in a safe place.The owner will need these documents in order to perform routine maintenance or post-compliance work, as well as to fulfill the reporting requirements associated with the Property Transfer Notification and Tenant Notification regulations. These documents include: ✓ The comprehensive initial inspection report ✓ The Letter of Full Compliance ✓ A reinspection report, completed on the initial lead inspection report,when deleading was done. Do not loose this document it is your guide to how each surface was deleaded ✓ Dust sample results, when deleading was done ✓ Deleading notifications, when deleading was done ✓ Deleading invoices from the authorized persons who did deleading work,when deleading was done ✓ Any post-compliance assessment determination reports ✓ Any Certification of Maintained Compliance or Certification of Restored Compliance ✓ Any waivers issued by CLPPP or by the Division of Occupational Safety pertaining to the property CLP-10B Revised 1/09,7/1/04 Page 1 of I V IV. LEAD INSPECTION / RISK ASSESSMENT REPORT Page 1 of14 RESIDENTIAL INSPECTION COMPANY P.O. Box 309 Reading, MA 01867 781-942-0188 St.# Address Apt. City Zip Code �®©tee❑❑❑❑❑❑❑❑❑❑❑❑ as®©a Number of Rooms in Unit 4r /J. Owner's Name: Ma Collins Propeeryp�e A'wS rofeV Owner's Address: 312 Lafayette Street Salem MA 01970 /�fi Singla Family v� Contact Information: Jennifer Kolodzie' 978619.5685 Multi Family_ #Units Client Name if different from owner): City of Salem Condominium._-_ #Units.-_ Client Address: 120 Washinciton Street Salem MA 01970 Day Care -_ other: Key: Lead Column Key: Deleadl IC Method Column Laundry in Basement? �y or No COV Covered CAP Capped SCR Scraped Finished Soace in Basement? or No VB Vinyl Baseboard COV Covered DIP Dipped MET Metal ENC Encapsulated REM Removed VR Vinyl Rep.Window MI Made Intact REP Replaced Testing Method Used: MR Metal Rep.Window PRE Prepared for Enc REV Reversed NO2S Exp.Date NA Not Accessible VR/MR VinyllMetal Rep Window INT Intact X-Ray Fluorescence NC No Coaling SFR Storm Frame Removed Tile Tile(testing suggested) Component does not exist Model RMD Serial#2400 DC Dropped Ceiling Comments I Notes 7N/S /S /� 3//3�9�Ga J�i�✓»�/y f1 � /97 -'f/L''� 7� . /Z ✓��-.,G4F e e sT2"T.--...... -------.........—.......—---------- ....... _.__—...._— Floor# (this is the level within building of unit being inspected) Floor# (this is the level within building of unit being inspected) /l !7`f{cz71/ - --- Ar L r ; r�Zs �� cry .;... B ---i- D 8 - - D j - _/(_- --- ----Jam.'--;--- -- - - A(Street Side) Start Here A(Street Side) Start Here Pb(lead)equal to or greater than 1.0 mg/cm'-with x-rav fluorescence or positive with Na,S is Dangerous. XRF Calibration Recorded in Log Book ✓ -Check off when complete Address verified through USPS ✓ -Check off when complete Research on Lead-Related History for Address ✓ -Check off when complete www siaic_m=.usi.lohcf�pi j+_or 800-532-9571 Inspector Name: Kevin Nestor Lic#11359 Signatur . Date: LURA rev 8108 151 ,► W, "W LEAD INSPECTION / RISK ASSESSMENT REPORT n Page' n of�L`T? RESIDENTIAL INSPECTION COMPANY P.O. Box 309 Reading, MA 01867 781-942-0188 St.# Address Apt. City Zip Code ®©©ZPN❑❑❑❑❑❑❑❑❑❑❑❑ ®oaoo Number of Rooms in Unit 47— 17 Owner's Name: Mary Collins Property P ;2e.«ov S ov &.«i W Owner's Address: 312 Lafayette Street,Salem MA 01970 Single Family /�/ Contact Information: Jennifer Kolodzie' 978-619.5685 Multi Family_ #Units Client Name if different from owner): City of Salem Condominium-- #Units___ Client Address: 120 Washinciton Street Salem MA 01970 Day care __ other:___- Key: Lead Column Key: Deleadl IC Method Column Laundry in Basement? �or No cov Covered CAP Capped SCR Scraped Finished SDace in Basement? or No VB Vinyl Baseboard COV Covered DIP Dipped MET Metal ENC Encapsulated REM Removed VR Vinyl Rep.Window MI Made Intact REP Replaced Testing Method Used: MR Metal Rep.Window PRE Prepared for Enc REV Reversed Na2S Exp.Date NA Not Accessible VR/MR Vinyl/Metal Rep Window INT Intact X-Ray Fluorescence NC No Coating SFR Storm Frame Removed Tile Tile(teshng suggested) ® Component does not exist Model RMD Serial#2400 DC Dropped Ceiling Comments I Notes Floorll o3 (this is the level within building of unit being inspected) FlooM,64,ry nrunyle in building of unit being inspected) I : L -------- A(Street Side) Start Here A(Street Side) Start Here Pb(lead)equal to or greater than 1.0 mg/Cm'with x-ray fluorescence or positive with Na2S is Dangerous. XRF Calibration Recorded in Log Book ✓ -Checkoff when complete Address verified through USPS ✓ -Checkoff when complete Research on Lead-Related History for Address ✓ -Check off when complete ww_w.anlama.us4lnh;dpM,or 800-532-9571 Inspector Name: Kevin Nestor Lic#11359 Signatu •-- Date: S-i�os LURA rev 8/08 { ' 1 � ADDRESS: 3/Z �A¢gyeT/e 57Rtlie�T zi�;C�" 'I� x/970 Page 2 ot,//-J INSPECTION HISTORY -1 IN ERIM CONTROL Determination Risk Assessment :TTTTTy Inspector Name:_ ,Lic#_ y R.A.Name: Lid N Signature Signature Lead Hazards? `rgent Pb.Hazards? Comprehensive Inspector NameA___Tom, Ic#/-TV Fust"fnken for Rilsk ' Initial Inspection ����iiii---- �Set�L� R.A.Ndme: _,Llt#_ / g ® Signature,? F Signature �J 9 Leal Hazards? Visual Portion of FLA.Name: ,Lic#_ Lic# Comp Initial Inspector Name: Reinspection for P _ w/Partici PCAD Interim Control N Signature F Signature_ Lead Hazards? Dust Taken for Risk �' R.A.Name:__ Addendum(add-on Inspector Name: Lid ��--Arlsment� m R�eins� . Initial Inspection) fssesy WSJ F Signature / / / / O Signature . ' ��, dam../ Lead Hazards? u - ��GYC.�I ry`/ Visual Portion of R.A.Name: ,LIC#__ Reinspection for -- AddendumasFull Interim_ Control P Signature____—._ lnsp. Lost Docs y Inspector Name: Lic# L'J 8 Signature_._..-- Lead Hazards? — _ _ Dust Taken Cor Risk P R.A.Name: ,Lic#_ Assessment Reins . _ Walk Through for Ta Signature -_ Ed/Consultation Inspector Name:_._--,Lic#_...— —i Signature Risk Assessment Recertification REINSPECTION HISTORY 1—y] R.A.Name:_-___,—__,Lic#__._ Visual Portion of ,f�-jp�/p� / rF Ins actor Namer�i — Signature nature Reoce.Reinspection � 1a , 1J [ N L10-LISignature -.------ .--.- R.A.Name: Lic#_ Visual Portion of Signature_-._._-.-_ Reece.Reins ection 1.-r I Inspector Name:_____,Lit#___ lIF Signature___. POST COMPLIANCE ASSESSMENT DETERMINATIONS PCAD Inspector Name: Lic# - Dust Taken for Reocc.Reinspection P Inspector Name: Lit#�S Fy F ' Signature- ---- — —..— SignatureLead Hazards? Dust Taken for 8 Full Ins coon __ Reece.Reins ection Inspector Name: —_,LIC#—._ Pe F Acttin as-PCAD Signature - Inspector Name: Lic#---- r--„ustn� [acct HazarasT N Signature-- ._—.. Ifs-�Re�i't"cc.Reins ection P Inspector Name:---,Lick t Visual Portion of F �Y �Inspector Name:_ ,Lic# $Ignatur8 PCAD Reins ection (r--Ji Visual Portion of ff eC F Signature Final Rem' ection 1" ►"/I Inspector Name: 0 r t I�� 11 Dust Taken forMF Inspector Name: ,Lic#— ? Signature - v PCAD Reins ection FinalR Portioinspe do e Inspector Name: Lic# Signature Fina Reins ection P F SignatureDust Taken for PCAD Reinspection I P Inspector Name: ,Lic#_ Dust Taken for Final Reins . No Reocc) 8 Inspector Name: ,Lic#_ F Signature F Signature ADDRESS: S%%Z elle 5T Page 3 ofL 'REOCCUPANCY CERTIF ATHISTORY COMPLIANCE HISTORY (CONT.) Certificate of Certificate of Reoccn anc Inspector Name: ,Lic#/3S! Maintained Inspector Name: ,Lid / ! O compliance Onl atter Signature Signature_ r High/Mod Risk No Work=No Dust q MOMS rule Work=7 Dust Certificate of Certificme of Reu' anc' inspector Name:___,Lie#_, Restored Inspector Name: Li p Com liance c#_ Only after Signature Signature- ---High./Mod Risk Dust wipes end oath. q rooms rule) o le Certificate of Inspector Name: ,LicitCerliCcale of . Reuccuanc Maintained Inspector Name:___,Lie#___ Signature _ Compliance Only after Signature High!Mod Risk Nu Work=No Dust 11 #rooms rule Work=7 Dust COMPLIANCE HISTORY Certificate of Letter of Full Initial Restored Com liance Inspector Name: ,Lic#.,_._ Com Compliance Inspector Name:—,Lic#_ No riorhistor / Signature Signature._.--._- -.__.._._.__.__...__ P Y g Dust wipes and oath. , No signsof UD people Letter of Interim OTHER HISTORY: WAIVERS/UD Control Inspector Name:_ Lic#_ Approved CLPPP Waiver No prior Comp. Signature__._--__-_..— / y / Inspector Name;, 9-, .—X.. Lic#„rS L Ex ,res in I r. --' ..Y" Attach to Comp Signature rNAfvex 3z 5'oa 3'7__-- Recertification of 32 sea 3b' Interim Control _ Approved Inspector Name:_._._.- Lic#_ TLP rP Waiver Inspector Name: ,Lic#_- Expires 2 yrs from Signature �.._1_..' ice. Si nature original Interim — — Attach to Comp 9 Control letter of Full Deleading Lic#-Inspector Name: .E3�/�- , 3� F D r DES Visual Com liance p Reins coon Inspector NamB: _,UC#___,-__ O Signature- SignatureDust wipes if Noo LOC Issued _ _------ Renee. Certificate of I UD 1 DES Dust Maintained Inspector Name: _,Lick_ _Taken _ Inspector Name: ,Lic#—_ Com Hance T P Signature __ Signature No Work=No Dust No LOC Issued F Work=7 Dust UD/DES Dust CertificateTaken of Bp Inspector Name: ,Lic#_ Restored Cum liance Inspector Name:- ,Lic# No Loc Issued F Signature Signature UD!DES Final Dust wipes and uuth. people Reins ection Inspector Name: ,LIC#LLI __ P No LOC Issued BSlgnatUfe i , e Page 4 of a EXPLANATION OF LEAD INSPECTION/RISK ASSESSMENT REPORT FORM COLUMNS This page provides general information needed to understand the lead inspection/risk assessment report. However,you should speak with the inspector/risk assessor before you start to do any work on your home. SIDE Refers to A, B,C, or D side of the building or room. See the diagram on the cover sheet.The "A"side of the building or room is the side facing the street that gives the property its address(usually, it is the front of the building). Keeping 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 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(or average 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 sulfide."Pos"means that there is a dangerous level of lead. • "N/A"means that the inspector was not able to test the surface. Unless the owner can get a sample to test,the inspector must assume the surface contains lead and require it to be deleaded,if necessary. • "MET'or"MR"means that a metal surface was not tested and only needs to be intact,even if it is a leaded surface. However,metal handrails,metal window sills,and metal railing caps,need to be deleaded if they test equal to or greater than 1.0 mg/cm2,or is marked"N/A." • For key to abbreviations like"COV","VB","VR"or"MR","NC","Tile","DC",see the cover page. • When a component box is slashed and there are test results above and below the diagonal line,the result on the "bottom"represents results below 5 ft. and the"top"result indicates the test result above 5 ft. TYPE 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.Speak to your risk assessor for more information. • "M/1"circled means that the surface is a moveable/impacted surface and must be deleaded in its entirety. • "SF"circled indicates that there is a storm frame present which requires the blind stop and exterior sill be deleaded as interior moveable/impacted surfaces. • "A/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. • "L"circled means that the surface is loose and must at minimum, be made intact. • If more than one choice is circled,the rules for deleading may change depending upon what method of deleading you 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 must check this surface and follow all the rules for deleading. Speak to the inspector for more information. • 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 surface is lead free, it just does not require deleading in its current condition. URG IIAZ? This column is only completed during a risk assessment. A risk assessment is an evaluation of a home's suitability for Interim Control. Only a licensed risk assessor can do a risk assessment,not all inspectors are risk assessors. If l"'is circled,then this surface is considered an"Urgent Lead Hazard"and some type of deleading work is required to qualify for Interim Control. IC DATE The date the licensed risk assessor determines the surface meets the standards for Interim Control. IC METH The deleading method or structural repair done to qualify the surface for Interim Control. Refer to the deleading codes key on the cover page. DELEAD The date that the lead inspector reinspects the surface and finds that it has been successfully brought back into DATE compliance. DELEAD The method used to bring a surface into full compliance. Refer to codes in the Key on the cover page of the PCAD METH EXCLUDED The amount of loose paint on a surface as measured by the lead inspector."N/A"means that the inspector was not SURFACES able to measure the loose paint,but has determined it is more than the cut-off for moderate risk making intact. LIRA Exp.8/08 nevin Neitor 11359 S//�•p Page 5O1.#ey Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# ��// Signature Date Address of Property: 3/Z/e!50 �1C!/2 ST Apt If City: J��Ciff HALLWAY:Interior # / or Common Hallway: Front Rear Floor# SIDE LOCATIOW LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A a Upper Walls..0.3 AIM NIA Y A Closet Door AIM L N/A Y A B Lower Walls AIM L NIA Y B CI Casing AIM L NIA Y A e Baseboards AIM L NIA Y v N�y C Closet Jamb AIM L N/A Y A B Chair Rail AIM L N/A Y D Closet Walls AIM L NIA V As CD Radiator AIM L NIA Y Cl Baseboard AIM L NIA Y Floor AIM L NIA Y 1 Closet Pole AIM L N/A Y Ceiling 0.0 AIM L NIA Y 2 Closet Shelf AIM L N/A Y B Door Q.) AIM L NIA Y 3 Cl Supports AIM L NIA Y C D Door Casing L NIA Y q, '4 Closet Floor AIM L N/A Y Door Jamb L NIA Y Closet Ceiling AIM L NIA Y 34 Threshold Q. AIM L NIAj Y A Window Sill MA AIM L N/A Y AB Door —O• AIM L NIA Y B Win Apron AIM L NIA Y ( OD Door Casing .R L NIA Y , ',{ , Win Casing AIM L NIA Y &2 Door Jamb L N/A Y , ,y ,�'Ci ��„ c D Header Stop M/1 L NIA Y 34 Threshold Q. AIM L NIA Y Int Stops M/I AIM L N/A Y A B Door AIM L NIA Y 1 Win Int Sash Mil AIM L NIA Y C D Door Casing AIM L NIA Y 2 ExlenorSill M/1 SF L NIA Y 12 Door Jamb AIM L NIA Y 3 Part Bead Mil L NIA Y 3 4 Threshold AIM L NIA Y 4 Blind Stop M/1 SF L NIA Y A B Door AIM L NIA Y Win Ext Sash Mll L N/A Y C D Door Casing AIM L NIA Y A Window SAI ... ....-.. :.....MA AAM L N/A Y.-.... ........ 