b'Final Completion FormTOTAL LEAD CONTAINMENTfor Post Renovation certifiedrenovatorsupply.com RRPCOMPLETIONCERTIFICATION FORM Reporting - 5 A&B Customer Name:Address: Once the project is completed, the most importantTelephone: E-mail: phase of your record keeping is required. The(Home)reporting is not only important to satisfy the EPA Official RRP Lead Test Results Date of Testrecord keeping requirements, it is your proof that Home Kit (Brand)Certified LBP Inspectors or Certification No.the job was done correctly. Your records should be Risk Assessors (Name)kept a minimum of 3 years so that any questions ItemLocation Test Result Item LocationTest Result1Yes No 11Yes Nothat may be raised later on are easily answered. 2Yes No 12Yes NoIn addition, the EPA Final Rule for RRP requires3Yes No 13Yes Nogiving the property owner and resident(s) copies of4Yes No 14Yes Nothe completion and RRP Report records. A properly 5Yes No 15Yes Nocompleted form is the best assurance that your 6Yes No 16Yes Noresponsibilities have been met, and it is easy to 7Yes No 17Yes No8Yes No 18Yes Nomake copies for the homeowner/resident that they9Yes No 19Yes Nocan sign as a confirmation for you. 10Yes No 20Yes NoConfirmation of Certified Firm Compliance with Lead Containment Work Practices RRP RuleThe end of renovation report describes the whole As an EPACertified Firm, I confirm that a Certified Renovator was assigned to the project, that the certified renovator providedon-the-job training for workers used on the project, that the certified renovator performed or directed workers who performed theproject from posting signs to cleaning verificationtasks required by the EPARRPfinal rule, and that the certified renovator performed the post-renovation cleaning verification.or clearance. The report should name the Certified Firm Signature: Date:Renovator designated by the Certified Firm as Certified Renovator:Certification No.Confirmation of Certified Renovator Compliance with Lead Containment Work Practices RRP Ruleresponsible for lead-safe work practices on thatAs an EPACertified Renovator, I confirm that the work practices as listed in745.86(b)(7), and as reviewed in this document wereproject. Also include proof of certification for the followed; and that the lead test results shown above were obtained by a good faith test, as required by the EPARRPRule.RenovatorSignature: Date:designated Certified Renovator. The report also must have a signed statement from the CertifiedRenovator that covers the following areas: Works Practices ConfirmationPre Renovation Set-upYES NO N/A Proof of non-certified worker training; Signs posted, clearly defining the work area before commencing, and remaining during renovation Proof of posting warning signs; Work area isolated to prevent dust and debris leaving, including plastic sheeting to confine area, tack mats topreventing tracking, dual entry sheeting for vertical entry way Description of results from used of EPA- Work area on exterior protected with sheeting 20 feet from edges, floors below, and all at risk foliage coveredrecognized chemical spot test kits; All objects removed, and/or covered with plastic sheeting with edges and seams taped Description of work area containment; All ducts and openings in work area covered Description of on-site waste containment Windows and Doors covered in work area (interior), or within 20 feet (exterior) with plastic sheeting withedges and seams sealed, and applied dual sheeting for entry into work area or into houseand transport; Interior Floor space covered up to 6 feet beyond perimeter or sufficient to contain and debris (interior) orground covered to 10 feet (exterior)Proof of proper post-renovation work area Precautions used to ensure all personnel, tools and other items, and containers of waste are free of dust anddebriscleaning; Precautions used to ensure no contamination from forbidden practices Records of inspections and/or riskYES NO N/AOpen flame, burning, torching of Lead Paintassessments conducted by Certified LeadUse of sanding/grinding, power-planing machines without HEPAfiltered exhaustInspectors or Risk Assessors, if applicable.Additional Comments:Use of Heat Gun to above 100oF Proof of successful cleaning verification.Works Practices Confirmation 2 tarea cleaned as folows: with new, damp clothAdditional CleaningAl Walsurfaces andatobjects in work area and within feof workrugsvacuum or wipedavacuum, outfited withYES N/A for Interior topproceding to floor with approved HEPA approved HEPA damp cloth, and floorsNO s, startingandrugs and fixtures) thoroughly cleaned withare wiped with Training and Protection of WorkerRemaining surfaces (furnitureand fixtures, carpets and If dust clearance sampling is performed in lieu of YES NO N/A beater bar for carpets andfurnituremopping systemthan Those surfaces otherwith 2-bucketmopped thoroughly Workers properly trained by