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Letter of Full Deleading Compliance - Correspondence - 12 FERRY STREET 3/6/2020
CexV�Q Greater Boston Lead Paint Testing R�MP�OlbDD ` 22 Joslin ST, Lunenburg, MA 01462 OwNOFNp P � Tel: 617-515-1023 Email: JoeSlyman@Hotmail.com LETTER OF FULL DELEADING COMPLIANCE Nefly Alvarez 12 Ferry ST North Andover MA 01845 near Nefty Alvarez, This letter is to certify that on 02/ 26 /20 I re-inspected your property located at 12 Ferry ST Unit None and relevant interior and exterior common areas,in the Cityrrown of ort n over On that date,those surfaces cited in the initial inspection report by Joseph S{Yman .License# 1430 conducted on 12_ ,_ 26 /18 as being in violation of Massachusetts General Laws,Chapter I 11,Section 197,and 105 CMR 460.000: for Regulations Lead Poisoning Prevention and Control,were determined to be in current compliance with those same laws.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 dwelline unit and relevant common areas shall remain in com lianee with the re uirements of the Lead Laws referenced above onlyas Ion as there continues to be no relin chl in or flaking lead paint or other accessible leaded materials as ton as coverin s and/or enca sulants tormin an effective barrier aver such aint or other leaded materials remain in lace and as Ion as surfaces reversed to correct lead hazards remain reversed and secure!• in lace. 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 second page or reverse side of this letter identifies the authorized persons)who performed deleading on the property and a general summary of the methods used to achieve compliance with the Lead Laws. A complete Reinspeetion Report is attached to this letter,which specifies how and on what date each surface was brought into compliance. To the best of my knowledge,the cost of the legally required deleading is S 2,063.00 The CLPPP authorized serial number for this Letter of Full Deleading Compliance is 36771430030420-12 This number is tracked and unique to this address and unit. DO NOT LOSE THESE DOCUMENTS. if the documents are lost,you will be required to have additional private inspector services that may cost you significant amounts of money.This Letter of Full Deleading Compliance is only for the address and unit noted above.tfyou change the street address,unit number or any other identifying information pertaining to the residential premises referred to in this Letter of Full Deleading Compliance, this Compliance Letter may be considered null and void by the Department of Public Health and/or a municipal health office. Do not alter this document in any way.Altering this document is fraudulent and may endanger the health and safety of a child which may result in significant legal consequences. In addition to any potential civil liability which may arise as the result of the alteration of this Letter of Compliance, the Massachusetts Department of Public Health's Childhood Lead Poisoning Prevention program may seek criminal prosecution of any person who alters this document after it is originally is ued. Sincerely, 03/ 04 /20 Joseph Slyman 1430 Inspector(print name) License M tgnature Date Questions?Call the Department of Public Health at 1 00-532-9571. DO NOT LOSE THESE DOCUMENTS Page I of 2 LOFDC—rev W17 Serial Number: 36771430030420-12 Address.12 Fer ST Unit#: None City(rown:North Andover Deleading History License#:❑DC Exp.Date I I Deleading Contractor ❑DS Deleading Methods: ❑ Scraping Making Intact(Exterior) El PowerSanding ❑ Caustics ❑❑ Heat Gun ❑ Making intact(interior) ❑ Liquid Encapsulation Removal ❑ ❑ Demolition ❑ Replacement ❑ Covering ❑ Other Work was done in the following rooms: Work was done on the following types of components: Start Date: I 1 finish Date: I f Cost: S Authorization# MR- _ Expiration Date: RRP w/additional Moderate Risk Training Authorization#34211 ✓OMN\I Issuance Date: 02106 2�� Moderate Risk Delcader(ownertageny Ne Alvarez ❑Making Intact(interior) ❑ Liquid Encapsulation Covering Deleading Methods: ❑✓ ❑Making Intact(Exterior) ©Covering ❑Removal ❑Other Work was done in the following rooms: Room#2 H8IIW1 2 "D" Side Enclosed Pocch. Work was done on the following types of components: Door and window components. Exterior trim. Start Date: 02/ 21 /20 Finish Date: 02/ 23/20 Cost:a; 2 os3 00 — Authorization# OL AL Low Risk Delcader(owner/agent) Issuance Date:=== OE AE OB AR Deleading Methods, ❑ Covering ❑Liquid Encapsulation ❑Replacement (ONLY doors,cabinet doors,shutters,shelves not affixed,drawers,windows on hinges) Work was done in the following rooms: Work was done on the following types of components: Start Date: / / Finish Date:---I I Cost:S t.oFDc-rev W17 Page 2 of 2 ffls.i�D Lead Dust Wipe LabvratoriOS' Analysis Report Environmental Hazards Services,L.L.C. 7469 Whitepine Rd Richmond,VA 23237 Report Number: 20-03-00013 Telephone:800,347.4010 Client: Greater Boston Lead Paint Testing Received Date: 03/02/2020 22 Joslin St. Analyzed Date: 03/03/2020 Lunenburg, MA 01462 Reported Date: 03/03/2020 Project/Test Address: 12 Ferry St; North Andover, MA 01845 Collection Date: 02/26/2020 Client Number. Fax Number: C Client 7 Laboratory Results 320-341-6939 Lab Sample Client Sample Collection Location Surface Total Pb Wipe Area Concentration Narrative Number Number (ug) (ft') (ug/ft') 10 20-03-00013- 1 RM 3 FL <5.00 1.00 <5.00 001 <5.00 0.788 <6.35 20-03-00013- 2 RM 3 SL 002 9.62 0.656 14.7 20-03-00013- 3 RM 3 WAN 003 <5,00 20-03-00013- 4 HALL 2 FL <5.00 1.00 004 <6.35 20-03-00013- 5 KIT SL <5.00 0.788 005 w/ <5.00 0.656 <7.63 20-03-00013- 6 KIT 006 -- <5.00 --- 20-03-00013- 7 BLANK 007 Page 1 of 2 Environmental Hazards Services, L.L.0 ;lient Number: 22-5877 Report Number: 20-03-00013 )roject/Test Address: 12 Ferry St; North Andover, MA 01845 Lab Sample Client Sample Collection Location Surface Total Pb Wipe Area Concentration Narrative Number Number (ug) (ft') (ug/ft2) ID Method: ASTM E-1979-17/EPA SW846 7000E Accreditation#: Reviewed By Authorized Signatory: �,A " ' �Q`�'Od�— Missy Kanode QA/QC Clerk Lead Hazard and Clearance Standards Table Description EPA-Effective 12/18/2019 HUD Grant Programs Hazard Standard, Floors z 10 µg/ftZ z 10 µg/ftZ Hazard Standard,Sills >_ 100 µg/ftZ ? 