168 BRIDGE STREET UNIT 1 LEAD INSPECTION REPORT 5-12-2022 Page 1 of
Action Lead Testing 978-503-1765 (office) 732-444-3627(fax)
15 Lincoln Street, # 157 Wakefield, MA 01880 * www.ActionLeadTesting.com
Lead Inspection 1 Risk Assessment
St.# 168 Street Name Bridge Street Type St unit 1
City Salem Zip Code 01970
Number of Rooms in Unit: 5
Owner Name: Kilroy Properties LLC Property Type:
Owner Address: 166 Bridge St, Q. Salem. MA 01970 ❑ Single Family
Contact Information: Maureen Radoncic ❑✓ Multi Family *of Units: 4
Client Name(if different from owner): ❑ Condominium #of Units:
Client Address: ❑ Day Care ❑ Other:
Key Lead Column Key Delead/IC Method Column Key Delead/1C Method Column Laundry in Basement? ❑Yes RINo
COV Covered COV Covered REM Removed Finished Space in Basement?❑Yes ❑✓ No
DC Drop Ceiling DIP Dipped REP Replaced
MET Metal ENC Encapsulated SCR Scraped Possible Pb Water Service Line
MR Metal Rep.Window INT Intact SFR Storm Frame Removed ❑Yes ❑No ✓❑ Not Tested
NA Not Accessible MI Made Intact SLD Sealed Testing Method Used
NC No Coating PRE Prepared for Enc. STP Stripped Na2S Expiration Date: /
Tile Tile(testing suggested) Component Does Not Exist VR/MR Vinyl/Metal Rep Window X-Ray Fluorescence i
VB Vinyl Baseboard VR Vinyl Rep.Window Model: RMD LPA1 Serial# 2871
—.-i
Comments/Notes: ❑ Demarcation Lines
❑ Submitted for Compliance Evaluation
Floor# Property Diagram/Unit Labels
1 (level within building of unit being inspected) FIOOr# C
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I 1 I I I 1 I 1 1 1 1 1 1 1 I
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L__J___L_-J_-_L-- _--A---l--J___ 168 unit 2 166 unit 2
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1 � I
A(Stree Side) Start Here A(Street Side) Start Here
A(Stroet Side)
Pb(lead)equal to or greater than 1.0 mg/cm z with x-ray fluorescence or positive with Na2S 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 ❑✓ ✓- ck off w omplete
www.statc.ma.us%dph/clppp or 800-532-9571 _ J
David Healey 4041 5/ 12 /22
Inspector's Name(print) License# Signature Date
LI/RA-revised 06/17
Address: 168 Bridge St Apt# 1 City Salem Page 2 of
INSPECTION HISTORY INTERIM CONTROL
Determination Visual
Inspector Name: ,Lic# R.A.Name: ,Lic#4041
Y Risk Assessment
N Signature I I F1
M
Signature
Lead Hazards? Urgent Pb.Hazards?
Comprehensive Dust Taken for
Initial Inspection Y Inspector Na :D yid Heale Lic#4041 Risk Assessment Y R.A.Name: ,Lic#
0 511121212 N Signature
Signature Urgent Pb.Hazards?
Lead Hazards?
Visual Portion of P R.A.Name: ,Lic#
Comp Initial Reinspection for
w/Partial PCAD Y Inspector Name:David Healey ,Lick 4041 Interim Control F
Signature
N Signature
---. .Tm
Lead Hazards?
Addendum(add-on Dust Taken for Risk MF
R.A.Name: Lic#
to Initial Ins ection Y Inspector Name: L'IC#4041 Assessment Reins .
Signature
N Signature
Lead Hazards? Visual Portion of
Reinspection for R.A.Name: Lid
Addendum as Full Interim Control P
Inspection Y Inspector Name: Lic#4041
F Signature
N Signature Ll
Lead Hazards? Dust Taken for Risk M
R.A.Name: LIC#Assessment Reins .
Walk Through for Inspector Name: ,LIC# Signature
Ed/Consultation
Signature
Risk Assessment
Recertification FN_
R.A.Name: ,Lic#
REINSPECTION HISTORY _TF
Visual Portion of P Inspector Name: ,Lic# Signature
Reocc.Reinspection Urgent Pb.Hazards?
F Signature
Dust Taken for FT1 I I EF
R.A.Name: Lic#
RA Recertification
Visual Portion of P Inspector Name: Lic# Signature
Reocc.Reins ection g
F Signature
POST COMPLIANCE ASSESSMENT DETERMINATIONS
Dust Taken for P Inspector Name: ,Lic#
Reocc.Reins ection
F Signature PCAD Inspector Name: Lic#
MN
Signature
Dust Taken for P Inspector Name: .LIC# Lead Hazards?
Reocc.Reinspection
F Signature
Full Inspection
Acting as PCAD MN
Inspector Name: Lic#4041
Visual Portion of Inspector Name: Lic# Signature
Final Reinspection
F Signature
Lead Hazards?
Visual Portion of P Inspector Name: Lic#
Visual Portion of Inspector Name: ,LIc# PCAD Reinspection
Final Reins ection
F Signature
EF
Signature e
Dust Taken for Final P Inspector Name: Lic# Dust Taken for P Inspector Name: Lic#
#
p PCAD Reinspection
Reins .(No Reocc F Signature
F Signature
Dust Taken for Inspector Name: ,Lic#
Dust Taken for Final P Inspector Name: .LIC# PCAD Reinspection P
Reins o Reocc F Signature
rFj Signature
History rev 6/17
Address: 168 Bridge St Apt# 1 City Salem Page 3 of
REOCCUPANCY CERTIFICATE HISTORY COMPLIANCE HISTORY(CONT.)
Certificate of Certificate of
Reoccupancy Maintained
Inspector Name: ,Lic# Compliance
Inspector Name: ,Lic#
Only after Signature Signature
I ligh/Mod Risk No Work=No Dust
#rooms rule Work=7 Dust
Certificate of Certificate of
Reoccupancy Restored
Inspector Name: ,Lic# Com liance Inspector Name: Lic#__
Only after Signature I I I I I Signature
High/Mod Risk Dust wipes and auth.
#rooms rule people
Certificate of
Certificate
Reoccu anc of
Inspector Name: Lic# Maintained Inspector Name: Lic#
Compliance
Only after Signature I I I I Signature
High/Mod Risk
# No Work=No Dust
rooms rule
Work—7 Dust
COMPLIANCE HISTORY
Certificate of
Letter of Full Initial Restored
Compliance Inspector Name:David Healey .Lick 4041 Compliance
Inspector Name: Lic#
Signature ITT Signature
No prior history/ Dust wipes and auth.
