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[ate i>urf <br /> Address of s;te 385, dligpogr � !S;yt;�i� Dat: �environmental rn.esryatfon �3 �3d �6 9 <br /> SOURCES OF EXPOSURE IDENTIFIED — DECISION LOGIC WORKSHEET <br /> Exposure Criteria—Check all criteria that apply for each sample below <br /> A—Above regulatory standard <br /> B—Area accessible to case <br /> C—Case contact or ingestion <br /> D-- Deteriorated surface <br /> E—Bare soil surface <br /> F--Proximity to exterior deteriorated paint or bare soil <br /> G—Other: <br /> PAINT <br /> Sample/XRF No. Type Location/ROOM Component A^p1icab1e Exposure Criteria <br /> 1p ®XRF ❑Lab ®A i�-B SC ®D ❑G <br /> X�1�rOR PdRC� � GOLG(IY1N <br /> I�XRF ❑Lab � �A �B ®G ®'D ❑G <br /> 7 �X myu-o Aver / ws Nao w ssac. <br /> ®XRF ❑Lab ®A IAB C bgD ❑G <br /> � � tdrP I'd QCYt G � LDLJ�R n <br /> ®XRF ❑Lab SIrrLLF ®A iIl 6 1�G D ❑G <br /> ❑XRF Ll Lab <br /> ❑A ❑8 ❑C 01) ❑G <br /> ❑XRF ❑Lab ❑A ❑8 ❑G ❑D ❑G <br /> 0xF ❑Lab ❑A ❑B El D 0 <br /> ❑ No palnl sources identified <br /> DUST <br /> Sample/XRF No. Type Location/Room Component Aaplicable Exposure,Criteria <br /> ❑XRF' ❑ Lab ❑A 06 ❑C ❑D ❑ F ❑G <br /> ❑A [I E3 0 0 0 ❑G <br /> ❑XRF ❑Lab <br /> ©XRF ❑Lab ❑A 08 ❑C 0 OF ❑G <br /> ❑XRF ❑Lab ❑A ❑e ❑C ❑D OF ❑G <br /> I� ❑XRF ❑Lab ❑A [3B (2C 0 OF ❑G <br /> l�No dust sources identified <br /> SOIL <br /> Sample/XRFNo. Type Location/Side Applicable Exposure Criteria <br /> i <br /> 5l I XRF [0 Lab ®A g8 ®C �> (RF ❑G <br /> ❑XRF ❑Lab ❑A ❑B ❑o ❑E OF: ❑G <br /> t. <br /> ❑XRF ❑Lab ❑A 0 D 0 ❑F 0 <br /> Q No soil sources identified <br /> OTHER <br /> Sample 10 No. Type Description Applicable Exposure Criteria <br /> El Test kit ❑Lab ❑A 0 ❑C ❑o ❑F CG <br /> ❑Test kit Cl Lab 0 0 ❑C 0 ❑F 0 <br /> a <br /> ❑Test kit C3 Lab <br /> 0 ❑e ❑C E-)C) 0 0 <br /> �[No other Sources identified <br /> E3104 Lead Poisoning Follow-up Form California Department of Health Services Childhood Lead Poisoning Prevention Branch Page 17 <br />