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DUST/DEBRIS DATA FORM <br /> (use additional sheets as necessary;PRINT all entries) <br /> Sampling Site Address: 49930 N Santiam Hwy SE,Idanha,OR 97350 <br /> Date: May 17,2021 and June 22,2021 <br /> Examiner Name: Karl Gerhauser <br /> Certification Title/No: OHA#2046 <br /> Examiner Firm: EnviroLead,LLC <br /> PO Box 31,Dayton,OR 97114 <br /> Inspection Covers: <br /> Dwelling units(Specify which units) Single family home <br /> Common areas(Specify which areas) None <br /> Exterior areas/outbuildings(Specify) Shop <br /> Dust <br /> Comments Sampling <br /> (For example;dust,deteriorated paint, Dimensions <br /> painted debris,paint chips,floor (if applicable) <br /> Location Description sample interior window sill sample, Sample II) [in]x[in] <br /> Date _window trough sample) Number to x IN in <br /> 5/17/21 Kitchen Side C Floor 001 10 x 14.4 <br /> 5/17/21 Underside Pool table 002 10 x 14.4 <br /> 5/17/21 Family room Side A Floor 003 10 x 14.4 <br /> 5/17/21 Lego Table 004 10 x 144 <br /> 5/17/21 Bath Window trough 005 2.5 x 25 <br /> 5/17/21 Attic Rafter 006 1.5 x 25 <br /> 6/22/21 Attic Service floor 001 10 x 14.4 <br /> 6/22/21 Attic Service floor 002 10 x 14.4 <br /> 6/22/21 Attic HVAC unit 003 10 x 14.4 <br /> 6/22/21 Attic Duct 004 lO x 14.4 <br /> 6/22/21 Attic Duct 005 10 x 14.4 <br /> 6/22/21 Attic Rafter 006 10 x 36 <br /> -6/22/21 Attic Rafter 007 10 x 36 <br /> 6/22/21 Attic Rafter 008 10 x 36 <br /> 6/22/21 Attic Rafter 009 10 36 <br /> 6/22/2] Attic Rafter 010 10 x 36 <br /> 49930 N Santiam Hwy SE,Idanha,OR 97350 - Page 16 <br />