No signs of UD people
Letter of Interim OTHER HISTORY:WAIVERS/CTD
Control-H Inspector Name: .Lic# Approved
CLPPP Waiver Inspector Name: Lic#
No prior Comp. Signature
Expires in 1 r. Attach to Comp Signature
Does
Recertification of
Interim Control Inspector Name: Lic# Approved
CLPPP Waiver Inspector Name: .Lic#
Expires 2 yrs from Signature I I F7 Signature
original Interim Attach to Comp g
Control Does
Letter of Full
Deleading Inspector Name: David Healey .Lic# 4041 UD/DES Visual
Com liance Reins ection P Inspector Name: .LIC#
Signature I I F Signature
Dust wipes if No No LOC Issued
Reocc.
Certificate of UD/DES Dust
Maintained Taken III [qF
Inspector Name: .Lic#
Com liance Inspector Name: ,Lic# -T I Signature
Signature No LOC Issued
No Work=No Dust
Work=7 Dust
UD/DES Dust
Taken PP Inspector Name: Lic#
Certificate of
-T-TT
Restored F Signature
Com liance Inspector Name: Lic#
No LOC Issued
Signature
Dust wipes and auth. UD/DES Final
people Rcins cction P Inspector Name: LIC#
F Signature
No LOC Issued
History rev 6/17
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 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.The inspector must assume the surface contains lead
and require it to be deleaded.Speak to the inspector about possible alternative testing options.
• "MET"or"MR"means that a metal surface was not tested.Metal handrails,metal window sills,and metal
railing caps need to be deleaded if they test equal to or greater than 1.0 mg/cm2,or are marked"MET"or
"N/A".All other metal surfaces must be intact.
• For key to abbreviations like"COV","VB","VR"or"MR","NC","Tile","DC",see the cover page.
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 part of a window 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.
• "F"circled means that the surface is a"friction"surface and must be deleaded at all points of potential friction.
• "L"circled means that the surface is loose and must,at a minimum,be made intact.Loose leaded floors must be
sealed with paint or similar coating and pass a dust wipe.
• If more than one choice is circled,the rules for deleading may change depending upon what method of
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 completed during a risk assessment,which is an evaluation of a home's suitability for Interim
Control. Only a licensed risk assessor can do a risk assessment. If"Y"is circled,then this surface is considered
an"Urgent Lead Hazard"and deleading is required to qualify for Interim Control.
IC DATE The date the licensed risk assessor determines the surface meets the standards for Interim 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 DATE The date that the lead inspector reinspects the surface and finds that it is in compliance.
DELEAD METH The method used to bring a surface into full compliance.Refer to codes in the Key on the report's cover page.
EXCLUDED The amount of loose paint on a surface as measured by the lead inspector."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.
RULED OUT Encapsulants only work well if the paint is in good condition. If the inspector sees that there
BOX are adhesion problems with eligible surfaces in a room,he/she will rule out encapsulation as a deleading method.
LIRA Exp.2017
David Healey 4041 '�"° 5/ 12/ 22 Page b OA-
Inspector(print) Lic# Signature Date
David Healey 4041
Risk Assessor(print) Lic# Signature Date
Address of Pr ert : 168 Bridge St Apt.# 1 city: Salem
ROOM#
SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH
A B Up Walls L N/A Y Window Sill M/I A/M L N/A Y
A B Low Walls L N/A Y B Win Apron L N/A Y
A B Baseboards L N/A Y C Win Casing 1 L NIA Y
A B Chair Rail L N/A Y D Header Stop M/I L NIA Y
A B Radiator L N/A Y Int Stops M/I L N/A Y
Floor L Q(dust) N/A Y 1 Win Int Sash M/I L N/A Y
Ceiling L N/A Y 2 Exterior Sill M/I SF L N/A Y
A B Door L N/A Y 3 Part Bead M/I L N/A Y
Door Edge F L N/A Y 4 Blind Stop 00 M/I SF L N/A Y
1 Door Casing L N/A Y lWin Ext Sash M/I L N/A Y
3 4 Door Jamb F L N/A Y Window Sill M/I AIM L N/A Y
Threshold L N/A Y 6B7n Apron L N/A Y
A B Door L N/A Y C Win Casing L N/A Y
C Door Edge F L N/A Y D Header Stop M/I L N/A Y
2 oor Casing L N/A Y Int Stops M/I L N/A Y
3 Door Jamb L N/A Y 1 Win Int Sash M/I L N/A Y
Threshold L N/A Y 2 Exterior Sill M/I SF L N/A Y
A B Door L N/A Y 3 Part Bead M/I L N/A Y
D oor Edge L N/A Y 4 Blind Stop M/I SF L N/A Y
1 Door Casing ) L N/A Y Win Ext Sash M/1 L N/A Y
r
3 4 Door Jamb F L N/A Y A Window Sill M/I AIM L N/A Y i
—a
Threshold L N/A Y B Win Apron L N/A Y
Closet Door L N/A Y C Win Casing L N/A Y
A CI Door Edge F L N/A Y D Header Stop M/I L N/A Y
CI Casing L N/A Y Int Stops M/I L N/A Y !