12 Door Jamb AIM NIA Y B Win Apron AIM L NIA Y 34 Threshold AIM L NIA Y C Win Casing AIM L NIA Y A B Door AIM L N/A Y D Header Stop MII L N/A Y C D Door Casing AIM L NIA Y Int Stops Mil AIM L NIA Y # Door Jamb AIM L NIA Y 1 Win Int Sash WI AIM L NIA Y Threshold AIM L NIA Y 2 Exterior Shc MII SF L NIA Y A Closet Door AIM L NIA Y 3 Part Bead MII L NIA Y B Cl Casing AIM L NIA Y 4 Blind Stop Mll SF L N/A Y C Closet Jamb AIM L NIA Y Win Ext Sash M/I L N/A Y AB D Closet Walls AIM L NIA Y -co Win Above 5' M/I AAM L NIA Y AB Cl Baseboard AIM L NIA Y CD Ceiling Moldind M11 AIM L NIA Y 1 Closet Pole AIM L NIA Y 2 Closet Shelf AIM L NIA Y 3 CI Supports AAM L NIA Y 4 Closet Floor AIM L NIA Y Closet Ceiling AIM L N/At Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION I MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SQ.IN.) DATE METHOD fGevih Ne3tor 11359 � ,S%/�OPage 0 Of 44 Inspector(print) Lie# Signature Date Risk Assessor(print) Lie# u Signature Date Address of Property:.3/Z gi4i el* ST Apt# City --�r40149 low 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 s Up Walls 0. MM L NIA Y ® Window Sill .q� 01 L NIA Y r] 14 A0 A B Low WallsG AIM L N/A Y B Win Apron . I �i 9 L N/A Y A B Baseboards . ` NIA Y pn/� l' C Win Casing 1.9 .®I L NIA Y rJ A B Chair Rail AIM L NIA Y e/ D Header Stop 59 L NIA Y , AB Radiator /Vit AIM L& Y 71p p 70/,� Int Stops ..1 0 L NIA Y r71' Floor , O. A/M L NIA Y Win Ind Sash C. QM L NIA Y 14 Ceiling — 0.3 AIM L N/A Y 2 Exterior Sill 5.g SF L NIA Y , (/ • A B Door /. AIM L NIA Y 3 Part Bead /.0 Qd L NIA Y 0p D Door Casing .g Q�NIA Y ;g y Ip N'r 4 Blind Stop SF L NIA Y �� (�2 Door Jamb �t L NIA Y ,7,o RIP% Win Ext Sash �. L NIA Y 3 4 Threshold AIM L NIA Y ® Window Sill 17.9 VP 4& L N/A Y Rew A B Door AIM L NIA Y B Win Apron 01 L N/A Y C D Door Casing MM L NIA Y C Win CasiL NIA Y ro 12 Door Jamb AIM L NIA Y D Header Stop L N/A Y ,] , 34 Threshold A/M L NIA Y Int Stops GY L NIA Y , ro A B Door A/M L NIA Y 1 Win Int Sash /to a L NIA Y C D EDoorCasing AIM L NIA Y m Exterior Sill y. SF L N/A Y ,� Vg 12 A/ML NIA Y 3 Pad Bead ,6®I L NIA Y 34 Threshold A/M L NIA Y 4 Blind Stop .519 SF L N/A Y �,7/,o A B Door AIM L N/A Y Win EM Sash . a L NIA Y ,? r / C D Door Casing AIM L N/A Y Window Sill L NIA Y rp 12 Door Jamb AIM L NIA Y B Win Apron —�&A L NIA Y C 34 Threshold AtM L NIA Y C Win Casing y. Mal L NIA Y /,7 A Closet Door AIM L NIA Y D Header Stop 9. L N/A Y , B Cl Casing A/M L N/A Y Int Slops .y kP61M L N/A Y , C Closet Jamb AIM L NIA Y 1 Win Int Sash Q� L N/A Y /, I /Z D Closet Walls AIM L N/A Y 2 Exterior Sill iii SF L N/A Y r Cl Baseboard . A/M L N/A Y ® Pad Bead /. 0 L NIA Y �i7�i V 1 Closet Pole AIM L NIA Y 4 Blind Slop �1 SF L NIA Y ] , 2 Closet Shelf AIM L NIA Y Win Ext Sash 01 L NIA Y 3 CI Supports AIM L NIA Y lFireplace 10. 1 AIM L NIA Y 4 Closet Floor A/M L NIA Y IMantle Iq 51 600 NIA Y q rp AB Closet Ceiling AIM L NIA Y C0 Win Above 5' A/M L NIA Y SY O Ceiling Moidin 70 A/M N/A Y , III r 0.4Y4 A/M L NIA Y AIM L N/A Y AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in the boxes can a made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT• IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 .1 8-a I Page Of-11 Inspector(print) Uc# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: .3/Z e�elle ST Apt.# City: HALLWAY: Interior # or Common Hallway: Front Rear 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 A B Upper Walls.. 0.3 AIM L NIA Y A Closet Door AIM L NIA Y A B Lower Walls /. AIM L NIA Y B kBaseboard g AIM L N/A Y A eSLIL Baseboards 9.� Mo N/A Y q «) /„/, C mb AIM L N/A Y A B Chair Rail it AIM L NIA Y D alls AIM L NIA Y AB CD Radiator 0.0 AIM L N/A Y oard AIM L N/A Y Floor _ 0.1 AIM L NIA Y 1 ole AIM L N/A Y Ceiling O• AIM L N/A Y 2 helf AMM L NIA Y (®B Door — 0 q AIM L NIA Y 3 orts AIM L NIA Y C D DoorCasing �. ( (Y N/A Y ,° ee.• vrr N •4 loor AIM L NIA Y 02 Door Jamb 9 q A90 NIA Y �7 vo „ l,; Closet Ceiling AIM L NIA Y 34 Threshold AIM L N/A Y A Window Si MA 010 NIA Y ,�/,� B Door / AIM L NIA Y B Win Apron AIM d NIA Y r/q/0 C D Door Casing 6f.C/ Om N/A Y rema M C Win Casing .CJ �f N/A Y $j>•/a 10 Door Jamb 9.9 A01%NIA Y /,�/,y /,« ® Header Stop Mil O NIA Y /q/w 34 Threshold AIM L NIAI Y Int Stops W Im,10 NIA Y 717/0 A(D qDoorCasing J0 L N/A Y q ,p e '04/40 Win Int Sash Mll 0140 NIA Y ,�/ �Z C D N/A Y �,7/,o Q r,/w 2 Exterior Sill /. Mit SF L N/A Y I (D2 l!)NIA Y ,7 rp e ''�, 3 Pad Bead Mil L NIA Y 34 .3 AIM L NIA Y 4 Blind Slop M!I SF L NIA Y A B �I L NIA Y t,/,7 ,p '�'(, ,u Win Ext Sash MA L N/A Y D NIA Y f, $ E ro A Window Sill 9 MA �I Q)NIA Y�2 /A Y r , B Win Apron AIM N/A Y .-. -.-- / J 34 Threshold ,.O.i AIM L N/A Y C Win Casing *G N/A Y A B Door / AIM L NIA Y 0 Header Stop '9.Cj Is (D NIA Y D Door Casing iL7. &G NIA Y ,X•o rP/ Int Stops .�'f 0 604)NIA Y #x DoorJamb g.�'f � NIA Y F7,-if,.) /M 1 Win Int Sash47.C7 OAO NIA Y R Threshold �/ AIM L N/A Y (Z! Extenor Shc .� SF L NIA Y A Closet Door .41 ®•(II NIA Y /q/r e h ,0 3 Part Bead C/.4 L NtA Y ,v/,a ® CI Casing .9 NIA Y r r0 Q °�i r° 4 Blind Stop /1/ I�I SF L NIA Y n/,p IQ C Closet Jamb � NIA Y rl „frO Win Ext Sash H MA L tlP Y q/y AB D Closet Walls— O. AIM L NIA Y CD Win Above 5' Mil AIM L NIAAB Y Cl Baseboard 9. /NA:&�QN/A Y , Jrifiu C D Ceiling Moldin \ Mll AIM L NIA Y Q Closet Pole Y �(�y�iip?' ��� :O.O 2 Closet Shelf Y3 Cl Supports Y (4 Closet Floor- 0.3 Y Closet Ceilin O• Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO,IN.) DATE I METHOD (MORE THAN 288 SO.IN.) DATE METHOD � S Kevin Nestor 11359 /�� J��/� G 7 Page o of / (l Inspector(print) Lic# Signature Date Risk Assessor(print) �/ Uc# Signature Date` Address of Property .3/Z . 6i c c el sr ARL# c1(y 11/ 4/j9 CONTINUATION OF ROOM — 11,*C4 WZ SIDE LOCATIONI I LEAD TYPE OF URG IC IC DELEAD OELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC OELEAD DELEAD SURFACE HAZARD HAZI DATE METH DATE METH SURFACE HAZARD HAZI DATE METH DATE METH A B Door AIM L N/A Y _ A Window Sn Cj.cj Mn d10 NIA Y o D D Door Casing AIM L WA Y 8 Win Apron 9C ARAN/A Y p # Door Jamb AIM L N/A Y C Win Casing at(1)WA Y Threshold AIM L WA Y ® Header Stop MA o WA Y A B Door AIM L NIA Y IN Stops qIMn Ams 4)WA Y Alirp /A Y 3 Win Int Sash MII ��N/A Y q/rp .C D Door casing AN L N # Door Jamb AN L NIA Y Exterior$11 MA SF L WA Y Threshold AAM L N/A Y Pad Bead M/I L NIA Y A B Door AIM L NIA Y Blind Stop MA SF L N/A Y CD Door Casing AAML WA Y Win EA Sash MA L NIA Y # Door Jamb AAM L WA Y A Window SBI MA AAA L NIA Y Threshold AIM L N/Al Y I B Win Apron ARA L NIA Y Closet Door AIM L NIA Y C Win Casing AIM L WA Y A Cl Casing AIM L N/A Y D Header Stop MA L NIA Y B Closet Jamb AIM L WA Y IM Stops MA AAA L N/A Y- C Closet Walla AIM NIA Y # Win Int Sash MA ARA L NIA Y D Cl Baseboard AMI L NIA Y Exterior Sid MA SF L N/A Y Closet Pole AMI L N/A Y Part Bead MA L NIAI Y # Closel Shelf ARA L WAI Y I Blind Stop Mn $F L NIA Y Cl Supports AIM L WA I Y Win Ext Sash MA L NIA Y Cl Drawers AIM L N/A Y A B Up Cab Frame AAA L N/A Y Cl Or Frame AIM L NIA Y C D Up Cab Door AAM L N/A Y Closet Floor AIM L NIA Y Up Cab Walls AIM L NIA Y Closet Ceding AIM L NIA Y # Up Cab Shies AAA L NIA Y Closet Door AIM L NIA Y Suppods AIM L NIA Y A CI Casing AIM L NIA Y Low Cab Fram AIM L NIA Y B Closet Jamb AIM L NIAI Y I AS FL"Cillloor ARA L NIA Y C Closet Walla AIM L NIA Y C D AAM L NIA Y D CI Baseboard AAA L WA Y AIM L N/A Y Closet Pole AIM L NIA Y ARA L NIA Y # Closel Shed AIM L NIA Y AIM L WA Y AB Cl Supports AAA L N/A Y b SIM Above 5' AIM L N/A Y AB Cl Drawers AAM L WA Y co Cab Above 5' AIM L WA Y CI or Frame AIM L WABA Y c o Cab Above 5' AIM L NIA Y CloselFloor AAA L WA Y AS Fireplace AIM L N/A V Closet Celling 11 AIM L N/A Y C D Mantle AAM L N/A Y B Sidelght(L) AIM L WA Y D Sidelight(R) AIM L NIA Y AB CD Win Above 5' AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these taxes can be made intact only t a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC E METHOD SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATTHOD (MORE THAN 288 SQ.IN.) DATE METHOD I RRA RenRcmmCont.8108 Kevin Nestor 11359 PageT Of p Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# d Signature Date Address of Property:3�Z lraf/P�B/i{ ✓`t— Apt# City: STAIRCASE / —/-Ixsr (dub -/ci/z2m r SIDE LOCATIONI I 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 I HAZARD HAZ? DATE METH DATE METH A n Upper Walls 0.7, AIM L NIA Y A Window Sill IMA AIM L NIA Y A B Lower Walls 4� AIM L NIA Y B Win Apron AIM L N/A Y A e Baseboards /.g AIM L NIA V jV17loo C Win Casing AIM L NIA Y A B Chair Rail 1-1� AIM L NIA Y D Header Stop M/I L N/A Y AB CD Radiator AIM L N/A Y Int Stops M/I AIM L NIA I Y Floor — 0.1 A/M L NIA Y 1 Win Int Sash MA AIM L NIA Y Ceiling _ CLI AIM L N/A Y 2 Exterior Sill MA SF L NIA Y AB Door AIM L NIA Y _ _ 3 Pad Bead Mil L NIA Y C D Door Casing AIM L NIA Y 4 Blind Stop Mill SF L N/A Y 12 Door Jamb AIM L NIA Y Win Ext Sash M/I L NIA Y 34 Threshold AIM L N/A Y A Window Sill M/I AMM L N/A Y A B Door AIM L NIA Y B Win Apron AIM L N/A Y C D Door Casing ARM L NIA Y C Win Casing AIM L N/A Y 12 Door Jamb AIM L NIA Y D Header Stop M/1 L N/A Y 3 4 Threshold AIM L N/A Y Int Stops Mil AIM L NIA Y A B Door AIM L NIA Y 1 Win Int Sash M/I ARM L N/A Y C D Door Casing AIM L N/A Y 2 Exterior Sill Mil SF L NIA Y 12 IDoor Jamb AIM L NIA Y 3 Part Bead Mil L NIA Y 3 4 Threshold AIM L N/A Y 4 Blind Stop MR SF L N/A Y A B Door AIM L WA Y Win EA Sash M/I L NIA Y C D Door Casing AIM L NIA Y Newel Post AIM L NIA Y 1 2 Door Jamb ARM L NIA Y Railing Capp / L NIA Y �o/, 3 4 Threshold AIM L NIA Y Handrail AIM L N/A Y A B Door AIM L NIA Y Balusters .q L N/A Y x7/gyp p �� AaW C D Door Casing AIM L NIA Y Lower Rail AIM L NIA Y # Door Jamb AIM L N/A Y Stair Treads— AIM L N/A Y Threshold AIM L N/A Y Stair Risers 9. OAO N/A Y A Close[Door AIM L NIA Y Stringer '/ �(�N/A V �� �u r. 8 Cl Casing AIM L NIA Y Floor Edge g. AIM L NIA Y ~� �e C Closet Jamb AIM L NIA Y Floor Casings ARM(I)NIA Y q ,a D Closet Walls AIM L NIA Y / Cl Baseboard AIM L N/A Y 1 Close[Pole AIM L NIA Y 2 Closet Shelf AIM L NIA Y � /SAI✓ 7LVO pnCGT I"Ycs+i% 3 ICI Supports AIM N/A Y '�PAV4"'Vj 4 ICIoset Floor AIM NIA Yi�r�N� Closet Ceiling I AIM L NIA Y co EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION 1111MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 /y�y� S-/COs Page AOf Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Propeq:.?XZ 44. e -c ST Apt # STAIRCASEy� 3 yy� 35�IAE tx ,z SIDE IOCATIONI 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 I HAZARD HAZ? DATE METH DATE I METH A B Upper Walls O.A AIM L N/A Y A Window Sill Mil AIM L N/A Y A B Lower Walls AIM L N/A Y B Win Apron AIM L NIA Y A B Baseboards AIM L NIA Y C Win Casing AIM L NIA Y A B Chair Rail / AIM L NIA Y D Header Stop MA L N/A Y AB CD Radiator AIM L NIA Y Int Slops MA AIM L N/A Y Floor .. 0.3 AIM L N/A Y 1 Win Int Sash M/1 AIM L NIA Y Ceiling .0. AIM L N/A Y 2 Exterior Sill MII SF L NIA Y B Door — AIM L N/A Y 3 Part Bead MA L N/A Y C D Door Casing 0.0 AIM L NIA Y 4 Blind Slop MII SF L NIA Y 62 Door Jamb 0.0 AIM L N/A Y Win Ext Sash M/I L NIA Y 34 Threshold 0.1 AIM L N/A Y A Window Sill WI AIM L N/A Y A B Door 10.6 ARA L N/A Y B Win Apron AIM L N/A Y D Door Casing Q. AIM L N/A Y C Win Casing AIM L NIA Y Q2 Door Jamb O• AIM L N/A Y D Header Stop MIA L NIA Y 34 Threshold 0. AIM L NIA Y Int Stops MA AIM L NIA Y A B Door AIM L N/A Y _ 1 Win Int SashIMA MA AIM L N/A Y C D Door Casing AIM L N/A Y 2 Exterior SillM/1 SF L NIA Y 12 Door Jamb AIM L N/A Y 3 Part BeadMn L N/A Y 34 Threshold AIM L NIA Y 4 Blind StopM/I SF L N/A Y A B Door AIM L NIA Y Win Ext Sash L N/A Y CD Door Casing AIM L NIA Y Newel Post..6.0 AIM L N/A Y 1 2 Doorjamb TT AIM L NIA Y Railing Cap AIM L N/A Y �ry 34 Threshold AAA L N/A Y Handrail AIM L N/A Y A B Door AIM L N/A Y Balusters Q.( AIM L N/A Y C D Door Casing ARA L NIA Y Lower Rail /r' NM L NIA Y # Door Jamb AIM L N/A Y Stair Treads O. f AIM L NIA Y Threshold AIM L NIA Y Stair Risers U AIM L N/A Y A Closet Door AIM L N/A Y Stringer .Q AIM L NIA Y B CI Casing AIM L NIA Y Floor Edge 0.0 AIM L NIA Y C Closet Jamb AIM L NIA Y Floor Casings O. AIM L N/A I Y - D Closet Walls AIM L NIA Y 5 �Y'0 9 Cl Baseboard AIM L NIA Y o 1 Closet Pole AIM L NIA Y ✓'r' �.�� C — Tie,Ri✓SOiy ' -0. Z. 2 Closet Shelf AIM L N/A Y 3 Cl Supports AIM L N/A Y 4 Closet Floor AIM L NIA Y Closet Ceiling AAA L N/A Y _EXCLUDED_SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC • IL1 1 IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 S0.IN.) DATE METHOD (MORE THAN 288 SO,IN.) DATE METHOD 14vin Nestor 11359 J � — S-/� O Jr' Page nl a.//0 •Inspector(print) Uc# Signature Date Risk Assessor(print) Uc# Signature Date Address of Property: 3/Z .Ci9FAcrGl�t ST Alit.# City: KITCHEN _ SIDE LOCATION/ LEAD TYPE OF URG IC IC OELEAD 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 UpperWalls MWA Y !Z& Cetp,4%y, e A Windowsill O. MA AIM L N/A Y A e Lower Walls AIM L N/A Y, 1N/,c tze 1 it B Win Apron 0.1 AIM L NIA Y A e Baseboards AAM L N/A Y (0 Win Casing 0.1 AAA L NIA Y A 0 Chair Rai .- AIM l NIA Y D Header Stop 0.0 MA L NIA Y r. nAS CD Radiator 0. AAM L WA Y IM Stops 06 MA AAA L NIA Y Floor — O. AAM L N/A Y Wm IM Sash 10.2 MA AIM L NIA Y Ceiling ...0.3 ARM L WA Y 2 WftadO. 0 SF ONIA Y r7V9- B Door — 0.0 ARA L NIA Y 3 MA L N/A YC D Door Casing 0.,3 AAM L N/A Y 4 6t SF 0 N/A YC)2 DoorJamb AIM L NIA Y MA L 0 Y ! / 34 Threshold O.1 AAM L N/A Y A Window Sill t3. 1 Mn AIM L N/A Y B 4CwhV AIM L N/A Y B Win Apron .O _ AIM L N/A Y C D g .1 AIM L N/A Y (P Wm Casing O.( AIM L N/A Y _O• AAA L NIA Y D Header Stop O.O MA L NIA Y 34 .Q AML WA Y Int Slops _ 0 3 Mfl AAM L NIA Y B .O AAM L WA Y 1 Win Int Sash MA AIM L NIA YCD ng O. 1 AIML NIA Y ® Exterior Sit / .0 rV SF NIA Y12 U• AIM L NIA V 3 Pad Bead NIA Y r�p e�r9)4 0.0 AAM L N/A Y 4 Blind Stop /1/ SF m NIA Y .? .) e s A Door 0.1 AIM L WA Y Win Ext Sash O N/A Y C D Door Casing AIM L NIA Y A B Up Cab Frame AAM L N/A Y 02 Door Jamb — 0,3 AAM L NIA Y C D Up Cab Door AIM L N/A Y 3.4 Threshold OC AlM L WA Y Up Cab Walls AAA L N/A Y A Closet Door AIM L N/A Y 12 Up Cab ShIn AIM L NIA V ® Cl Casing -,0.3 AIM N/A Y 34 Supports AAM LN/A Y C Closet Jamb .1 AIM NIA Y Low Cab Frem AAM L WA Y D Closet Walls 9. AIMON/A Y AS Low Cab Door AIM L N/A Y Cl Baseboard.0. AIM L N/A Y C D Low Cab Wells ARAL WA Y (> Closet Pole ARM L N/A Y Low Cab SAIv• AIM L NIA Y 2 Closet Shell AIM L N/A Y 12 Supports AIM L N/A Y 3 CI Supports Q AIM L NIA Y 34 Drawee AIM L N/A Y AS 4 Closet Floor je.3 AIML WA Y p Win Abo"5' M/I AAd L N/A Y Closet Ceiling 10.Q AIM L WAI Y /0-/1-j'0 swi-.09 sl'ae '09 -lWr1 hOOM rS 1W Za4-5� 7'X.401/.50001 = -0• I C/ Co✓eovn v40 D.O EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. TIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE MET (MORE THAN 288 SO.IN.) DATE METH00 HOD Kevin Nestor 11359 Page f/�!O J� Page&Of� Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address or Property: sr Apt._# cites /ems CONTINUATION OF ROOM —AC/TC17FW SIDE LOCATIONILEAD 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 HAZI DATE METH DATE METH A B Door —0-. AIM L NIA Y A Window SIR Mil A/M L WA Y CIIJ Door Casing Q. ARA L NIA Y B Win Apron ARA L WA Y # , Door Jamb 0. 