<p> Attachment 2-A: Sample Visual Inspection Form</p><p>SAMPLE VISUAL INSPECTION FORM</p><p>Date and Time of Clearance Lead Dust Sampling Technician Client Property Address</p><p>Location Identify visible areas of dust, paint chips, painted debris, and deteriorated paint. (Note location: walls, ceiling, floors, doors, windows, trim, cabinets, approximate square footage, etc.)</p><p>Chapter 2 Attachment Attachment 2-B: Completed Sample Visual Inspection Form</p><p>SAMPLE VISUAL INSPECTION FORM</p><p>Date and Time of 8/5/09 11:00AM Clearance Lead Dust Sampling Jane White Technician Client The Smith Family Property Address 78 East Main Street Hammond, IN 89898</p><p>Location Identify visible areas of dust, paint chips, painted debris, and deteriorated paint. (Note location: walls, ceiling, floors, doors, windows, trim, cabinets, approximate square footage, etc.) Entry Area</p><p>Living Room</p><p>Dining Room</p><p>Kitchen Window above sink; deteriorated paint on window sash. Client said deteriorated paint was tested and is not lead-based paint. Common Area</p><p>Bedroom #1 East window; deteriorated paint on lower sash and dust and paint Small bedroom chips in trough. Client said deteriorated paint was tested and is not (Street Side) lead-based paint.</p><p>Bedroom #2 Dust and paint chips on floor. Small bedroom (Back of the house)</p><p>Bath #1</p><p>Exterior</p><p>Chapter 2 Attachment</p>