Y
C Closet Jamb F L NIA Y 1 Win Int Sash M/I L N/A Y
Closet Walls L N/A Y 2 Exterior Sill M/I SF L NIA Y
CI Baseboard L N/A Y 3 Part Bead M/I L N/A Y
ft
1 Closet Pole L NIA Y 4 Blind Stop M/1 SF L N/A Y
2 Closet Shelf L N/A Y Win Ext Sash M/I L N/A Y
3 CI Supports L N/A Y A B Fireplace L N/A Y
4 Closet Floor L❑(dust) N/A Y L
Mantle L NIA Y
Closet Ceiling L N/A Y Win Above 5' L N/A Y
COMMENTS/STRUCTURAL DEFECTS: Ceiling Moldin L N/A Y
F M/I AIM L NIA Y
r
F M/1 AIM L NIA Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/1 AIM L NIA Y
by a Deleader(MORE THAN 288 SQ.IN.) F M/I AIM L N/A Y
IC IC F M/1 AIM L N/A Y
SIDE LOCATION MEASURE:LOOSE PAINT DATE METHOD F M/1 AIM L NIA Y
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more AIM surfaces wit"adhesion problems
LI/RA Rep 2017 Room
David Healey 4041 � -_J 5/ 12/ 22 Page�—Of-kl
Inspector(print) Lic# Signature Date
David Healey 4041 I I
Risk Assessor(print) Lic# Signature Date
Address of Pr ert : 168 Bridge St Apt.# 1 city: Salem
ROOM# 07,
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 L N/A Y A Window Sill M/I CA/9 L N/A Y
A B Low Walls L N/A Y Win Apron L N/A Y
Q Q 0
A 8 Baseboards L N/A Y C Win Casing L N/A Y
c D 6 -
A B Chair Rail L N/A Y D Header Stop M/I L N/A Y
A8
Radiator L N/A Y Int Stops M/I L N/A Y
Floor L❑(dust) N/A Y Win Int Sash M/I L N/A Y
Ceiling L N/A Y Exterior Sill M/I SF L N/A Y
Door L N/A Y 3 Part Bead M/I L NIA Y
C D Door Edge F L N/A Y 4 Blind Stop M/I SF L N/A Y
1 Door Casing 1 . L N/A Y Win Ext Sash WI L N/A Y
34 Door Jamb F L N/A Y Window Sill M/1 A/ L N/A Y
Threshold L N/A Y Win Apron 1. L NIA Y
Door L N/A Y Win Casing L N/A Y
C D Door Edge F L N/A Y D Header Stop M/I L N/A Y
2 Door Casing L N/A Y Int Stops M/I L NIA Y
34 Door Jamb L N/A Y Win Int Sash M/I L N/A Y
Threshold L N/A Y Exterior Sill M/I SF L NIA Y
A B Door L N/A Y 3 Part Bead M/I L N/A Y
Door Edge F L N/A Y 4 Blind Stop M/I SF L NIA Y
12 Door Casing L N/A Y Win Ext Sash M/I L NIA Y
3 4 Door Jamb F L N/A Y A Window Sill M/I A/M L NIA Y
Threshold L N/A Y B Win Apron L N/A Y
Closet Door L N/A Y C Win Casing L N/A Y
Cl Door Edge F L N/A Y D Header Stop M/I L N/A Y
B Cl Casing L N/A Y Int Stops M/I L N/A Y
C Closet Jamb F L N/A Y 1 Win Int Sash M/I L N/A Y
D Closet Walls L N/A Y 2 Exterior Sill M/I SF L N/A Y
Cl Baseboard L N/A Y 3 Part Bead M/l L N/A Y
1 Closet Pole L N/A Y 4 Blind Stop M/I SF L N/A Y
2 Closet Shelf VY L N/A Y Win Ext Sash M/I L N/A Y
3 Cl Supports L N/A Y k Ph Fireplace L N/A Y
4 Closet Floor L❑(dust) N/A Y C D Mantle L N/A Y
AB
Closet Ceiling L N/A Y CD Win Above 5' L N/A Y
COMMENTS/STRUCTURAL DEFECTS: Ceiling Molding L N/A Y
F M/I A/M L N/A Y
F M11 A/M L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M11 A/M L N/A Y
by a Deleader(MORE THAN 288 SQ,IN.) F M/I A/M L N/A Y
IC IC F M/I A/M L N/A Y
SIDE LOCATION MEASURE:LOOSE PAINT DATE METHOD F M11 A/M L N/A Y
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more AIM surfaces with adhesion problems
TA/RA Rep 2017 Room
David Healey 4041 '�"°� 5/ 12/ 22 Page 7 OfV
Inspector(print) Lic# Signature � Date
David Healey 4041 7
Risk Assessor(print) Lic# Signature Date
Address of Pr ert : 168 Bridge St Apt.# 1 city: Salem
ROOM#
SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH
A B Up Walls L N/A Y A Window Sill M/I A/M L N/A Y
A B Low Walls L N/A Y B Win Apron L N/A Y
A B Baseboards L N/A Y C Win Casing L N/A Y
A B Chair Rail L N/A Y D Header Stop M/1 L N/A Y
A BCD Radiator L N/A Y Int Stops M/1 L N/A Y
Floor L❑(dust) N/A Y 1 Win Int Sash M/I L N/A Y
Ceiling L N/A Y 2 Exterior Sill M/I SF L N/A Y
A B Door L NIA Y 3 Part Bead M/I L NIA Y
oor Edge F L N/A Y 4 Blind Stop M/1 SF L N/A Y
1 Door Casing /A Y Win Ext Sash M/I L N/A Y
34 Door Jamb F /A Y A Window Sill M/I A/M L N/A Y
Threshold L N/A Y B Win Apron L N/A Y
A B Door L N/A Y C Win Casing L NIA Y
C D Door Edge F L N/A Y D Header Stop M/1 L N/A Y
12 Door Casing L N/A Y Int Stops M/I L N/A Y
34 Door Jamb F L N/A Y 1 Win Int Sash M/I L N/A Y
Threshold L N/A Y 2 Exterior Sill M/I SF L N/A Y
A B Door L N/A Y 3 Part Bead M/I L N/A Y
C D Door Edge F L N/A Y 4 Blind Stop M/1 SF L N/A Y
12 Door Casing L N/A Y Win Ext Sash M/1 L N/A Y
3 4 Door Jamb F L N/A Y A Window Sill M/I A/M L N/A Y
Threshold L N/A Y B Win Apron L N/A Y
Closet Door L N/A Y C Win Casing L N/A Y
A Cl Door Edge F L N/A Y D Header Stop M/I L NIA Y
B Cl Casing L N/A Y Int Stops M/I L N/A Y
C Closet Jamb F L N/A Y 1 Win Int Sash M/I L N/A Y
D Closet Walls L N/A Y 2 Exterior Sill M/I SF L N/A Y
Cl Baseboard L N/A Y 3 Part Bead WI L N/A Y
L
1 Closet Pole L N/A Y 4 Blind Stop M/I SF L N/A Y