11 AIM L WA Y C Wm Casing ARA L NIA Y Threshold 0.1 F AIM WA Y D Header Stop MA L WA Y COA Door AIM L WA Y Int Stops MA AIM L N/A Y CO Door Casing O.) AIM L NIA Y Win lNSash MR ARA L NIA Y # Door Jamb AIM L NIA Y Exterior SR MA SF L WA Y Threshold 0.0 ARM L NIA Y Pat Bead Mn L NIA Y A B Door ARM L NIA Y Blind Stop MA SF L N/A Y C D Door Casing ARM L WA Y Win Ext Sash MA L WA Y # Door Jamb AIM L NIA Y A Window Sp MA ARM L WA Y Threshold ARM L NIA Y 8 Win Apron ARA L WA Y Closet Door ARA L N/A Y C Win Casing AIM L WA �Y A Cl Casing AIM L NIA Y D Header Stop MA L N/A Y B Closet Jamb AIM L NIA Y Int Stops Mn ARA L NIA Y C Closet Walls ARA L NIA Y # Win Int Sash MR ARM L N/A Y D Cl Baseboard ARA L NIA Y Exterior Sill MA SF L WA Y Closet Pok AMI L NIA V Pan Bead AIR L N/A Y # Closet Shelf AIM L NIA Y Blind Stop Mn SF L NIA Y CI Supports A/M L N/A Y Win Ext Sash Mn L NIA Y CI DrawersARA L N/A Y A B Up Cab Frame AIM L N/A Y Cl Dr Frame A/M L N/A Y C D Up Cab Door AIM L N/A Y Closet Floor AIM L WA Y Up Cab wads A/M L N/A Y Closet Ceiling AIM L NIA Y # Up Cab Shia AIM L WA Y Closet Door AIM L WA Y Supports AIM L WA Y A Cl Casing AIM L NIA Y Low Cab Frarn AIM L NIA Y B Closet Jamb AIM L N/A Y A B Low Cab Door ARA L N/A Y C Closet Walls AIM L NIA Y C D Low Cab Walls AIM L WA Y D Cl Baseboard PJM L WA Y # Low Cab ShNs AIM L WA Y Closet Pole AIM L WA Y Supports AIM L NIA Y Closet Shop AIM L NIA V Drawers AIM L N/A Y Cl Supports ARA L N/A Y AB StMAbove ' O.,3 ARM L WA Y A Cl Drawers ARA L N/A Yo Cab Above 5' AIM L WA Y AS CI Dr Frame ARM L NIA Y D Cab Above 5' AIM L NIA Y Closet Floor A/M L NIA Y A B Fireplace A/M L NIA Y Closet Ceiling AIM L WA Y CD Mantle AIM L NIAI Y e Sldelight(L) A/M L NIA Y CO S!delight(R I AIA L WAI Y AB C Win Above5' ARM l WA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT ICIC SIDEJ LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD I (MORE THAN 288 SD.IN.) DATE METHOD I.I/RA RenitwmCont.8/08 ZL t(evih Nestor 11359 , ",�.- �"/�O Page�Ot 70 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: Ii4Fi¢9CT/C $T Apt.# Cityc�ias HALLWAY:Interior # or Common Hallway: Front Rear 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 A 8 Upper Walls AIMd)NIA Y t7 i0�jPjyt���, Y A Closet Door AIM L N/A Y A 8 Lower Walls— O. AIM L N/A Y B Cl Casing AJM L NIA Y A 8 Baseboards AIM L NIA Y C Closet Jamb AIM L NIA Y A e Chair Rail Q.O A/M L N/A Y D Closet Walls AIM L NIA Y CD Radiator AIM L N/A Y Cl Baseboard AIM L N/A Y Floor O. A/M L NIA Y 1 Closet Pole AIM L N/A Y Ceding O.f A/M L NIA Y 2 Closet Shelf A/M L NIA Y A®Door . p.' A/M L NIA Y 3 Cl Supports AIM L N/A Y C D Door Casing O.O AIM L NIA Y 4 Closet Floor AIM L NIA Y 02 Door Jamb .( AIM L NIA Y Closet Ceiling AIM L NIA Y 3 4 Threshold Lj.01 AIM L NIA Y A Window Sill O. Ali AIM L N/A Y A B Door O. AIM L N/A Y B Win Apron Q.ZA AIM L NIA Y AD Door Casing O if AIM L NIA Y C Win Casing O.Z, AIM L N/A Y 02 Door Jamb 04 AIM L N/A Y ® Header Stop O•( M/I L NIA Y 3 4 Threshold G AIM L NIA Y C Int Slops „O. II AIM L N/A Y AB Door A/M L NIA Y Win Int Sash—p.if MA AIM L NIA Y C D Door Casing A/M L NIA Y 2 Exterior Sill 9. 0 SF mN/A Y ,1/4. ,, ,j qeW 12 Door Jamb AIM L N/Al Y 3 Part Bead . 10 40)NIA Y 7/10 %/10 Aft 3 4 Threshold AIM L NIA Y 4 Blind Stop MIND SF m N/A Y vT �pI&N 00/11/6 Aellff 7—B Door AIM L NIA Y Win Ext Sash / 10 1 NIA Yv� ,Z w C D Door Casing A/M L NIA Y A Window Sill MII AIM L N/A Y 12 Door Jamb A/M L N/A Y B Win Apron AIM L N/A Y 3 4 Threshold AIM L N/A Y C Win Casing AIM L NIA Y A B Door AIM L N/A Y D Header Stop MA L NIA Y C D Door Casing AIM L NIA Y Int Stops M/1 AIM L NIA Y # Door Jamb A/ML NIA Y 1 Win Int Sash MI AIM L N/A Y Threshold AIM L N/A Y 2 Exterior Sili Mn SF L NIA Y A Closet Door AMM L NIA Y 3 Part Bead I Mil L N/Al Y B Cl Casing AIM L N/A Y 4 Blind Stop Mll SF L NIA Y C Closet Jamb AIM L NIA Y Win Ext Sash MII L NIA Y AB D Closet Walls AIM L NIA Y CD Win Above 5' M/I AIM L N/A Y A8 Cl Baseboard AIM L NIA Y CD Ceiling Moldin N41 AIM L NIA Y 1 Closet Pole AIM L N/A Y /C 2 Closet Shelf AIM L NIA Y 3 Cl Supports AIM L NIA Y 4 Closet Floor AIM L N/A Y Closet Ceiling AIM L NIA Y - EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 2118 SO.IN.) DATE METHOD (MORE THAN 288 SQ.IN.) DATE METHOD Kevin Ne%tor 11359 1-1-- ��/, _ 5=/�-Q F Page Lr of'9'J Inspector(print) Lic# Signature Date Risk Assessor(print) Signature Date Address of Prooert :—?/Z 419,5��e $T' Apt # City: PANTRY 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 eD/ATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B Upper Walls A/o NIA Y i7//pSLZ ire B Up Cab Frame Q. AIM L NIA Y A B Lower Walls AIM L N/A Y C D Up Cab Door Q: AIM L NIA Y A B Baseboards eo' AIM NIA Y Up Cab Walls AIM /A Y ,]/,o pa A B Chair Rail / AIM L NIA Y 2 Up Cab ShNs 0.0 AIM L NIA Y AB CD Radiator AIM L NIA Y 34 Supports AIM L NIA Y ���� ��4 ro Floor D. ARM L NIA Y A B UD Cab Frame Q. AIM L NIA Y Ceiling 0. AIM L NIA Y D Up Cab Door 0.( AIM L NIA Y Door AIM L NIA Y Up Cab Walls g NIA Y �a C D Door Casing AIM L NIA Y 2 Up Cab Shiva 00 AIM L NIA Y 02 Door Jamb (f. AIM L N/A Y 34 Suppods ARM L NIA Y it e,* o r 34 Threshold 0.0 AIM L N/A Y Low Cab Frain 0. AIM L NIA Y A B Door AIM L NIA Y I3 Low Cab Door ,- AIM L N/A Y C D Door Casing AIM L NIA Y C D Low Cab Wall AIM L NIA Y 12 Doar Jamb AIM L N/A Y Low Cab ShNs /. ARM L NIA Y 34 Threshold ARM L N/A Y 2 Supports /. AIM L N/A Y A VCasing AIM L N/A Y 34 Drawers 0. AIM L NIA Y B Cl AIM L NIA Y Low Cab Frain . ARM L N/A Y C AIM L NIA Y A B Low Cab I Q.( AIM L NIA Y D AIM L NIA Y Low Cab Wall 0.� AIM L NIA Yrd AIM L NIA Y Low Cab Shl 0.r AIM L NIA Y 1 AIM L NIA Y 2 Supports / ARM L NIA Y 2 Closet Shelf ARM L NIA Y 34 waivers AIM L NIA Y 7j/R rSlyt e-b 3 Cl Supports AIM L NIA Y Low Cab Fram O.Z, AIM L NIA Y 4 Closet Floor ARM L N/A Y A B Low Cab Do AIM L N/A Y Closet Ceiling AIM L N/A Y C0 Low Cab Walls 0. AIM L NIA Y A B Up Cab Frame AIM L NIA Y Low Cab Shivs 0.0 AIM L NIA Y C D Up Cab Door AIM L NIA Y 92 Supports ARM L& Y Up Cab Walls AIM L NIA Y 34 Drawers ARM L NIA Y 1 2 Up Cab ShNs AIM L N/A Y A Window Sill 1.6 ✓g(! ARMQ NIA Y Y1/4) r, aeeow 34 Supports AIM L N/A Y B Win Apron AIM L NIA Y C Win Casing A1M L N/A Y . 7/,a w e fAGKs �i9s/rf� 0 .O ® Header Stop d� d>NIA Y Sebe - IntStaps — O.( MR AIM L NIA Y Win Int Sash Z.Mil ARM L NIA Y _ /�,((,,�� -rL 2 Exterior d SF ONIA Y /� Al �a/w'o ��4'jt� �/S 19R� /S w 3 Part Bead �! Q3NIA V ,T n /M o ro �L4 Blind Stop Qd�l SF d)NIA V Y1,0"C N ro //�rr. ,�Iyy�Q/� , Win Ext Sash m NIA Y �J (jM Mir/rs EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Yvevih146ftor 11359 ; /V401 •O/� Page15,Qr?0 Inspector(print) Lie# Signature Date Risk Assessor(print) Lie# �/ Signature Date Address of Prooerly:3/Z ,LAfiPAe7c ST Ant.# City_, ROOM d2 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 a Up Walls _ 0.� A/M N/A Y A Window Sill cIV 4)(C)NIA Y ,?p A B Low Walls e' AIM L NIA Y B Win Apron '/ CM UNIA Y � IO A s Baseboards AI N/A Y t� 10 o�y •� C Win Casing g)y0NIA Y 11711 iN A a Chair Rail A/ML N/A Y ® Header Stop ! / 0NIA Y ,i141 AB Radiator 0.1 A/M L N/A Y Int Stops YJV CA tj N/A Y r 10 Floor _ O-Z AIM L N/A Y m Win Int Sash 10 GM0 N/A Y ,�Y Ceiling .o A/M L NIA Y 2 Exterior Sill SF &N/A Y �Y7�� B Door ' /. AIM L NIA Y 3 Part Bead QA m NIA Y , Y C D Door Casing 00 NIA Y .7/,p 4 Blind Stop W,410 SF JD N/A Y I (fl2 Door Jamb �. NIA Y 7fp Win Ext Sash . mN/A Y �� 1 34 Threshold t N/A Y A Window SBI �1�N/A Y LA�0 AB Door NIA Y �•�, B Win Apron NIA V •• 1,� OD Door Casing rJ. N/A Y ► ,T tJ A( • Gq1 C WinCaelg QA10 NIA Y 02 Door J—am b7-7 N/A Y �I ,p * Y y1 ® Header Slop mNiA Y , 3 4 Threshold Q.1 NIA Y Int Stops ,gM(M(�N/A Y 7—B Door ®11 L N/A Y 17 I� e �•y • 1 Win Int Sash l®D 011 Qj NIA Y Yp OD Door-Casing �j. OA L NIA Y i7 to �•ly zo 0 E tenor Sill o+ Mil SF L NIA Y 7 14, J/ 1 Door Jamb L N/A Y w �� t 3 Pan Bead N#MA L NIA Y 34 Threshold Aird L N!A V 4 Blind Stop M/I BF L NIA Y ���p V/ AB Door AIM L NIA Y Win Ext Sash N M/I L NIA Y ,r C D Door Casing AIM L N/A Y A Window SBI _ 41.91 QD 00 NIA Y 12 Door Jamb AIM L NIA Y B Win Apron 11 0 (E)N/A Y 34 Threshold A AIM L NIA Y C Win Casing .51 QUI m N/A Y A Closet Door cJ .y ,�t L NIA Y xZ , e,9 Atfe , ® Header Stop J 4V (j)N/A V r B Cl Casing L N/A Y ,o Int Stops 9 a QM O N/A Y 0 Closet Jamb LN/A Y q 1 Win lnl as (� gDNmN/A Y r� YB D Closet Walls Aj AIM L NIA Y , /tfr �• 2 Exterior Sill 0 SF m N/A Y , pVz Cl Baseboard /. A/M L NIA Y ® Part Bead Q. Mil L NIA I Y ?Vtj VA Closet Pole AIM L NIA Y 4 Blind Stop ®I SF 6 NIA Y ,>:/1N 2 Closet Shelf AD L N/A ,Y ,7(,O y, Win Ext Sash 0 NIA Y , �p 3 Cl Supports AIM L NIAJ Y A B Fireplace A/M L NIA Y 4 Closet Floor ®1 L NIA Y ,� , Yf'E' C D Mantle AIM L NIA Y Aa Closet Ceili O.� A/ML N/AFY Cp Win Above S' A/M LNIA Y s/�-OC/ SjaQ L• CeilingMoldin /.IQ AIM L NIA Y X 41 z1n110 ?elq j I/& AIM L NIA I Y •D IZ/IW a'ti f/G�rf?G =.Z•!) /` ilf�/ AM L NIA1 Y A/M L N/AY EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD .0 Kevin Nestor 11359 �� .S/�a 9 Page&Of� .Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Prooertr. 3/Z .Ce9Pw e,* X07 ROOM 3 _ SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ7 DATE METH DATE METH SURFACE HAZARD HAZ DATE METH DATE METH A a up Walls — O.0 AIM L NIA Y ® Window Sib I.O a ONJA Y � pAep A e Low Wells c AIM L NIA Y B Win Apron .q V O N/A Y rT 1p A e Baseboards . I ABC N/A Y !O y/,e C Win Casing 9.9 A, d N/A Y A e Chair Rai /. AIM L N/A Y D Header Stop NIA Y r7 , Al Radiator 0. AIM L N/A Y Int Stops 0A 4W Qa NIA Y r 7 Floor AIM LWA Y mWinfmSash 1�11AONIA Y , ra Cooing Q. ARA L WA Y 2 Exterior Sol SF C[j WA Y r i A B Door rf.41 00 WA Y 7 , R 3 Part Bead O '0 Q)N/A Y , R ©D Door Casing ').g 60 NIA Y ,7 r0 4 Blind Stop A%� SF (D N/A Y oor ,Z ! m2 DJamb $.g 00NIA Y r A) SG Win Exl Sash C>NIA Y 34 Threshold –0.1 AIM L N/A Y Whdow Sol .( > d WA Y 7!o A B Door ty.1 60 L NIA Y , ra B Win Apmn <D N/A Y 1 ro 6D Door Cas ng CJ �11�WA Y r7 ro C Win Casing 5� 4W-1 N/A Y 1 Door Jamb .q SIN WA Y r7 D Header Stop 9. 0 N/A Y 7 r 34 Threshold o.Z AIM L NIA Y Int Stops 4IM O WA Y 7/,4 A B Door AIM L NIA Y i- Win Int Sash 6A 0 owA Y r7 r C D Door Casing AIM L NIA Y (V ExtedorSB . 0 SF m N/A Y rt r 12 Door Jamb AIM L NIA Y 3 Part Bead 1 .0 kP WA Y !7 34 Threshold AIM L WA Y 4 Siad Stop /1/ SF O WA Y A B Door AIM L NIA Y Win ExtSash cJ IA Y 17 I C D Door Casing AIM L N/AY ® Window SB r . IV 1&m NIA Y 12 Door Jamb AIM L N/A Y B Win Apron q. AM& N/A Y , r 34 Threshold ARA L N/A Y C Win Casing POM/0>N/A Y , r A Closet Door 4o L NIA Y r W D Header Stop ON CIr N/A Y r7 B Cl Casing 9 L N/A Y r7� Int Stops dill /0 A NIA Y r r m Closet Jamb AWL N/A Y H/to 1 Wm IM Sash V PSR 0NIA Y ,7! D Closet Walls O. AIM NIA Y 2 Exterior Sill M8 SF L a Y ,7 Cl Baseboard 99 AIMQNIA Y , /"r f/,&&,/.;P ® Part Bead JW MA L& Y r ! 6 Closet Pole AIM L NIA Y 4 Blind Stop IV,4 Mn SF L GK Y r 2 Closet Shelf C/. AA0 WA Y ,Z /?�,Zi/r0 Win Ext Sash MA L 10 Y , ! 3 Cl Supports C11 ASL NIA Y !), r B Fireplace AIM L NIA Y 4 Closet Floor NIA AIM IA Y C D Mantle AIM L NIA Y AB Closet Celli Q AIM L N/A Y Co Win Above 5' AIM L NIA Y Calling Mold AV ARA®N/A Y iW 7 ftr �, AIM L N/A Y AAA L N/A Y ARA L NIA Y EXCLUDED SURFACES:Surfaces list In these xes can ma a Intact only by a licensed de Bader. SIDE LOCATION MEASURE:LOOSE PAINT - IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 OJ`' Page 1014 Inspector(Print) Uc# Signature Date Risk Assessor(print) Uc# Signature Date Address of Firooerty —SM 4011504 eA sl Apt It City CONTINUATION OF ROOM —Xp0M 3 SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIOW LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZI DATE METH I DATE I METH SURFACE HAZARD HAV DATE METH DATE I METH A / ® m NA YAB Door AIM L NIA Y Window SB r ANIP C D Door Casing A/M L NIA Y B Win Apmn ��. CID m NIA Y # Door Jamb A/M L WA Y C Win Casing rj. 0 eA NIA Y . r Threshold AIM LNIA Y ® Header Stop Cj•r7ED 0)N/A Y A B Door AIM L NIA I Y Int Stops 0 m WA Y r7'� C D Door Casing 2 L N/A Y / Win IM Sash m WA Y r # Door Jamb AIM L NIA Y Exterior Sill SF Q�WA Y r Threshold AIM L N/A Y Part Bead ./ �1 NIA Y r� r A B Door AIM L NIA Y Blind Stop SF m NIA Y y r Aga C D Door Casug AIM L NIA Y Win Ext Sash 9. 0 WA Y rJu vie Door Jamb AIM L NIA Y A Window SB MA AIM L WA Y Threslald AIM L N/A Y B Win Apron AIM L NIA Y Closet Door AIM L NIA Y C Win Casing AIM L N/A Y A Cl Casing ARA L N/A Y D Header Stop JW L NIA Y B Closet Jamb AIM L NIA Y IM Stops Mn A/M L NIA Y C Closet Walt A/M L NIA Y Win int Sash MA AIM L N/A Y D Cl Baseboard ARA L N/A Y Extrlor Sn Mil SF L NIA Y Closet Pot ARA L NIA Y Pad Bead MA L NIA Y # Closet Shelf AIM L NIA Y Blind Stop W SF L NIA Y CI Supports AIM L WA Y Wm Ext Sash MA L NIA Y Cl Drawers AIM L NIA Y A B Up Cab Frame lit AIM L NIA Y CI Or Frame AIM N/A Y CD Up Cab Door AIM L.N/A Y Closet Floor AIM L N/A Y Up Cab Wags AIM L NIA V Closet Ceiling AIM L NIA Y # Up Cab Shl" AIM L NIA Y Closet Door AIM L NIA Y Support N AIM L NIA Y A Cl Casirg ARA L N/A Y Low Cab Frain X AIM L N/A Y B Closet Jamb AIM L WA Y AB Low Cab Door ARM L N/A Y C Closet Walls AIM L NIA Y CD Low Cab Wells ARA L N/A Y D CI Baseboard ARA L NIA Y # Low Cab ShIvs AIM L NIA Y Closet Pole AIM L N/A Y Supports ARA L WA Y # Closet Shed A/M L N/A Y Orewers AIM L NIA Y AB CI Support AIM L NIA Y co Slava Above 5' ARA L N/A Y Cl Drawee AB AIM L NIA Y it) Cab Above 5' A/M L NIA Y AB CI Dr Frame AIM L N/A V co Cab Above 5' AIM L N/A Y Closet Floor AIM L NIA Y AS Fireplace AIM L N/Al Y Closet Ceiling A/M L NIA Y C D Mantle A/M L NfA Y B SldelipM(L) ARA L WA Y C 0 Sidelight(R) A/M L WA Y AB D Wm Above 5' AIM L WA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINTIC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METH00 (MORE THAN 288 SO.IN.) DATE METHOD I.VRA RenRoomiCont.8108 Kevin Nestor 11359 Page J��'�`7 Page Inspector(print) Lic# Signature Date Risk Assessor(print) Uc# //// S gnature Date Address of Property: 3/2 .�i¢FiiLfCll� ST Aot 0 Ctty: ROOM SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DEL EAD 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 Up Walls AIM N/A Y ® Id �'f.s 10 ON/A Y t q qzp A B Low Walls AIM L NIA Y B ,@)I m NIA Y A BSa Baseboards �/.� PWNIA Y r /IC! tO�, /1/ C g .c/ &G NIA Y r7�i0 A B Chair Rai AIM L N/A Y D op Cm NIA Y !�/AB Radiator U. AIM L NA Y .( RDI QA NIA YFldor AIM L NIA Y sh .C/ 0 NIA Y r� ! ilkCeding _ 0.3 AIM L N/A Y 2 l �. SF NIA Y r7 !G Door L N/A Y / 3 Part Bead m NIA Y /r MIA, GGC�D,, Door Casing r7. L NIA Y ! / Blind Stop �► SF 0 NIA Y t�t ✓ Wt Door Jamb ��N/A Y !