100 µg/ft z Clearance,Floors <40 µg/ftZ <10 µg/ftz Clearance,Sills < 250 µg/ftZ < 100 µg/ft z Clearance,Troughs <400 µg/ftZ <100 µg/ft2 Clearance, Porch Floors Not Regulated <40 µg/ftZ The Reporting Limit(RL)is 5.00 ug Total Pb. Reported results are not corrected for field blanks. Dust wipe area and results arE calculated based on area measurements determined by the client. All internal quality control requirements associated with this batch were met, unless otherwise noted. The condition of the samples analyzed was acceptable upon receipt per laboratory protocol unless otherwise noted on this report.Results represent the analysis of samples submitted by the client.Sample location,description,area,etc.,was provided by the client. Results reported above in ug/ft2 are calculated based on area supplied by the client. If the report does not contain the result for afield blank,it is due to the fact that the client did not include a field blank with their samples. EHS sample results do not reflect blank correction. This report shall not be reproduced except in full,without the written consent of the Environmental Hazards Services,L.L.C. ELLAP Accredtitation through AIHA-LAP,LLC(100420), NY ELAP#11714. Legend ug=microgram ugiftz=micrograms per square foot Pb=lead mL=milliliter W=s uare foot Page 2 of 2 Page 1 of 0 Greater Boston Lead Paint Testing 22 Joslin ST, Lunenburg, MA 01462 Tel: 617-515-1023 Email:JoeSlyman@Hotmail.com Lead Inspection 1 Risk Assessment 5t.# 12 Street Name Ferry Street Tyre_ T Unit —Cl North Andover Zip Code 01845 Number of Rooms in Unit: Owner Name: Neftv Alvarez Property Type: Owner Address: 1_2 Feny ST. North Andover. MA 91845 ❑✓ Single Family Contact information: Multi Family #of Units: Client Name(if different from owner): Condominium #of Units: Client Address: Day Care ❑ Other: ISja lead Column COSY Delead/IC Method Column Ku Dekad/TC Method Column Laundry in Basement:' 2 Yes FjNo COV Covered COV Covered REM Removed Finished Spacc in Basement? Yes ❑✓ No DC Drop Ceding DIP Dipped REP Replaced Possible Pb Water Service line MET Metal ENC Encapsulated SCR Scraped MR Metal Rep.Window (NT Intact SFR Storm Frame Removed Yes 0 No Not Tested NA Not Accessible MI Made Intact St.D Sealed Testing Method Used NC No Coating PRE Prepared for Eric. STP Stripped Na2S Expiration Date: � f Tile Tile(testing suggested) Component Does Not Exist VR/MR Vinyl/Metal Rep Window VB Vinyl Baseboard ® X•Ray Fluorescence VR Vinyl Rep,Window Model: LPA-1 Serial N 3377 Comments/Notes: ❑ Demarcation Lines ❑ Submitted for Compliance Evaluation Floor# (level it in building Cn'g of unit being inspected) Floor# Property Diagram/(Snit Labels i b d �- : : • . r ! r , r . • ...4..1...�..J...i..J...t--i.............. ! . r • • r . . 1 . • r 1 • . • r! r 1 r . . r , . . !B)i .:...' ..:...1... ...... • r...}... • t...t..j-_-}---1---r_-i...:---(..: • • • , r , i • . • • r . . , . B ...r... ...i...}.. ..i._. .. J-_.w...}.. .. ...}.-}...............t...... D B �...} • ,r t..l..•..l..J...t.. .................. r r 'uI r r r • .. r r Y . r r • r • . r r r ...}._.i_...t...r....•...ti...Y.._T•_ 1 .r... ...i......�.._t_..,t..._}..1....�..i.._r .r._.! A(Street Side) Start Here A(Street Side) Start Here A(ShatSide) Pb(lead)equal to or greater than 1.0 mg/cm2 with x-ray fluorescence or positive with Na2S is Dangerous. XRF Calibration Recorded in Log Book ✓-Check off when complete Address Verified through USPS 0 ✓-Check off when complete Research on Lead Related History for Address 0 ✓- heck off when complete wxwstate.ma.us/dph/clppp or 800-532.9571 Joseph Slyman 1430 1 12/ 26 /19 Inspector's Name(print) License# Signature Date IJ/RA-revised O&17 Address: 12 Ferry ST Apt4_ City North Andover Page-2 of 2D INSPECTION HISTORY INTERIM CONTROL, Determination Lic# Visual R.A.Name: Lic# M�Y Inspector Name: Risk Assessment N Signature e Signature Lead Hazards Ur ent Pb.Hazards'' N vst a en or R.A.Name: Lic# Comprehensive 1430 Risk Assessment Initial Ins coon Y Inspector Nam :Jo e h SI man LIc# Y 1 2 2 6 1 9 N Signature N Signature Urgent Pb Haruds'? Lead Hazards r visual Portion of P R.A.Name: Lie# Cnmp Initial Remspeetion for w!I'artial PCAD Y Inspector Name: Lic# Interim Control F Signature N Signature - Lead Hazards? Dust Taken fur Risk P R.A.Name: Lie# Addendum( nival add-on LIC# Assessment Reins to] (ns .euan �, Inspector Name: F Signature 9 Signature Lead Hazards? Visual Portion of Remspcetion for R.A.Name: Uc# Addendum as Full Ins ccuon Interim Control 8Inspector Name: Lic# F Signature Y Signature Lead Hazards? Dust Taken I'ur Risk p R.A.Name: Lit#. ASSeSfimL"nl Reins Walk Through for Inspector Name: Lic# Signature rdrConsuitatton Signature Rlsk Assessment Lic# Rceertiftcatton R.A.Name REINSPECTION HISTORY ,,Lic# N Signature visual Ponion of P inspector Name: Ur ent Pb.Hazards? Rcocc Rcuis fion F I Signature Dust Taken for p R.A.Name; Lic# RA Recertification visual Portion of NF Inspector Name:,_ _,Lic# F Signature Renee.Reins etion Signature POST COMPLIANCE ASSESSMENT DETERMINATIONS Dust Taken for P Inspector Name; Lic# Reocc.Reins coon PCAD Inspector Name: LIc# F Signature 8 N Signature Dust Taken for a Inspector Name: LIc# t,ead Hazards? Reoce Reins ction F Signaturetnspectian Y Inspector Name: Lic# Actin as PCAD Visual Portion of Inspector Na e:Jo e h Sly man Lic# I N ISIgnature Final Kems ection Lead Hazards? 