TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 25134 Date: 12/22/2008 

Address: 3224 Myrtle Ave 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

gf Video of property (DVD) 

0 Executive Summary 

l/ Signed Access Agreement for subject property 

0^ Painting Agreement 

D Settlement documents (i.e., for damage or to replace plants, etc.) 

D Photographs 

[?f Satisfactory restoration signed by Property Owner 

a Property close-out check list signed by EPA 

H^ Property information from Douglas County Assessor's Office 

D 

D 

D 

Signatiu-e J^ Date 
PROPERTY SUMMARY 

Date: 12/22/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Property Address: 3224 Myrtle Ave SAID: 25134 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

122A.4 Other Relevant Information: None 

Access Date: 11/18/08 

Work Began: 11/20/08 

Closeout Date: 12/10/08 

Enclosures: 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracking Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOCIES. INC. 
ENVIRONMENTAL A 

CONSTRUCTION TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: 393 4 rn\^rV\ f nU€ Date: |,^i^^c?l J 

Phone: <^3;i-33? V ^^= St)\^M 

T 

Plant & Pennanent Landscapinfr j n Rmwiin In Plyi» 

Iteoi# 

Description and Location 

OnMq) 

r\<fc. 

Pfe.T^y^gring Cr^nditjon of Structures 

Does your Basement have a history of leaking? Yes — No ^ 

Item^ Description & Location 

On Map 

'J^SCS­ " ^ ' 

Propeity Owner Prudent Employee 

Signatuie;.,^^^^^'^ ^ Signature: ^^.^,>>.^' 

2605 4242 Medical Dilvft, SuKe 4280 N. 24*^ Street, Sittft 308 8080 Ward PaikMiy. Sute 406 Omaha, Nebraska 68110 San Antonio, TX78229 Kans8S Cily. HO 04114 
5^513^ 

Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. 

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a number of propertiej 

located in Omaha, Nebrasica, includingtiie property located at ^^^c^M Tfi^. \ f \\- e rkj ^ 

The EPA requests your permission to allow Prudent to perform LBP Stabilizatioiiittiiis property. By 

signingtiiis form,tiie property owner grants permission to Prudent to perform activities related to LBP 

Stabilization including scraping paint and painting ofthe referenced property. Furtiier,tiie owner/tenent 

verifiestiiattiiey have received the LBP pamphlet "Renovate Right." 

If you have any questions about tiie LBP stabilization planned for your property, please contact Prudert's 

i^d^iniiiftnitive Clerk for the Lead Based Paint Stabilization, Mrs. Deborah Akereie-Johnson, 

at (402) 504-1004. Cieneral questions abouttiie Omaha Lead Site cleanup can be directed to the EPA 

Public Infonnation Centers at (402) 731-3045 (Soutii Omaha office) or (402) 991-9583 (North Omaha. 

office). 

ProiiBtyAeceMOfaitedBv: J^ OL\//XW A) <. /V \ o- ^ C OvA. 

(Please Print Name) 

Property Omer SigutDte: n - it -oz 

(Date) 

PROPERTY INFORMATION 

(To be coaplcttd hrf rciidnt tBd/or propatr owner - pkaae priat) 

RBSDENTNAIIE: ^CLV/O^/^ V S^o^\(y ^ 6^ ^ Renter 

RESIDENT ADDRESS: ^73~H /YNwr-lr U As/ff'. 

W RENTAL, PROPERTY OVVNED BY: 

SiCiJirr\' ^ 0IIVNER!8 HAUNO ADDRESS; 

OWNERrSTELBPHONENUMBER.HOME: f JO^ > 93;2 - 33f^yyoRK. . t \ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ^ NUMBER OP OCCUPANTS 7 YEARS OLD ANO OLDER: 

NUMBER OFCHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 6 HOURS OR MORE PER WEEK, ^ : 

COMHENTSORSPeCIALiNSTRUCnONS: (LE DOGS, ENTRY GATES, ETC.) 