2 Closet Shelf L N/A Y Win Ext Sash WI L N/A Y
3 Cl Supports L N/A Y A B Fireplace L NIA I Y
4 Closet Floor L❑(dust) NIA Y C D Mantle L N/A Y
AB
Closet Ceiling L N/A Y CD Win Above 5' L N/A Y
COMMENTS/STR TURAL DEFECTS: Ceiling Moldin L N/A Y
F M/I A/M L N/A Y
F M11 A/M L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/I A/M L N/A Y
by a Deleader(MORE THAN 288 SQ.IN.) F M/I A/M L N/A Y
SIDE LOCATION MEASURE:LOOSE PAINT IC IC F M/I A/M L N/A Y
DATE METHOD F M/I A/M L N/A Y
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more A/M surfaces with adhesion problems
LI/RA Rep 2017 Room
David Healey 4041 .d ,, S/ 12/ 22 Page-&of
Inspector(print) Lic# Signature � Date
David Healey 4041
Risk Assessor(print) Lic# Signature Date
Address of Pr ert : 168 Bridge St Apt.# 1 city: Salem
ROOM#
SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH
A B Up Walls L N/A Y A Window Sill i M/I A/ L N/A Y
A B Low Walls L N/A Y B Win Apron L N/A Y
A B Baseboards L N/A Y C Win Casing t L N/A Y
A B Chair Rail OF L N/A Y D Header Stop M/I L NIA Y
A o Radiator L N/A Y Int Stops M/I L N/A Y
Floor L[](dust) N/A Y Win Int Sash M/I L N/A Y
Ceiling L N/A Y Exterior Sill M/I 5F L NIA Y
A Door r L N/A Y 3 Part Bead M/I L N/A Y
C D-Door Edge F L NIA Y 4 Blind Stop M/I SF L NIA Y
1 2 Door Casing L N/A Y Win Ext Sash NV.M/l L N/A Y
34 Door Jamb F L N/A Y A Window Sill M/I AIM L N/A Y
Threshold L N/A Y B Win Apron L N/A Y
oor L N/A Y C Win Casing L N/A Y
C Door Edge F L N/A Y D Header Stop NVI L N/A Y
12 Door Casing L N/A Y Int Stops M/I L N/A Y
3 4 Door Jamb F L N/A Y 1 Win Int Sash M/I L N/A Y
Threshold L N/A Y 2 Exterior Sill M/I SF L N/A Y
A B Door L N/A Y 3 Part Bead M/I L N/A Y
C D Door Edge F L N/A Y 4 Blind Stop M/I SF L N/A Y
12 Door Casing L N/A Y Win Ext Sash M/I L N/A Y
3 4 Door Jamc F L N/A Y A Window Sill M/I Ar N/A Y
Threshold L NIA Y B Win Apron L N/A Y
Closet Door L NIA Y C Win Casing L N/A Y
Cl Door Edge F L N/A Y Header Stop M/I L N/A Y
B Cl Casing L NIA Y Int Stops M/I L N/A Y
Closet Jamb F L NIA Y 1 Win Int Sash M/I L NIA Y
D Closet Walls L N/A Y Exterior Sill M/I SF L N/A Y
Cl Baseboard L NIA Y Part Bead M/I L N/A Y
1 Closet Pole L NIA Y 4 Blind Stop M/l SF L N/A Y
2 Closet Shelf L N/A Y Win Ext Sash M/I L N/A Y
3 Cl Supports L N/A Y A B Fireplace L N/A Y
4 Closet Floor L[](dust) N/A Y C D Mantle L N/A Y
AB
Closet Ceiling L N/A"Y c o Win Above 5' L N/A Y
COMMENTS/STRUCTURAL DEFECTS: Ceiling Moldin L N/A Y
F M/I A/M L N/A Y
F MII A/M L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/1 A/M L NIA Y
by a Deleader(MORE THAN 288 SQ.IN.) F M/1 A/M L N/A Y
SIDE LOCATION MEASURE:LOOSE PAINT IC IC F M/1 A/M L N/A Y
DATE METHOD F M/l AIM L N/A Y
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more A/M surfaces with adhesion problems
LI/R.A Rep 2017 Room
David Healey 4041 5/ 12/ 22 Pageq—Of
Inspector(print) Lic# Signature Date
David Healey 4041 7
Risk Assessor(print) Lic# Signature Date
Address of Property: 168 Bridge St Ant.# 1 City: Salem
KITCHEN
SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZAR HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH
A B Up Walls T L /A Y" A Window Sill M/1 AIM L N/A Y
SLL
A B Low Walls L NIA Y Win Apron L N/A Y
A B Baseboards L N/A Y C Win Casing L N/A Y
A B Chair Rail L N/A Y D Header Stop M/I L N/A Y
AB
CD Radiator L N/A Y Int Stops M/I L N/A Y
Floor L[:](dust) N/A Y 1 Win Int Sash M/I L NIA Y
It: Ceiling L N/A Y 2 Exterior Sill M/I SF L N/A Y
A Door L N/A Y 3 Part Bead M/I L N/A Y
D Door Edge F L N/A Y 4 Blind Stop M/1 SF L NIA Y
1 Door Casing L N/A Y Win Ext Sash M/1 L N/A Y
3 4 Door Jamb F L N/A Y A Window Sill M/1 AIM L N/A Y
Threshold L N/A Y B Win Apron L NIA Y
A Door L NIA Y q;Win Casing L N/A Y
D oor Edge F L N/A Y Header Stop M/I L N/A Y
2 oor Casing L N/A Y Int Stops M/I L NIA Y
3 4 Door Jamb F L N/A Y 1 Win Int Sash M/I L N/A Y
Threshold L N/A Y 2 Exterior Sill M/I SF L N/A Y
Q B Door i. NIA Y 3 Part Bead M/I L N/A Y
Door Edge F L NIA Y 4 Blind Stop M/I SF L N/A Y
1 2 Door Casing L N/A Y Win Ext Sash M/1 L N/A Y
3 4 Door Jamb F L N/A Y B Up Cab Frame L N/A Y
Threshold L N/A Y C Up Cab Door L N/A Y
Closet Door L N/A Y Up Cab Walls L /A Y
A C1 Door Edge F L N/A Y 12 Up Cab Shlvs L N/A Y
kClosetShelf
L N/A Y 3 4 Supports L NIA Y
C b F L N/A Y Low Cab Fram L N/A Y
D Closetlls L NIA Y Low Cab Door 0 L NIA Y
Clard L NIA Y C Low Cab Walls L NIA Y
1 le L N/A Y Low Cab Shlvs L N/A Y
2 L N/A Y 12 Supports L N/A Y
3 L N/A Y 3 4 Drawers L N/A Y
4 L❑(dust) N/A Y CDWin Above 5' 00 L N/A Y
L N/A Y Ceiling Moldin L N/A Y
it