012121 p F Signature Visual Ponion of P Inspector Name: Lic# visual Portion of Inspector N Lic# PCAD Reins ction Final Reins on p F Signature co F 5ignature Dust Taken for p Inspector Name: LIc# Dust Taken far Final Inspector Na :Jos' h St man Lic#1430 PCAD Reins ctian tRinstl,lo RcocclF Signatu6 2 0 F Signature Dust Taken for p Inspector Name: Lic# Uust Taken for FinalFF] Inspector Nato Lie# PCAD Reins ction Reins . Ni Reoce F Signature F Signature History rev 6117 Address:12 Ferry ST Apt: Ciry North Andover Pale v of 20 REOCCUPANCY CERTIFICATE HISTORY COMPLIANCE HISTORY(CONT.) Certificate of Certificate of Reoceu ancv Maintained Inspector Name: ,Llc# Inspector Name: Lic# Coot hance Only fter Signature Only a Risk Signature No Work No Dust tli a Work=7 Dust (#rooms rule) Certificate of Certificate of Reoccu ancr Restored Inspector Name: Lic# Cnm Rance Inspector Name: Lic# Only after Signature Signature High/Mod Risk Dust wrpcs and auth. (9 rooms rule) Nogle Certificate of Certificate of Reoccu ancv Inspector Name: Lle# Maintained Inspector Name: Lic# Coin 9Nance Only after Signature I I I I Signature IlighlMod Risk No Work-No Dust iY rooms rule Work=7 Dust COMPLIANCE HISTORY. Certifieateof Letter of Full Initial Restored Inspector Name: Lic# Coin Nance Inspector Name: LIe# Compliance Signature Na prior history! Signature Dust wipes and auth. No signs of UD people Letter or Interim OTHER HISTORY:WAIVERSIUD Control Inspector Name: Lie# Approved CLPPP Waiver Inspector Name: Lic# Signature No prior Comp, Signature Expires in I yr. Attach to Camp Does Recertification of Approved interim Control Inspector Name: Lic# CI,TPP Waiver Inspector Name: Lic# Expires 2 yrs from Signature Signature Aaach to Comp original Interim Does Control Letter of Full UD/DES Visual Deleading Inspector Nam :Jo Ph Slyman Lic# id30 Reins flan 1> Inspector Name: Lic# Comr1hance 0 121 2 6 2 0 signature I Signature Dust wipes If No No LOC Issued Reoce. Certificate of UD/DES Dust .Lit:# Maintained Taken P Inspector Name: Com Rance Inspector Name: Lic# F Signature Signature No LOC Issued No Work=No Dust Work=7 Dust 11D J DES Dust Taken I' Inspector Name: Lic# Certificate of Signature Restored Lic# Com fiance inspector Name: - No LOC Issued Signature U'D/DES Final Dust wipes and Guth. Rein Lion FP 8 Inspector Name: Lic# o le I Signature No LOC Issued history rev 6117 Page 4 of_�V 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 components)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/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.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 he 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 r Joseph SI man 1430 12 26 19 Page 7 Of, inspec?or iprin?) Lic# Si na e Date Risk Assessor(print) Lic tI Si Date Address ofProoerN- 12 Ferry ST Apt # city, North Andover ROOM#.I 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 HAZ9 DATE METH DATE METH 8 f-IUp Walls L N+A Y A Window Sicl L /I AW L NIA Y A 5 low Walls L NIA Y B Win Apron L NIA Y A 5 Baseboards L NIA Y C Win Casing L NIA. Y A 8 Chair Rail L NIA Y D Header Stop WI L NIA Y Radiator L NIA Y Int Stops M/l L N/A Y Floor ' L�dusq WA Y 1 Win Int Sash M/I L N/A Y Ceiling L NIA Y 2 Exterior Sill MA SF L N/A Y A B Door L N1A Y 3 Part Bead Mil L N/A Y �jl�)DDoor Edge r' F L N/A Y 4 Blind Stop Mil SF L N.rA. Y 12 Door Casing r L NIA Y Win Ext Sash Mll L NIA Y 34 Door Jamb 1 F t NIA Y 'Mndow Sail MA &TM L NlA Y Threshold L WA Y B Win Apron L N/A Y A B Door L NIA Y C Win Casing ty L N/A Y C,j Dow Edge F L N/A Y D Header Stop L N/A Y 12 Dow Casing {'} L NIA Y Int Stops M11 L N/A Y 34 Door Jamb F L WA Y 1 Win Int Sash Mll L N/A Y Threshold ` L NIA Y Exterior Sill M/I SF L N/A Y A B Door L NIA Y 3 Part Bead MII L NIA Y C D Door Edge F L WA Y 4 Blind Stop Wl SF L N/A Y 12 Door Casing L WA Y Win Ext Sash f. MA L NIA Y 3 4 Door Jamb F L NIA Y 1! Window Sill M I ArM L NIA Y Threshold L NIA Y B Win Apron L N/A Y Closet Door L NIA Y C Win Casing L NIA Y A Cl Door Edge F L N/A Y D Header Stop WI L N/A Y B Cl Casing L NIA Y Int Stops MII L N/A Y C Closet Jamb F L NIA Y 1 Wm Int Sash WI L NIA Y D Closet Walls L NIA Y 2 Exterior Sill WI SF L NIA Y Cl Baseboard L NIA Y 3 Part Bead M/I L NIA Y 1 Closet Pole ( L NIA Y 4 Bind Stop NUI SF L N/A Y 2 Closet Shelf ( L NIA Y Vr'in Ext Sash n M/! L N/A Y 3 Cl Supports { L N?A Y a 8 eplace L NIA Y 4 Closet Floor L❑(#,st) N/A Y C D Mantlo L N/A Y Closet Ceiling L NIA Y tin Above 5' L N/A Y COMMENTS/STRUCTURAL DEFECTS j0efing Mooin L NIA Y L F M/I AIM L N/A Y F M/1 A/M L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/l A/M L N/A Y by a Deleader(MORE THAN 288 SO,IN) F MA AIM L NIA Y IC IC F M'I AIM L NIA Y SIDE LOCATION MEASURE.LOOSE PAINT DATE %IETnOC F FAq AIM L N/A I Y El Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problems LIAT A Rep 2017 Room Joseph SI man 1430 12 /26 /19 Page i?Of_ � inspector(print) Lie Sign tur Date Risk Assessor(print) Lie# Signature Date Address of Propertit. 12 Ferry ST A # city: North Andover CONTINUATION OF ROOM( ) SIDE LOCATION) LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION; LEAD TYPE OF URG IC ;C DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH AB Door L NIA Y Low Cab Fram L N/A Y C D Door Edge F L N/A Y A B Low Cab Door L NIA Y 12 Door casing ( L N1A Y C D Low Cab Walls L NIA Y 3 4 Door Jamb F L NIA Y # Low Cab ShIvs L NIA Y Threshdd L NIA Y Supports L NIA Y A B Door L WA Y Drawers L NIA Y C D Door Edge F L NIA Y A Window Sill r II A/M L N/A Y 12 Door Casing L N/A Y Win Apron L NIA Y 3 4 Door Jamb F L N/A Y C Wo Casing t L N/A Y Threshold L NrA Y D Header Stop ),4 MA L NIA Y A B Door L N/A Y Int Stops n r W, L N/A Y C D Door Edge F L N/A Y # Win Int Sash M11 L N/A Y 12 Door Casing L WA Y Exterior Sill MA SF L NIA Y 3 4 Door Jamb F L N/A Y Part Bead M/I L N/A Y Threshold L NIA Y Blind Stop MA SF L N/A Y Closet Doe L N/A Y Win Ext Sash Mtl L N/A Y A CI Door Edge F L NIA Y A Window Sill M/I A/M L N/A Y B Cl Casing L N/A Y B Vain Apron L N/A Y C Closet Jamb F L NIA Y C Wm Casing L NIA Y C Closet Wags L WA Y D Header Stop MA L NIA Y D CI Baseboard L N/A Y In:Stops MA L NIA Y Closet Pole L N/A Y # Win Int Sash MA L N/A Y Closet Shelf L N/A Y Exterior Srll MA SF L N/A Y Cl Supports L N/A Y Part Bead M/I L NIA Y CI Drawers L NIA Y Blind Slop WI SF L N/A Y Cl Or Frame L NIA Y win Ext Sash M/1 L N/A Y Closet Floor L❑(dust)N/A Y A B Fireplace L NIA Y Closet Ceiling L NIA Y C D Martel L NIA Y c o Shlvs Above 5' 1 L N!A Y A B Sidelight(L) L N/A Y A9 CD Cab Above 5' L NIA Y C D Sidelight(R) L N/A Y AB a8 c o Cab Above 5' L N/A Y c a Win Above 5' L N/A Y .L, C D Up Cab Door L NIA Y CD lWin Above 5' 1 L NIA Y Up Cab Waft L NIA Y F W