TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 29560 Date: Novembers 

Address: 3836 Maple St. 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

21 Video of property (DVD) 

[?f Executive Summary 

Bf Signed Access Agreement for subject property 

0 Painting Agreement 

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

D Photographs 

H ' Satisfactory restoration signed by Property Owne r 

D Property close-out check list signed by EPA 

^ Property information from Douglas County Assessor's Office 

D 

D 

D 

^ ^ —^fe 

40310614 i 

Superfund 
PROPERTY SUMMARY 

Date: 10/12/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: October 

Property Address: 3836 Maple St. SAID: 29560 

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: 09/17/08 

Work Began Date: 9/24/08 

Closeout Date: 10/31/08 

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 & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: 3^30 <^^k ^ ^ - Date: f-/&-0 ^ 

Phone: ^/Q-^^ 35 1 ' ^^" f I BVID: 2^15 W 

Plant & Permanent Landscaping To Remain In Place 

Item# 

Description and Location 

On Map 

Pre-Existing Condition of Structures 

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

Item# Description & Location .^escnpaon ec L/Ocauon 

On Map V^ Clacks.iA c<5/0>^// '^'^'^"^'^y ^^^'^'f-^ 

Property Owner Prudent Employ 

Signature Signature: 

8080 Ward Parkway, SuHe 405 

Kansas City, MO 64114 

Phone: (816) 363-3703 

2505 N. 24'(s^et, Suite 308 

Omaha, mbraska 68110 

Phone: (402)504-1004 

4242 Medical Drive, Suite 4260 

San Antonio, TX 78229 

Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402) 604-1005 
V > -iX^^ 

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

Enviromnental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a number of properti( 

located in Omaha, Nebraska, including the property located at gy?) ^ YVX/OjCilo .S / es 

The EPA requests your permission to allow Prudent to perfonn tlfiip St^ilization^iiis propCTty. By" 

signing this form, the property owner grants permission to Prudent to perform activities related to LBP 

Stabilization including scraping paint and painting of the referenced property. Further, the owner/tenant 

verifies that they have received tiie LBP pamphlet ''Renovate Right." 

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

i^^minlgh-ntive Clerk for the Lead Based Paint Stabilization, Mrs. Deborah Akerelis.Tnhn!tnn, 

at (402) S04-1004. General questions abouttiie Omaha Lead Site cleanup can be directed to the EPA 

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

office). r ^ \ 

Prapcfty Accen Orauied ] (Please Pri^ame ) 

Propeity Owner Signauie: 

7 (Signature) f\ (pate) 

PROPERTY INFOFMATION 

(To lie coaplcted by rttldent uid/or property owBcr - picaae print) 

RESIDENT NAME: /x?f [r^r^(7 rownerj Renter 

-ZQ^i^ fActfU s^. RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAIUNG ADDRESS; SuMt 

OWNER'S TELEPHONE NUMBER • HOME: V • \ .m^: jB^^LJllL 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: O NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: L_ 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 8 HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY OATES, ETC.) 

AUTHDRITY FOR ENVIRONMENTAL RESPONSE ACTIONS; The activWes to twlnvlementod by EPA under tfcii agreement are punnBl to SoetJoo 104 

of CERCLA. 42 U.S.C 9604. EPA'S right of access to the property isptovided fbr n Section 104(e) of CERCLA. 42 U.S. C 960S(e), which prortJes entry 

for ''<lirtBmi«f"g««« iiMMitor rcipoMa, Of choosiny ortaldng any response aclion under (his title, or otoemite enforcingfte proviiions of <fae tifle." 

2505 N. 24* Street, Suite 308 4242 Medical Drive, Suite 4250 Ward Pari»ray> SuHe 405 Omaha, Nebraslta 68110 San Antonio, TX 7822& 

« s City, MO 64114 Phone : (402)504-1004 ie:(816)36»70 3 

iaAa\ %tL\.vttrt 
Current Sample Pre-Renovation Fonti^ 

Eftoeihw until April 2010. 

Conlbmanon of Recdpt of Lead Pamphlet 

Q/ | have received a copy of the pamphlet, Fienovate Right Important Lead HazenJ 

information for FamSies, CNld Care Providers and Schools infonning me of 

the potential risk of the lead hazard exposure from renovation activity to be 

perfonned in my dwelling unit. I received this pamphlet belfoie the v\;ork t>egan. 

ofrsdpient y j ->>^ Date 

of recipient 

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

If the lead pamphlet was delivered txjt a tenant signature was not otitainable, 

you may check the appropriate box below. 