COMM N, //ST UCTURAL DEFECTS: F M/I AIM L N/A Y
. 1 F M/1 AIM L N/A Y
F M/1 AIM L NIA Y
F MA AIM L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/I AIM L N/A Y
by a Deleader(MORE THAN 288 SQ.IN.) F M/I AIM L N/A Y
SIDE LOCATION MEASURE:LOOSE PAINT IC IC F M/I AIM L NIA Y
DATE METHOD F M/I AIM L N/A Y
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more AIM surfaces with adhesion problems
1,1/RA Rep 2017 Kitchen
David Healey 4041 '�`" 5/ 12/ 22 Page-IQ Of
Inspector(print) Lic# Signature Date
David Healey 4041
Risk Assessor(print) Lic# Signature Date
Address of Property: 168 Bridge St AM.# 1 city: Salem
KITCHEN
SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD
SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH
A D Up Walls L N/A Y A Window Sill M/I A/M L N/A Y
A B tChair
Walls OF L N/A Y B Win Apron L NIA Y
A B
boards L N/A Y C Win Casing L NIA Y
A B Rail L N/A Y D Header Stop M/I L N/A Y
AB
CD Radiator L N/A Y Int Stops M/I L N/A Y
„:Floor L (dust) N/A Y 1 Win Int Sash M/1 L N/A Y
Ceiling L N/A Y 2 Exterior Sill M/I SF L NIA Y
A B Door L N/A Y 3 Part Bead M/I L NIA Y
D boorEdge F L N/A Y 4 Blind Stop M/I SF L NIA Y
12 Door Casing L N/A Y Win Ext Sash M/I L N/A Y
3 4 Door Jamb F L N/A Y A Window Sill M/I A/M L N/A Y
Threshold L N/A Y B Win Apron L N/A Y
A B Door L N/A Y C Win Casing L N/A Y
C D Door Edge F L N/A Y D Header Stop M/I L N/A Y
12 Door Casing L N/A Y Int Stops M/I L N/A Y
3 4 Door Jamb F L N/A Y 1 Win Int Sash I WI L N/A Y
Threshold L N/A Y 2 Exterior Sill M/I SF L N/A Y
A B Door L N/A Y 3 Part Bead M/I L N/A Y
C D Door Edge F L N/A Y 4 Blind Stop M/I SF L N/A Y
12 Door Casing L NIA Y Win Ext Sash M/1 L N/A Y
34 Door Jamb F L NIA Y AB Up Cab Frame L N/A Y
Threshold L N/A Y C D Up Cab Door L N/A Y
Closet Door L N/A Y Up Cab Walls L N/A Y
A Cl Door Edge F L N/A Y 12 Up Cab Shlvs L N/A Y
B Cl Casing L N/A Y 34 Supports L N/A Y
C Closet Jamb F L NIA Y Low Cab Fram L N/A Y
D Closet Walls L N/A Y A B Low Cab Door L N/A Y
Cl Baseboard L NIA Y C D Low Cab Wall L N/A Y
1 Closet Pole L NIA Y Low Cab Shlvs L N/A Y
2 Closet Shelf L N/A Y 1 2 Supports L N/A Y
3 Cl Supports L N/A Y 34 Drawers L N/A Y
4 Closet Floor L❑(dust) N/A Y A B Win Above 5' L N/A Y
Closet Ceiling L N/A Y Ceiling Moldin L N/A Y
COMMENTS/STRUCTURAL DEFECTS: F M/I A/M L N/A Y
F M/I A/M L N/A Y
F M/I A/M L N/A Y
F M11 A/M L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/1 A/M L N/A Y
by a Deleader(MORE THAN 288 SQ.IN.) F M/1 A/M L NIA Y
SIDE LOCATION MEASURE:LOOSE PAINT IC IC F M/1 A/M L N/A Y
DATE METHOD F M/1 A/M L N/A Y
Check the box if this ROOM is RULED OUT for encapsulation
EJ because there are 3 or more A/M surfaces with adhesion problems
LI/RA Rep 2017 Kitchen
David Healey 4041 -J 5 / 12 /22 Page 4 Of
Inspector(print) Lic# Signature ,/4,� Date
David Healey 4041
Risk Assessor (print) Lic# Signature Date
Address of Property: 168 Bridge St Apt.# 1 City: Salem
BATHROOM#
k
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
p Walls L N/A Y A B Up Cab Frame L NIA Y
A B Low Walls L N/A Y C D Up Cab Door L N/A Y
A B Baseboards L N/A Y Up Cab Walls L N/A Y
A B Chair Rail L N/A Y 12 Up Cab Shlvs L N/A Y
AB
CD Radiator L N/A Y 34 Supports L N/A Y
RDDoor
or L (dust) N/A Y • Low Cab Fram L N/A Y
ling L N/A Y AB Low Cab Door L NIA Y
or L N/A Y C D Low Cab Walls L N/A Y
Edge F L N/A Y Low Cab Shlvs L N/A Y
12 Door Casing L N/A Y 12 Supports L N/A Y
34 Door Jamb F L NIA Y 34 Drawers 7L L N/A Y
Threshold L N/A Y A Window Sill M/I A/M L N/A Y
A B Door L N/A Y B Win Apron L N/A Y
C D Door Edge F L N/A Y C Win Casing L N/A Y
12 Door Casing L N/A Y D Header Stop M/1 L N/A Y
3 4 Door Jamb F L N/A Y Int Stops M/I L N/A Y
Threshold L N/A Y 1 Win Int Sash M/1 L N/A Y
A B Door L N/A Y 2 Exterior Sill M/I SF L N/A Y
C D Door Edge F L N/A Y 3 Part Bead M/I L N/A Y
12 Door Casing L N/A Y 4 Blind Stop M/I SF L N/A Y
3 4 Door Jamb F L N/A Y Win Ext Sash M/I L N/A Y
A
Threshold L N/A Y C b
A Win Above 5' L NA Y
Closet Door L NIA Y Ceiling Moldin L NA Y
A Cl Door Edge F L N/A Y Medicine Cab L NA Y
B Cl Casing L N/A Y F M/I A/M L N/A Y
C Closet Jamb F L N/A Y F M/1 A/M L NIA Y
D Closet Walls L N/A Y F M/I A/M L N/A Y
Cl Baseboard L N/A Y F M/l A/M L N/A Y
1 Closet Pole L N/A Y F M/I A/M L N/A Y
2 Closet Shelf L N/A Y F M/I A/M L N/A Y
3 Cl Supports L N/A Y F M/I A/M L N/A Y
4 Closet Floor L❑(dust) NIA Y F M/1 A/M L N/A Y
Closet Ceiling WL L N/A Y F M/1 AIM L N/A Y
F M/I A/M L N/A Y F Mll A/M L N/A Y
F M/1 A/M L N/A Y F M11 A/M L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS/STRUCTURAL DEFECTS:
by a Deleader(MORE THAN 288 SQ.IN.)
