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State ID## <br /> w XRF READINGS <br /> dF . <br /> Address sampled Date collected <br /> f' 3� sour �Pv�r A D3/3a gay <br /> City Cour' Zr <br /> P <br /> .SnLk-fw S/P7J <br /> XRF PAINT READINGS(mg/cm') <br /> Model Serial No. Testing mode used: <br /> t <br /> K:-R4J XL 3038 7�O1sL 5;7�i✓�fiep <br /> Calibrations—NIST 1.02 Standard Niton:K&L Mode,20 Ssec Each RMD:S'_r.dard Mode i <br /> tst.Reading 2nd. Reading 3rd Reading i <br /> Calibration Mode Used No. Value No. VaL;e No. Value Average of 3 PCS Rar.a <br /> Beginning <br /> Rea ding <br /> No. Location Roam/Side(per HUD) Component Condition Reading <br /> (per HUD) Substrate/Color (mg/cm) <br /> ®InteriorLiving room ElBedroom ❑Door casing ❑Door ElIntact ®Wood ❑ Plaster ,es <br /> ley C3Exterior �Kitchen 10 Bathroom ❑Window sash ®Wall ®Fair{slightly del-) ❑Drywall ❑Metal <br /> ff ❑Other. ❑Window sill ❑Poor(very det.) ❑Other a,03 <br /> S'de, A B C (0) El Other: uppjW Color: avvio <br /> ®Interior ®Living roam ❑Bedroom LJ Door casing E-1 Door i LJ Intact C9 Wood ❑ Plaster es <br /> ❑Exterior ❑Kitchen ❑Bathroom ❑Window sash ❑Wall ®Fair(sTightly det.) ❑Drywall ❑Metal ;:._ <br /> ❑Other. ❑Window silt € ❑Poor(very det.) ❑Other <br /> S. A B (f p ®Other. G/� � Color: <br /> Interior ®Living rpom. i Bed.00mI . <br /> ❑Door casing ❑ Door ❑Intact ®Wood ED <br /> ❑Exterior ❑Kitchen ❑ Battroom ❑Window sash ❑Wailt?�Fair(slightly dot.) ❑Drywall ❑Metal i <br /> i ` <br /> ❑Other. ❑Windowsill ❑ Poor(very del.) ❑Other So i <br /> I <br /> Side: A 8 D Other: SXLLF I Color. <br /> ®Interior Rr Living room ❑Bedroom ❑ Door casing ❑ Door ❑ Intact- Wood ❑Plaster [Yas <br /> J ❑Exterior ❑Kitchen Ba:hraom ❑Window sash ❑Waif ®Fair(slightly del.) ❑ Drywall ❑ Metal Si N.) I <br /> I ❑Other: 5d Window sill i ❑Poor(very del.) ❑Other <br /> Side. A R C D ❑Other: i Calor: j9ROWA/ <br /> ®Interior ❑Living room Z1 Bedroom $�Door casing ❑ Door i ❑ Intact ®Wood ❑ Piaster [Yes <br /> ❑Exterior ❑Kitchen ❑Bathroom ❑Window sash ❑Wall j R Fak{slightly del.) ❑Drywall ❑Metal N7 <br /> ❑Other. GLa ❑Window sill ❑ Poor(very del.) ❑Other <br /> Qr U� <br /> Side: A B D El Other: Color: <br /> ®Interior ❑uving room ®Bedroom ❑Door casing ®poor ❑intact CS Wood ❑Plaster ❑'res <br /> ❑Exterior ❑Kitchen ❑Bathroom ❑Window sash ❑Wall ®Fair(slightly del) ❑Drywall ❑ Metal R Pio <br /> ❑Other: c-uSL.OS ❑Window sill ❑Poor(very det.) ❑Other Lie <br /> Side: Color: r <br /> Side: A t3 C � WKr� <br /> ®Interior ❑Living room ®Bedroom ❑Door casing ❑Door ❑Intact ®Wood ❑Plaster ❑Yes <br /> ❑Exterior ❑Kitchen ❑Bathroom ❑Window sash 29 Wall W Fair(slightly del.) ❑Drywall ❑Metal C?�rJo <br /> ❑Other: TLfJJs ❑Window sill ElPoor(very del.) C3Other v,UO <br /> Side: AD B C D ❑other: ut°PLR Color: BLL <br /> 0 Interior ❑Living room ®Bedroom ❑Door casing ❑Door ❑ Intact CS Wood ❑Plaster ❑Yes <br /> y ❑Exterior ❑Kitchen ❑Bathroom 0 Window sash ❑Walt Fair(slightly det.) ❑Drywall ❑Metal ®do <br /> ❑Other: �� `— ❑Window sill ❑Poor(very del.) ❑Other Doo <br /> Side: A & C D ❑Other. u pOW Color- els¢ <br /> ❑Interior ❑Living room ❑Bedroom ❑poor Casing ❑Door ❑Intact ❑Wood ❑Plaster ❑Yes <br /> ❑Exterior ❑Kitchen ❑Bathroom ❑Window sash ❑Wall ❑Fair(slightly det.) ❑Drywall ❑Metal 0pf,K enR ❑rso <br /> ❑Other: ❑Window sill ❑Poor(very del.) ❑Other LRROIR <br /> Side: A B C D ❑Other. Color: <br /> Calibrations—NIST 1.02 Standard Niton:K&L Mode,20 Ssec Each SMD-Stan.dard Mode <br /> tst-Reading 2nd.Reading 3rd.Reading <br /> Calibration Mode Used No. Value No. Value No. Value Average of 3 PCS Rance <br /> Ending <br /> 3/04 Lead Poisoning Follow-up Form California Department of Health Services Childhood Lead Poisoning Prevention Branch Paye 15 <br />