AIM L N/A # Up Cab Shtvs L N/A Y F MA AIM L NIA Supports L N/A Y t F M/I A/M L N/A =A,,M F MA AIM L NIA F MA A/M L WA EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS I STRUCTURAL DEFECTS' by a Deleader(MORE THAN 288 SQ.IN.) IC IC SIDE LOCATION MEASURE:LOOSE PAINT DATE 4r=TI-OD a Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more A1M surfaces with adhesion problems Ll/RA Rep 2017 Room contd. Joseph S! man 1430 �� 12 26 19 pap—1Of, Inspector(print) Lic# Si atu Date Risk Assessor(print) Lic# Signa ure Date Address of Property 12 Ferry ST Apt # City North Andover ROOM#2 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 r rl 9 Up Walls 1 L N/A Y A Window Sill IfAl A/M L N/A Y A a Low Wags L N/A Y B Win Apron L N/A Y A e Baseboards L NIA Y / Win Casing L N/A Y A n Chair Rag L NIA Y D Header Stop M/I L NIA Y ry is Radiator L N/A Y Ini Stops MII L NIA Y Floor r' L Q(dusl) N/A Y 1 Win Int Sash VP M/I L N/A Y Ceiling L NIA Y -z( 2 ExlehorSill V11 Mil SF L NIA Y AMDoor itL NIA Y 3 Part Bead MII L NIA Y D Door Edge F L N/A Y 4 Blind Stop M/1 SF L NIA Y j 2 Door Casing L N/A Y 4Y,n Ext Sash M/I L NIA Y 3 4 Door Jamb F L N/A Y A Window Sill M/I AIM L N/A Y Threshold / L N/A Y B Wn Apron L NIA Y A, Door L NIA Y C Win Casing L N/A Y C D Door Edge F 1, N/A Y D Header Stop M/1 L NIA Y 1,2 Door Casing L WA Y Int Stops M/1 L N!A Y 3 4 Door Jamb F L N/A Y ' 1 Wm Int Sash M/1 L NIA Y Threshold L N/A Y 2 Exterior Sill &VI SF L N/A Y A B Door L N/A Y 3 Part Bead M/I L NIA Y Door Edge F L N/A Y 4 Blind Stop M/I SF L N/A Y 12 Door Casing L WA Y 'Kin Ext Sash MA L N/A Y 3 4 Door Jamb F L NIA Y A Window Sill M/I AIM L N/A Y Threshold L N/A Y B Win Apron L N/A Y Close(Door L N/A Y C Win Casing L N/A Y A Cl Door Edge F L WA Y D Header Stop (NJ L NIA Y T l CI Casing L NIA Y Int Stops WII L N/A Y C Closet Jamb F L NIA Y 1 Win Int Sash M/1 L N/A Y D Coset Walls J L NIA Y 2 Exterior Sill M/I SF L N/A Y CI Baseboard ,l L N/A Y 3 Part Bead M/I L N/A Y jFloor L N/A Y 4 Blind Stop M/I SF L NIA Y Y� L N/A Y Win Ezt Sash fXI L NIA Y 3 L WA Y A B Fireplace L N/A Y 4 L❑(dust) NIA Y C D Mantle L NIA Y a L NIA Y '2� l°7 Wm Above 5' L NIA Y COMMENTS I STRUCTURAL DEFECTS: Ceiling Moldin L NIA Y - F Mil A/M L NJA Y F MA A/M L N/A Y EXCLUDED SURFACES Surfaces listed in these boxes can only be made intact F MN AIM L N!A Y by a Deleader(MORE THAN 288 SQ.IN.) F Mn A/M L N/A Y SIDE LOCATION MEASURE:LOOSE PAINT IC IC F MII AiN L N/A Y DATE MET-<00 F M/1 AIM L N/A Y a Check the box if this ROOM is RULED OUT for encapsulation Ebecause there are 3 or more A/M surfaces with adhesion problems LURA Rep 2017 Room Joseph Sl man 1430 12 26 19 page _of�v Inspector(print) Lic# Signal Date Risk Assessor(print) Lic# Signature Date Address of Prooert)r 12 Ferry ST Apt,# City: North Andover ROOM# 3 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 r n Up Walls L NIA Y A Wndow,Sill LIM11 A/M L N/A Y A a Low Walls L NIA Y B Win Apron L N/A Y as Baseboards L WA Y C Wn Casing 1 � L NIA Y r n Chair Rail L NIA I Y D Header Slop MA L NIA Y ABCD Radiator L NIA Y .-26, l Int Stops - M/I L NIA Y Floor t L Ddust) NIA Y 1 Wm Int Sash Mll L N/A Y Ce"ding L N/A Y )r 2 Exterior Sill M/I SF L NIA Y C' Door L N/A Y 3 Part Bead I L N/A Y C D Door Edge F L NIA Y 4 Blind Stop W SF L N/A Y 12 Door Casing { I L NiA Y Win Ext Sash M/I L N/A Y 3 4 Doa Jamb F L QUA Y A Window Sill WI A/M L NIA Y Threshold L WA Y B Win Apron L N,A Y A D Door L NIA Y C Wm Casing L NIA Y C Door Edge F L WA 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 IF L NiA Y 1 Win Int Sash M/I I. NIA Y Threshold L NIA Y 2 Exterior Sill M/I SF L NIA Y A B Door L WA Y 3 Part Bead M/I L WA Y C D Door Edge F L N/A I Y 4 Blind Stop Mil 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 WA Y A Wundow Sill M/I AIM 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 1i 1 CI Door Edge F L WA Y D Header Stop M/1 L N/A Y B CI Casing L WA Y Int Stops M/l L N/A Y C Closet Jamb F L WA Y 1 Wrn Int Sash MA L NIA Y D Closet Walls L WA Y 2 Exterior Sill M/I SF L WA Y Cl Baseboard , L N/A Y 3 Part Bead M/I L N/A Y 1 Closet Pole Aj L N/A Y 4 Blind Stop W SF L WA Y 2 Closet Shelf Aj# L N/A Y Win Ext Sash M/1 L NIA Y 3 CI Supports L WA Y - AB Fireplace L WA Y 4 Closet Floor L❑(dust)NIA Y 00 Mantle L N/A Y ne Closet Ceiling L NIA Y - + c g W n Above 5' L WA Y COMMENTS/STRUCTURAL DEFECTS_ Ceiling MoldinS L NIA Y -2 ` F M?I AIM L N/A Y F Mill ArM L I'VA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F Mn AIM L NIA Y by a Deleader(MORE THAN 288 SQ.IN.) F M/I AIM L NIA Y IC IC F M/I AIM I.NA Y SIDE LOCATION MEASURE:LOOSE PAINT DATE METHOD F MM A/M L NIA Y a Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problems L.I/RA Rep 2017 Room Joseph SI mart 1430 12/ 26 / 19 Page``l of � Inspector(print) Lic# Sig Cy Date r r Risk Assessor(print) Lic# Signa`W Date Address of Property: 12 Ferry ST Apt.# City North Andover KITCHEN SIDE LOCATIONJ LEAD TYPE OF URG IC IC DELEAD DELEAC SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ2 DATE METH DATE METH A 6 C 0 Up Wails Qoif L N/A Y A Window Sill _) M/I A/M L NIA Y A s Low Walls L NIA Y ® Win Apron L N/A Y s Baseboards L NIA Y C Win Casing L NIA Y A 6 Chair Rail L NIA Y D Header Stop WI L NiA Y r �- AS C o Radiator L WA Y nl Stops ti MII L NIA Y Floor L❑(dust) NIA Y ) i 'Alin Int Sash Vie M/I L N/A Y Ceiling L NIA Y 2 Exterior Sill M/I SF L N/A Y A Loa L N'A Y 3 Part Bead Mil L NIA Y D Door Edge F L N'A Y 4 Blind Stop MA SF L NIA Y 4 Door Casing L NiA Y Win Ext Sash AN MJI L NIA Y 3 4 Door Jamb F L NA Y A ,"/endow Sill W A/M L NIA Y Threshold L N/A Y 3B Win Apron L WA Y B Door L NIA. Y C Win Casing L NIA Y CD Coa Edge F L WA Y D Header Stop M/I L N/A Y 1�A Door Casing L NIA Y Int Stops WI L N/A Y 3 4 Qoa Jamb F L WA Y 1 Win Int Sash Mil L N/A Y !Door eshold L NIA Y 2 Exterior Sill WI SF L N/A Y A a L NIA Y 3 Part Bead WI L N/A Y C D or Edga F L NIA Y 4 Blind Stop MJI SF L NIA Y 12 or Casing L NIA Y 4 in Ext Sash Mil L N/A Y 3 4 Jamb F L WA Y A B Up Cab Frame L NJA Y eshold L NIA Y D Up Cab Door-, L N/A Y Closet Door L N/A Y Up Cab Wails L NJA Y A Cl Door Edge F L N/A. Y 