Laserfiche WebLink
ENVIRONMENTAL INVESTIG 'ON —Summary Statement <br /> Address sampled <br /> 3� S Date of referral <br /> �SiKevT T wy <br /> City/County/Zip D3 I Z6 /a9 <br /> Date of environmental invesfigaticn Trme arrl�d at address pq <br /> S"UG�CR�nf SrfN/.TD a97f r ,?S 6 d 3/ 30 /0 Time depa ted address <br /> Phone Estimated year built Date of summary statement <br /> Case Local ID# l � Zit b 9 <br /> Environmental professional name <br /> Medi-Cal x 0,01we00 <br /> 1/A X E=xpiration date <br /> �-106 lI 407 ! d 9 <br /> Persons present during initial environmental investigation Environmental investigation closure date <br /> C61� G`ly�� Mo7NS�� GRtavtame}�(�R PKNI a8 2r o <br /> Reason for El closure: <br /> ❑ No environmental lead hazard sources identified <br /> H Clearance achieved <br /> 1.VISUAL.ASSESSMENT(Note paint condition,areas of bare soil,areas of remodelin /renovation in the last 6 months) <br /> Exterior <br /> Rin m, r: r s aSoefdL 4MAOrl, <br /> interior r <br /> Rousing Environment/Characterisfics <br /> .Estimated year built Pre-1978? <br /> Pre-1920 ❑ 1920-1939 El 1940-1949 01950-1956 C)1950-1979 E) 1980+ '❑Don't know Yes <br /> Remodeling,painting or renovation within the last year? ❑Yes [9 No E3 Don't know Who did this remodeling?Check all that apply: <br /> Where was most recent remodeling done? ©Self/Family ❑Property owner ❑Licensed contractor <br /> "❑Interior ❑Exterior ❑Both Don't know Don't know ❑Other <br /> Describe: <br /> Is this site close to a lead industry? <br /> ❑Yes ®Na El Don't know <br /> specify: <br /> Lead pipes or solder? <br /> ❑Yes ❑No ®Don't know <br /> Water sampled? <br /> Yes ❑No <br /> 10103 Lead Poisoning Follow-up Form California Department of Health Services Childhood Lead Poisoning Prevent;on Branch Appendix A-1 <br />