Lead Based Paint (LBP) Survey

• Audit Title

• Site

• Location
  Address

• Conducted on

  Date

• Prepared by

• Certification Number:

Field Observations

• What is the name of the structure being sampled?

• Picture of the structure being sampled

  Media

• When was the structure built?

• Approximately how many square feet is the overall building?

• Describe the interior of the structure. Include approximate square footage of each space, components in the space, composition of the floors, walls, ceilings, etc...., number of windows, how is the structure heated/cooled, and/or any other specific information.

• Describe the exterior of the structure. Include the composition of the walls, roof, fondation, components around the structure, and/or any other specific information.

Sample 1

• Sample Number

• Sample Description

• Picture of the Suspect Material

  Media

• Drawing of the Space being Sampled

  Drawing

• Approximate square footage of the suspect material

Sample 2

• Sample Number

• Sample Description

• Picture of the Suspect Material

  Media

• Drawing of the Space being Sampled

  Drawing

• Approximate square footage of the suspect material

Sample 3

• Sample Number

• Sample Description

• Picture of the Suspect Material

  Media

• Drawing of the Space being Sampled

  Drawing

• Approximate square footage of the suspect material

Sample 4

• Sample Number

• Sample Description

• Picture of the Suspect Material

  Media

• Drawing of the Space being Sampled

  Drawing

• Approximate square footage of the suspect material

Sample 5

• Sample Number

• Sample Description

• Picture of the Suspect Material

  Media

• Drawing of the Space being Sampled

  Drawing

• Approximate square footage of the suspect material

Sample 6

• Sample Number

• Sample Description

• Picture of the Suspect Material

  Media

• Drawing of the Space being Sampled

  Drawing

• Approximate square footage of the suspect material

Sample 7

• Sample Number

• Sample Description

• Picture of the Suspect Material

  Media

• Drawing of the Space being Sampled

  Drawing

• Approximate square footage of the suspect material

Sample 8

• Sample Number

• Sample Description

• Picture of the Suspect Material

  Media

• Drawing of the Space being Sampled

  Drawing

• Approximate square footage of the suspect material

Sample 9

• Sample Number

• Sample Description

• Picture of the Suspect Material

  Media

• Drawing of the Space being Sampled

  Drawing

• Approximate square footage of the suspect material

Sample 10

• Sample Number

• Sample Description

• Picture of the Suspect Material

  Media

• Drawing of the Space being Sampled

  Drawing

• Approximate square footage of the suspect material

Conclusion of Survey

• How many samples were collected?