FORM 6
EP 1110-1-28
SUMMARY OF
31 Aug 01
LEAD-HAZARD RISK ASSESSMENT RESULTS
Installation
POC
Phone Number:
Building Address or Location
Housing Unit No. (if applicable)
Location of Identified Lead-Based Paint and/or Lead Hazards
Basis for
Room
Determination of
Number
Surface Type
Sample
Results
EPA
Sample
Hazard
or
(floor, window
Type (dust,
of Lab
Action
Comments
ID#
Identifie
sill, etc.)
paint, soil)
Analysis
Levels
(e.g., deteriorated
r
paint)
Page _____ of _____
B-19
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