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TRANSMISSION VERIFICATION REPORT <br /> TIME 08/07/2069 15:26 <br /> NAME ENVIRONMENTAL HEALTH <br /> FAX 2094688392 <br /> TEL <br /> SER. # BROD9J925044 <br /> r :RESULT <br /> ATE,TIME 68!07 15:26 <br /> AX NO./NAME 915166205656 <br /> URATION 915100:00:18 <br /> AGE(S} 01 <br /> 01ODE OK <br /> STANDARD <br /> ECM <br /> -state of Cailfornia—Health and Hurnen-services Ag2nay <br /> California bepartmant of Public Health <br /> LEAD HAZARD EVALUATION REPORT <br /> Section 1 — Date at Lead Hazard Evaluation <br /> 06127109 <br /> Section 2 — TYPe of Lead Hazard Evalttatiorr MI'Mok one box only) -- <br /> L Lead Inspection ❑ Risk assessment Lvje <br /> Clearance fnsPeCtion ❑ 4ther(Specify) <br /> Sectlon 3—Structure Where Lead Hazard Evaluation Was Conducted <br /> address[numb[number,stroe%apartment(If applicablej] '---- ..---,- <br /> 38 SDUrH AIRPORT WAY C� µ <br /> Tip Code�--� <br /> __ _ _ srocF_70 sAnr�oAc uiN_ 95206 <br /> of gtruuctlen date(year] ^ tYpe of struoture <br /> at structure Chidnan bv7rg In&tructure7 <br /> 9)4 ] multi-una building School or daycare — <br /> 0 Single tam; Q Yes ❑ IVa <br /> ryr dwen;r�g Lj Other <br /> --- n l7ort't Knpw <br /> Section 4 —Owner of structure(H buslnessrfagency, fiat contact person) <br /> Name .�� <br /> KIND, PETER R. 8c ILA M. Telephone number <br /> Address(number,street,apartment(If applii ble)] <br /> 3835 EAST MAIN STRty <br /> EET ��ST�CCKTO�—� state <br /> p coca�'- <br /> Section 5 Results;of Lead Hazard Evaluation(check all that apply) <br /> CAt~1FORNIA 95215 <br /> pA Y) k <br /> ❑ No lead-ba8ed paint detected Intact lead-based paint defeated <br /> ❑ Deteriorated lead-basad paint detected <br /> l= 1 <br /> No lead hazards detected ❑ Lead-contaminated dust found 0 Lead-contaminated soli found <br /> ❑ Other_ <br /> Section 6 — individual Conducting Lead Hazard Evaluation —~ <br /> Name <br /> OMRAN SOOD Tefephone number —� <br /> (209)468-9965 <br /> Address[number,street apariment(if applicablo)]— -- <br /> 600 EAST MAIN STREET <br /> STOCKTON zip Code <br /> C"PMoertlficaU4nnumber - _ CALIFORNIA 95202 <br /> I A ne.A. Slgnatwo ---- <br /> t Oat'-.._� <br />