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State ID# XRF READINGS Address sampled Date collected 38s _56t4m PaRr w l I city 03 3v o� county Zip S/ f Al S�v .Io t474 9S74`6 XRF PAINT READINGS(m cm') Model Serial No. Testing mode rs=,, Ny'yt�l+l X 303� Z�rS� SGY/jvAr1,>'/J . Calibrations—NIST 1.02 Standard Niton:K&L Mode,20 Ssec Each RAID:Standard Mode 1st. Reading 2nd.Reading 3rd.Reading Calibration Mode Used No. Value No. Valve N'o. Value Average of 3 ?CS Range Beginning kK _ 'L /10 Reading f`K Ccndit;'on Result No. Location Room/Side(per HUO) Component (per HUD) Substrate/Color ?std.? ❑Interior ❑Living room ❑Bedroom ❑Door casing ❑Door ❑ Intact fWood ❑ Plaster ❑ Yes S ®Exterior E)Kitchen EJ Bathroom C3 Window sash ❑Waii ❑Fair(siightly del-) ❑Drywall El Metal ®No Other: too t,[# ❑Window sill ®Pccr(very de!.) ❑Other Side: 6 B C D �Oiher: $fFS�80fhe� Color: 19ROWA/ ❑Interior ❑Living room ❑Bedroom ❑Door casing ❑Docrmm� ❑Intact ®Wood ❑ Plaster ®Yes / 9 Exterior ❑Kitchen C1 Bathroom El W+ndow Sash [I Wall ❑Fair(s:ghlly det.) El Drywall E]Metal ❑No b ER Other: PORGK ❑Window sill Pocr(aery del.) ❑Other /0 Side 8 C D SOlher: 604',j4MV I Color: 6–RLy ❑Interior ❑Living room ❑Bedroom ❑Door Casin g ❑Dcc: ❑[nrc, '�Wood ❑Plaster ®Yes ®Exterior ❑Kitchen L2Bathroom ❑Window sash ❑Wali ❑Fair r:ghtly Let) ❑prywalt EJ metal 71 No 7 -4lher �QRLN 69 Window sill I ®Pcc,iverj ca;.) - ❑Other 3.2v Side: 0 B C 6 [I Other: Color. ❑Interior ❑Living room ❑Bedroom ❑Door casing ❑ peer ❑ Inta_: ®Woad ❑Plaster 23 Exlerior El Kitchen El Bathroom El Window sash 25 Wall ! ®Fair ®Yes lslighuy del,) ❑Drywall ❑Meta! ❑No to Other: AOR CJWindow sill I ❑Pccr t;ery d-l-) ElOther Side: A B D ❑Other. LD�L� I Gotor. 6�y 12 9� ®Interior ❑Living room ®Bedroom ®Door casing ❑Dor_r Elinlact ®Wood ElPlaster ❑Yes ❑Exterior ❑Kitchen ❑Bathroom ❑Window sash ❑Wa9 ®Fa:r(slightly tet.) ElDrywart E3 metal ®No Ll other: EJ Window sill ❑Poor(very del.) ❑Other 0100 Side: AB C D ❑Other: Color: (r,efy ®Interior ❑Living room 19 Bedroom ❑Door casing 54 Docr ❑Iniac: ®Wood ❑Plaster ❑Yes ❑Exterior ❑Kitchen ❑Bathroom ❑Window sash ❑Wall 6?Fa's IsSghtly del.) ❑Drywall ❑Metal 9 No )0 ❑Other: ❑Window sill ❑Poor(very det.) ❑Other 0.0p El Other. Color: pyN� Side: A 8 C 0 � ®Interior ❑Living room 9 Bedroom ❑Door casing Cl Door ❑Intact ®Wood ❑Plaster ❑Yes II ❑Exterior ❑Kitchen ❑Bathroom ❑Window sash ®Wall ®Fair(s!ightly del) ❑Drywall ❑Metal ®No f ❑Other: ❑Window sill ❑Poor(very de[.) ❑Other 400 Side: A B C D ❑Other. t4 Mk Color: t,VN_%7L_ ®Interior ❑Living room ®Bedroom ❑Door casing ❑Door ❑Intact 'Z Wood ❑Plaster ❑Yes ❑Exterior ❑Kitchen ❑Bathroom Cl Window sash ❑Waa 0 Fair(slightly det.) ❑orywalr ❑Metal 10 No Z ❑Other: ®Window sill ❑Poor(very(lei.) ❑Other Side: A ® C .D ❑Other. Color. L/ 401 ®interior ®Living room ❑Bedroom $3 Door casing ❑Door ❑Intact ®Wood ❑Plaster ❑Yes ❑Exterior ❑Kitchen Bathroom ❑Window sash ❑Wall ®Fair(slightly del.) ❑Drywall ❑Metal No j ❑Other: ❑Window sill ❑Poor(very del.) Cl Other Side: A # C D ❑Other. Color. Calibrations—NIST 1.02 Standard Niton:K&L Mode,20 Ssec Each RIh1D:Standard Mode 1st.Reading 2nd.Reading 3rd.Reading Calibration Mode Used No, Value No. Value No. Value Average of 3 PGS Range Ending 3104 Lead Poisoning Follow-up Form California Deparment of Health Ser.ices Childhood Lead Poisoning Prevention Branch Page 15