Certified Renovator in proper Lead Safe Work PracticesAdditional CleaningExterior or debris on foliage, or on ground, colected, bagged and sealed. forand removed.cleaning verification, provide a copy of the dustYES NO N/A Any dustmisted, folded inward, bagged and sealed Al sheting Workers trained on application of these practices on sitesampling report to the person who contracted forPost Cleaning Verification System (Interior) removal of al dust and debris by proper match toNO N/A Visual inspection to confirmsubsequent visual inspection cloth, confirmedCard YES Second cleaning required withcleaned with wet disposableCleaning VerificationclothWorkers instructed on proper use and application of all safety and protection equipment and clothing such asVerified each window silproperlywet disposable cloth to matchnew, dryat disposablewipedmatchnew, wet dis-Cleaning Verification Cardwith newsecond cleaning withthe work areawithwithSecond cleaning requiredone hour after thehorizontal surfaces withinto ain approvedwith new, wet dis- RRP Compliance Statement:foot, hand, head and body protective garments, breathing masks, and proper cleaning of hands, face etc. dur-the renovation within 30 days of the completion of ing and after entering and exiting the work area, and hygiene practices for food and beverage.Third Cleaning required,and otherto hold cloth for floors)work area wipedmatch with Thisofform folows the Compliance and Certification Requirements of the EPARRPRule 745.86(b)(7) anddother sections requiring documentation ofuse Lead Safe Work Practices by Certified Firms and Certified Renovators as required for renovations where lead based coatings are present. Alstatementsand Uncarpeted floors, countertops,aand mountsurfaces within theatain approvedwhosecontained herein,ap the work performed as documented are the sole responsibilities of the Certified Firm and the Certified Renovatorposable cloth (using longahandleand other horizontalclothtofor floors) toVerification Cardsignaturesignatures and namesear on this document, and these practices were explained and understoin detail by the owner of the residencethe renovation (see 40 CFR 745.86(d)). Handling Waste and Initial Cleaning where the renovations were caried out. As required, a copy of this form wil be held by the Certified Firm for thre years from the date of completion,Cleaning Verification Cardhandle and mount to holdcloth match Cleaningdisposable cloth and a copy was delivered to and acepted as complete by the owner of the property where the renovations were caried out as acknowledged by theirUncarpeted floors, countertops,newdisposablecleaning with new, drybelow.posable cloth (using longwithwetFirm Signature:Cleaning Verification CardCertified Renovator: YES NO N/A Second cleaning requiredone hour aftertthe secondany one cloth Home Owner Signature:Third Cleaning required,square fecleaned withcleaned as aboveDate:The AWDI 4 page form that includes all the needed Waste contained to prevent releases of dust/debris before waste is removed from work areaNo area greater than 40iers removed once areaCertification No.Warning signs and bar of dust and debris on surfacesthe work area technician Date:System (Exterior) below Post Cleaning Verificationinspection determining removalneded and performed inspector, risk asesor or sampling Waste removed from work area was stored under containment in enclosure, or behind barrier, at conclusionparts of Post Renovation Reporting. While EPAof each workday to prevent releases of dust and debrisYES NO N/A Visualand visual inspectiontesting by certified Second cleaningclearance, cleaning and/or provides a checklist, their form does not includeOptional dustbariers removed 2010-AWDI, LC - Al Rights Reserved. May be Reproduced without changes. TLC Logo used with permision.All waste transported was contained to prevent releases of dust and debrisWarning signs and the required narrative. The AWDI form is written Work area cleaned until no dust and debris and residue remains at end of each dayAll paint chips, debris and components collected without allowing dust dispersal in heavy-duty bags (6mil)with the narrative included in rule 745.86 Record and properly sealedAll protective sheeting misted, folded dirty-side inward, properly taped shut or sealed in heavy duty bagKeeping Requirements so simple check boxes and (6mil)All sheeting used to isolate work areas from non-contaminated rooms, remained in place until final cleaningproper information and signatures are easy to do and proper removal of other sheeting, then properly disposed of in sealed bags, as waste.and provide all the documentation you will need.THE 4 PAGE AWDI FORM CONTAINS THE LEAD TESTING DOCUMENTATION, ASSIGNMENT CONFIRMATIONS, COMPLETE ITEM-BY-ITEMCONFIRMATION OF ALL REQUIRED PROCEDURE AND A PLACE FOR NOTES ON ANY SPECIAL PROCEDURES FOLLOWED TO COMPLY WITH THE EPA RRP RULE.'