2 Up Cab Shlvs L NIA Y B Cl Casing L N/A Y 3 4 Supports J L NIA Y C Closet Jamb F L WA Y Low Cab Fram L NIA Y D Closet Walls L WA Y A B Loa Cab Door L NiA Y Cl Baseboard L N/A Y Low Cab WallsL WA Y 1 Closet Pole L NIA-. Y Low Cab ShIvs L N/A Y 2 Closet Shelf L WA Y t1 Supports L N/A Y 3 Cl Supports L NIA Y 3 4 Drawers L N/A Y 4 Closet Floor L[](dust)N/A Y A a C o V✓n Above 5' L N/A Y Chet Ceiling L N/A Y Ceiling Moldin L N'A Y COMMENTS I STRUCTURAL DEFECTS. F Mil A/M L NIA Y F Mil NM L NIA Y F M/I AtM L N/A Y F M/I AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F Mil A/M L NIA Y by a Deleader(MORE THAN 288 SQ.IN.) F Mn AIM L NA Y IC IC F M/I A)M L NA Y SIDE LOCATION MEASURE:LOOSE PAINT r, CASE - HOC' F Mil AIM L NJA Y a Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problems Ll/RA Rep 2017 Kitchen Joseph Slyman 1430 12/ 26 / 19 Pagel 0Of_ Inspector(print) Lic# iA ')c Date Risk Assessor(print) Lic# na re Date Address of Pro 12 Ferry ST Apt.# city: North Andover CONTINUATION OF ROOM( K ( ) } SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIOW LEAD TYPE OF URG IC IC IDILEAD DELEAO SURFACE HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ? DATE PdETH DATE METH A Door jaiL NIA Y A B Dow L NIA Y C D Door Edge F L N/A Y C D Door Edge F L N/A Y 2 Door Casing i L WA Y 12 Door Casing L NIA Y 4 Door Jamb k F L WA Y 3 4 Door Jamb F L N/A Y Threshold L WA Y Threshold L NIA Y A B Door L N/A Y A B Door L WA Y C D Door Edge F L N/A Y C D Door Edge F L NIA Y j 2 Door Casing L WA Y 12 Door Casing L N/A Y 3 4 Door Jamb F L N/A Y 3 4 Door Jamb F L NIA Y Threshold L N/A Y Threshold L N/A Y A B Door L N/A Y A B Door L N/A Y D Doa Edge F L NIA I Y C D Door Edge F L NIA Y Door Casing L N/A Y 12 Door Casing L N/A Y 3 4 Door Jamb F L NIA Y 34 Door Jamb F L N/A Y Threshold L N/A Y Threshold L NIA Y A 8 Door L NIA Y A B Door L N/A Y C Door Edge F L NIA Y C D Door Edge F L N/A Y 1 2 Door Casing L WA Y 12 Door Casing L N/A Y 3 4 Door Jamb F L N/A Y 3 4 Door Jamb F L N/A Y Threshold L NIA Y Threshold L WA Y W4 . L NIA Y A B Door L N/A Y F L N/A Y C D Door Edge F L N/A Y L WA Y 12 Door Casing L WA Y' F L N/A Y 3 4 Door Jamb F L N/A Y L NIA Y Threshold L N/A Y A B Door L WA Y A B Dos 1 L WA Y C D Door Edge F L WA Y C D Door Edge F L N/A Y 12 Door Casing L WA Y 12 Door Casng 1. L N/A Y 3 4 Door Jamb F L N/A Y 3 4 Door Jamb F L N/A Y Threshold L N/A Y Threshold L N/A Y A B Door L N/A Y F Mil A,,M L NIA C D Door Edge F L N/A Y F M/I A1M L WA 12 Dos Casing L NIA Y F MII AIM L NIA Y 3 4 Door Jamb F L N/A Y F MA AIM L N/A Y Threshold L NIA Y F MA AIM L WA Y COMMENTS I STRUC RAL DEFECTS; F Mll AIM 1,N/A Y F MA AIM L NIA Y F Mtl NM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be majintact COMMENTS I STRUCTURAL DEFECTS: by a Defeader(MORE THAN 288 SQ,IN.) ICSIDE LOCATION MEASURE:LOOSE PAINT PATE Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with arhesion problems LIIRA Rep 2017 Room contd(D) M1. Joseph Si man 1430 12 /26 /19 Page Cf Inspector(print) Lic# Si Date Risk Assessor (print) Lic#' Signature Date A dress of Property: 12 Ferry ST Apt# City: North Andover I VA M EA6 LOCATION( LEAD TYPE OF URG IC C 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 Up Walls L NIA Y A B Up Cab Frame L NIA Y low Walls L NIA Y D Up Cab Door L NIA Y ,A Baseboards t j L NIA Y Up Cab Walls L N/A Y Chair Rail L WA Y 1 2j,Up Cab Shlvs L NIA Y A6 cc Radiator L N/A Y 3 4 Supports L NIA Y Floor L (dust) WA Y Low Cab Fram L NIA Y Ceiling L NIA Y AB Low Cab Door L N/A Y A$ Door L NIA Y Low Cab Wal L NIA Y D Door Edge F L NIA Y Low Cab Shtvs L NIA Y 1 2 Door Casing L NIA V 1 2 Supports L NIA V 34 Door Jamb F L WA Y 1 Drawers L N!A Y Threshold ` L NIA Y A Window Sill Mll AIM L NIA Y A B Door L WA Y Win Apron L N/A Y C D Door Edge F L WA Y C Wm Casing L N/A Y 12 Door Casing L N/A Y Header Stop r W1 L N/A Y - 3 4 Oow Jamb F L N!A Y Int Stops 41 L N/A Y Threshold L WA Y 1 Win Int Sash WI 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 MA L N/A Y 12 Dow Casing L WA Y 4 Blind stop WI SF L N/A Y 3 4 Dow Jamb F L WA Y Win Ext Sash MA L N/A Y All Threshold L WA Y G o Win Above 5' L NA Y Closet Dow L NIA Y Ceding Moldtnc klhl, L NA Y AI To` As A Cl Door Edge F L NIA Y C D Medicine Cab L NA Y B Cl Casing L WA Y F MA AW t.WA Y C Closet Jamb F L WA Y F W1 AV L NIA Y D Closet Walls L N/A Y F MA AIM L N/A Y Cl Baseboard L WA Y F M/I AtM L N!A Y 1 Closet Pole L WA Y F M!I AAM L N/A Y 2 Closet Shelf L WA Y F M/I AIM L N!A Y 3 CI Supports L NIA Y F Mrl AIM L NIA Y 4 Closet Flaw L❑{dust) NIA Y F MA AW L NIA Y Closet Ceiling L NIA Y F M/I AIM L N!A Y F M1 AW L WA Y F MA A/M L N/A Y F MA A!M L NIA Y F MA AQ L WA I Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS!STRUCTURAL DEFECTS: by a Deleader(MORE THAN 288 SO,IN.) SIDE LOCATION MEASURE:LOOSE PAINT C C o DATE YETHOL Check the box if this ROOM is RULED OUT for encapsulation Fbecause there are 3 or more AJM surfaces with adhesion problems 1-URA Rep 2017 Bath Joseph SI man 1430 12 /26 /19 PageL"Of Inspector{print} Lic Sign ture Date Risk Assessor (print) Lic# Signat` Date Address of Property: 12 Ferry ST Apt it City North Andover BATHROOM r SIDE LOCATION! LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIOW LEAD TYPE OF URG IC C DELEADJ DELEAD SURFACE HAZARD HAZ DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A u Up Walls L WA Y A Up Cab Frame L WA Y A e Low Walls L N/A Y C D Up Cab Door L WA Y A e Baseboards L N/Al Y Up Cab Walls ` L WA Y r- n Chair Rail L WA Y 12 Up Cab Shlvs L N/A Y A CD Radiator L WA Y 114 Supports L N/A Y Floor L❑(dust; NIA Y Low Cab Fram 1 L N/A Y Ceding L NIA Y A B Law Cab Door L NIA Y A 8 Door L N/A Y D low Cab Walt L WA Y C D Door Edge F L N/A Y Low Cab Shlys L N/A Y 12 Door Casing L N/A Y 12 Supports L WA Y 3 4 Door Jamb F L N/A Y 3 4 Drawers L NIA Y Threshold L NIA Y f� # A Window Sill M/I AIM L WA Y A 8 Door L N/A Y B Wm Apron L N/A Y C D Door Edge F L N/A Y (C}Wm Casing L N/A Y 12 Door Casing L NIA Y Header Stop /I L N/A Y 34 Door Jamb F L N/A Y Int Stops MII L N/A Y Threshold L NIA Y 1 Wm Int Sash M/I L N/A Y A B Door L WA Y 2 Exterior Sill M/I SF L WA