IC IC
SIDE LOCATION MEASURE:LOOSE PAINT
DATE METHOD
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more A/M surfaces with adhesion problems
LI/RA Rep 2017 Bath
David Healey 4041 5/ 12 / 22 Pagewofz
Inspector(print) Lic# Signature Date
David Healey 4041
Risk Assessor(print) Lic# Signature Date
Address of Pro 168 Bridge St Apt.# 1 city: Salem
HALLWA nterior 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 Up Walls L N/A Y Closet Door L N/A Y
A B Low Walls L N/A Y A Cl Door Edge F L N/A Y
A B Baseboards L N/A Y B a Casing L N/A Y
A B Chair Rail L N/A Y C Closet Jamb F L N/A Y
AB
Radiator L N/A Y D Closet Walls L N/A Y
o Floor L[](dust) N/A Y Cl Baseboard L N/A Y
Ceiling L N/A Y 1 Closet Pole L N/A Y
A Door L N/A Y 2 Closet Shelf L N/A Y
D Door Edge F L N/A Y 3 Cl Supports L N/A Y
12 Door Casing L N/A Y 4 Closet Floor L (dust) N/A Y
3 4 Door Jamb F L N/A Y Closet Ceiling L N/A Y
Threshold L N/A Y A Window Sill M/l A/M L N/A Y
Alloor L N/A Y B Win Apron L N/A Y
C D Door Edge F L N/A Y C Win Casing L N/A Y
12 Door Casing L N/A Y D Header Stop M/I L N/A Y
3 4 Door Jamb F L N/A Y Int Stops M/I L N/A Y
Threshold L N/A Y 1 Win Int Sash M/I L N/A Y
A B Door L N/A Y 2 Exterior Sill M/I SF L N/A Y
C Door Edge F L N/A Y 3 Part Bead M/I L NIA Y
1 2 Door Casing L N/A Y 4 Blind Stop M/I SF L N/A Y
3 4 Door Jamb F L N/A Y Win Ext Sash M/I L N/A Y
Threshold L N/A Y A Window Sill MA A/M L N/A Y
1A oor L N/A Y B Win Apron L N/A Y
D oor Edge F L N/A Y C Win Casing L N/A Y
1 Door Casing L N/A Y D Header Stop M/I L NIA Y
34 Door Jamb F L N/A Y Int Stops M/I L N/A Y
Closet Door L N/A Y 1 Win Int Sash M/1 L N/A Y
A Cl Door Edge F L N/A Y 2 Exterior Sill M/1 SF L N/A Y
B CI Casing L N/A Y 3 Part Bead M/I L N/A Y
C Closet Jamb F L N/A Y 4 Blind Stop M/I SF L N/A Y
D Closet Walls L N/A Y Win Ext Sash Mil L N/A Y
AB
CI Baseboard L N/A Y CD Win Above 5' L N/A Y
1 Closet Pole L N/A Y Ceiling Moldin L N/A Y
2 Closet Shelf L NIA Y F M/I A/M L N/A Y
3 Cl Supports L N/A Y F M/I A/M L N/A Y
4 Closet Floor L❑(dust) N/A Y F M/l A/M L N/A Y
Closet Ceiling L N/A Y COMMENTS/STRUCTURAL DEFECTS:
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact
by a Deleader(MORE THAN 288 SQ.IN.)
SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD
❑ Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more A/M surfaces with adhesion problems
Ll/RA Rep 2017 Hall
David Healey 4041 � j 5 / 12 / 22 Page 15Of
Inspector(print) Lic# Signature Date
David Healey 4041 '�`° �
Risk Assessor(print) Lic# Signature Date
Address of Pro ert : 168 Bridge St Apt.# 1 city: Salem
STAIRCASE# Common
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 o Up Walls L N/A Y A Window Sill M/I AIM L N/A Y
A B Low Walls L N/A Y B Win Apron L N/A Y
A B Baseboards L N/A Y Win Casing L N/A Y
A B Chair Rail L N/A Y D Header Stop WI L N/A Y
AB
CD Radiator L NIA Y Int Stops Mil L N/A Y
3 x, Floor L Q(dust) N/A Y 1 Win Int Sash WI L N/A Y
Ceiling L N/A Y 2 Exterior Sill M/I SF L N/A Y
A Door L N/A Y 3 Part Bead wl L N/A Y
D Door Edge F L NIA Y 4 Blind Stop MII SF L N/A Y
Door Casing L NIA Y Win Ext Sash M/I L N/A Y
4 Door Jamb F L N/A Y A Window Sill WI AIM L N/A Y
Threshold L N/A Y B Win Apron L N/A Y
FA'bDoor L N/A Y C Win Casing L NIA Y
D Door Edge F L N/A Y D Header Stop M/I L N/A Y
2 oor Casing L N/A Y Int Stops M/I L N/A Y
3 4 Door Jamb F L N/A Y 1 Win Int Sash M/I L N/A Y
Threshold L N/A Y 2 Exterior Sill M/I SF L N/A Y
Door L N/A Y 3 Part Bead M/l L N/A Y
C D Door Edge F L N/A Y 4 Blind Stop M/I SF L NIA Y
12 Door Casing L N/A Y Win Ext Sash M/I L N/A Y
3 4 Door Jamb Ift F L N/A Y Newel Post L N/A Y
y,
Threshold L N/A Y Railing Cap AIM L N/A Y
B Door L N/A Y .r;::.Handrail AIM L N/A Y
C Door Edge F L NIA Y Balusters L N/A Y
1 Door Casing L / Y Lower rail L NIA Y
4 Door Jamb F L /A Y Treads F L N/A Y
Closet Door L N/A Y Risers L N/A Y
A Cl Door Edge F L NIA Y Stringer L N/A Y
B Cl Casing L N/A Y Tread edge>5 L N/A Y
Closet Jamb F L N/A Y Landing floor L ❑(dust) N/A Y
Closet Walls L N/A Y Floor Edge L N/A Y
Cl Baseboard L N/A Y Floor Casing L N/A Y
rzi
Closet Pole L N/A Y F M/1 AIM L NIA Y
2 Closet Shelf L N/A Y F M/1 AIM L NIA Y
Cl Supports L N/A Y F M/1 AIM L N/A Y
4 Closet Floor L❑(dust) N/A Y F M/I AIM L N/A Y
Closet Ceiling 1,00oi L N/A Y F M/I AIM L NIA Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS/STRUCTURAL DEFECTS:
by a Deleader(MORE THAN 288 SQ.IN.)