�!g Win Ext Sash O WA Y t / ZOE 3 4 Threshold AIM L N/A Y A window Sol MA AIM L NIA Y A B Door �. 0 L NIA Y ! /v v ro„ ,! B Win Apron AIM L NIA Y IDD Door Casing 5. I L NIA Y r !p a tp C Win Casing AIM L NIA Y 62 Door Jamb 5'. 08 L N/A Y /a �, a D Header Stop MA L NIA Y 34 Threshold 0.3 AIM L NIA Y IM Stops MA AIM L N/A Y A 6 Door AIM L N/A Y 1 Win Int Sash MA AIM L N/A Y C D Door Casing AIM L NIA Y 2 Exteriorsit MA SF L NIA Y 12 Door Jamb AIM L NIA Y 3 Part Bead MA L NIA Y 3 4 Threshold AIM L N/A Y 4 Blind StopMil SF L NIA Y A B Door AIM L N/A Y Wm Ext Sash AMA L N/A Y C D Door Casing AIM L NIA Y A Window SBI Mn AIM L N/A Y 12 Door Jamb A/M L N/A Y B Wm Apron _ .n AAA L N/A Y 3 4 IThreshold AIM L NIA Y C Win Casing 1 . 1 VM L N/Al Y A Closet Door QNm NIA Y r D Header Stop 1. 1 MA L N/Al Y ® CI Casing 440 WA Y t� yF IM Stops 0.gA AAA L NIA Y C Closet Jamb NO 00 N/A Y !7 p s 1 Win he Sash MA AIM L NIA Y D Closet Walls 0.3 A/M L N/A I Y 2 Exterior Sig MA SF L N/A Y �s, Cl Baseboard AN4)NIA Y n/0 3 Ped Bead MA L N/A Y 15 Closet Pole ARA L NIA Y 4 Blind Stop MA SF L NIA Y 2 Closet Shen AIM L 10 Y I / r ! t0 Il! Win Ext Sash MA L NIA Y 3 ICI Supports Qm1 L N/A Y NB Fireplace AIM L NIA Y 4 Closet Floor AIM L NIA Y D Mantle AIM L NlA Y AB Closel Ced' 0.3 ARA L WA Y Win Above S AAM L NIA Y Celi g Mold' ARA L N/A Y;&LN /M/00 Axz j;j*4r AIM L NIA Y AIM L N/A Y AIM L MAI Y EXCLUDED SURFACES:Surfaces listR in these xes can made Intact only t f a licensed a ea er. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC iC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 S0.IN.) DATE METHOD Kevin Nestor 11359 � ��_ S/�Q J Page'=! Of,z/— Inspeclor(prinl) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property Apt If Citv�i�19V� HALLWAY:Interior # j' or ommonHallway: Front Rear Floor# SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAO 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 Upper Walls O. AIM L N/A Y A Closet Door A/M L N/A Y A B Lower Walls c AIM L N/A Y B Cl Casing A/M L N/A Y A B Baseboards y. ! 00N/A Y 1211, �O p/,° /jvrs C Closet Jamb AIM L N/A Y A B Chair Rail AtM L NIA Y I D Closet Walls AIM L NIA Y AB CD Radiator AIM L NIA Y Cl Baseboard A/M L N/A Y Floor .-O. A/M L NIA Y 1 ClosetPole A/M L N/A Y Ceiling —O.f AIM L NIA Y 2 Closet Shelf A/M L N/A Y SAB Door 02 NIA Y r io 3 Cl Supports AIM L N/A Y CD Door Casing A:0440)N/A Y ,'►�rp 4 Closet Floor AIM L NIA Y d 2 IDoor Jamb 19f. ASC�NIA Y Closet Ceiling A/M L NIA Y 3 4 Threshold —40.t AIM L NIA Y A Window Sill M/I AIM L NIA Y OB Door 040 NIA Y r�� a iO„( B Win Apron AIM L N/A Y CD Door CasingAMON/A Y _ cl• r7 rtl Q 'n�i. ,tl C KExtedorSill g A/M L NIA Y 10 Door Jamb �/ lQ ON/A Y r� to Irl r, ro D op VIA L NIA Y 34 Threshold Q. AIM L N/A Y Int Mil A/M L NIA Y A B Door &I ®N/A Y o RC r, rp 1 sh MII AJM L NIA Y OD Door Casing 0d)N/A Y �r'1 rJ *N !J w NJ 2 ll M/I SF L NIA Y m2 DoorJamb *N N/A Y fir! M „ rp 3 M/I L N/A Y 34 Threshold — O.1 AIM L N/A Y 4 M/1 SF L NIA Y A B Door q.19 Ami 10N/A ry&AW 14to Win Ext Sash Mll L NIA Y C 0 Door Casing 9. OQ NIA Y ,R �. rtl A Window Sill M/I AIM L NIA Y m2 Door Jamb 9. N/A Y 7 n p ,tl B Win Apron AIM L N/A Y 3 4 Threshold .3 AIM L NIA Y C Win Casing AJM L NIA Y A B Door A/M L N/A Y D Header Stop M/I L NIA Y C D Door Casing AIM L NIA Y Int Stops MA A/M L NIA Y # Door Jamb AIML NIA Y 1 Win int Sash M/I A/M L N/A Y Threshold AIM L N/A Y 2 Exterior SRI M/I SF L NIA Y A Closet Door A/M L NIA Y 3 Part Bead I&I L N/A Y B Cl Casing AIM L NIA Y 4 Blind Stop M/I SF L NIA Y C Closet Jamb AIM L N/A Y Win Ext Sash M/I L N/A Y AB D Closet Walls AIM L NIA Y D Win Above 5' MA AIM l N/A Y Cl Baseboard A/M L N/A Y AD D D Ceiling Moidin MA AIM L N/A Y 1 Closet Pole AIM L N/A Y 2 Closet Shelf AIM L N/A Y 3 CI$UDD01a A/M L NIA Y 4 Closet Floor A!M L NIA:Z:r— AN L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT ICIC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD 5=ik-aq Ttlz- Cc ,poolvewn we,ce /2acax-Dat) o.v lCeviA Nestor 11359 /If-1-/vool�— /� Orj' Page 7bof./740 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property:.3/Z Li4if � ST Apt.# Ci :�I-Clow, HALLWAY:Interior 116 or Common Hallway: Front Rear Floor# 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 Upper Walls 0.2 AIM L NIA Y A Closet Door AIM L NIA Y A B Lower Walls AIM L NIA Y B CI Casing AIM L NIA Y A B Baseboards d. 1 AIM L NIA Y C Closet Jamb AIM L N/A Y A B Chair Rail AIM L N/A Y D Closet Walls AMM L NIA Y AB CD Radiator AIM L NIA Y Cl Baseboard AIM L NIA Y Floor O• AIM L N/A Y 1 Closet Pole AIM L NIA Y Ceiling —0.12, AIM L N/A Y 2 Closet Shelf AIM L N/A Y B Door 0.0 AIM L NIA Y 3 CI Supports AIM L NIA Y C D Door Casing AIM L N/A Y 4 Closet Floor AIM L NIA Y 02 Door Jamb—Q. AIM L NIA Y Closet Ceiling ARM L NIA Y 34 Threshold O.1 AIM L NIA Y A Window SillM/l AIM L NIA Y A a Door AIM L NIA Y B Win Apron AIM L NIA Y C D Door Casing O.Z. AIM L NIA Y C Win Casing AIM L NIA Y 02 Door Jamb 0.1 AIM L NIA Y D Header Stop M/I L N/A Y 34 Threshold _ 0. 1 AIM L NIA Y I L" Int Stops M/I A/M L NIA Y A B Door AIM L N/A Y 1 Win Int Sash M/I AIM L NIA Y 6 D Door Casing O.M. AIM L NIA Y 2 Exterior Sill M/I SF L NIA Y 02 Door Jamb .1 ARM L NIA Y 3 Pad Bead MIA L NIA Y 3 4 Threshold --70-3 A/M L NIA Y 4 Blind Stop M/I SF L NIA Y A B Door —0- 1 ARM L NIA Y Win Ext Sash M11 L N/A Y CB Door Casing 0.3 A1M L N/A Y A Window SJl M/I AIM L N/A Y 02 Door Jamb --0.1 AIM L N/A Y B Win Apron AIM L NIA Y 34 Threshold — O.1 AIM L N/A Y C Win Casing AIM L N/A Y A B Door AIM L NIA Y D Header Stop Mil L NIA Y C D Door Casing AIM L N/A Y Int Stops MR AIM L N/A Y # Door Jamb AIM NIA Y 1 Win Int Sash M/I AIM L N/A Y Threshold AIM L N/A Y 2 Exterior SHI MR SF L N/A Y A- Closet Door AIM L N/A Y 3 Pad Bead M/I L WA Y B CI Casing AIM L N/A Y 4 Blind Stop Mll SF L NIA Y C Closet Jamb ARM L NIA Y Win Ext Sash MR L NIA Y AB D Closet Walls AIM L NIA Y D D Win Above 5' M/I AIM L NIA Y AB Cl Baseboard AIM L N/A Y D D Ceiling Moldi M/I AIM L NIA Y 1 Closet Pole AIM L N/A Y S-lY'o9 2 Closet Shelf AIM L NIA Y S�be C — 7XOO/YSO,101 s O,O 3 Cl Suppods AIM L N/A Y 4 Closet Floor AIM L NIA Y Closet Ceiling AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ,IN.) DATE I METHOD (MORE THAN 288 SQ.IN.) DATE METHOD g•-iY a5 r.�' srrr�.cc�se Co��ovcr�s .4.ee ��sTfA onr �' ��� �.c Sr�itc..4-se A�'Z , Kevin Nestor 11359 ��eo .— Paget/or'Td Inspector(print) Uc# Signature Date Risk Assessor (print) UC# Signature Dale Address or ProoeM: 3/Z LAFi44e1�� ST Ant.III BATHROOM / SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAO 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 sla Upper Walla /.g gDL WA Y ,7�!✓ /I I• Low Cab Fram g. �I L NIA Y j�,]//porr1i, ,• /�G A B Lower Walla 9. la L WA Y /7�/u ISM rr ro Low Cab Door 9. �I L NIA Ys�— A a Baseboards p9. C I L NIA Y , r71ic' , •/(p C D Low Cab Walls O. A/M L N/A Y A B Chak Rei /./ L N/A Y /LGs. lrj(o e Low Cab 9.g � L NIA Y ,7/t e,., ro�r w GK AS c0 Radiator /¢ AIM L Y ,�/D LO D Supports AIM L WA Y Floor AIM L NIA Y 7 qJ -0.1 34 IDrdwers AIM L WA Y Ceiling p. AIM L N/A Y A jSw Big B1D 60 L N/A Y r e>B Door .9 �fAl L NIA Y jR-e^ 8 pron 45M L NIA Y /r7/rte C D Door Caskg CAG L,NIA Y ( ery e+/„rp ® asing ON L NIA Y /,�/J 02 Door Jamb 9• CAG NIA Y r� �•� ro D r Stop .3 0NIA Y ,-7/rp 3 4 Threshold .-O• ARA L NIA Y ps 0 �m NIA Y /,7/r Door 9. .9 &P L NIA Y /r7 „ iZC'iJ (� Sash r'j, tory A& L N/A YC D Door Casing 9. �L NIA Y / /o RC '�/w w tN! 2 r Sill SF NIA Y /17 A7 V02 DoorJamb SII L NIA Y (7/p , ! 3 ead ,30 NIA Y r7 r0 Vie34 Threshold AIM L NIA Y 4 Oop /¢ 0 SF m N/A Y /,� V9 A Closet Doo , I0 L NIA Y ZJ,I a /r ru xt Sash m NIA Y r /p VCI Casing .g �1 L WA Y rNp JZCK rr/io AD bove 5 MA AIM L NA Y AS C Closet Jamb 9.( A L NIA Y 17//0 X-CM %,/i0 ZrOt CD Mold' MA AIM L NA Y qMir Aa D Closet Walls . ( AIM L N/A Y /7/4 tint y/,(o CD Medicine Cab Mn A/M L NA Y Cl Baseboard AIM L NIA Y ABD Wall O/C MA AIM L NA Y m Closet Pok ARA L NIA Y MA AIM L NA Y 2 Closet Shetl CON/A Y Z/,71t/t{* y M/I AIM LNA Y 3 CI BUDport$ AIM L WA Y r to Jt flk rr/(p KGM" MA AIM L NA Y 4 Cbsetfbor �. TWA Y Z rT/ R' , , WYYY NA Y Closet Ceiling ARA L WA Y / ML r (o MnNA Y A� Up Cab Frame q. L N/A Y rT ro t1 r/r, NA YCD UD Cab Door �L NIA Y , rp q„ �r/iw NA YUp Cab Walb rJ. A!M L WA Y (�/ /zQjst /ir,4 GSM NA YD2 Up Cab Shiva g L WA Y ,7NA Y34 Supports AIM L WA v / ( RL a/to NA Y 0 S / ii /o Cd/ 7-/.7/ro 5/a v-u/4P••w- cfffAvdW-c'9•�,9�j - s.% , S,ore 3 _ bowweou x 3- 9. 9 Reny aP/°`"`,` ••%o ticoa�i�/��R �\ D,�Rws.� �a+4are . f-9 5/�t g - TRRNSo.•r = l �! ��i�� Ge' (/Gi'f!= O.O �%'-� y:�i ZJ/shv/L � iQt EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC I SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 � � 5-/�O� Page got-109 Inspector(print) Lic# Signature Date IZskAssessor(print) Lic# �/ Signature Date Address of Propertv:.'3/Z ziQFi4 elle 5T Apt# D(�• ,Sj��C� ROOM SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAV DATE METH DATE METH SURFACE HAZARD HAZ DATE METH I DATE METH A B UPWaIls 00 AIM L NIA Y A Window SR r1.1 19 &6 NIA Y A B Low Walls AIM L NIA Y 8 Win Apron r7.1 JAI 0 NIA Y A/ A B Baseboards /. �WA Y rj/rd - PIM '4 /�l Win Casing .C'f ,A86 NIA Y ,7/N /., w A B Chair Rai AIM L NIA Y D Header Stop0 (bN/A Y �i1/,r 5 RP �„ Aco 9 Radiator �. AIM L INA Y Ind Stops 9.9 ISD CM m N/A Y Floor AIM L N/A Y C9 Win Int Sash 1q.4j,S W m N/A Y i7/ e „ ,o 16 Calling .3 AIM L N/A Y 2 Exterior Sol All IM11 SF LV Y rx/w 1,1/4 5)B Door L NIA V t a P 3 Pad Bead MA L Ck Y C D Door Casing ,Qp1 L NIA Y ,? , 0 4 Blind Stop W4 MA SF L& Y 02 Door Jamb Y rp d a /!► Wm Ext Sash MA L CA Y 3 4 Threshold Q. AIM L N/AY A Wallow Sol /. (dpi m NIA Y Ae Door ®t L WA Y , is 8 Wm Apron 9.7 600 N/A Y .7/ro,Qem 40 Rep" C D Door Casing ft N/A Y 0 of C Win Casing .QW0 NIA Y ,7/40 M w ,J fj m2 Door Jamb N/A Y , e Header Stop &NIA Y ,71,0 3 4 Threshold p.( AIM L WA Y IntStops 1009 d,N/A Y A B Door AIM L NIA Y in IN Sash 61M NIA Y rV,a OR&amt C D Door Casing AIM L NIA Y 2 Exterior Sit 40 SF &N/A Y ,o 12 Doorjamb A/M L WAI Y 3 Pad Bead FNI m NIA Y ,7/16 r, it 34 Threshold AJM L NIA Y 4 Blind Stop 9. lb SF Ib NIA Y A B Door AIM L NIA Y WM Fat Sash19.1 C)N/A Y r N Cs*A ro CID Door Casing AJM L NIA Y A Window SOI MA ARM L N/A Y 12 Doorjamb AIM L N/A Y B Win Apron AIM L N/A Y 34 Threshold AIM L NIA Y C Win Casing AAM L N/A Y ® Closet Door L NIA Y ,7 D Header Stop MA L N/A Y B CI Casing ,N L WA Y /,7//e 1 ,r f p IM Stops MA AIM L NIA Y C Closet Jamb 04 N/A Y a7/1e . tU 1 Win IM Sash MA AIM L N/A Y D Closet Walls 0.3 AIML WA Y 2 Extedm SBl MA SF L NIA Y CI Baseboard /{,g,P• AN L Y , p y n 3 Part Bead MA L N/A Y m Closet Pole >r AIM L N/A Y 4 Blind Stop MA SF L N/A Y 2 Closet She" AIM L NIA Y , „ r0 tt Win Ext Sash MA L N/A Y 3 Cl Suppods `j. ®L NIA Y r7/,0 ieeof , , I NMIB Fireplace AIM L N/A Y 4 Closet Floor AMI L WA Y CD Mantle AIM L N/A Y A9 Closet Ceili z. AAM L NIA Y D Win Above 5' AAA L NIA Y 5-/jP,O� Ceokg Mold' AIM L N/A Y r7/!o q., r IY1l wptli) CCovbe4t ' //✓ Cr6StI = 6 �t AIM L NIA Y V/Z R m AIM L WA Y ld C-*9 AJM L WA Y Surfaces Ilis Ineye xes can be made intact only by a licensed deleader. !IDE LOCATION MEASURE:LOOSE PAINT IC I IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 �J. /` _ S/�fj % Page23of j Inspector(print) Lic# Signature Date Risk Assessor(print) /A rLic# Signature Date,� / Address of Prooertv:.?/Z/�✓7y�/! 1* 5 Apt.# Cb! ROOM 6 SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD OELEAD SURFACE HAZARD HAZ DATE METH DATE METH SURFACE HAZARD HAZ DATE METH DATE METH A B Up Walls O. AIM L NIA Y A Window SB VLNIA Y p A B Low Walls AMIL N/A Y B Win Apron ,®1 L NIA Y f7/to zrD A B Baseboanls y.g 60N/A Y f7/fes x /4. C Win Ca" 01 L NIA Y A B Chair Rai AMI L NIA Y Header Stop .161 L N/A Y .7/1 ,j Oeo Ac 1)s Radiator AMI L N/A Y IM Stops r"f. F�Q �1 L NIA Y r7/i Floor O. AIM L NIA Y O Win Int Sash g.Gj IW �I L NIA Y n tvfz Ceiling _ p. AAA L NIA Y 2 Exterior Se y.'j V SF 6 N/A Y B Door L NIA Y , 3 Part Bead 9 AWA Y /,7/t C D Door Casing AS L NIA Y ,7 fd 4 Blind Stop SF ID NIA Y 7/ivrd 02 Door Jamb 9. L N/A Y t x Win Ext Sash 0 N/A Y t7/ 3 4 Threshold —, D.) AIM L WA Y A Window Sit (0�1 L N/A Y A Door �i L NIA Y 7 p -0„ B Win Apron g. r'�I L N/A Y / to CD Door Casing 9. L N/A Y ,? n, w C Win Casing ON L N/A Y t t0 02 Door Jamb ARM L WA Y , ro M b„ ,C (9 Header Stop 9. L NIA Y /f7 to 34 Threshold — 0.3 AIM N/A Y Int Stops CJ. L WA Y AB Door / AIM N/A Y 1 Win lMSash �I L N/A Y r7/ pD Door Casing AIM L NIA Y ® Exterior SRI INI SF a)NIA Y 7 132 Door Jamb 0.3 AIM L NIA Y 3 Part Bead ®I 0 WA Y �f 7/40 (/ 34 Threshold AAM L WA Y 4 elind Stop SF d)N/A Y AB Door A/M L WA Y Win Ext Sash 19 m N/A Y r7/ C D Door Casing AMM L N/A Y A Window SB MB AIM L N/A Y 12 Door Jamb AIM L NIA Y B Win Apmn AIM L NIA Y 34 Threshold AIM L NIA Y C Win Casing ARM L N/A Y Closet Door a L WA Y Irl,714bi D Header Stop MA L N/A Y B CI Casing A31 L WA Y Irx Stops MA AIM L NIA Y C Closet Jamb AS L WA Y , 1 Win Int Sash MA AIM L N/A Y D Closet Walls O.3 AIM L N/A Y 2 Exterior Sig MA SF L NIA Y CI Baseboard .9 AAA L N/A Y ,7 ! , 3 Part Bead MA L N/A Y Q Closet Pole G AIM L N/A Y 4 Blind Stop MA SF L NIA Y 2 Closet She# AAM L N/A Y r7k f „ Win Ext Sash MA L N/A Y 3 Cl Supports AIM L N/A Y t7/ I, 9 Fireplace AIM L N/A Y 4 Closet Floor_0.z, AIM L N/A Y C D Mamle AIM L N/A Y Closet Ceri O. AMI L N/A Y A p Win Above S \ AAM L N/A Y Calling Moldir4 0. AN L N/A Y AIM L N/A Y AIM L NIA Y AIM L MAI Y _ Surfaces lis—tM in these boxes can be made Intact only t ir a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 So.IN.) DATE METHOD (MORE THAN 288 So.IN.) DATE METHOD Kevin Nestor 11359 //� �t�01^ Page2q-of Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# /l Signature Date Address of Progsft 9/2, L�9F.4�e ST Apt# City .59�,Ol CONTINUATION OF ROOM —te400A 6 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 7B-Door AIM L WA Y A Window Sill MR ARA L NIA Y C D Door Casing A/M L N/A Y B Win Apron AIM L NIA Y If Door Jamb AIM L N/A Y C Win Casing AIM L NIA Y Threshold ARA L WA Y D Header Stop MA L NIA Y A 8 Door AIM L N/A Y Ind Stops /Alt AIM L NIA Y C D Door Casing AIM L WA Y # Win Int Sash MA A/M L N/A Y # Door Jamb AIML WA Y Exterior Sp Mn SF L WA V Threshold AIM L NIA Y Pant Bead Wl L NIA I Y A B Door AIM L WA Y Blind Stop MA SF L NIA Y C D Door Casing AIM L NIA Y Win Exl Sash MA L WA Y # Door Jamb AIM L NIA Y A Window sit MA AIM L NIA Y Threshold A IVI L N/A Y B Win Apron AIM L N/A Y Closet Door AIM L NIA Y C Win Casing AIM L NIA Y A Cl Casing AIM L NIA Y D VExt p MA L N/A Y B Closet Jamb o.3 AIM L N/A Y MA AIM L N/A Y Q,' Closet Walls 0.3 AIM L N/A Y # h Mll AIM L NIA Y D Cl Baseboard