Y C D Door Edge F L NIA Y 3 Part Bead M/I L NIA Y 12 Door Casing L NIA Y 4 Biind Stop MA SF L NIA Y 34 Door Jamb F L WA Y Wm Ext Sash MA L N/A Y as Threshold L NIA Y o ftn Above 5' L NA Y Closet Door L WA Y Ceiling Moldmc L NA Y A Cl Door Edge f L WA Y c c 61ed tine Cab L NA Y B n Casing L WA Y F M/I kM L NIA Y C Closet Jamb F L WA Y f M11&M L N/A Y D Closet Walls L NIA Y F M/I AIM L NIA Y Cl Baseboard L N/A Y F MI!AIM L NIA Y 1 Closet pole L WA Y F MA AIM L N/A Y 2 Closet Shelf L WA Y F Mil AIM L N/A Y 3 CI Supports L WA Y F MA AIM -N!A Y 4 Closet Floor L❑(dust)NIA Y F M/1 AIM L NIA Y Closet Ceiling L NIA Y F MA AIM I_NIA Y F MA AN L NIA Y F M/I A/M L WA Y F M9 AAA L N/A Y F MA AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS/STRUCTURAL DEFECTS: by a Deteader(MORE THAN 288 SO.IN.) IC 10 SIDE LOCATION MEASURE:LOOSE PAINT DATE M.ET i4_.k E] Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problems IA/RA Rep 2017 Bath 1 Joseph Siyman 1430 12/ 26 / 19 Page Of Inspector(print) Lic# S' na a Date Risk Assessor(print) Lic# Alnatu Date Address of Pro ST q L# Cit : North Andover HALLWAY:6ehor # or Common Hallway: Front Rear Floor#_— SIDE LOCA OW L TYPE OF URG IC IC DELEAD DELEAD SIDEJ LOCATIONI 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 r L WA Y Closet Door L NIA Y A a Low Walls L WA Y A CI Door Edge F L N/A Y A. a Baseboards L NIA Y B Cl Casing I L NIA Y A B ChalrRaii L N!A Y C Closet Jamb .� F L N/A Y As Radiator L NIA Y D Closet Walls L N/A Y Floor L❑(dusl) WA Y Cl Baseboard L NIA Y Ceiling L NIA Y 1 Closet Pole L N/A Y Door L WA Y 2 Closet Shelf L NIA Y C D Door Edge F L WA Y 3 CI Supports L N/A Y 1 2 Door Casing L WA Y 4 Closet Floor L (dust) N/A Y 3 4 Door Jamb F L WA Y Closet Ceiling L NIA Y Threshold L WA Y A Window Sill M/1 A/M L N/A Y ALB Door L WA Y B Win Apron L NIA Y C D Door Edge F L WA Y C Win Casing L WA Y 12 Door Casing L WA Y D Header Stop Mil L N/A Y 3 4 Door Jamb F L WA Y Int Stops Mli L NIA Y Threshold L NIA Y 1 Wnn Int Sash M/I L NIA Y A B Door L WA Y 2 Exterior Sill W SF L N!A Y C D Door Edge F L N/A Y 3 Part Bead Wl L N/A Y 12 Door casing L WA Y 4 Blind Stop W SF L N/A Y 3 4 Door Jamb F L WA Y Win Exi Sash M/I L NIA Y Threshold L NIA Y A Windom Sill M/I A/M L WA Y A B Door / L WA Y B Win Apron L WA Y C D Door Edge F L NIA Y C Win Casing L N/A Y 12 Door Casing / L WA Y D Header Stop MII I. N/A Y 3 4 Door Jamb F L N/A Y Int Stops M/I L NIA Y Closet Door t L NIA Y 1 Win Int Sash M/I L N/A Y A Cl Door Edge F L N/A Y 2 Exterior Sill M/I SF L WA Y B cI Casing L WA I 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 WA Y Win Ext Sash M/I L WA Y AE Cl Baseboard L WA Y Win Above 5' L N/A Y 1 Closet Pole L WA Y Ceiling Modin L NIA Y 2 Closet Shelf L WA Y F M/I AAi L N/A Y 3 Cl Supports L WA Y F M/I AIM L N/A Y 4 Closet Floor EC:I(dust]NIA Y F Mil A/M L WA Y Closet Ceiling /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 nAie nC raETHcc ❑ Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problems LVRA Rep 2017 Hall Joseph Slyman 1430 12/ 26 / 19 Page NOfao Inspector(print) Lic# gn te Date Risk Assessor(print) Lic# igna a Date Address of Pro 1-2,Egrry ST a,pI,# ctt North Andover HALLWAY:Interi r # or Common Hallway: Front Rear Floor#_ SIDE LOCATION/ PE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAC DELEAD SURFACE HAZARD HAV DATE I METH DATE METH SURFACE HAZARD HAZ DATE I METH DATE METH A r Up walls ; L NlA Y Closet Door L WA Y � n Low Watts L N/A Y A Cl Door Edge F L WA Y A 9 Baseboards L WA Y G��? B Cl Casing L WA Y A a Chair Rail L N/A Y C Closet Jamb F L WA Y A 6 Radiator L NIA Y D Closet watts L WA Y Floor L❑(dust) WA Y Cl Baseboard L N/A Y Ceiling L N/A Y C j 1 Closet Pole L WA Y B Door L NIA Y 2 Closet Shelf L N/A Y C D Door Edge F L WA Y 3 CI Supports L N/A Y 12 Door casing L N/A Y 4 Closet Floor L Q(dust) N/A Y 3 4 Doti Jamb 9.V F L WA Y _DT Closet Ceiling L WA Y Threshold t L NIA Y A window Sill M/l *4 L NIA Y 2-2G AT Door L NIA Y B Win Apron L N/A Y Z10- C'b'Door Edge F L WA Y Wm Casing L N/A Y 12 Door Casing L WA Y Header Stop A JJA M/I L NIA Y 34 Door Jamb F L WA Y Int Stops WI L WA Y Threshold L WA Y 1 Win Int Sash M/I L N/A Y A B Door L NIA Y 2 Exterior Sill W SF L NIA Y C D Door Edge F L WA Y 3 Part Bead Nlll L NIA Y 12 Door Casing L N/A Y 4 Blind Stop W SF L NIA Y 34 Door Jamb F L WA Y Wm Ext Sash Mil L NIA Y Threshold L WA Y A Window Sill f WI AIM L WA Y A B Door L WA Y B Win Apron L NIA Y C D Door Edge F L WA Y C Win Casing L N/A Y 12 Door Casing L N/A Y D Header Stop Mill L NIA Y 34 Door Jamb F L NIA Y Int Stops MII L NIA Y Closet Door L WA Y 1 Win Int Sash Mn L N/A Y A Cl Door Edge F L WA Y 2 Exterior Sill Mil SF L NIA Y B CI Casing L WA Y 3 Pan Bead MII L NIA Y C Closet Jamb F L WA Y 4 Blind Stop W SF L N/A Y D Chet wells L NIA Y Win Ext Sash Wl L NIA Y a5 Cl Baseboard L WA Y Win Above 5' L WA Y 1 Closet Pole L WA Y Ceiling Moldind 011 L NIA Y 2 Closet Shelf L WA Y F MII A/M L WA Y 3 CI Supports L WA Y F MA AIM L WA Y 4 Closet Floor L❑(dusl) WA Y F Mil AIM L N/A Y Closet Ceding L NIA Y COMMENTS I STRUCTURAL DEFECTS: EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact by a Deieader(MORE THAN 288 SQ.IN,) SIDE LOCATION MEASURE:LOOSE PAINT Ic DATE IC METj4W ❑ Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problems I_VRA Rep 2017 Hall Joseph S) man 1430 r 12 26 19 Page�0'�L) Inspector(print) Lie# r re Date Risk Assessor(print) Lic# Signature Date Address or Property: 12 Ferry ST A 1.