>2^ ^ 

AOTHOWryTOR ENVnwyNMBbn'AL RESPONSE ACTTOO; Tlw actMliei to be faytea^^ 

Of CEROA. 42 U.S.C 9604. EPA'I right of woeis to (he propertyto providedfi)r in Sectioa 104(e) of CBRO ^ 42 U.S. C 960^ 

flir "deliniiiBiagte iwed (br letpoiiM, or duosnig ortddng any lespoose acdon ifflder (hto title, or oAeiv ^ 

0 8 0 Wind Parfomy. Silts 406 2606 N. 24^ StrMt, Suite 308 4242 Medical Ditv*. SuKe 42S0 
Current Sample iSe-Renovation Form 

Effective until April 2010. 

Confinnation of Receipt of Lead Pamphlet 

S I iBve received a copy of ttie pamptiiet, fierKvate FS^ : Imptxtant Lead Hazani 

Inkmnatlcmftyr^n^lies, CNId Cam Pnyi^demwTd Schools trtfanvAngrrjecX 

the poterrtiai risk of the lead hazand eoqxisure from renovation activity to be 

perfomied in my dwelling unit, i received this pamphlet bdloie the work t)egan. 

^rjcJo. ^ <k s nVo-»r \ f> ^ ll-\^~07^ 

Self-Certification Option (for tenant-occupied dwellings only) — 

if the lead pamphlet was delivered but a tenant signature was not obtainable, 

you may check the appropriate box below. 

• Refusal to sign — I ceitify that I have made a good faith effort to defiver the 

pamphlet, Renovate FVc^: Important Lead Hazard Infonnation for FamSes, CIM Cam Providers and Schods, to the rantal dwelRng unit listed below at the 

date and time indicated and that the occupant refused to sign the confinnation 

of receipt, i lurther certify that i have left a copy of the pamphlet at the unit with 

the occupant. 

Q Unavailable fbr signaturs — I certify that I have made a good faith effort to 

deOver the pamphlet, Fienovate fVght Important Lead Hazani Infonnatton far 

FiatnlBes, ChBd Cam pmviders and Schools, to the rantal dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. I lifllher certify that I have left a copy of the pamphlet at the unit by sliding it 

under the door. 

Cg>tf>-gAi? Qo>\i>N.Vc>/N h'l^'dif /A33 

Printed name of person certifying Attempted delivery 

date and time » „ lead pamphlet defivery 

.A..JJ n,. ^ 

Signature of person certifying lead pamphlet delivery 

^Aio^o ^ x t C^/3) 

Unit Address 

Note Regarding Mailing Option—As an altemative to delivery in person, you 

may man the lead pamphlet to the owner and/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Documerrt vvith a certificate of rnailing fiom the 

postoflloe). 
paint match form: 

Paint matching form: 

Property address: 59aM YYiLrd-k h ^ 

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Explanation: 

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Douglas County, Nebraska Propeity Record - R1802850000 

Print Report 

NEW Feature-F >arcel Dimensions available @ scale 0-50 ft vi«st of 90th St - Vle W O n Ma p Infonnation is valid as of 2008-11-5 Treasurer's Tax Report 

New Feature ->->- > Auto Sales Search 

Owner 

IVIARION JAVANDS 

ETAL 

3224 MYRTLE AVE 

OI\/IAHANE 68131-0000 

Property Informatio n 

Key Number: 

Account Type: 

Parcel Number: 