L WA Y /1711 c: —0/4 11V Mn SF L WA Y Closet Pole AAA L NIA Y Mn L N/A Y # Closet Shell AIM L NIA Y Mn SF L NIA Y Cl Supports AIM L WA Y sh Mn L NIA Y Cl Drawers AIM L N/A Y A 8 Up Cab Frame AIM L N/A Y Cl Dr Frame /. " AIM L N/A Y C D UP Cab Door AIM L N/A Y Closet Floor OD A/M L NIA I Y Up Cab Wails AIM L N/A Y Closet Celll O•C) AIM L N/A Y Up Cab ShNs AAA L N/A Y Closet Door AIM L NIA Y Supports AAA L NIA Y A Cl Casing AIM L WA Y Low Cab Fram AIM L N/A Y 8 Closet Jamb AIM L WA Y AB Low Cab Door AIM L NIA Y C Closet Walls AIM L WA Y C D Low Cab Walle AIM L N/A Y D CI Baseboard ARA L WA Y # Low Cab ShM AIM L N/A Y Closet Pole AIM L WA Y Supports AAM L NIA Y # Closet Shell ARM L NIA Y Drawers A/M L N/A Y As CI Supports AIM L N/A Y ca Shiva Above 5' AIM L NIA Y Cl Drawers ARA L NIA Y AS Cab Above S' AIM L WA Y CI Dr Frame AIM L WABA Y o Cab Above 5' ARA L WA Y Close/Floor AIM L WA V A B Fireplace ARA L NIA Y Closet Cuing AIM L N/A Y C D Mantle AJM L NIA Y B rSldelgM(L) AIM L N/A Y C D Sidelght(R) AIM L NIA Y e CDAWin Above S' ARA L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDEJ LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD LI/RA RenRoomCont.8/08 'Kevitl Nestor 11359l/�O f Page Z5Ct;14 inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date`,,/ Address of Property32 Apt# CRY,ty STAIRCASE 3 - SP.CQ^oV 7D 7774/9Z> Lpd z 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 n Upper Walls— O. A/M L NIA Y A Window SBI M/I A/M L NIA Y A B Lower Walls / A/M L NIA Y B Win Apron AIM L N/A Y A a Baseboards Q. A/M L NIA Y C Win Casing AIM L N/A Y A B Chair Rail /. ' A/M L NIA Y D Header Stop MA L N/A Y AB Co Radiator A/M L N/A Y Int Slops MA AAM L N/A Y Floor AIM L N/A Y 1 Win Int Sash MA A/M L NIA Y Ceiling �. A/M L N/A Y 2 ExteriorSill M/I SF L NIA Y A B Door — o-3 AIM L N/A Y 3 Part Bead M/I L NIA Y C Door Casing AIM L NIA Y 4 Blind—Stop M/I SF L NIA Y 2 Door Jamb — 0.0 AIM L N/A Y Win Ext Sash M/1 L N/A Y 34 Threshold /� AIM L NIA Y A Window Sill Mn AIM L NIA Y AB Door AIM L N/A Y B Win Apron AIM L NIA Y C D Door Casing A/M L N/A Y C Win Casing AIM L N/A Y 12 Door Jamb AIM L NIA Y D Header Stop - MIA L NIA Y 34 Threshold AIM L WA Y Inl Stops M/1 AIM L NIA Y A B Door AIM L N/A Y 1 Win Int Sash MA A/M L NIA Y C D Door Casing A/M L NIA Y 2 Exterior Sill MA $F L NIA Y 12 Door Jamb A/M L N/A Y 3 Pan Bead MA L NIA Y 34 Threshold A/M L NIA Y 4 Blind Stop M/I SF L NIA Y A B Door AIM L NIA Y Win Ext Sash Mn L N/A Y C D Door Casing AIM L N/A Y Newel Post O. AIM L N/A Y 12 Door Jamb A/M L N/A Y Rating Cap O. ( AIM L N/A Y 34 Threshold AAM L N/A Y Handrail �/ AIM L N/A Y A B Door AIM L NIA Y Balusters — O.1 AIM L NIA Y C D Door Casing AIM L N/A Y Lower Rat ARM L NIA Y # Door Jamb A/M L NIA Y Stair Treads O. AIM L NIA Y Threshold AIM L N/A Y Stair Risers p. AAM L NIA Y A Closet Door AIM L N/A Y Stringer AIM L NIA Y B Cl Casing A/M L NIA Y Floor Edge O. AIM L NIA Y C Closet Jamb A/M L N/A Y Floor Casings AIM L NIA Y D Closet Walls AIM L N/A Y Cl Baseboard AAM IWAY 1 Closet Pale A/M 2 Closet Shelf AAM 3 Cl Supports AIM 4 Closet Floor A/M Closet Ceiling A/M EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 O�J PageZ6Ot- Inspector(print) Lic# Signature Date Risk Assessor(print) L"iic#-�J� Signature Date Address of Property 3/Z 4!+ ! 4yG/G S? Apt x City: ROOM r/ SIDE LOCATIONI I LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZI DATE METH DATE METH SURFACE HAZARD HAZ DATE METH DATE I METH A e Up Walls .3 AIM L N/A Y (2) Window Sp Mn A/M L WA Y A B Low Walls AIM L N/A Y B Win Apron 0. AIM L N/A Y A e Baseboards O.2 ARA L N/A Y C Wm Casing —0.3 AIM L N/A Y A 8 Chair RagAIM L NIA Y D Header Stop .0 Mn l N/A Y AS Radiator d. AIM L NIA Y Int Stops — 0.3 Mn ARA L NIA Y Floor 0.11 ARA L NIA Y G) Win Int Sash 0.3 Mn AIM L NIA Y -*0 V Ceding 0.0 AIM L N/A Y 2 ExtedorsW 9. SF NIA Y A B Door Z AIM L NIA Y 3 Pad Bead 6. m NIA Y r �/ D Door Casing 0.3 AIM NIA Y 4 Blind Stop SF ONIA Y /W, 02 Door Jamb Q./ AIM L N/A Y Win Ext Sash NIA Y 34 Threshold —O• AIM L NIA Y A Window SolMn AIM L NIA Y A B Door O. AIM L NIA Y _ B Win Apron AIM L NIA Y Door Casing O. t ARA L WA Y _ C Win Casing AIM L N/A Y 02 Door Jamb —0..3 AIM N/A Y D Header Stop Mn L N/A Y 34 Threshold O.Z. AIM L N/A Y Int Stops MA ARA L N/A Y A B Door ARA L N/A Y 1 Win Int Sash Mn ARA L NIA Y C D Door Casing AIM L NIA Y 2 Exterior Sul MR SF L N/A Y 12 Door Jamb AIM L N/A Y 3 Part Bead MA L NIA Y 34 Threshold AIM L N/A Y 4 Blind Stop MR SF L NIA Y A B Door AIM L N/A Y IWIn Ext Sash Mn L NIA Y 'C D Door Casing ARA L N/A Y A ww&w SBI MA A/M L NIA Y 1 2 Door Jamb AIM L NIA Y B Win Apron ARA L NIA Y 34 Threshokt ARA L NIA Y C Win Casing AJM L N/A Y A Closet Door_ 0.2. A/M L NIA Y D Header Stop Mil l N/A Y B CI Casing .O AIM L NIA Y Int StoPs Mn ARA L NIA Y C Closet Jamb 6.01 AIM L NIA Y 1 Win lM Sash MA AIM L N/A Y m Closet Walls 02. ARA L NIA Y 2 Exterior Shc MA SF L NIA Y Cl Baseboard- 0.( AIM L NIA Y 3 Pad Bead MA L N/A Y ('t> ClosetPole AIM L N/A Y X 1 4 Blind Stop MR SF L NIA Y 2 Closet Shea,,,0. t AIM L N/A Y Z Wln Ext Sash MA L N/A Y 3 CI Supports 00.0 ARA L WA Y B Fireplace AIM L N/A Y 4 Closet floor O. ARA L NIA Y C D Mantle AIM L N/A Y AB Closet Ceili 0.3 AIM L N/A Y p Win Above 5* ARA L NIA Y Ceding Moll 0.( AIM L NIA Y AIM L N/A Y AIM L N/A Y ARA L WA Y EXCLUDED SURFACES:Surfaces listed In these DoxeS can made Intact only by a licensed clefea er. SIDE LOCATION MEASURE:LOOSE PAINT ICIC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) GATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 a9 Pagl 4 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Datet, Address of Property: Ant O City: /Cis1 ROOM Y SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ I LEAD TYPE OF URG SIC IC DELEAD DELEAD SURFACE HAZARD HAZ DATE METH DATE METH SURFACE HAZARD HAZ DATE METH DATE METH A B Up Walls — O. AIM L NIA Y A Windom SJI O.I MA A/M L N/A Y A B Low Walls AIM L NIA Y B WinApion — Q. AIM L N/A Y A B Baseboards O.Z. AIM L WA Y ,sC,�1 Wm Casing O. AAA L N/A Y A e Chau Rai AIM L N/A Y t{y Header Stop O.O Mil L N/A Y Al Radiator 10.4 ARA L WA Y Int Stops 0.0M/1 AAA L NIA Y Floor 10.5r AIM L NIA Y O Win Int Sash-10.IMA AIM L N/A Y k/12r Coling Q. AMM L NIA Y 2 Exterior sin (d9 SF O NIA Y x V4.B Door 0.0 AIM L N/A Y 3 Part Bead 0 NIA Y r7/ru I/ C D Door Casing 0.1 AIM L NIA Y 4 BIbW Stop /1/.¢ SF 0 NIA Y /Z m2 Doorjamb —p. 1 AAA L NIA Y Win Ext Sash ONIA YVP 34 Threshold — Q. AIM L N/A Y A Window Sig Mn AMI L NIA Y (5B Door — O.Z. AIM L N/A Y B Win Apron AN L NIA Y C D Door Casing .3 AIM L N/A Y C Win Casing A+M L WA Y 10 Door Jamb — .3 AIM L WA Y D Header Stop W L N/A Y 34 Threshold O• AIM L NIA Y Int Stops W ARA L N/A Y A B Door — 0. 1 AMI L N/A Y 1 Win Int Sash MA ARA L N/A Y �D Door Casing O.Z. AIM L N/A Y 2 Exterior Sit MA SF L NIA Y m2 Doorjamb 0.0 AIM L WAI Y I I 1 3 Part Brad MA L NIA Y 34 Threshold — 0.7. AJM L NIA Y 4 Blind Stop Mill SF L N/A Y A B Door —0- f AAA L NIA Y twin E)d Sash MA L NIA1 Y 0 D Door Casing O.1 AIM L N/A Y A Window Sit Mn AAA L NIA Y 10 Doorjamb O.O AIM L NIA Y B Win Apron AIM L NIA Y 34 Threshold — O. AAA L NIA Y C Win Casing A/M L WA Y Closet Door.. >. AIM L NIA Y D Header Stop W L NIA Y B CI Casing /. AIM L N/A Y Int Stops MA AIM L N/A Y C Closet Jamb Q.1 AMI L N/A Y 1 Win IM Sash MA AAA L NIA Y D Closet Walls G AIM L NIA Y 'VA04 *YIAA 2 Exterior SR MA SF L N/A Y /., Cl Baseboard /. AIM L N/A Y 3Part Bead MA L N/A Y tv Closet—Pole AMM L N/A Y 4 Blind Stop W SF L NIA Y 2 Closet Shed �/ IUM L N/A Y Win Ext Sash Mn L N/A Y 3 CI Supports AIM L NIA Y B Fireplace AAA L NIA Y 4 Cineol Floor Q.3 AIM L NIA Y D Zile AMI L NIA Y AB Closet Cedirg /� AIM L NIA Y A q / D Win Above 5' AAA L N/A Y Ceding Mold' Q. AAA L N/A Y AIM L N/A Y AAA L N/A Y AIM L NIA Y aces Ist m these xes can ma Intact only a Icen NIA Baler. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 S0.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD 7MO- -la/S aiV 7772r- fciM!oa7 ,Cox- Kevin Nestor 11359 /��`a o S'/�09 Page;90f Inspector(p"nt) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: ee ST ADL# Cites 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 HAZI DATE METH DATE METH SURFACE HAZARD HAZ DATE METH DATE METH A B Door — 0-1 ARM L WA Y CWV G, A Window sm MA AIM L N/A Y C D Door Casing 0. AIM L WA Y B Win Apron A/M L NIA Y # Door JamVA AIM L WA Y rZ a ae4opluill C Win Casing A/M L NIA Y Threshold e., AIM L N/A Y D Header$top MA L WA Y A B IDoor AIM L WA Y Int Stops MA ARM L N/A Y C D IDoor Casing I ARO L WA Y # Win Int sash M/I ARM L NIA Y # jDoorJ=b I AIM L N/A Y Eztedor Sill MR SF L WA Y ThreshoW I I AIM L WA Y Part Bead MR L WA Y A B Door AIM L N/A Y Blind Stop MA SF L N/A Y C D Door Casing ARM L WA Y Win Ext Sash MR L WA Y # Door Jamb ARM L N/A Y A Window sit I IW ARA L WA Y Threshold ARA L N/A Y B Win Apron ARA L NIA Y Closet Door—O.Z AN L N/A Y C Win Casing ARA L N/A Y A Cl Casing ARA L WA Y D Header Stop IMA L NIA Y B Closet Jamb Q.r AIM L N/A Y Int Stops MA ARM L N/A Y © Closet Walls Aq_ AIM L NIA V ;9,7t,4 oolowil f # Win Int Sash MA A/M L N/A V D Cl Baseboard A/M L NIA Y Exterior Sil MR SF L NIA Y Closet Pole /. AIM L N/A Y I Part Bead . MR L NIA Y # Closet Shed ARA L N/A Y Blind Stop Mll SF L NIA Y Cl Supports ,e- ARM L N/A Y Win EA Sash Mn L NIA Y Cl Drawers ARA L NIA Y A B Up Cab Frame A/M L N/A Y Cl Dr Frame ARM L NIA Y C D Up Cab Door AIM L N/A Y Closet Floor p. ARA L N/A Y Up Cab Walls AIM L NIA Y Closet Ceiling AIM L N/A Y # Up Cab Shiva AIM L N/A Y Closet Door ARM L N/A Y Supports AIM L NIA Y A Cl Casing A/M L WA Y Low Cab Fram A/M L N/A V _ B Closet Jamb AIM L N/A Y A B Low Cab Door ARA L WA Y C Closet Walla AIM L WA Y C D Low Cab Wails AIM L WA Y D Cl Baseboard AIM L N/A Y # Low Cab ShIvs ARA L NIA Y Closet Pole A/M L NIA Y Supports ARA L WA Y # Closet She" ARA L NIA Y Drawers AIM L N/A Y AB Cl Supports ARA L N/A Y c o Shiva Above V AIM L WA Y As Cl Drawers AIM L WA Yb Cab Above 5A/M L NIA Y As Cl Dr Frame AIM L NIA Y co Cab AboveV AIM L NIA Y Closet Floor ARM L WA Y A B Fbepiaoe AIM L N/A Y Closet Ceiling AIM L WA Y C D Mantle A/M L WA Y B Sidelight(L) AIM L NIA Y `5W4tfi/N� .�y Daps(., '='/Jyyaa D.O CD SWelighl(R) AIM L N/A Y As C D 'Nin Above 5' ARM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCALION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO,IN.) DATE METHOD LIRA ReoRaomCunt.8/08 Kevin Nestor 11359 e / e .� OJPage0lof lJ Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# // Signature Date Address of Property: Apt# City: ROOM 41 SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZI DATE METH DATE METH A e Up Walls — O. AIM L WA Y A Window S111 -0.( Mil AIM L NIA Y A 8 Low Walls AIM L WA Y B Win Apron 0. ARA L WA Y A 9SLL Baseboards 0.1 AIM L NIA Y m Win Casing—0. AIM L NIA Y A e Chair Rai / AIM NIA Y D Header StoO.1 MA L WA Y AB Radiator O AIM L NIA Y IM Stops .— 0.3WI AIM L N/A Y Floor AIM L WA Y Wm IM Sash .,? MA AIM L N/A Y qJ j0/u .e VP— Ceiling — 0j A1M L N/A Y 2 Exterior sin SF /A Y /w u w B Door — O ARA L WA Y 3 Pan Bead •0 m N/A Y C D Door Casing 0.3 AAA L N/A Y 4 Blind Stop pt SF (D N/A Y r-1/xJ y c 02 Door Jamb —O.! ARA L N/A Y Win Ext Sash 9, m NIA Y 3 4 Threshold AIM L NIA Y A Window Sii M4 AIM L NIA Y A B Door — 0.3 AIM L WA Y B Win apron AIM L NIA Y Ct)Door Casing—a.Z AIM L WA Y C Win Casing AAA L NIA Y ()2 Door Jamb 0.1 A/M L NIA Y D Header Stop MA L NIA Y 34 Threshold 4>.Z AIM L WA Y IM Stops W AIM L NIA Y A B Door AAA L N/A Y 1 Win Ind Sash W AIM L N/A Y C D Door Casing ARA L NIA Y 2 Exterldr SGl MA SF L NIA Y 12 Door Jamb AIM L NIA Y 3 Part Bead M4 L WA Y 34 Threshold AIM L NIA Y 4 Blind Stop MA SF L WA Y A B Door AIM L NIA Y Wm Ext Sash M/I L NIA Y C D Door Casing AIM L NIA Y A Window Sill Mil AIM L WA Y 12 Door Jamb AIM L NIA Y B Win Apron ARA L WA Y 34 Threshold AIM L WA Y C Win Casing AIM L NIA Y A Closet Door AIM L NIA Y D Header Stop Mn L NIA Y B Cl Casing 0.1 AIM L NIA Y Int Stops Mn AAA L N/A Y C Closet Jamb 0.0 AIM L N/A Y 1 Win Int Sash MA AAA L NIA Y ® Closet Walls 0• AIM L NIA Y 2 Exterior Sill MA SF L N/A Y Cl Baseboard. AIM L NIA Y 3 Pan Bead W L N/A Y Closet Pole 0. 1 AIM L NIA Y �r 1 4 Blind Stop MA SF L NIA Y 2 Closet Shelf AIM L N/A Y I Win Ext Sash MA L NIA Y 3 CI Supports .O AIM L NIA Y B Fireplace AAA L N/A Y 4 Closet Floor O• AIA L N/A Y C 0 Mange AAA L NIA Y AB Closet Celing AIM NIA Y o Wm AboveS AIM L WA Y Calling Moldi AIM L NIA Y AIA L NIA Y AIM L N/A Y AIM L WA Y EXCLUDED SURFACES:Surfaces listedin ese boxes Can made Intact on a ices e Mer. TIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ.IN.) DATE METHOD (MORE THAN 288 SQ.IN.) DATE LMETHOD Kevi�Nestor 11359 7J, ��y�.r S/�•O�/ Page.�O-Or70 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Pro e : 3/Z elle SrApt.# City: STAIRCASE.. 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 a Upper Walls Z• ANO WA Y � /D gQ 'Y4. A Window SN M/I A/M L NIA Y A 8 Lower Walls AIM L N/A Y 17110 j&iry Jq u gep B Win Apron A/M L N/A Y A a Baseboards AMM L NIA Y C Win Casing AIM L N/A Y A B Chair Rail AIM L NIA Y D Header Stop Mil L NIA Y AS CD Radiator /. AMt L NIA Y Int Stops M/I AIM L NIA Y Floor / AIM L NIA Y 1 Win Int Sash Mil AIM L NIA Y Ceiling AIM L NIA 2 Exterior Sill M/1 SF L NIA Y A B Door 0.0 AIM L NIA Y 3 Part Bead Mil L NIA Y D Door Casing /9 N/A Y ,? 'n r,Jp 4 Blind Stop Mil SF L N/A Y 02 Door Jamb Q. AIM L N/A Y Win E#Sash M/I L N/A Y 34 Threshold .3 AIM L NIA Y A Window Sill M/l AIM L N/A Y A B Door AIM L NIA Y B Win Apron A/M L NIA Y C D Door Casing AIM L NIA Y C Win Casing AIM L N/A Y 12 Door Jamb AIM L N!A Y D Header Stop Mn L N/A Y 3 4 Threshold A/M L N/A Y Int Stops MA AIM L N/A Y A B Door AIM L NIA Y 1 Win Int Sash Mil AIM L NIA Y C D Door Casing AIM L NIA Y 2 Exterior Sit M/I SF L N/A Y 1 2 Door Jamb A!M L NIA Y 3 Pad Bead Mil L NIA Y 34 Threshold A/M L NIA Y 4 Blind Stop MII SF L NIA Y A B Doar AMM L NIA Y Win Ext Sash Mil L N/A Y C D Door Casing AIM L N/A Y Newel Post 6Ir9NIA Y 12 Door Jamb A/M L N/A Y Railing Cap A/M L NIA Y 3 4 Threshold AIM L NIA Y Handrail � NIA Y y 1�y ,o A B Door A/M L N/A Y Balusters ,,I A/M L NIA Y C D Door Casing AIM L NIA Y Lower Rail /. ' A/M L NIA Y # Door Jamb A/M L NIA Y StairTreads Threshold A/M L NIAJ Y I Stair Risers AIM jS1 N/A Y A Closet Door AIM L NIA Y Stringer A/M L NIA Y B Cl Casing AMM L NIA Y Floor Edge AIM L N/A Y C Closet Jamb AIM L WA Y Floor Casings A/M L N/A Y D Closet Walls AIM L NIA Y s/ -0 q Cl Baseboard AIM L N/A Y O / '40C.