Date of sample collection:
Total number of samples collected:
KEY: (1) Room Number or Identifier: must correspond with the unique Unit Number used for each unit as identified in the Risk Assessment
Report.
(2) Sample ID #: Must correspond to the unique sample numbers generated during sample collection and submitted in Laboratory
Report as part of the Risk Assessment Report.
(3) Results of Lab Analysis: Report Dust in g/ft; Paint Chips in % by weight and g/g (parts per million (ppm)) and soil in ppm.
(4) EPA Action Levels : Dust: 40 g/ft for floors; and 250 g/ft for window sills; Paint chips 0.5% by weight (5000 g/g (ppm)); and
soil: 400 ppm bare soil in play areas; 1200 ppm bare soil in non-play areas.
(5) Basis for Determination of Hazard: Dust exceeds Table A-1 action level for surface evaluated or as otherwise defined, paint chip
exceeds Table A-1 definition for LBP and is deteriorated or as otherwise defined, and soil exceeds Table A-1 action levels based on child
access and use.
Figure B-6: Summary Form, Lead-Hazard Risk Assessment Results
Page _____ of _____
B-20
Previous Page