IC IC
SIDE LOCATION MEASURE:LOOSE PAINT DATE METHOD
Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more AIM surfaces with adhesion problems
LI/RA Rep 2017 Stair
David Healey 4041 t•��/ ' 5 / 12 / 22 Page aOf
Inspector(print) Lic# Signature Date
David Healey 4041
Risk Assessor(print) Lic# Signature Date
Address of Pro ert : 168 Brid q a St Apt.# 1 city: Salem
STAIRCASE# Common
P
ATION/ 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 SURFACE HAZARD HAZ? DATE METH DATE METH
alls L N/A Y A Window Sill ' M/1 AIM L N/A Y
A B Low Walls L N/A Y B Win Apron L N/A Y
A B
Baseboards L N/A Y C Win Casing L N/A Y
A B Chair Rail L N/A Y D Header Stop , M/I L N/A Y
JICRad
ator L N/A Y Int Stops M/I L N/A Y
r L[:](dust) N/A Y 1 Win Int Sash M/I L N/A Y
ng L N/A Y 2 Exterior Sill M/1 SF L N/A Y
rL N/A Y 3 Part Bead M/I L N/A Y
r Edge F L N/A Y 4 Blind Stop M/I SF L N/A Y
r Casing L N/A Y Win Ext Sash M/l L N/A Y
34 Door Jamb F L N/A Y Window Sill M/I A/M L NIA Y
Threshold L N/A Y B Win Apron L N/A Y
FA Door L N/A Y C Win Casing L N/A Y
D Door Edge F L N/A Y D Header Stop M/I L N/A Y
2 Door Casing L N/A Y Int Stops M/I L N/A Y
34 Door Jamb F L N/A Y 1 Win Int Sash M/I L N/A Y
Threshold L N/A Y 2 Exterior Sill IV, M/I SF L N/A Y
oor L N/A Y 3 Part Bead M/I L NIA Y
C Door Edge F L N/A Y 4 Blind Stop M/I SF L N/A Y
12 Door Casing L NIA Y Win Ext Sash M/I L N/A Y
3 4 Door Jamb F L N/A Y Newel Post L NIA Y
Threshold L N/A Y Railing Cap A/M L N/A Y
B Door L N/A Y Handrail A/M L N/A Y
C Door Edge o. F L N/A Y Balusters L N/A Y
1 2 Door Casing L N/A Y Lower rail L N/A Y
3 4 Door Jamb F L N/A Y Treads F L N/A Y
Closet Door L N/A Y _'Risers L NIA Y
A Cl Door Edge F L N/A Y Stringer L N/A Y
B Cl Casing L N/A Y Tread edge>5 L N/A Y
Closet Jamb F L N/A Y Landing floor L ❑(dust) N/A Y
D Closet Walls L N/A Y Floor Edge L N/A Y
Cl Baseboard L N/A Y %:Floor Casing L N/A Y
1 Closet Pole L N/A Y F Mil A/M L N/A Y
2 Closet Shelf L N/A Y F M/1 AIM L N/A Y
3 CI Supports L N/A Y F M/I A/M L N/A Y
4 Closet Floor L[—](dust) N/A Y F M/1 A/M L N/A Y
Closet Ceiling L N/A Y F M/l A/M L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS/STRUCTURAL DEFECTS:
by a Deleader(MORE THAN 288 SQ.IN.)
SIDE LOCATION MEASURE:LOOSE PAINT IC IC
DATE METHOD
❑ Check the box if this ROOM is RULED OUT for encapsulation
because there are 3 or more A/M surfaces with adhesion problems
LIRA Rep 2017 Stair
David Healey 4041 ,, 5 / 12 /22 Page-t5Of L
Inspector(print) Lic# Signature Date
David Healey 4041
Risk Assessor (print) Lic# Signature Date
Address of Property: 168 Bridge St Apt.#1 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
Siding L N/A Y Window Sill A/M L NIA Y
Corner Boards L NIA Y A Win Casing L NIA Y
A Lower Trim L NIA Y Window Sash L NIA Y
Upper Trim L /A Y Cellar Win Sill A/M L NIA Y
Win Above 5' L /A Y A Cal Win FrameL NIA Y
Porch Above 5' L N/A Y Cel Win Sash L NIA Y
Storm Door L N/A Y Screen Frame L NIA Y
Strm Door Edge F L N/A Y Cellar Win Sill A/M L N/A Y
A Door L N/A Y A Cel Win FrameL N/A Y
934
Door Edge F L N/A Y Cel Win Sash L N/A Y
Door Casing L N/A Y Screen Frame L N/A Y
Door Jamb F L N/A Y Cellar Win Sill A/M L N/A Y
Threshold L N/A Y A Cel Win FrameL N/A Y
Kickplate L N/A Y Cel Win Sash L N/A Y
Storm Door L N/A Y Screen Frame L N/A Y
Strm Door Edge F L N/A Y Foundation L N/A Y
A Door L N/A Y A Bulkhead L N/A Y
1 2 Door Edge F L N/A Y Fences L N/A Y
3 4 Door Casing L N/A Y Shutters L N/A Y
Door Jamb F L N/A Y Newel post L N/A Y
Threshold L N/A Y Railing Cap A/M L N/A Y
lKickplate L N/A Y Handrail A/M L N/A Y
Door I L N/A Y A Balusters L N/A Y
A Door Edge F L N/A Y Lower Rail L N/A Y
1 2 Door Casing L N/A Y Treads F L N/A Y
3 4 Door Jamb F L NIA Y Risers G L NIA Y
Threshold L N/A Y Tread edge L N/A Y
Kickplate L NIA Y Landing floor L N/A Y
Window Sill A/M L N/A Y Stringer L N/A Y
A Win Casing L N/A Y Lattice L N/A Y
#L Window Sash L N/A Y Drain Pipes L N/A Y
Window Sill A/M L NIA Y A Elec Conduit L N/A Y
A Win Casing L N/A I Y I I j Oil Fill Pipe L /A Y
#41 Window Sash L N/A I Y Overhang Tri L IA Y
COMMENTS I STRUCTURAL DEFECTS: �_A�Lamp ,vel L N/A Y
A F M/1 A/M L N/A Y
A F M/I AIM L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area 11200 ppm for are soil)
intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION AREA MEASUREMENT RESULT REMED REMED
SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD (Square Feet) (PPM) DATE METH
A Play Area
A Bare Soil
A Comments:
A
LIRA Rep 2017 Ext A
David Healey 4041 5/ 12/ 22 Page L Of
Inspector(print) Lic# Signature Date
David Healey 4041
Risk Assessor (print) Lid Signature Date
Address of Property: 168 Bridge St Apt.#1 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 JAW !A Y Window Sill A/M L N/A Y
Comer Boards L N/A Y B Win Casing L N/A Y
B Lower Trim L N/A Y # lWindow Sash L N/A Y
Upper Trim L !A Y Cellar Win Sill A/M L N/A Y
Win Above 5' L N/A Y B Cel Win Frame t, L /A Y
Porch Above 5' L N/A Y # t Cel Win Sash L /A Y
Storm Door L N/A Y ) Screen Frame L N/A Y
Strm Door Edge F L N/A Y Cellar Win Sill A/M L N/A Y
B Door L N/A Y B Cel Win Frame / Y
1 2 Door Edge F L N/A Y # Cel Win Sash LV/j Y
3 4 Door Casing L N/A Y Screen Frame k.1 I /A I Y
Door Jamb F L N/A Y Cellar Win Sill L /A IY
Threshold L N/A Y B Cel Win Frame
Kickplate L N/A Y #� Cal Win Sash L / Y
Storm Door L N/A Y Screen Frame /A Y