--ave 4aJ /'= 40.0 1 Closet Pole A/M L N/A Y 2 ICloset Shelf AIM L NIA I Y 3 Cl Supports A/M L N/A Y 4 Closet Floor A/M L N/A Y Closet Ceiling AIM L NIA Y _ EXCLUDED SURFACES: Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 S0.IN.) DATE METHOD (MORE THAN 288 S0.IN.) DATE METHOD Kevin Nestor 11359 �� ,S/r�'� Page; OI�U Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Addresso(Procerty: 3/Z f/p�1e * ST Apt# CKv: ROOM Q 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 Up Walls 02 AIM L NIA Y Window Sill UA Mn ARA L NIA Y A e Low Walls AIM L NIA Y B Win Apron d.0 ARA L WA Y A e Baseboards 47. AIM L NIA Y C Wm Casing —0.Z. ARA L WA Y A B Chair Rai AIM L NIA Y - D Header Stop L NIA Y A s Radiator AIM L N/A Y e$ IN Stops Mn AIM L NIA Y Floor AIM L NIA Y 6 ty Win int Sash .I MA AIM L NIA Y Calling O• ARA L NIA Y 2 ExteriorSin SF L NIA Y AB Door _ ARA L NIA Y 3 Pad Bead O. L NIA Y C D Door Casing ARA L NIA Y 4 Q SF L NIA Y 12 Door Jamb AIM L NIA Y Wln Ext Sash MA L NIA Y 34 Threshold AIM L WA Y A Window Sill MA ARA L N/A Y A B Door AIM L NIA Y B Win Apron AIM L NIA Y C D Door Casing ARA L NIA Y C Win Casing ARA L N/A Y 12 Door Jamb AIM L NIA Y D Header Stop MR L NIA Y 34 Threshold AIM L NIA Y Int Stops W AIM L NIA Y A B Door A/M L NIA Y 1 Wm Int Sash Mll AIM L N/A Y C D Door Casing AIM L NIA Y 2 Exterior SUl MR SF L NIA Y 12 Door Jamb AIM L N/A Y 3 Part Bead MR L NIA Y 34 Threshold AIM L NIA Y 4 Blind Stop MR SF L NIA Y A B Door AIM L N/A Y Win Ext Sash W L NIA Y C D Door Casing ARA L WA Y A Window Sill M11 AIM L NIA Y 12 Door Jamb AIM L NIA Y B Win Apron AIM L NIA Y 3 4 Threshold ARA L NIA Y C Win Casing AIM L NIA Y A Closet Door AIM L WA Y D Header Stop 1. MA L N/Al Y B CI Casing AIM L WA Y IM Stops MR AIM L NIA Y C Closet Jamb AIM L N/A Y 1 Win Int Sash MA AIM L NIA Y D Closet Walls AIM L WA Y 2 ExteriorSN MA SF L NIA Y Cl Baseboard AIM L NIA Y 3 Part Bead Mil L WA Y 1 Closet Pole AIM L NIA Y 4 Blind Stop MA SF L NIA Y 2 Closet Shen AIM L NIA Y Win Ext Sash w L NIA Y 3 CI—Supports ARA L NiAl YB Fi eplacs A M L NIA Y 4 Closet Floor AIM L NIA Y C D Mantle ARA L N/A Y AB Closet Ceiling AIM L NIAFY D Win Above 5' AIM L NIA Y k-O9 Calling Moldii4 OC ARA L NIA Y fi « S/DC C — s5 /SNP./ =0.0 AtM L WA Y WihGC CRS/N,1S of O.O AIM L WA Y A44c Cdt NM N= A 0 (�-9/17/A)h0' 1/O l AIM L NIA Y EXCWDED SMV-=. Surfaces Initial In these boxes can mace Intact only by a licensea ae eader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE HOD iS ti 4v /f S� 'R� Kevin Nestor 1135977. /!� — Page���0 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address 21 Property: 3�Z .CAFAyG ST Apt# Ctty ROOM // SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION! LEAD TYPE OF URG IC IC OELEAD DELEAD SURFACE HAZARD HAV DATE METH DATE METH SURFACE HAZARD HAZ DATE METH DATE METH A 8 Up Walls G AIM L WA Y A window sin M/I AIM L N/A Y A a Low Wads /. A/M L N/A Y B Wm Apron A1M L NIA Y A 8 Baseboards AIM L NIA Y C Win Casing AIM L NIA Y A e Chair Rai AIM L NIA Y D Header Stop MA L N/A Y AS Radiator AIM L N/A Y Int Stops MA AIM L N/A Y Floor AIM L NIA Y gr 1 Wm Int Sash MA AIM L NIA Y Ceiling d if AIM L N/A Y 2 Exterior Sol MA SF L NIA Y A B Door �/ AAA L N/A Y 3 Part Bead MA L N/A Y OD Door Casing Q. AIM L NIA Y 4 Blind Stop MA SF L NIA Y ®2 Door Jamb — AIM L NIA Y win Ext Sash M/I L NIA Y 34 Threshold it AIM L N/A Y A Window SB MA ARA L N/A Y A B Door AIM L N/A Y B Win Apron AIM L NIA Y C D Door Casing AIM L NIA Y C Wm Casing AIM L NIA Y 12 Door Jamb A/M L NIA Y D Header Stop M/I L WA Y 3 4 Threshold AAA L NIA Y Int Stops MA AAA L NIA Y A B Door AIM L NIA Y 1 Win IM Sash M/I AIM L N/A Y C D Door Casing A/M L N/A Y 2 Exterior sin Mn SF L NIA Y 12 Door Jamb AAM L NIA Y 3 Part Bead MA L WA Y 34 Threshold A/M L N/A Y 4 Blbtd Stop MA SF L N/A Y A B Door AIM L WA Y Win Ext Sash MA L N/A Y C D Door Casing AIM l WA Y A Window Shc Mn AIM L N/A Y _ 12 Door Jamb AIM L NIA Y B Win Apron AIM L NIA Y 34 Threshold AIM L NIA Y C Win Casing AIM L NIA Y A Closet Door AIM L NIA Y D Header Stop M71 L N/A Y B Cl Casing ARA L NIA Y Int Stops MA A/M L N/A Y C Closet Jamb AIM L WA Y 1 Win Int Sash Mn AIM L NAA Y D Closet Walls AIM L NIA Y 2 Exterior Sill MA SF L NIA Y GBaseboarAIM L NIA Y 3 Part Bead MA L NIA Y 1Clo5M Pole A/M L N/A Y 4 Blind Slop Mn SF L N/A Y 2 Closet Shelf AIML WA Y Win Ext Sash MA L NIA Y 3 Cl Supports AIM L NIA Y AS Fireplace AIM L NIA Y 4 Closet Floor AAA L N/A Y CD Mantle AIM L NIA Y Closet Ceiling AIM L NIA Y ABe Win Above 5' ARd L WA Y Coding Moldi 0.0 AIM LN/A Y (�J/jLG C/jS�M4S O.O AIM L NIA1 Y AJM L N/A Y A/M L N/A Y EXCLUDED SURFACES:Surfaces listed 10 esekeS Can m e In1a I only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 75. �'ds.�— �/��! Page 330#-Y Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Dates Address of Property: 3/Z -.9rFi9r�1�IlC ST Mt# Cl/v: ROOM /_., SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIOW 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 —0.3 AIM L N/A Y A Window Se _O.( MA AIM L N/A Y S- T. A e Low Walls AIM L NIA Y B Win Apron O. ARA L N/A Y A BSLa Baseboards 0.0 ARA L WA Y C Win Casing O.Z. AIM L N/A Y A B Chair Rai /. AIM L WA Y ® Header Stop A Mill L®1 Y q/I pya ra Al Radiator AIM L WA Y IM Stops MA AIM L 10 Y 1,7,110RCi4 /p Z F= AIM WA Y 7- Win Intsash /.T MB AIM do)N/A v ,7 / „ y Ceding AN L N/A Y &QC CS=A 2 Exterior Se MA SF ai,NIA Y 141,1,a Door 0.0 AIM L WA Y 3 Part Bead MA 0 N/A Y w/„ C D Door Casing O.1 AIM L NIA Y 4 Blind Stop /. MA SF L WA Y °1,/ro m2 Door Jamb O.I AIM L NIA Y Win Ext Sash MA d)NIA Y 3 4 Threshold /. AIM L NIA Y A Window Sil O.O MA AIM L N/A Y S' A®Door —().3 AIM L WA Y B Win Apron — .11 AIM L N/A Y C D Door Casing 0.3 AIM L NIA Y C Win Casing 0.1 AIM L NIA Y 1 Door Jamb — .O AIM L NIA Y (Q Header Stop V MA L to Y r7/w X01 y R 3 4 Threshold IG AAN L N/A Y G Int Stops /�/,fQ.MA AAA L Y ,7/,0 r. ro AB Door AIM NIA Y 1 Win Int Sash MA AIM(DNIA Y ,7 ILL C D Door Casing AIM L NIA Y m E)tedor SIB IV4 W SF LIP Y ,?/,p It, jo (/ 12 Door Jamb AAA L N/A Y 3 Part Bead MA L 40 Y 34 Threshold AIM L NIA Y 4 Bind stop MA SF L 10 Y 7/� 4W Ayfi. I VA A B Door AAA L NIA Y Win Ext$ ash MA l Y C D Door Casing AIM L N/A Y A Window$ii Mn AIM L NIA Y 12 Door Jamb AIM L WA Y B Win Apron ARA L NIA Y 34 Threshold AAA L NIA Y C Win Casing AIM L N/A Y A Closet Door O.O AIM L N/A Y D Header Stop Mn L N/A Y 0 Cl Casing O.1 AIM L WA Y IN Stops WI AIM L NIA Y C Closet Jamb 0.If AIM L N/A I Y 1 Win Int Sash Mil AIM L NIA Y D Closet Walls AIM L WA Y 2 Extedor SB MA SF L NIA Y n Cl Baseboard- MI.1 AL NIA Y 3 Part Bead MA L N/A Y (Y Closet Pole /1/L. AIM L WA Y 4 Blind Stop MA SF L NIA Y 2 Closet Shell vc. AAA L NIA Y 4/f C Win Ext Sash MA L N/A Y 3 CI Supports NG AIM L N/A Y 8 Fireplace AIM L N/A Y 4 lCloselFlocr rd V AAA L NIA Y (,,,4. D Mande AAA L N/A Y AB Closet Ceiling A/M L NIA r Win Above 5' AIM L WA Y 5-/kl-017 Ceiling Moldir4 AAA L WA Y AA" c4lNM IV$ .,v Cksetr = I.O X Z 41110 AIM L N/Al V •J /O�////t3 4r.,y AIM L N/A Y / A/M L WA I Y EXCLUDED SURFACES: aces lisf@ in these EMT= made Intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT ICIC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD /o-ii i0 Tlfis / +� wAs Re sscY�D. 7 " c�S.�r is lk-mw A .s70KO!W P Kevin Nestor 11359 / .— ✓�'��"Q`! Page0f & Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: 3/z '41w"ov4efi1c vTApt# CRY: ROOM /3 - 4,0V1Vb cY A*r ISIDE LOCATION/ LEAD TYPE OF URd 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 a Walls ARM L N/A Y A Window Sig 0.6 W AIM L WA Y 6 A BOp WallsO p AIM L NIA Y Gt/a B Win Apron ,e- AIM L N/A Y A B Baseboards /. ' AIM L N/A Y C Win Casing AIM L NIA Y ,,/ A B Chair Rai AIM L NIA Y Header Stop MA L to Y r�/•o� -7r(ro As Radiator 1'--1 AAA L N/A Y hd Stops D.O W ARM L WA Y Floor 0. AIM N/A Y Win Int Sash MA AAMOWA Y I?Aa Zeetir '*`YNke .cnr Ceiling _ AIM L N/A Y 2 Exterior Sig MA SF L j� Y q!•O S4-&j/140 /tC A Door p AAA L N/A Y 3 Part Bead MA L Y /.7/.p (ql„ n ra /jGK- C D Door Casing O.O Allot L NIA Y 4 Blind Stop MA SF L "k Y n/.o pr,�. XeAy 2 Door Jamb O.O AIM L NIA Y Wm Ext Sash MA L& Y 3 4 Threshold A/M L NIA Y A Window Sit Mn ARM L N/A Y A B Door A/M L NIA Y B Win Apron ARM L N/A Y C D Door Casing AIM L NIA Y C Win Casing AIM L NIA Y 12 Door Jamb AIM L NIA Y D Header Stop MA L N/A Y 34 Threshold AIM L NIA Y Int Stops MA AIM L N/A Y A B Door AIM L N/A Y 1 Win Int Sash Mn AIM L N/A Y C D Door Casing AIM L WA Y 2 ExterlorSil MA SF L N/A Y 1 2 Door Jamb AIM L WA Y 3 Part Bead Mn L NIA Y 3 4 Threshold AIM L WA Y 4 Blind Stop Mn SF L WA Y A B Door AIM L WA Y Win Ext Sash Mn L NIA Y C D Door Casing AIM L NIA Y A Window SB Mn AIM L WA Y 12 Door Jamb AIM L N/A Y B H!in Apron AAA L NIA Y 34 Threshold AIM L NIA Y C Win Casing AIM L N/A Y A Closet Door F' AAA L N/A Y (/ D Header Stop MA L NIA Y ® CI Casing AIM L N/A Y Int Stops MA AIM L NIA Y C Closet Jamb /. AIM L NIA Y 1 Win IM Sash MA AIM L WA Y D Closet Walls .( AIM L NIA Y 2 Exterior Sig MA SF L N/A I Y Cl Baseboard /. AIM L NIA Y 3 Part Bead X MA L WAI Y r:p Closet Pole AIM L N/A Y 4 Sim Stop Mn SF L N/Al Y 2 Closet SheA p.0 AIM L N/A Y-1 Win Ext Sash MA L N/A Y 3 CI Supporta U.O AIM L N/A Y B Fireplace AAA L NIA Y 4 Closet Floor AIM L NIA Y C D Mantle AAA L NIA Y Closet Ceding AIM L N/A Y ASWinAbove 5' AIM L NIA Y Ceding Moldl AIM L NIA Y a O. O / AIM L N/A Y O Z/17/ro `Y�r+ 1 dl sr/W AIM L N/A Y .Gi¢LG� eca/0,WW a /.O (ar r Mo AAM L N/A Y EXCLUDED SURFACES: aces 186 ID ese xes Can m e Intact only by a licensed dele er. SIDE LOCATION - MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD S-/�a 9 S/D� a ,eGZrCTz�G/�- Service- ip/ Q' Z 7rytc- arisr.. /o -��-io 7/Y/S 1fao.•T .ys�D 7A4-- Aefr4 ,-8.uf /76aAr- ,gyp w.rr iP-e.fWwo. Kevin Nestor 11359 ',��y.l�ia-- ,5���J� Page3�or 1�t1 Inspector(print) Lie# Signature Date Risk Assessor (print) Uc# Signature Date Address of Property: 3/Z z+gF.4i/eTle 57— Apt# City: �i97�ePAI BATHROOM o2 SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELFAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAO SURFACE HAZARD HAZ DATE METH DATE METH SURFACE HAZARD HAZ DATE METH DATE METH A asla uppewalls OO AIM L NIA Y Low Cab Fram 0.01 AIM L N/A Y A a LpwerWalls AIM L NIA Y AS Low Cab Door 40.01 AAA L WA Y A e Baseboards 0 D AIM L N/A Y &D Low Cab Walls 0.0 AIM L NIA Y A e Chair Rai 1-11AIM L N/A Y Low Cab ShM AIM L NIA Y AD CD Radiator AIM L N/A Y 2 Supports / ARA L NIA Y Floor AAA L N/A Y 34 Drmrs d. AIM L NIAJ Y Caging ARA L NIA Y — G A Window SN W AIM L NJAj Y As Door —0.1 AIM L NIA Y — B Wln Apron .7, AIM L N/A Y C D Door Casing O.1 AIM L WA Y © Wm Casing p.0 AIM L WA Y ()2 Dow Jamb 6.0 AIM L N/A Y D Header Stop ((/ MA L 7�1 Y 3 4 Threshold L AIM L N/A Y G Int Stops _ MA ARA L WA Y A B Door AIM L NIA Y 1� Win Int Sash .7 0 00 OWA Y N h ao IR- C D Door Casing AIM L NIA Y 2 Erderiw Sgt l2� SF QWA Y ,7/.d y 1 2 Door Jamb AIM L N/A Y 3 Ped Bead 10 C>NIA Y q,p - ,yAe 34 Threshold AIM L NIA Y 4 Blind Stop MA SF L N/A Y A Closet Door AIM L WA Y Win lxt Sash $.O 0 ON/A Y .�r AS B Cl Casing AIM L NIA Y C D Win Above 5' MA AIM L NA Y AB C Closet Jamb AIM L NIA Y CD Ceding Mold' WI AIM L NA Y Aa D Closet Walls AIM L NIA Y MedkJne Cab MA AIM L NA Y AS Cl Baseboard AIM L NIA Y Wag O/C W ARA L NA Y 1 Closet Pole AIM L NIA Y W AIM L NA Y 2 Closet Shed ARA L NIA Y MA AIM L NA Y 3 CI Support AIM L NIA Y WI AAA L NA Y 4 Closet Floor AIM L NIA Y MA AAA L NA Y Closet Caging AIM L NIA Y MA AAA L NA Y A B Up Cab Fra O. AIM L N/A Y MA AIM L NA Y C Up Cab Door O. AIM L NIA Y MA AIM L NA Y Up Cab Welt AIMd>N/A Y 7/� n r MA AIM L NA Y )2 7t6eY&ft O. AIM L NIA Y MA AIM L NA Y 34 SuppuRe O. AAA L NIA Y Mn AIM L NA Y Side c -�Nrcc c.•�v= -o. EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only b f a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SD.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD io-ii-•v 7fi'iS /�iv•av w.p-z Resrave� , T� ��T iS brow .� -sm�Qe RRe� Kevin Nestor 11359 Page Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property .3/Z Apt # City /E'm HALLWAY:Interior # q or Common Hallway: Front Rear Floor# SIDE LOCATION/ I 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 Upper Walls 4o.4 AIM L N/A Y A Closet Door AIM L N/A Y A B Lower Walls AIM L N/A Y B Cl Casing AIM L NIA Y IL B Baseboards 4-0.2, AIM L NIA Y C Closet Jamb AIM L N/A Y A B Chair Rail AIM L NIA I Y D Closet Walls AIM L NIA I Y AS ,,// C D Radiator 0. AIM L NIA Y Ate eS Cl Baseboard I AIM L NIA Y "Threshold AIM L NIA Y 1 Closet Pole A/M L NIA Y AIM L N/A Y = G 2 Closet Shelf AIM L NIA Y AIM L NIA Y 3 Cl Supports AIM L NIA Y O.O AIM L NIA Y 4 Closet Floor A!M L N/A Y O AIM L NIA Y Closet Ceiling AIM L NIA Y . AIM L NIA Y A Window Sdi M11 AIM L NIA Y A Door O. AIM L NIA Y B Win Apron AIM L N/A Y C D Door Casing 0. AIM L NIA Y C Win Casing AIM L NIA Y 02 Door Jamb —0_11 AIM L N/A Y D Header Stop M/I L NIA Y 34 Threshold _O. If AIM L NIA Y Int Stops M/I AIM L N/A Y AB Door 0.0 AIM L NIA Y 1 Win Int Sash M11 A/M L NIA Y C D Door Casing O. AIM L NIA Y 2 Exterior Sill M/I SF L NIA Y 10 Door Jamb U. AIM L NIA Y 3 Part Bead MII L NIA Y 34 Threshold O• A/M L NIA ly 4 Blind Stop M/1 SF L NIA Y A BKDoor — A/M L NIA Win Ext Sash M/I L N/A Y D A/M L N/A A Window Sill MII A/M L N/A Y 2 A/M L N/A B Win Apron AIM L N/A Y 34 AIM L NIA C Win Casing AIM L NIA Y A B"Thmshold — p. 1 AIM L N/A D Header Stop MA L NIA Y C0g O.O AIM L N/A Int Stops M/I AIM L N/A Y # --U. AIM L N/A Y 1 Win Int Sash M/I A/M L N/A Y V.i AIM L N/A Y 2 Exterior Sill MA SF L N/A Y A Closet Door „Q. .0 AIM L NIA Y LP 3 Part Bead MA L N/A Y ClUD Casing �� AIM L NIA Y 4 Blind Stop Mll SF L N/A Y C Closet Jamb— •1/<>UMf L N/A Y C Win Ext Sash MII L NIA Y D Closet Walls U. •/ AIM L NIA Y Na c o Win Above 5' M/I AIM L N/A Y CLaasebeerd Q AIM L NIA Y h/j CD Ceiling Molding M/I AIM L N/A Y Closet Pole AIM L NIA Y Su�� 2 Closet Shelf A/M L NIA Y 0 3 Cl Supports AIM L NIA Y ClJNC/Z et �L(X)� — �•Z 4 Claret Floor O AIM N/A Y 6 Cy/irMAI o• 6 Closet Ceiling O. AIM L NIA Y ?