EPA ICR No. 1715.11; OMB Control No. 2070-0155

ATTACHMENT 8

  SEQ CHAPTER \h \r 1 Optional Recordkeeping Checklist for Firms

  SEQ CHAPTER \h \r 1 Draft optional Recordkeeping Checklist for Firms:

Name of
Firm:________________________________________________________________

Date and Location of
Renovation:_________________________________________________

Brief Description of Renovation:
_________________________________________________

________________________________________________________________________
____

Name of Assigned
Renovator:____________________________________________________

Name(s) of Trained Workers, if
used:______________________________________________

________________________________________________________________________
____

Name of Dust Sampling Technician, Inspector, or Risk Assessor, if
used:__________________

________________________________________________________________________
_____

	  SEQ CHAPTER \h \r 1 Copies of renovator and dust sampling
technician qualifications (training certificates, certifications) on
file.  

	Certified renovator provided training to workers on (check all that
apply):  

		Posting warning signs			Setting up plastic containment barriers

		Maintaining containment		Avoiding spread of dust to adjacent
areas	

		Waste handling			Post-renovation cleaning	

	  SEQ CHAPTER \h \r 1 Test kits used by certified renovator to
determine whether lead was present on components affected by renovation
(identify kits used and describe sampling locations and
results):_____________________________________________________________

	_______________________________________________________________________

	_______________________________________________________________________

	Warning signs posted at entrance to work area.  

	Work area contained to prevent spread of dust and debris

		All objects in the work area removed or covered (interiors)

		HVAC ducts in the work area closed and covered (interiors)

		Windows in the work area closed (interiors)

		Windows in and within 20 feet of the work area closed (exteriors)

		Doors in the work area closed and sealed (interiors)

		Doors in and within 20 feet of the work area closed and sealed
(exteriors)

		Doors that must be used in the work area covered to allow passage
but prevent spread of dust  

		Floors in the work area covered with taped-down plastic (interiors)

$

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avy objects (exteriors)

		If necessary, vertical containment installed to prevent migration
of dust and debris to adjacent property (exteriors)

	Waste contained on-site and while being transported off-site

	Work site properly cleaned after renovation

		  SEQ CHAPTER \h \r 1 All chips and debris picked up, protective
sheeting misted, folded dirty side inward, and taped for removal

		  SEQ CHAPTER \h \r 1 Work area surfaces and objects cleaned using
HEPA vacuum and/or wet cloths or mops (interiors)

	  SEQ CHAPTER \h \r 1 Certified renovator performed post-renovation
cleaning verification (describe results, including the number of wet and
dry cloths used):________________________________

	_______________________________________________________________________
_		If dust clearance testing was performed instead, attach a copy of
report.

	I certify under penalty of law that the above information is true
and complete.

_________________________________________________
________________________

	Name and Title								Date