# city: North Andover ROOM# r ' ` :,� c F:�, S— e 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 Up Walls L N'A Y (� A Window Sill MA �M L N/A Y j A e Low Walls L NIA Y B Win Apron L WA Y A a Baseboards L NIA Y C Win Casing L WA Y A a Chair Rail L NIA Y D Header Stop MA L NIA Y A a Radiator L NIA Y Int Stops MA L NIA Y Floor L❑(dusl) NIA Y Wm Int Sash I L N/A Y y , r1r)w g L t�lA Y 2 Exterior Sill M/I SF L NIA Y r $ L NIA Y 3 Part Bead Mil L N/A Y C DEdge F L N!A Y 4 Blind Stop M/I SF L N/A Y 1 2 Cas ng „ L NIA Y `Z'26 Win Ext Sash I L NIA Y34 Jamb F L N/A Y A Window SI?I r- 'i Y Threshold L NIA Y B Win Apron L N/A Y A B Dow L N;A Y L NIA Y L� Dow Edge F L WA Y ({D Header Stop W1 L N/A Y a 12 Dow Casing L NIA Y int Stops WI L NIA Y 34 Dow Jamb F L N/A Y 1 Win int Sash M/I L N/A Y , ' NT Threshold I L NIA Y 2 Exterior Sill M/l SF L N/A Y Y A B Dow L NIA Y 3 Part Bead MA L N/A Y C D Dow Edge F L NJA Y Plind Stop . MA SF L NJA Y 12 Door Casing L NIA Y n Ext Sash M)l L WA Y - 3 4 Door Jamb F L NIA Y Window Sill M/i A/M L NJA Y 7,--Tad7. L NIA Y B Win Apron L NIA Y Closet Dow L NJA Y C Win Casing L NIA Y A Cl Dow Edge F L NIA Y D Header Stop Mil L NJA Y B CI Casing L NiA Y int Stops WI L NIA Y C Closet Jamb F L N1A Y 1 Win int Sash Mil L N/A Y D Closet Walls L NIA Y 2 Exterior Sig MA SF L N/A Y Cl Baseboard L NIA Y 3 Part Bead M/I L NIA Y 1 Closet Pole L NIA Y 4 Blind Stop Mil SF L NIA Y 2 Closet Shelf L NIA Y Wm Ext Sash M/I L N/A Y 3 Cl Supports L NIA Y A B Fireplace L N/A Y 4 Closet Flow L❑(dust)NiA Y C D Mantle L N/A Y A Closet Ceiling L NtA Y e e Win Above 5' L NJA Y COMMENTS/STRUC URAL DEFECTS Ceiling Moldin L N/A Y •2( F Mil A/M L NIA Y F MA A;M L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/I AIM L NIA Y by a Deleader(MORE THAN 288 SQ.IN.) F Mil AIM L NIA Y C IC F Mtl AIM L N/A Y SIDE LOCATION MEASURE:LOOSE PAINT -4-1 DATE htcTHGD F M/I AjM L NX Y El Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problems LIIRA Rep 2017 Room Joseph Siyman 1430 �� 12/ 26 / 19 Page LOfi'10 Inspectorr(print) LiC# Sigpatur`e Date Risk Assessor(print) Lic 4 Sign2tvf'�— Date Address of Property: 12 Ferry ST Aot.# city: North Andover BASEMENTILAUNDRY AREA SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ I LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ DATE METH DATE METH SURFACE HAZARD HAV DATE METH DATE METH A Walls L NIA Y A u Serviceboard L N/A Y At Walls `� L NIA Y A B Shelves ` L NIA Y p Walls L N/A Y C D Supports L NIA Y c s Walls L WA Y A B Shelves L NIA Y n L Baseboards L NIA Y C D Supports f L N)A Y c o Chair rails L N/A Y A B Shelves L NIA Y Floor LL[](dust) NIA Y C D Supports L NIA Y Ceiling L NIA Y A B Window frame hill L N/A I Y A ct Chimney L NIA Y C D Window Sash { Myl L NIA Y A a Support Colum L NIA Y 12 Exterior Sill M/I L NIA Y A B Door L NIA Y 34 Part Bead M/1 L NIA Y C or E e z F L N/A Y Win Ext Sash M/I L NIA Y 12 Door Casing L NIA Y A B W Widow frame W1 L WA Y 34 Door Jamb F L WA Y C D window sash M/1 L NIA Y Ttrreshold L WA Y 12 Exterior Still M11 L N/A Y A B Door L NIA Y 34 Part Bead Mil L NIA Y C D Door Edge F L N/A Y Win Ext Sash Mil L NIA Y 12 Dow Casing L NIA Y A B Window frame MA L N/A Y 3 4 Dow Jamb F L WA Y C D Window Sash MA L NIA Y Threshold L NIA Y 12 Exterior Sill Nin L N/A Y Closet Door L NIA Y 3 4 Part Bead MA L NIA Y A Ci Doer Edge F L N/A Y Win Ext Sash FF M/1 I_ NIA Y B Cl Casing L N/A Y Newel Posts L N/A Y C Closet Jamb F L WA Y A B Handrail AIM L N/A Y D Closet Walls L N/A Y C D Batusters L N/A Y Cl Baseboard L N/A Y 12 Lower rail L N/A Y 1 Closet Pole L N/A Y 34 Treads L F L N/A Y 2 Closet Shelf L N/A Y Risers L NIA Y 3 CI Supports L NIA Y Stringer L WA Y 4 Closet Floor L[](dust) NIA Y Tread Edge L N/A Y Closet Ceding L NIA Y Landing floor L ❑(dust) NIA Y c e Cabinets �`^ L NiA Y e Oil Tank L N/A Y A B Benches L N/A Y Win Above 5' L N/A Y C D Supports L NIA Y { 1)r F Mtl NM L N/A Y A a Pipes L N/A Y `�^,�, F Mil AIM L NSA Y A a Sink L NIA Y F MA AIM L NIA Y A a Dra npipe L NIA Y F MA KM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact CommenWStructural Detects by a Deleader(MORE THAN 288 SQ.IN.) SIDE LOCATION MEASURE:LOOSE PAINT N!j o Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problems LI/Rr%Rep 2017 Elsmnt/Laundry Joseph SI man 1430 12 / 26 /19 Page 0Of--AV Inspector(print) Lie gn r Date Risk Assessor (print) Lic# SignaqW Date Address of Property: 12 Ferry ST Apt.# City North Andover EXTERIOR A Side SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIONI LEAD TYPE OF URG C IC DELEAD DELEAD A SURFACE HAZARD HAZ? DATE METH DATE METH A SURFACE HAZARD HAZ7 DATE METH DATE METH Siding L N/A Y Window Sill A/M L NIA Y Comer Boards L NIA Y A Wn Casing L WA Y A Lower Trim L NIA Y V,,dow Sash L N/A Y Upper Thin (L)N/A Y Cellar Win Sill (�,AIM L N/A Y Win Above 5' f-L)NIA Y A Cel Wn Frame L NIA Y Porch Above 5 L A Y6 a Cel Win Sash L N/A Y Storm Door L NIA Y Sc sari Frame L N1A Y Strm Door Edge F L NIA Y Cellar Win Sill A/M L NIA Y rV Door 14 L N/A Y A Cel Win Frame L N/A Y 142 Door Edge F L NIA Y ji # ICel Wn Sash I L NIA Y 3 4 Door Casing L N/A Y Iscreen Frame L N/A Y Door Jamb F L N/A Y Cellar Wn Sill I AIM L N/A Y Threshold L NIA Y A Cal Win Frame L N/A Y KlCkptate L N/A Y Cal Wm Sash L N/A Y Storm Door L N/A Y Screen Frame L N/A Y Stim Door Edge ` F L WA Y Foundation r L N/A Y A Door L N/A Y A Bulkhead L NW Y 1 2 Door Edge F L WA Y Fences L WA Y 3 4 Door Casing L WA Y Shutters L N/A Y Door Jamb F L N/A Y Newel post L NIA Y Threshold L N/A Y Railing Cap A/M L N/A Y Kickplate L WA Y Handrail AIM L NIA Y Door L NIA Y A Balusters L N/A Y A Door Edge F L WA Y Lower Rail L N/A Y 1 2 Door Casuig / L NIA Y Treads F L NIA Y 3 4 Door Jamb F L N/A Y Risers L NIA Y Threshold L N/A Y Tread edge L NIA Y Kickplate L N/A Y Landing flow L NIA Y Window Sill AIM L WA Y Stringer f � I L N/A Y A Wn Casing ^ L N/A Y Lattze L NIA Y # Window Sash L NIA Y Drain Pipes L N/A Y Window Sig A/M L N/A Y A Elec Conduit L NIA Y A Win Casing L N/A Y Oil Fill Pipe L N/A Y Window Sash L NIA Y Overhang Trim L N/A Y 2 � COMMENTS/STRUCTURAL DEFECTS A Lamp Post L N/A Y A F M/I AIM L NIA Y A F Mil AN L NiA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area 11200 ppm for bare soil) intact by a De':eader(MORE THAN 2880 SO.IN.) LOCATION AREA MEiASUREMEN'r RESULT REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT C GATE C raEtt+op (Square Feet) (PPM) DATE METH A Play Area A Bare Soil A Comments A LIRA Rep 2017 Ext A Joseph SI man 1430 12/ 26/ 19 Page LECl, Inspector(print) Lic# Si at a Data Risk Assessor (print) Lic# Signature Date Address ofProoerty; 12 Ferry ST AM.