-' / �QY/'/p 'N 15hiCG WAS Mi %�.S~ EXCLUDED SURFACES:Surfaces listedIn these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) ;DATE METHOD tcst 0Aoberts/ae OF -IS7�/ACOtSe = Z• 3 ® � _�v/4 I,�i7//o I�G/M, /Wn/;c k'ef" Kevin Nestor 11359 i/� — S—��''d% Page 2lof 7 0 'Inspector(print) Uc# Signature Date Risk Assessor(print) Lic# Signature Date Address f Propeft3/Z *44fe c . eirr CONTINUATION OF ROOM — LG 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 Door —6,3 AIM L N/A Y A Window Sin Mn ARA L N/A Y CC Door Casing—45.0 AIM NIA Y B Win Apron AIM L NIA Y #Z Door Jamb ARA L NIA Y C Win Casing ARA L NIA Y Threshold AIM L NIA Y D Header Stop MA L NIA Y A B Door —10,31 AIM L NIA Y IM Stops MA AIM L N/A Y Ca Door Casing ./ AIM L N/A Y # Win Int Sash MR ARA L N/A Y 03 Door Jamb 0.3 AIM L N/A Y Extedor Se Mill SF L N/A Y Threshold AIM L N/A Y e Pad Bead MA L WA Y A B Door AIM L N/A Y Blind Stop MR SF L N/A Y C D Door Casing AIM L NIA Y Win Ext Sash MA L N/A Y If Door Jamb ARA L NIA Y A Window sit Mn A/M L NIA Y Threshold ARA L N/A Y B Win Apron AIM L NIA �Y Closet Door AIM L N/A Y C Wm CasDg A/M L N/A Y A Cl Casing AIM L NIA Y D Header Stop Mn L NIA Y B Closet Jamb ARA L N/A Y Int Stops MR AIM L N/A Y C Closet Walls AIM L NIA Y Win Int Sash MA ARA L N/A Y D CI Baseboard AIM L NIA Y E;;Z Sill M1I SF L NIA Y Closet Pole A/M L N/A Y Part Bead MR L N/A Y a Closet Shelf AIM L NIA Y Blind Stop MR SF L N/A Y CSUPponARA L WA Y Win Ext Sash . Mn L N/A Y Cl Drawers AIM L NIA Y 6B Up Cab Frarm 0.f AIM L NIA Y Cl Dr Frame AIM L NIA V C D Up Cab Door 0.3 A/M L NIA Y Closet Floor ARA L N/A Y Up Cab Wa d. ARA L NIA Y Closet Ceiling ARA L N/A Y #1 Up Cab Shft4o.3 AIM L NIA Y Closet Door AIM L N/A Y Suppods AIM L NIA Y A Cl Casing AIM L NIA Y Low Cab Fram AN L NIA Y B Closet Jamb AIM L NIA Y As Law Cab Door A/M L N/A Y C Closet Walls AIM L N/A Y CO Low Cab Wal AIM L N/A Y D CI Baseboard AIM L N/A Y # Low Cab Sh ARA L NIA Y Closet Pole AIM L N/A Y Supports AIM L N/A Y t: Closet Shen AIM L N/A Y Drawers AIM L N/A Y CI Supports AIM L N/A Y A B StM Above Yj A/M L NIA Y CI Drawers ARA L WA I Y A D Cab Above 5' AIM L NIA Y Cl or Frame AIM L NIA Y As CaD Above 5' AIM L NIA Y Closet Floor AIM L WA Y B FirepWce AIM L NIA Y Closet Ceiling AIM L NIA Y CD Mantle ARA L NIA Y J'r/o. f1"AtG W.,fs 8 Sldelight(L) ARA L WA Y 7>!t-� � �S y� S� �Rt�¢ CD Sldeltht(R) ARA LN/A Y A8 Q Win Above 5' ARA L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only b f a licensed deleader. BIDE LOCATION MEASURE:LOOSE PAINT IC I ICSIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD LI/RA RenRoomConl.8/08 Kevin Nestor 11359 7vn- Page 2(1 Of� Inspector(print) Lic# Signature Date Risk Assessor(print) / Lic# /J Signature Date' Address of Prooertv:3/Z e4g!j BIT't' P AOL# city—!�;x 45zovv STAIRCASE S ,l3NL,lt'f/e/p'!� $T!i/tGS SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ DATE METH ,nDlATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B Upper Walls �. AIMON(A Y 0tr a oorjr A Window Sill Mll AIM L NIA Y A B Lower Walls Q. AIM L NIA Y B Win Apron AJM L NIA Y A B Baseboards AIM L NIA Y C Win Casing AIM L NIA Y A B Chair Rail .� (OWN/A, Y r1 ap D Header Stop M/I L N/A Y AB CD Radiator ter' AIM L NIA Y Int Stops M/I AIM L NIA Y Floor AIM L NIA Y 1 Win Int Sash MA AIM L NIA Y Ceiling 6. A/MQNIA Y r tC tri 2 Exterior Sill MA SF L N/Al Y B Door Q.O AIM L NIA Y 3 Part Bead I M/I L N/Al Y ' // 2 C1�D, Door Casing 00 AIM L NIA Y 4 Blind Stop M/1 SF L NIA Y WDoor Jamb U 13 AIM L NIA Y Win Ext Sash M/I L NIA Y 34 Threshold Q AIM L NIA Y A Window Sill M/I AIM L N/A Y A B Door 00 NIA Y /.l,u Ktt rr r" 14Ze4> B Win Apron AIM L NIA Y D Door Casing NIA Y /, ,p * '�,� tJ C Win Casing AIM L N/A Y 02 Door Jamb 4W NIA Y 07/"j ' '� , p, D Header Stop M11 L N/A Y ( 34 Threshold Q. AIM L NIA Y Int Stops M/I AIM L N/A Y 713 Door AIM L N/A Y 1 Win Int Sash MA AIM L NIA Y C D Door Casing AIM L NIA Y 2 Exterior Sill MA SF L N/A Y 12 Door Jamb AIM L NIA Y 3 Part Bead M/I L NIA Y 34 Threshold AIM L NIA Y 4 Blind Stop M/I SF L NIA Y A B Door AIM L N/A Y Win Ext Sash Mil L NIA Y C D Door Casing AIM L NIA Y Newel Post /' AIM L NIA Y 12 Door Jamb AIM L N/A Y Railing Cap AIM L WA Y 34 Threshold A/M L NIA Y Handmil /. AIM L NIA Y A B Door A!M L NIA Y Balusters AIM L N/A Y C D Door Casing AMLNIA Y Lower Rail AIM L NIA Y # Door Jamb AIM L N/A Y Stair Treads 0.O AIM L N/A Y Threshold AIM L NIA Y Stair Risers AIM(L)N/A Y t7 to p�r1/6 A Closet Door AIM L NIA Y Stringer I AIM L NIA Y B Cl Casing AIM L NIA Y Floor Edge --I AIM L N/A Y C Closet Jamb AIM L NIA Y Floor Casings Y 012>0 /} D Closet Walls A/M L NIA Y S��_U IF d Cl Baseboard AIM L NIA Y /��a W � �s•�ar '1 41.0 1 Closet Pole AIM L N/A Y CS 2 Closet Shelf A/M L NIA Y 3 Cl Suppo s AIM L NIA Y i 4 Closet Floor AIM L NIA Y Closet Ceiling AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 S0.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 _ `/3 O�j Page 3SDr 770 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic If Signature Date Address of Property: 312'/:Lafayette Street Apt.# City: Salem PORCH® B C D (circle one) (!0 2nd fl 3rd fl 4th fi (circle one) GFT Si Ae 710 Std? �Z « elle VSidijiq NI LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD E HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH a)N/A Y IH c1rr Support Clmn •Q O*M L NIA Yards 0NIA Y rod, Ar Newel Post pAIM L NIA Y L N!A Y y �r�,o r{'/l' Railing Cap O. AIM L NIA Y Aja NIA Y , , !�a,L /hf. Hand2il Q. AIM L NIA Y�r L NIA Y Balusters-0. � AIM L NIA Y V A Storm Door fir' AIM L NIA Y Lower Rail ,S'AIM L NIA Y B Door Q. AIM L NIA Y ,i ,(� „ c Stair Treads AIM L NIA Y BjQ( S leb Door Casing NIA Y W.711, r, ,o ew Stair Risers ,C AIM L N/A Y D Door Jamb 0 L NIA Y 51,71(a °u p Stringer AIM L N/A Y 62 Threshold L NIA Y via CCGN �„ ,o ,?�'y� Lower Walls Q. AIM L NIA Y 34 Kickplate �' AIM L NIA Y Lattice /. AIM L N/A Y A Stomr Door AIM L NIA Y LowerTdm Q. AIM L N/A Y B Door AIM L NIA Y — _— _ — Floor 0. AIM L N/A Y C Door Casing AIM L NIA Y A B Window Sill AIM L NIA Y _ D Door Jamb AIM L NIA Y C D Win Casing AIM L N/A Y 12 Threshold AIM L NIA Y 12 Window Sash AIM L NIA Y _ 34 Kickplate AIM L NIA Y 34 Mullions AIM L NIA Y A B Window Sill ®]1 L NIA Y r ru A B Window Sill _AIM L NIA Y _ D Win Casing g. �LN/A Y qq CD Win Casing AIM LN/A Y 2 Window Sash AIM L N/A Y Sj7J _ 'q7)7/,,0 (/ 12 Window Sash AIM L N/A Y 3 4 Mullions �' AIM L NIA Y 3 4 Mullions AIM L NIA Y A B Window Sill to L NIA Y t�/4 ,o AB Window Sill AIM L NIA Y D Win Casing L NIA Y 7`T,• „j C D Win Casing AIM L NIA Y 10 Window Sash AIM L NIA Y l�p �/ 12 Window Sash AIM L NIA Y 3 4 Mullions AIM L NIA Y 3 4 Mullions AIM L NIA Y A B Window Sill �V L NIA Y W,f w A B Window SRI AIM L NIA Y D Win Casing 4).j !&L N/A Y �Ajo CD Win Casing AIM L N/A Y 12 Window Sash p oor AIM L NIA Y '12 Window Sash AIM L NIA Y 4 Mullions AIM L NIA Y 3 4 Mullions AIM L NIA I Y A B Window Sill AIM L NIA Y A B Window Sill AIM L NIA1 Y I _ C D Win Casing AIM L NIA Y C D Win Casing AIM L NIA Y 12 Window Sash A/M L NIA Y 12 Window Sash A/M L NIA Y 34 Mullions AIM L NIA Y 34 Mullions AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 1440 SQ.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD �Kbvin Nestor 11359 ��� S/3 6`j Page4Oof v Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: 312 Lafayette Street Apt.# City: Salem PORCH ® B C D (circle one) (P2nd fl 3rd fl 4th fl (circle one) /GflTS/DG 70 3/7- ,LAFi¢elelAc SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAV DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH AB Siding L NIA Y , ,o A/. SupportClm ,0AIM L N/A Y s CD Comer Boards L NIA Y p WS°,, ,p Newel Post O. AIM LN/A Y � Upper Trim L NIA Y 7 ,p -c- r�, ,o Railing Cap O.0 AIM L NIA Y (JOO Ceiling ,.b Q�N/A Y ,� ,o Handrail 0.1 AIM L NIA Y L Joists �' L N/A Y Balusters0 0. / AIM L NIA Y V �g A Storm Door /.0 ®11 L NIA Y ,o /(e-� 4, L> Lower Rad p Q s AIM L NIA Y II ee B Door 0. AIM L NIA Y Stair Treads AM L N/A Y / © Door Casing RfM Y ,7 ,• Stair Risers AIM L NIA Y D Door Jamb �. Y ro Slinger AIM L NIA Y 02 Threshold O Y , p rt. Lower Walls /. AIM L N/A Y 34 Kickplate /UAMY ,2 ,4 M ,N rp Lattice Q. AIM L NIA V A Storm Door Y Lower Tim O. f AIM L N/A Y It B Door Y Floor AIM L NIA Y C Door Casing AIM L NIAl Y A B Window Sill AIM L N/A Y D Door Jamb AMM L NIA Y C D Win Casing AIM L N/A Y _ 12 Threshold AIM L NIA Y 1 2 Window Sash AIM L N/A Y 3 4 Kickplate AIM L NIA Y 3 4 Mullbns AIM L NIA Y AB Window Sill OL N/A Y Oil,o A B Window Sill AIM L NIA Y D Win Casing ®i L NIA Y q,p jSA C D Win Casing AIM L N/A Y 2 Window Sash AFM L N/A Y 4wr I/ 12 Window Sash AIM L N/A Y 34 IMutflons AIM L NIA Y 34 Mullions AdM L NIA1 Y A B Window Sill R I jeM L NIA Y ,7 p AB Window Sill AIM L N/Al Y OD Win Casing 0 L NIA Y ) N O Win Casing AIM L NIA I Y 10 Window Sash AIM L N/A Y q rp ✓ 12 Window Sash AIM L N/A Y 34 Mullions AIM L NIA Y 34 Mullions AIM L N/A Y A B Window Sill L NIA Y 7 ,p $�� A B Window Sill AIM L NIA Y D Win Casing 415i OM L NIA Y 5 C D Win Casing AIM L NIA Y 12 Window Sashe 7d V AIM L NIA Y j'p,,(, r7 roYIZ 12 Window Sash AIM L NIA Y Mullions AIM L NIA Y 3 4 Mullions AIM L NIA Y A B Window Sill A/M L N/A Y A B Window sill AIM L N/A Y C D Win Casing AMM L NIA Y C D Win Casing AIM L WA Y 12 Window Sash AIM L NIA Y 12 Window Sash AIM L NIA Y 34 Mullions AIM L NIA Y 34 Mullions AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 1440 SQ.IN.) DATE METHOD (MORE THAN 288 SQ,IN.) DATE METHOD •Kevin Nestor 11359i� �- S/.3'Q S Page Y/Of TO Inspector(print) Lic# Signature Date Risk Assessor (print) Lic# Signature Date Address of Property: 312.312%Lafayette Street Apt.# City: Salem 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 HAZ? DATE METH DATE METH A SURFACE HAZARD HAZ? DATE METH DATE METH A Comer Boards L NIA Y IHt JJ/'tt• Mr Window Sill AM L NIA Y Siding F „ Cf NIA Y ,� u M ,s�, /Y1S" A Win Casing AIM L NIA Y J. „L ;; Iffindow,Sash I AIM L NIA Y Upper Trim di WA Y /y ,d Cellar Win Sill AIM L WA Y Win Above 5' m NIA Y , rs /„ A Cel Win Sash A/M L N/A Y Porch Above 5' , L WA Y # CeI Win Frame AIM L WA Y Slorm Door AIM L NIA Y Screen Frame A/M L N/A Y Door AIM L NIA Y Cellar Win Sill AIM L N/A _Y A Door Casing AIM L NIA Y A Cel Win Sash AIM L NIA Y 1 2 Door Jamb AM1 L WA Y G es Get Win Frame AIM L NIA Y 3 4 Threshold AIM l WA V Screen Frame AIM L WA Y Kickplate A/M L NIA Y Cellar Win Sill AIM L NIA Y Storm Door AIM L NIA Y A Cel Win Sash AIM L N/A Y Door AMI L NIA Y CeI Win Frame AIM L NIA Y A Door Casing AIM L NIA Y Screen Frame AIM L N/A Y 1 2 Door Jamb AIM L NIA Y Cellar Win Sill AIM L NIA Y 3 4 Threshold AIM L NIA Y A CeI Win Sash AIM L NIA Y _ Igckplate A/M L N/A Y CeI Win Frame NM L N/A Y Door AIM L NIA Y Screen Frame NM L N/A Y A Door Casing NM L NIA Y Foundation L NIA Y -- 1 2 Door Jamb AIM L N/A Y A Bulkhead NM L NIA Y 3 4 Threshold NM L NIA Y Fences AIM L WA Y Window Sill AIM L NIA Y Shutters AIM L NIA Y A Win Casing NM L NIA Y Newel Post AIM L N/A Y # Window Sash NM L NIA Y Railing Cap AIM L NIA Y Window Sill AIM L NIA Y Handrail NM L NIA Y A Win Casing NM L NIA Y A Balusters NM L NIA Y # Window Sash NM L NIA Y Lower Rail NM L NIA Y Window Sill NM L NIA Y Stair Treads AIM L WA Y e$ A Win Casing NM L N/A Y Stair Risers NM L NIA Y # Window Sash T NM L NIA I Y Stringer NM L NIA Y A Lamp Post T L NIA I Y Porch Floor AIM L WA Y Drain Pipes 0C L NIA Y A Elec Conduit /. L NIA Y Oil Fill Pipe /. L NIA V Overhang Trim NM L WAII Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area 1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT SIC IC LOCATION AREA MEASUREMENT RESULT RIMED RIMED A (MORE THAN 1440 S0.IN.) DATE METH (Square Feet) (PPM) DATE METH A Play Area A Bare soil A Comments: A 'Kevin Nestor 11359 j��yC .S/3 0 j� Page TZff�u Inspector(print) Lic# Signature Date Risk Assessor (print) Lic# Signature Date Address of Property: 312.312%Lafayette Street Apt.# City: Salem EXTERIOR B Side SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION! I LEAD I TYPE OF URG IC IC DELEAD DELEAD B SURFACE HAZARD HAZ? DATE METH DATE METH B SURFACE HAZARD HAZ? DATE METH DATE METH Siding m NIA Y ,7,p 4 M-C Window Sill A/M L NIA Y Comer Boards 7,1 6 N/A Y r , Aj — o r, ,) B Win Casing A/M L NIA Y B Lower Trim 4) NIA Y 4-7114 My— �, a # lWindow Sash AIM L N/A Y Upper Trim All, mN/A Y r t0,r RFame in Sill �t LN/A Y Win Above 5' 6 N/A Y ,T 04 ,l ro B Sash A/M L NIA Y ,� /� "*/"/,Ol 16t Porch Above 5' L NIA Y �' AI ' Frame AIM L N/A Y Storm Door A/M L NIA Y rame AIM L NIA V Door AIM L NIA Y in Sill /.Q L N/A Y B Door Casing A/M L NIA Y B Sash A/M L N/A Y p /rt ra u ao 111111 2 DoorJamb AIM LNIA Y #� Fra A/M L N/A Y q to SGL3 4 Threshold AIM L NIA Y rame ®I L NIA Y c+ oi� to C Kickplate AIM L N/A Y Cellar Win Sill ,p L NIA Y Storm Door A/M L N/A Y B Cel Win Sash AIM L NIA Y to Door AIM L NIA Y #3 Cel Win Fram to AIM L NIA Y r7 sr—& B Door Casing AFM L N/A Y l Screen Frame Y.7 AIM d)NIAY r l,; �a M, o Iaw 1 2 Door Jamb A/M L N/A Y Cellar Win Sill A/M L N/A Y 3 4 Threshold AIM L NIA Y B Cel Win Sash AIM L NIA Y Kickplate AIM L N/A Y # CelWinFrame AIM L NIA Y Door AIM L N/A Y Screen Frame AIM L NIA Y B Door Casing AIM L NIA Y Foundation MCI L NA Y 1 2 IDoorJamb AIM L NIA Y B Bulkhead /. AIM L NIA Y 3 4 Threshold AIM L N/A Y Fences,94 Q. A/M L NIA Y Window Sill AFM L NIA Y ShuttersAIM L N/A Y B Win Casing AIM L NIA Y Newel Post A/M L N/A Y # Window Sash AIM L NIA Y Railing Cap ArM L N/A Y Window Sill AIM L N/A Y Handal A/M L N/A Y B Win Casing AFM L N/A Y B Balusters AIM L NIA Y # Window Sash A/M L N/A Y Lower Rail A/M L N/A Y Window SOI A/M L NIA Y Stair Treads AIM L NIA Y /fie B lWin Casing AIM L NIA Y Stair Risers AIM L NIA Y # lWindow Sash I I AIM L N/Al Y I Stringer A/M L NIA Y B Lamp Post L NIA Y I Porch Floor AIM L NIA Y Drain Pipes Q. L N/A Y ,Site- 6 A,,Aa0WS ,Ave Aoff ve F/ve- pi&T , B Elet Conduit L NIA Y OH Fill Pipe L NIA Y Overhang Trim AIM L NIA I Y Excluded Surfaces: Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED B (MORE THAN 1440 S0.IN.) DATE METH (Square Feet I (PPM) DATE METH B —• Play Area B Bare soil B Comments: B IJ Kevin Nestor 11359 �s�p-- —4-11S.6 Jam' PageN-of T8 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: 312 Lafayette Street Apt.# City: Salem PORCH A B 0 D (circle one) dg) 2nd fl 3rd fl Ah fl (circle one) <cfir S/De M .3/L iCA�' e77e VCeiling N/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC DELEAD DELEAD E HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH 0 N/A Y Wo' yr Argy SupportClmn [40.0 „) AIM L NIA Y S ardsiq �N/A Y , •„ Newel Post AIM L NIA Y 0.0 L NIA Y Rafting Cap A/M L N/A Y 0.0 L NIA Y Handrail AIM L NIA Y /. L NIA Y Balusters AIM L NIA Y Storm Door /. AIM L NIA Y Lower Rol AIM L NIA Y B Door O. AIM L N/A Y Stair Tread , AIM L N/A Y C Door Casing O• AIM L NIA Y Stair Risers AIM L NIA Y D Door Jamb O•/ A/M L NIA Y Stringer AIM L N/A Y 02 Threshold AIM L N/A Y G Lower Walls AIM ONIA Y w; ,z� „ , em 34 Kickplate 40 ( A/M L NIA Y Lattice 0.0 AIM L NIA Y A Storm Door A/M L NIA Y Lower Trim O.1 AIM L NIA Y B Door AIM L NIA Y Floor 0-2. AIM L NIA Y C Door Casing AIM L NIA Y A B Window Sill A/M L N/A Y D Door Jamb AMM L N/A Y C D Win Casing AIM L N1A Y 12 Threshold A/M L NIA Y 1 2 Window Sash _AIM L N/A Y 34 Kickplate A/M L NIA Y 34 Mullions AIM L N/A Y Window Sill /.0 CD4>N/A Y .57,71,o zew , A B Window Sill AIM L NIA Y C D Win Casing 13.1 40N/A Y r7 ro /RCM r „ra ,eC�- CID Win Casing AMM L NlA Y 1 Window Sash AIM NIA Y ,Q eeM ,,,0 Xf&I 12 Window Sash AIM L NIA Y 34 Mullions AMM L N/A Y 34 Mullions AIM L NIA Y B Window Sill 6UP N/A Y , ,o)Ary ,o A B Window Sill AIM L NIA Y C D Win Casing 7j.3 +��N/A Y ,7 ,D SQA °�. .. C D Win Casing AIM L NIA Y 1�Window Sash 4V AMM L N/A Y z eh 14„ o 1 OR 12 Window Sash AW L NIA Y 3 4 Mullions AIM L N/A Y 34 liTullions A1M L N/A Y 713 Window Sill A/M L N/A Y A B Window Sill AIM L NIA Y C D Win Casing A/M L NIA Y C D Win Casing AIM L N/A Y 12 Window Sash AIM L N/A Y 12 Window Sash AIM L NIAJ Y 34 Mullions AIM L NIA Y 34 Mullions I AIM L N/A Y A B Window Sill AIM L NIA Y A B Window Sill AIM L N/A Y C D Win Casing AMM L NIA Y C D Win Casing AIM L N1A Y 1 2 Window Sash AIM L NIA Y 1 2 Window Sash AIM L N/A Y 34 Mullions A/M L N/A Y 34 Mullions AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 1440$0.IN.) DATE METHOD (MORE THAN 288 SQ.IN.) DATE METHOD KevinNestor 11359 /V � S'/3'O�j Page?