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TACT (IF DIFFERENT THAN OWNER): PHYSICAL LOCATION OF TESTING SITE: LABORATORY CHAIN OF CUSTODY NUMBER: PART II: VISUAL ASSESSMENT SUMMARY OF VISUAL ASSESSMENT: Is there visual evidence of dust and debris in the unit? dust samples. Unit needs to be re-cleaned. Yes No (check one) If Yes, DO NOT collect PART III: SUMMARY OF LEAD DUST SAMPLING RESULTS): SAMPLING LOCATION ENTRY FLOOR LIVING ROOM FLOOR CHILD S BEDROOM FLOOR KITCHEN FLOOR LIVING ROOM WINDOW SILL BEDROOM WINDOW SILL KITCH.

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