Strm Door Edge F L N/A Y Foundation L N/A Y
B Door L N/A Y B Bulkhead L N/A Y
1 2 Door Edge F L N/A Y Fences L N/A Y
3 4 Door Casing L N/A Y Shutters L N/A Y
Door Jamb F L N/A Y Newel post L N/A Y
Threshold L N/A Y Railing Cap A/M L N/A Y
Kickplate L N/A Y Handrail A/M L N/A Y
Door L N/A Y B Balusters L N/A Y
B Door Edge F L NIA Y Lower Rail L N/A Y
1 2 Door Casing L NIA Y Treads F L N/A Y
3 4 Door Jamb F L N/A Y Risers L N/A Y
Threshold L N/A Y Tread edge L N/A Y
Kickplate L N/A Y Landing floor L N/A Y
Window Sill A/M L N/A Y Stringer L N/A Y
B Win Casing L N/A Y Lattice L N/A Y
4 Window Sash L N/A Y Drain Pipes L N/A Y
Window SillIlk A/M L NIA Y B Elec Conduit L N/A Y
B Win Casing L N/A Y Oil Fill Pipe L N/A Y
# Window Sash L N/A Y Overhang Trim L N/A Y
COMMENTS/STRUCTURAL DEFECTS: B Isupport Clmns L N/A Y
B I F M/1 A/M L N/A Y
B I F M/1 A/M L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area 11200 ppm for bare soil)
intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION AREA MEASUREMENT RESUL REMED REMED
SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD (Square Feet) (PPM) DATE METH
B Play Area
B Bare Soil
B Comments:
B
I.I/RA Rep 2017 Ext B
David Healey 4041 ' . 5/ 12 / 22 Page Of
Inspector(print) Lic# Signature Date
David Healey 4041
Risk Assessor (print) Lic# Signature Date
Address of-Property: 168 Bridge St Ant.#1 City: Salem
EXTERIOR C Side
SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDEJ 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 L N/A Y Window Sill A/M L NIA Y
Corner Boards L N/A Y C Win Casing L N/A Y
C Lower Trim L N/A Y Window Sash L N/A Y
Upper Trim L /A Y Cellar Win Sill AIM L NIA Y
Win Above 5' L N/A Y C Cel Win Frame L N/A Y
Porch Above 5' Ua L N/A Y # Cel Win Sash L N/A Y
Storm Door L N/A Y Screen Frame L N/A Y
Strm Door Edge F L N/A Y Cellar Win Sill AIM L N/A Y
C Door L N/A Y C Cel Win Frame L N/A Y
1 Door Edge F L N/A Y # Cel Win Sash L N/A Y
3 4 Door Casing L N/A Y Screen Frame L N/A Y
Door Jamb F L N/A Y Cellar Win Sill AIM L N/A Y
Threshold L N/A Y C Cel Win Fram L N/A Y
Kickplate L N/A Y # Cel Win Sash L N/A Y
Storm Door L N/A Y Screen Frame L N/A Y
qDoor
Edge F L NIA Y Foundation L N/A Y
C L N/A Y C Bulkhead L N/A Y
2 F L NIA Y Fences L NIA Y
3 4 ing L N/A Y Shutters L N/A Y
b F L N/A Y Newel post L N/A Y
L N/A Y Railing Cap A/M L N/A Y
L N/A Y Handrail A/M L NIA Y
L N/A Y C Balusters L N/A Y
C Door Edge F L N/A Y Lower Rail L N/A Y
1 2 Door Casing L N/A Y Treads F L N/A Y
3 4 Door Jamb F L N/A Y Risers L N/A Y
Threshold L N/A Y Tread edge L NIA Y
Kickplate L N/A Y Landing floor L NIA Y
Window Sill A/M L N/A Y Stringer L N/A Y
C Win Casing L N/A Y Lattice L N/A Y
# Window Sash L N/A Y Drain Pipes L N/A Y
Window Sill A/M L N/A Y C Elec Conduit L N/A Y
C Win Casing L N/A Y Oil Fill Pipe L N/A Y
# Window Sash L N/A Y Overhang Trim L N/A Y
COMMENTS/STRUCTURAL DEFECTS: C Support Clmns L N/A Y
C F M/1 A/M L N/A Y
C F M/I A/M L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area 11200 ppm for bare soil)
intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION AREA MEASUREMENT RESULT REMED REMED
SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD (Square Feet) (PPM) DATE METH
C Play Area
C Bare Soil
C Comments:
C
Ll/RA Rep 2017 Ext C
David Healey 4041 � 5 / 12 /22 Page'T Of L
Inspector(print) Lic# Signature Date
David Healey 4041 '�`
Risk Assessor (print) Lic# Signature Date
Address of Property: 168 Bridge St Apt.#1 City: Salem
EXTERIOR D Side
SIDE LOCATION/ LEAD 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 L N/A Y Window Sill A/M L N/A Y
Corner Boards L N/A Y D Win Casing L NIA Y
D Lower Trim -L.N/A Y Window Sash L N/A Y
Upper Trim L /A Y Cellar Win Sill A! L /A Y
Win Above 5' L N/A Y D Cel Win Fram C. L /A Y
Porch Above 5' L N/A Y # Cel Win Sash Y
Storm Door L N/A Y Screen Frame L /A Y
Strm Door Edge F L N/A Y Cellar Win Sill A/ L /A Y
D Door L N/A Y D Cel Win Frame /A Y
Door Edge F L N/A Y Cel Win Sash L Y
3 4 Door Casing L N/A Y Screen Frame L /A Y
Door Jamb F L N/A Y Cellar Win Sill L /A Y
Threshold L N/A Y D Cal Win Frame /A Y
Kickplate L N/A Y Cel Win Sash L Y
Storm Door c L N/A Y Screen Frame /A Y
Strm Door Edge j F L N/A Y Foundation L N/A Y
7 Door L N/A Y D Bulkhead L N/A Y
Door Edge F L N/A Y Fences L N/A Y
3 4 Door Casing L N/A Y Shutters L NIA Y
Door Jamb F L N/A Y Newel post L N/A Y
Threshold L N/A Y Railing Cap A/M L N/A Y
Kickplate L N/A Y Handrail AIM L N/A Y
Door /A Y D Balusters L N/A Y
18D Door Edge F N/ Y Lower Rail L NIA Y
boor Casing /A Y Treads (,, F L N/A Y
3 4 Door Jamb F /A Y Risers L N/A Y
Threshold L /A Y Tread edge L N/A Y
Kickplate L N/A Y Landing floor C L N/A Y
Window Sill L N/A Y Stringer L N/A Y
D Win Casing L N/A Y Lattice L N/A Y
#` Window Sash L N/A Y Drain Pipes L NIA Y
Window Sill jr A/M L N/A Y D Elec Conduit L N/A Y
D Win Casing L N/A Y Oil Fill Pipe L N/A Y
# Window Sash L N/A Y Overhang Trim L N/A Y
COMMENTS/STRUCTURAL DEFECTS: D Support Clmns L N/A Y
D F M/I A/M L N/A Y
D j j F M/I A/M L N/A Y
EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area/1200 ppm for bare soil)
intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION AREA MEASUREMENT RESULT REMED REMED
SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD (Square Feet) (PPM) DATE METH
D Play Area
D Bare Soil
D Comments:
D
LI/RA Rep 2017 Ext D