�Dr7a Inspector(Print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: 312%Lafavette Street Apt.# City: Salem �/ PORCH A B© D (circle one) �2nd fl 3rd fl 4th fl (circle one) eldWr S/De 7n ✓�/Z �Z AAFA C7/e Veiling NI LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC EAD DELEAD E HAZARD HAZ DATE METH DATE METH SURFACE HAZARD HAV DATE METH DATE METH L NIA Y , �y Support CMn v. AMM L NIA Yards �I L NIA Y Newel Post O. AIM L NIA Y O. L NIA Y Railing Cap O. AIM L N/A Y " , L N/A Y G Handrail ,..0. AIM L N/A Y L NIA Y Balusters O. 1 AIM L NIA Y ® Ston Door /.' AIM L N/A Y Lower RaB C.l AIM L NIA Y B Door gyp. AIM L N/A Y StairTreads, AIM L NIA Y C Door Casing 0. AIM NIA Y Stair Risers O.� AIM L NIA Y D Door Jamb .3 AMM L NIA Y Stinger O.Z. AIM L NIA Y 2 Threshold _O•f AIM L NIA Y lower Walls AIM L NIA Y 3 4 Kickplate AIM L NIA Y Lattice AIM L NIA Y A Storm Door AIM L N/A Y Lower Trim O. AIM L N/A Y B Door AIM L N/A Y Floor O.Z. AIM L NIA Y C Door Casing AIM L N/A Y Window Sill O AIM L NIA Y D Door Jamb AIM L NIA Y C D Win Casing AIM L NIA Y MC 12 Threshold AIM NIA Y 1 2 Window Sash V AIM L NIA Y 3 4 Kickplate AIM L NIA Y 3 4 Mullions V AIM L N/A Y A B Window Sill AIM L N/A Y A B Window Sill AIM L N/A Y C D Win Casing AIM L NIA Y C D Win Casing AIM L NIA Y 12 Window Sash AIM L NIA Y 12 Window Sash AIM L NIA Y 3 4 Mullions AIM L NIA Y 34 Mullions AIM L N/A Y A B Window Sill AIM L NIA Y A B Window Sill AIM L NIA Y C D Win Casing AIM L N/A Y C D Win Casing AIM L N/A Y _ 12 Window Sash AIM L NIA Y 12 Window Sash AIM L NIA Y 3 4 Mullions AIM L NIA Y 34 Mullions AJM L NIA Y A B Window Sill AIM L NIA Y A B Window Sill AM L N/A Y C D Win Casing AMM L NIA Y C D Win Casing AIM L NIA Y 1 2 Window Sash AIM L NIA Y 12 Window Sash AIM L NIA Y 3 4 Mullions AIM L N/A Y 3 4 Mullions AIM L NIALY A B Window Sill AMM L NIA Y A B Window Sill AIM L N/A Y C D Win Casing AIM L NIA Y C D Win Casing AIM L NIA Y 12 Window Sash AIM L NIA Y 12 Window Sash AIM L N/A Y 3 4 Mullions AIM L NIAJ Y I I I 13 4 Mullions AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 1440 S0.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD Kevin Nestor 11359 �wyG Sia-v S Page 7.7 0t 4 Inspector(print) Lic# Signature Date Rsk Assessor (print) Lic# Signature Date Address of Property: 312.312% Lafayette Street Apt.# City: Salem EXTERIOR C Side SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ 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 C)i Y , ,o /°„ n Window Sill AIM L NIA Y Comer Boards 40)NIA Y ,a 1& ofj ' C Win Casing AIM LN/A Y C Lower Trim N/A Y ,r to /17r Aor— # Window Sash AIM L NIA Y Upper Trim NIA Y (G /yf Al/ ,,p Cellar Win SAI &0 NIA Y Win Above 5' (0N/A Y , rJ °„ a JyJ C Cel Win Sash 4&0 N/A Y57,7/&: a-•rn 1+1„/gy o(_ Porch Above 5' L NIA Y S # f Cel Win Frame , Ci N/A Y Stam Door AIM L NIA Y V,71,° P.► w o &Off Screen Frame AIM L NIA Y Door &V L NIA Y , ° „ ja3 in Sill 7 !� NIA © Door Casing `J. *(D N/A Y ,� „ C Sash AIM L N/A Y 1 Door Jamb .a �IL N/A Y ,� n °�ir a #� Frain AIM LSA Y 3 4 Threshold Q. AIM L NIA Y rame AIM m NIA Y Kickplale Q.� AIM L N/A Y in SAI AIM L NIA Y Stomr Door AIM L NIA Y C SashAIM L N/A YDoor AIM L NIA Y # Frem AIM L N/A Y Door Casing f. 0I L N/A Y rame AIM L NIA Y 1 2 Door Jamb /,C L N/A Y P7171jJ Cellar Win Sill AIM L NIA Y 4 Threshold ./ AIM L NIA Y C Tel Win Sash AIM L N/A Y Kickplate AIM L NIA Y # Cel Win Frame AIM L N/A Y Door 0,42, AIM L NIA Y Screen Frame AIM L NIA Y ® Door Casing—0,1 AIM NIA YFoundation Q NIA YV,7/j,: o 1 2 Door Jamb AIM L NIA Y C Bulkhead AIM L N/A Y 3 Threshold AIM L NIA Y Fences G AM L N/A Y Window Sill AIM L NIA Y Shutters AIM L N/A Y C Win Casing AIM L NIA Y Newel Post tO.Z A•M L N/A Y 7V %roo 7- # lWindow Sash A AIM L NIA Y Railing Cap AIM L N/A Y Window Sill AIM L NIA Y Handrail AIM L N/A Y S C 1win Casing AIM L NIA Y C Balusters Q.0 AIM L NIA Y # Window Sash AIM L N/A Y Lower Rail Q. AIM L NIA Y Window Sill AIM L NIA Y Stair Treads AIM L N/A Y C Win Casing AIM L NIA Y Stair Risers AIM L N/A Y # Window Sash AIM L NIA Y Stringer AIM L N/A Y C Lamp Post L N/A Y Porch Floor AIM L NIA Y Drain Pipes 1}.O L N/A Y g 1->0.t.GNCS tco. . bou,GS / t S• C jElec Conduit L N/A Y LtJ007 411vm2 1917— Daati #J? = 41ZQ Oil FAI Pipe /. L N/A Y Ove hang Tnm A M L NIA Y Exc uded Surfaces: Surfaces listed in this box can be made �q/.,/�� AAw&v &Si"T -Soil Test Results intact only by a licensed deleadersW /o /H1� (Must be less than 400 ppm for play area 11200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED C (MORE THAN 1440 SO.IN.) DATE METH (Square Feet) (PPM) DATE METH C Play Area C Bare soil C Comments: C S-/3-0 Fir2 D 57a.Ve FbaW~yATto/V s001ftc S .¢0- v 'e.~f AJi¢CGS - O.S %-I 1011,%o /VDW .N [35.+x!' S/.)/.v /y/3”- y - ,/ /Ly KBVIn Nestor 11359 S—/3—O /`' Pagez6Of Inspector(print) Lic# Signature Date Risk Assessor (print) Lic# Signature Date Address of Property: 312-312'/2 Lafayette Street Apt.# City: Salem EXTERIOR D Side SIDE LOCATION/ LEA TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD D SURFACE HAZARD HAZ? DATE METH DATE METH D SURFACE HAZARD HAZ. DATE METH DATE METH Siding &NIA Y ,O / „ �'Yi Window Sill AIM L WA Y Comer Boards0N/A Y ,7 Q Al.,I. X D Win Casing A/M L NIA Y D Lower Tum 97.4f m NIA Y o • o m Window Sash AIM L NIA Y Upper Trim A4 IDNIA Y ,7 p 01 N�i, oo A4Cellar Win Sill L NIA Y Win Above 5' ONIA D CeI Win SashV AIM L NIA Y ,g N Rept X Porch Above 5' L NIA Y //C It f Cal Win Frame 4F. 4P L N/A Y Storm Door A/M L NIA Y Screen Frame AIM L NIA Y J,� ry ,Z' ��r rojeeol Door A/M L NIA Y Cellar Win Sill QAI L NIA Y 5C& D Door Casing AIM L N/A Y D Gel Win Sash V AIM L N/A Y , to 4/„f„ KX 1 2 Door Jamb A/M L WA Y #y Cel Win Frame &9 L N/A Y , a 54l 3 4 Threshold AIM L NIA Y Screen Frame AIM L N/A Y Kickplate AIM L NIA Y Cellar Win Sill / ® L NIA Y , L to I Reoo .- Storm Door AIM L NIA Y D Cel Win Sash V AIM L N/A Y ,7�ro M �O„ o RC Door A/M L NIA Y ?, CeI Win Frame 9. 4D L N/A Y /am 011,,Iw A D Door Casing AIM L NIA Y Screen Frame AIM L NIA Yy ZeA ' , 1 2 Door Jamb AIM NIA Y Cellar Win Sill ARM L N/A Y 3 4 Threshold AIM L NIA Y D Cal Win Sash AIM L N/A Y _ Kickplate AIM L N/A Y 9 CeI Win Frame AIM L NIA Y Door AIM L NIA Y Screen Frame AlM L NIA Y D Door Casing AIM L NIA Y Foundation L NIA Y 1 2 Door Jamb ARM L N/A Y D Bulkhead AIM L N/A Y 3 4 Threshold AIM L N/A Y Fences A/M L NIA Y Window Sill A/M L NIA Y Shutters / AIM L NIA Y D Win Casing AIM L NIA Y Newel Post _ AIM L NIA Y # lWindow Sash AIM L NIA Y Railing Cap AIM L NIA Y Window Sill AIM L NIA Y Handrail AIM L NIA Y D Win Casing AIM L NIA Y D Balusters AIM L NIA Y # Window Sash AIM N/A Y Lower Rail AIM L NIA Y Window Sill AIM L NIA Y Stair Treads A1M L NIA Y � D Win Casing A/M L NIA Y Stair Risers A/M L N/A V # Window Sash AIM L NIA V Istringer AIM L N/A Y D Lamp Post L WA Y I Porch Floor AIM L WA Y .J a S Drain Pipes 0.0 L NIA Y .9cc wiNaows Arte /Az�ave ��✓�" F�tT, D Elm Conduit L NIA Y ro r )✓m Oil FBI Pipe /' L NIA1 Y Overhang Trim AIM L N/A I Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC Ic LOCATION AREA MEASUREMENT RESULT REMED REMED D (MORE THAN 1440 SO,IN.) DATE METH (Square Feet) (PPM) DATE METH D Play Area D Bare soil D Comments: D Kevin Nestor 11359 _ S=/3-p � Page—or -70 Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Property: 312.312%Lafa ette Street Apt.# Citv: Salem GARAGE / S be C 1eFT r r1VC/n1G Gf�2AGES SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD A SURFACE HAZARD HAZ? DATE METH DATE METH C SURFACE HAZARD HAZ? DATE METH DATE METH Siding O.Z. L NIA Y Siding N/A Y A Comer Boards ,7 NIA Y �Ir ,a My'^ C Comer Boards g. ON/A Y 1,71,0&mr %, o r++S Lower Tdm L NIA Y Lower TdmN/A Y Upper Trim77 LNIA Y ,7 ^,r ,a Upper Tdm �C} QN/A Y ,7 ,� /t'rt « Door, 6 .p AIM L N/A Y Door A/M L NIA Y A Door Casing AIM L NIA Y C Door Casing AIM L N/A Y Door Jamb 0./ AIM L N/A Y Door Jamb AIM L NIA Y Threshold A/M L N/A Y e Threshold AIM L NIA" Y Window Sill N/A Y ,5t,A, Window Sill CDON/A Y A Win Casing N/A Y 17 ra C Win Cas' mN/A Y _ ,7 Win Sash . NIA Y n W 0 Win Sash .4PON/A Y S7r71, A Foundation .,-e L NIA Y C Foundation W4CI L N/A Y 5--4f7-401 0: 'detT�.¢T _ EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC Ic A (MORE THAN 1440 S0.IN.) DATE METHOD C (MORE THAN 1440 SO.IN.) DATE METHOD A C A C A C 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 D SURFACE I HAZARD HAZ? DATE METH DATE METH SidingL NIA Y b iy Anr Siding 9.9 mN/A Y ,7/m jWjrj,01.AQ B Comer Boards L NIA Y qjjW Z�r ra /h� D Comer Boards .9 OWA Y i7 ro 01K -14 Aa II'1 Lower Trim /. L NIA Y Lower Tdm L N/A Y Upper Trim L N/A Y 7 ,p y/y" '`�„ /jp,� Upper Tdm L NIA Yda- Door Q. A/M L NIA Y Door AIM L N/A Y .ABS Door Casing p. AIM L N/A Y D Door Casing L N/A Y - 7/b SCiI A Door Jamb 0.1 AIM L NIA Y Door Jamb L N/A Y r7/b Threshold 00 AIM L NIA Y Threshold /4e AIM L N/A Y LWindow Sill &%15 NIA Y , , /L- Window Sill AIM L N/A Y B Win Casing �b N/A Y , o D Win Casing AIM L N/A YWin Sash N/A Y AWinSash A!Ml NfA Y Foundation L NIA Y I D Foundation L N/A Y S/3-09 6-i1-vq 0 : rnavc'V-14W" z S1aiC/P t SffcD -AGG S a.O EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE!LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT fC IC B (MORE THAN 1440 SO,IN.) DATE METHOD D (MORE THAN 1440 SO.IN.) DATE METHOD B D B D B D 1. ♦ f y Ke%hn Nestor 11359 S—/.3-0�7 Page 70 i10 Inspector(print) Lic# Signature Date Risk Assessor(print) Lida Signature Date Address of Property: 312312%Lafayette Street Apt.# Ci Salem GARAGEo2 5/De C Gi9r 6;rs SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD A SURFACE HAZARD HAZ DATE METH DATE METH C SURFACE HAZARD HAZ. DATE METH DATE METH Siding _0.z L N/A Y _ Siding L N/A Y A Corner Boards / L NIA Y C Comer Boards /. L WA Y Lower Trim L N/A Y Lower Trim /. L WA Y Upper Trim L N/A Y /,� ,� /ICS .b�,r° CM Upper Trim J!.' ON/A Y 4% /CSM Door AIM L NIA Y Door AJM L NA Y A Door Casing AFM L N/A Y C Door Casing AFM L NIA Y Door Jamb AIM L N/A Y Door Jamb AJM L NIA Y Threshold AIM L NIA Y Threshold AIM L N/A Y Window Sill AIM L NIA Y Window Sill AIM L NIA Y A Win Casing A!M L NIA Y C Win CasingIt AJM L NIA Y Win Sash AM1 L NIA Y Win Sash AIM L NIA Y A IFoundation L NIA Y C Foundation I L N/A Y _ EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC A (MORE THAN 1440 SO,IN.) DATE METHOD C (MORE THAN 1440 SO,IN.) DATE METHOD A C A C 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 D SURFACE HAZARD HAZ? DATE METH DATE METH gej Siding —.O. 1 L NIA Y Siding .t L NIA Y —• __ B Corner Boards m L N/A Y D Corner Boards L NIA Y Lower Trim L NIA Y Lower Trim /. L N/A Y Upper Trim mNIA Y w,QlOM ��, Upper Tdm 3.� 4)NIA Y r7 Ciq/O� , Door AIM L N/A Y Dow AIM L NIA Y B Door Casing NM L N/A V D Door Casing A/M L NIA Y Door Jamb AIM L NIA Y Door Jamb Q. AIM L NIA Y p Threshold AIM L N/A Y T*e&" s:/ A/M L NIA Y Auo Window Sill AJM L N/A Y Window Sill A/M L NIA Y g&7VILIA RC B Win Casing AIM L N/A Y D Win Casing A/M L NIA Y Win Sash AIM L N/A Y Win Sash AIM L N/A Y B IFoundation I L NIA Y D Foundation L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC B (MORE THAN 1440 SO.IN.) DATE METHOD D (MORE THAN 1440 SO.IN.) DATE METHOD B D B D B D ,o -/�-/v �s G�,s-�e w.� �.�,aveD /•v .�� �ncery, Kevin Nestor 11359 -7j, /�/ti�,! October 11,2010 Page I OfL snI pector(print) Uc# Signature Date Risk Assessor (print) Lic# Signature Date �_I•r' Address of Property: 312.3121/2 Lafayette Street Apt.# City: Salem BASEMENTILAUNDRY AREA 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 Aa Wall A/M L N/A Y Aa Pipes/&C AIM L NIA Y AB Wall AIM L N/A Y Sink AIM L N/A Y 1XV/10 AB WallsA/M L N/A Y AB Drainpipe AIM L NIA Y AAB Walls AIM L N/A Y n Serviceboard AIM L N/A Y AD C D Baseboards AIM L NIA Y A B Shelves AIM L NIA Y AD CD Chair rails AIM L NIA Y C D Supports AIM L N/A Y Floor AIM L NIA Y A B Shelves AIM L N/A Y Ceiling .py AIM L NIA Y C D Supports AIM L N/A Y ADon Chimney O. AIM L NIA Y A B Shelves AIM L N/A Y Aj CO u5 ppo""°'° lr. AIM L NIA Y j�To C D Supports ArM L N/A Y B Doo r( e, AIM L NIA Y Window Fra 1.0 MP AIM /A Y i Z i r0 /yf C D Door Casing 0.0 AIM L NIA Y A B Window Sash MA AIM NIA Y 714/10 �yr2 Door Jamb 40.0 AIM L N/A Y Exterior Sill N Mil AIM L NIA Y 3 4 Threshold / AIM L NIA Y 2 Part Bead M/I AIM L NIA Y A Doorbs. AIM L N/A Y 34 Win Ext Sash n/ M/I AIM L NIA Y /C�D,, Door Casing 0.0 AIM L NIA Y Window Fram MII AIM L N/A Y 6)2 Door Jamb 0,0AIM L N/A Y AB Window Sash MII AIM L NIA Y 34 Threshold A/M L N/A Y C D Exterior Sill M/I AIM L NA Y A B Door( Q$ 1W, AIM L NIA Y 12 Part Bead MA A/M L NIA Y iqn Door Casing /.0 1ON/A Y �// s'o 34 Win EM Sash M/I AIM L N/A Y 1 Door Jamb 0• AIM L NIA Y Window Frame M/1 A/M L NIA Y 3 4 Threshold 0.1 A/M L NIA Y A B Window Sash M/I AIM L NIA Y AD C D Cabinets AIM L NIA Y C D Exterior Sill M/I AIM L NIA Y A B Benches AIM L NIA Y 12 Part Bead MII AIM L NIA Y C D Supports AIM L NIA Y 34 WEsh M/I AIM L N/A Y A Closet Door AIM L NIA Y Window Frame M/I AIM L NIA Y B CI Casing A/M L N/A Y A B Window Sash 9/1 AIM L NIA Y C Closet Jamb AIM L N/A Y C D Exterior Sill MA AIM L NIA Y D Closet Walls AIM L NIA Y 12 Part Bead Mll AIM L N/A Y Cl Baseboard AIM L NIA Y 34 Win Ext Sash M11 AIM L NIA Y 1 Closet Pole AIM L N/A Y Newel Posts AIM L NIA Y 2 Closet Shelf AIM L N/A Y A B Handrail AIM L NIA Y 3 Cl Supports AIM L NIA Y C D Balusters AiM L NIA Y 4 Closet Floor AIM L NIA Y 12 Lower rail AIM L NIA Y Closet Ceiling AIM L N/A Y jylt 34 Treads AIM L NIA Y /0—//-1O 6Ta�w t/✓t FG`9T "i %, Risers AIM LNiA Y aOf�ftaS vPf¢/itj� �4I►��/�C�n O.S/41.. Bringer AIM L N/Al Y Z•7 6 Oil Tank L N/A I Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT ICIC I I SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ.IN.) DATE METHOD (MORE THAN 288 SQ.IN.) DATE METHOD io-i/-io 77/1r- d�Aser�iC�ivT AP577W 4U,9'5aim/Tc� 7th 7 ".Ci4,y.✓2vL i ,9, 77&- ezoF4e7sJ e4e f.e .47