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State ID# <br /> +rr��r�rnr`�r�mrr_ <br /> XRF READINGS i <br /> Address sampled p1f� 3 ,)F 3 Date collected <br /> 3O Soot r��e W# 03 /30 �d9 , <br /> City Cour. zip <br /> Sr(PGk71JA1 �! drihv `ISZo6 I <br /> XRF PAINT READINGS(mglcm') <br /> Model Serial No. Testing mode used: <br /> i <br /> Nyi�N 3d3A- �is� s��n)eo � <br /> Calibrations--NIST 1.02 Standard Mlon:K$L Mode,20 Ssec Each AMD:Standard Mode <br /> 1st.Reading 2nd-Reading 3rd.Reading <br /> Calibration Mode Used No. Value No. VaL;e No. Value Average of 3 PCs Range <br /> Beginning <br /> Reading II Condition Reading R�soll <br /> No. Location Roam/Side(per HUD) Component I (per HUD) substrate/Color (mg/CrTf) i >s-'J.? <br /> ❑Interior ❑Living room ❑Bedroom ❑Door Basin I — I <br /> g ❑Door � ❑[Hiatt Wood ❑ Piaster <br /> C-) t? � a Exterior Q Kitchen ElBatP,rcom ❑Window sash [3Wall ❑ Fair(slightly del.) ❑Drywall ❑Metal ❑yg;;.;c <br /> ZC Cl Other: ❑Window sit] ❑ Poor(very del.) ❑Other <br /> Side: A B C D E3 Other: Color:` <br /> ❑Irterior ❑Living room ]Bedroom ❑Door casing ❑Door ❑ Intact ❑Wood ❑Plaster ❑ ;as <br /> ❑S,xterior ❑Kitchen ❑Bathroom ❑Window sash ❑Wall ❑ Fair(slightly del.) ❑ Drywall ❑Metal <br /> ❑Other: ❑Window sill i ❑Poor(very del-) ❑Other i <br /> S'dz: A B C D 1-1 Other: Color: <br /> I � <br /> ❑Interior ❑Living roam 'Bedroom ❑Door casing ❑Door I ❑ Intact ❑Wood ❑Piaster <br /> ❑Exterior ❑Kitchen a Bat;room ❑Window sash ❑Wal! I ❑Fair(slightly dei.) ❑Drywall ❑Metal i <br /> ❑Other' ❑Windowsill ❑ Poor(very dei.) ❑Other <br /> Side: A B C D ❑Other: Color �i ! <br /> ❑interior ❑Living room ❑Bedroom ❑Door casing ❑Door f ❑Intact ❑Wood ❑Plaster _Yes <br /> ❑Exterior ❑Kitchen !Bathroom ❑Window sash ❑Wafl ❑ Fair(slightly del.) ❑ Drywall ❑Meta! I so <br /> ❑Other: ❑Window sill ❑ Poor(very dei.) ❑Other j <br /> Side: A B C D ❑Other: I Color: <br /> I <br /> ❑Interior ❑Living room LII Bedroom ❑Door casing ❑Door ❑intact ❑Wood ❑Plaster [Y=s <br /> ❑Exlericr' ❑Kitchen ❑Bathroom ❑Window sash ❑Wall I ❑Fair(slightly del.) ❑ Drywall ❑Meta! ❑rto <br /> ❑Dlher: ❑Window sill I ❑ Poor(very dei.) ❑Other <br /> Side: A B C D ❑Other' Color: <br /> ❑Interior ❑Living room ❑Bedroom ❑Door casing ❑Doer i ❑ Intact ❑Wood ❑ Plaster ❑Yzs <br /> ❑Exterior ❑Kitchen ❑Bathroom ❑Window sash ❑Wall ❑Fair(slightly dei.) ❑Drywall ❑Metal L No <br /> ❑Other: ❑Window sill ❑Paor(very del.) ❑Other <br /> Side: A B C D ❑Other. Color: <br /> ❑Interior ❑Living room ❑Bedroom ❑Door casing ❑Door ❑Intact ❑Wood ❑Plaster <br /> ❑Yes <br /> ❑Exterior ❑Kitchen ❑Bad room ❑Window sash ❑Wall ❑Fair{slightly del-) ❑Drywall ❑Metal ❑r:o <br /> ❑Other. ❑Window sill ❑Poor(very det.) ❑Other <br /> Side: A 8 C D ❑Other: Color: <br /> ❑Interior ❑Living room ❑Bedroom ❑Door casing ❑Door ❑Intact ❑Wood ❑Plaster ❑Yes <br /> ❑Exterior ❑Kitchen ❑Bathroom ❑Window sash ❑Wall ❑Fair(slightly dei.) ❑Drywall ❑Metal ❑!Jo <br /> ❑Other: ©Window sill ❑Poor(very del.) ❑Other <br /> Side: A B C D ❑Other. Color: <br /> ❑Interior ❑Living room ❑Bedroom ❑Door casing ❑Door ❑intact ❑Wood ❑Plaster ❑Yes <br /> ❑Exterior ❑Kitchen ❑Bathroom ❑Window sash ❑Wall ❑Fair(slightly del.) ❑Drywall ❑Metal ❑No <br /> Other: ❑Window sill ❑ Poor(very del.) ❑Other <br /> Side: A B C D ❑Other- Color: <br /> Calibrations—NIST 1.02 Standard Pliton:X&L Mode,20 Ssec Each AMD:Standard Mode <br /> I st.Reading 2nd.Reading 3rd.Reading <br /> Calibration Madge Used No- Value No. Value No. Value Average of 3 PCS Rance <br /> Ending K& 1100 ',76 1,00 f 00 09— 2 <br /> 3/04 Lead Poisoning Fallow-up Fcrm California Department of Health Services Childhood Lead Poisoning Prevention Branch Pave 15 <br />