# City: North Andover EXTERIOR B Side SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD I SIDEJ LOCATIONI I LEAD TYPE OF URG IC IC DELEAD DELEAD B SURFACE HAZARD HAZ? DATE METH DATE METH B SURFACE HAZARD HAZ? DATE METH DATE METH Siding L NIA Y Window Sill t AIM L NIA Y Comer Board L WA Y B Wm Casing ' } r ! A Y s-Zy H C t B Lower Trim L NIA Y Window Sash L N/A Y Upper Trim L /A Y 9L- Cellar Win Sill AIM L NIA Y Win Above 5' L iA Y B Cel'Nn Frain L NIA Y Porch Above 5 NIA Y Z' & Cel Win Sash L NIA Y Storm Door L NIA Y Screen Frame L NIA Y Stan Door Edge F L NIA Y Cellar Wm Sill A/M L NIA Y Door L NIA Y B Cot Wm Frame L NIA Y 1 2 Door Edge F L N/A Y tt Cot Win Sash L WA Y 3 4 Door Casing k L NIA Y Screen Frame L NIA Y DaorJamb F L NIA Y Ceilar'ddmShc AIM L NIA Y Threshold L WA Y B Cat Win Frame L NIA Y ckplate L NIA Y Cat Win Sash L NIA Y Stone Door L NIA Y Screen Frame L NIA Y Firm Door Edge F L NIA Y Foundation Mi L NIA Y B Door L NIA Y B Bulkhead L NIA Y 1 2 Door Edge F L WA Y Fences ( L NIA Y 3 4 Door Casing L NIA Y Shutters L NIA Y Door Jamb 4F L NIA Y Newel post L NIA Y Threshold L NIA Y Railing Cap A/M L NIA Y Kickptate L NIA Y Handrail AIM L NIA Y Door , L N/A Y B Balusters L NIA Y B Door Edge F L N/A Y Lower Rail L NIA Y 1 2 Door casing L N/A Y Treads F L NIA Y 3 4 Door Jamb F L NIA Y Risers L NIA Y Threshold L NIA Y Tread edge L NIA Y Kickplate L WA Y Landing floor L NIA Y M ( AIM L NIA Y Stringer 7 L NIA Y L A Y tl r- Lattice L N/A Y sh } L NIA Y Dram Pipes L NIA Y A/M L WA Y B Elec Conduit L N/A Y �C}WA Y '2 Oil Fitt Pipe L N/A Y sh L WA Y Ovefiang Trim !L /A Y ; COMMENTS/STRUCTURAL DEFECTS: B Support Clmns L WA Y B F M/1 AiM L NIA Y B F M/I AIM L NA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(f.Aust be less than 400 ppm for play area 11200 ppm for bare soil) intact by a Deleader(MORE THAN 2880 So.IN.) LOCATION AREA IVIFASURFAIE N'1' RESULT REMED REMED SIDE LOCATION MEASURE;LOOSE PAINT C DATE I rt WE tHOCI Square Feet) (PPM) DATE METH B Play Area B Bare Soil B Comments: B LURA Rcp 2017 Ext B Joseph St man 1430 12 / 26 / 19 Page aor Inspector(print) Lic# I a re Date Risk Assessor (print) Lic#° Sig u Date Address of Property 12 Ferry ST Ant # City: North Andover EXTERIOR C Side SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ I 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 J, Window Sill ( 7 AIM L N/A Y Comer Boards L NIA YGCt Win Casing L NIA Y - f C lower Trim L NIA Y i Window Sash L NIA Y Upper Trim L A Y -Z6 IT Cellar Wirt Sill AIM L N/A Y 14§n Above 5' ,L /A Y - C Call Win Frame L N/A Y Porch Above 5 N/A Y # Cel Win Sash L N/A Y Storm Door L N/A Y Screen Frame L N/A Y Stan Door Edge F L NIA Y Cellar Wm Sill AIM L WA Y C Door 1,miL NIA Y C Cel Wm Frain L N/A Y 1 2 Door Edge F L NIA Y it Cel Wn Sash L N/A Y 3 4 Door Casing L NIA Y Screen Frame L WA Y Door Jamb F L NIA Y Cellar Win Sill ( AIM L NIA Y Threshold L N/A Y C Cel Win Frain L N/A Y Kickplate L N/A Y Cel Win Sash L INA Y Storm Door L NIA Y Screan Frame L NIA Y Strm Coor Edge F L WA Y Foundation L N/A Y C Door L N/A Y C Bulkhead L NIA Y 1 2 Doa Edge F L NIA Y Fences L N/A Y 3 4 Door Casing L WA Y Shutters L N/A Y Door Jamb F L N/A Y Newel post L N/A Y Threshold L NIA Y Railing Cap AIM L NIA Y Kidplate L N.rA Y Handrail A/M L NIA Y Door L N/A Y C Balusters L NIA Y C Doer Edge F L WA Y Lower Rail L N/A I Y 1 2 Doe Casing L N/A Y Treads F L N/A Y 3 4 Door Jamb F L NIA Y Risers L N/A Y Threshold L NIA Y Tread edge L NIA Y Kickplate L N/A Y Landing floor L N/A Y Window Sid AIM L N/A Y Stringer L N/A Y C Win Casing L A Y Lattice L N/A Y r wndaw Sash L N/A Y Drain Pipes L N/A Y Window Sill . I AIM L NIA Y C Elec Condu t L N/A Y #i Win Casing L /A Y 'G Od Fid Pipe L NIA Y Window Sash N/A Y Overhang Tri r. L /A Y COMMENTS I STRUCTURAL DEFECTS: C Support Clmn `t NIA Y C F Mll AIM L N/A Y C F MA AN 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 SO,IN.) LOCATION ARIA MEASt1RFMFNT RESULT REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT IC DAIS I is MEr,+ec• (Square Feet) (PPM) DATE METH C Play Area C Bare Soil C Comments: C LMA Rcp 2017 Ext C ili� Joseph SI man 1430 12 126 /19 Page, Of �±✓ Inspector(print) Lic# Sig r �-j ture Date Risk Assessor (print) L aic# Sig Date Address of Property: 12 Ferry ST Act # City North Andover 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 IHAZ? DATE METH DATE METH D SURFACE HAZARD HAZ? DATE METH DATE METH Siding L L NIA Y Window Sill AIM L NIA Y Comer Boards L NIA Y D Win Casing L NIA Y D Lower Trim L WA Y Window Sash L N/A Y Upper Trim i L /A Y 2 Cellar Win Sill AIM L N/A Y Wm Above 5' NIA Y D Cal Win Frain L N/A Y Porch Above 5 L N/A Y Cel Win Sash L NIA Y Storm Door L NIA Y Iscreen Frame L N/A Y Stnn Door Edge F L NIA Y Cellar Win Sill r NM L N/A Y D Door L N/A Y D Cal'Alin Frame r L N/A Y 1 2 Door Edge F L N/A Y 4 Cal Win Sash L N/A Y 3 4 Door Casing r L WA Y 4. Tut Screen Frame L N/A Y oa D Jamb F L N/A Y Z -4X Cellar Wm Sill AIM L NIA Y Threshold L NIA Y D Cal Win Frame L NIA Y t4ickplate L NIA Y Cal Win Sash L WA Y Storm Door L N/A Y Screen Frame L NIA Y Stms Door Edge F L N/A Y Foundation L NIA Y D Door L WA Y D Bulkhead L N/A Y 1 2 Door Edge F L N/A Y Fences L N/A Y 3 4 Door Casing L WA Y Shutters / L NIA Y Door Jamb F L WA Y Newd post L NIA Y Threshold L N/A Y Railing Cap AfM L NIA Y Kickpiate L NIA Y Handrail A/M L N/A Y Door 71 L WA Y D Balusters L N/A Y 0 Door Edge F L WA I Y laver Rail L NIA Y 1 2 Door Casing L WA Y Treads F L N/A Y 3 4 Door Jamb F L WA Y Risers L N/A Y Threshold L WA Y Tread edge L NIA Y Kickplate L N/A Y Landing floor L N/A Y Window Sill AIM L WA Y Stringer L NIA Y D Wn Casing L N/A Y Lattice L NIA Y # Wuidow Sash L NIA Y Drain Pipes L N/A Y Window Sill f AIM L NIA Y D Elec Conduit `� L WA Y D Win Casing L NIA Y Oil Fill Pipe L WA Y # Window Sash L WA Y iOverhang Trim L /A Y COMMENTS/STRUCTURAL DEFECTS: D Support Clmns `L NIA Y D F MA AIM L WA Y D F MA AIM L N?A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area/1200 ppm for bare soil) intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION ARVA NIHASUREMEN'l RESULT REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT Ice TE C METHM (Square Feet) (PPM) DATE METH D Play Area D Bare Soil D Comments: D t_L'!ZA Rep 2017 Fat D