0285 0000 18 

Residential 

1802850000 

Parcel Address: 3224 MYRTLE AV 

OMAHA NE 68131-0000 

Legal Description: MONTCLAIR ADD LOT 79 BLOCK 0 47.5 X 120 [ 

Value Informatio n 

2008 

2007 

2006 

2005 

2004 

2003 

Land 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

Improvement 

$72,200.00 

$72,200.00 

$72,200.00 

$72,200.00 

$33,100.00 

$33,100.00 

Total 

$74,700.00 

$74,700.00 

$74,700.00 

$74,700.00 

$35,600.00 

$35,600.00 

Land Informatio n 

Acres 

0.13 

SF 

5760.0 

Units 

1.0 

Depth 

120.0 

Widtii 

48.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

11/13/2008 11:45 AlVI lof 3 
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2 1/2 Story Unfin 3224 Myrtle Av 

i ' i M.I 

i 

L. -?s\ • ^ 

J,,, MI!>jq.n. 3 t • :<t SflaonaFloar 

tl l isf. . ;9 '*: 

sil* t'-.(il •-•.-*«! •7$ III IS 

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CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

11/13/2008 11:45 AM 2 of 3 
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Square Footage: 

Perimeter 

Unit Type: 

Built Aa: 

HVAC: 

Exterior: 

Interior: 

Roof Cover: 

Roof Type: 

Floorcover: 

Year Built 

1915 

Detail Type 

Add On 

Appliance 

Basement 

Fixture 

Fixture 

Garage 

Porch 

Porch 

1780.0 

0.0 

2 1/2 Story Unfm 

Central Air to Air 

Frame Siding 

Drywall 

Composition Shingle 

Hip 

Allowance 

Year Percent 

Remodeled Remodeled 

0 0% 

Detail Description 

Unfinished Attic W/floor 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

Detached 

Slab Roof Ceil 

Wood Deck 

Percent Complete: 

Quality: 

Condition: 

Condo Square Footage: 

Rooms: 

Units: 

Baths: 

Bedrooms: 

Stories: 

Foundation: 

Sprinkler Square Footage: 

Adjusted Year 

100.0% 

Average 

Average 

0.0 

8.0 

1.0 

2.0 

4.0 

2.5 

Block 

0.0 

Physical Age Built 

1915 93 

Units 

817.0 

1.0 

812.0 

1.0 

2.0 

240.0 

178.0 

84.0 

11/13/2008 11.45 AM 3 of: 
RUDE 

Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAID: S^Sli'-t j j 

Property Address: ^.^< 7 /Acjji.fi^ , fHl h 

Owner's Name: ^'\}^kA < l/Zlfilldh) 

Performance Standards/close-Out Criteria 

YES NO 

Was the entire structure(s) painted with the exception ofthe stated, excluded areas? This would 

include painting of other associated features including fascia, eaves, siding, all trim, porches, box 

beams, columns, rails, and exterior surfaces of garages. iX 

3 7 2.

 Was all scraping and other preparattion work completed satisfactorily? 

3. Were all required areas ofthe structure(s) primed as needed and painted with two top coats? 

4. Was the paint products utilized equivalent to a 30 year product/quality? ^ 

5. Are ali of the areas where contaminated materials have been spiiied 

^ 

thoroughly vacuumed/ cleaned? 

6. Did the contractor collect/vacuum all falling and scraped paint chips on the entire property, 

roacways, alleyways, public access areas and also remove any other generated debris? 

7. Is the grass area that surrounds the structure(s) in reasonably good condition? 17 

8. Are all items such as poiyethyiene sheeting, iadders, paint brushes, cones, barrier tape etc. t / 

properly removed? 

9.

 is there any evidence of property damage that was done by the contractor? Any property damage 

y needs to be completed prior to the EPA Close-Out. 

10. Are there any property items that were temporatiiy re-located by the contractor !> ' 

that need to be moved back? 

11. Are there any (known) lingering issues with the property owner(s) that have been left unresolved? U ' 

Other Considerations?property Owner Discussions?Additional Work that is Required 

Prudent Representative Signature: 

Date •,//<V-T—^ /P'/^'^J ' ./ / ^ /],./. 

Property Owner Signature: /UJ^ir^^^yir^^ ^ / 

Date: /^-/^-^^ ^