Q Rehisal to sign — I certify that I have made a good faKh effort to deliver the 

pamphlet, ^?anovafe F^ght Impoitun Lead Hazard Infonnation for FiamKes, ChKd Care Pmvlders and Schools, to the rental dwelling unit listed below at the 

date and time indicated and that the occupant relused to sign the conflnnation 

of rec^ I further certify that I have left a copy of the pamphlet at the unit with 

the occupant. 

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

deliver the pamphlet, Fienovate Fiight Important Lead HazanJ Infonnation fbr 

Fgnaiee, ChOd Care pmvlders and Schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confinnation of receipt. I ^rther oeitHy that I have left a copy of the pamphlet at the unit by sliding it 

under the ( 

^ v^ •^e.reAL fMo ^ 

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/f,

of per

 r\ ­9

son certifying Attempted delivery 

 date and time 

 lead pamphlet delivery 

Signature of person certifying lead oamphlet deliveiy 

0/r\dhcc, fu ^ 

UnltAddiBSs 

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

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

at least 7 days before renovation (Document with a certificate of mailing from the 

post office). 
paint match form 

Paint matching form: 

property address: ^0"5G f^i ^ s-f. BVID: 7f^C?o 

Area: ^^^.r€. ^aru ^ ^^^o^- ^^^^c..)U^< 

Explanati on: 

Area: color: 

Explanati on: 

Area: color: 

Explanati on: 

Area: Color: 

Explanation: 

Area: Color: 

Explanation: 

Page 1 
[ Acces s INFmHATION TRACKING SHEET 

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Douglas County Account Information Page 1 of2 f 

Douglas County, Nebraska Property Record - Rl61iS74K>000- | 

Print Rfport 

NEW FMtuiw • ParcM Dimanilom •vailabia Q teals 0-50 ft wast of SOD) St • VIe W O n Ma p Infonnation is valid as of 2008-7-14 Treasurefl^TaxRepprt 

1 New Feature -»-•• • AutQ Sales Sffa.rch | 

Owner | 

CUDJO LOIS 1 

3836 MAPLE ST {i\\^\V{v' ^ 

OMAHA NE 68111-0000 Y ^ 

' • •• \ • 1 

Property Information 

KeyNumtten 2577 0000 16 

Account Type: Residential i 

Parcel Number: 1625770000 

Parcel Address: 3836 MAPLE ST 

OMAHA NE 68111-0000 

Legal Description: LINCOLN HEIGHTS LOT 16 BLOCK 14 40 X 120 

Value Information { 

Land //nprovement Total 

2008 $2,300.00 $48,200.00 $50,500.00 

2007 $2,300.00 $48,200.00 $50,500.00 

2006 $2,300.00 $48,200.00 $50,500.00 

2005 $2,300.00 $18,400.00 $20,700.00 

2004 $2,300.00 $16,700.00 $19,000.00 

2003 $2,300.00 $16,700.00 $19,000.00 

Sales Information 

Sales Date: 2004-06-28 

Deed Type: WD Booir; 2004 1 Page: 086056 

Price: $50,000.00 

1 Grantor: 1 Gertrude A McCarrell 

Grantee: LoisCudjo 

Validnnvaiid: 

Valid 

1 Exclusion Reason: 

Land Information 

1 Acres SF 1 Unite Deptfi Widtii Vacant 

L 4800.0 [ 1.0 120.0 0-11 40.0 No 

[improvement Information 

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uouglas County Account Information Page 2 of2 w 

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CUCK TO ENLARGE IMAGE 

Square Footage: 1214.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality. Fair 

Unit Type: Condition: Fair 

Built As: 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Aluminum Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinider Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1926 0% 1926 82 

Detail Type Detail Descripti'on Unite 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 860.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 324.0 

Porch End Solid Wall 140.0 

User Attic Full Finish 354.0 

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'2. W«i«tti(»|>ingtiidoaii^ia«pantion^¥^ / y.-f *':* ' A At.-<A'" . . ^ ' ^ A ,^.j ^ 

3. Wde i&n^dn d iueas of die ainictarej(s)primsd is iweded caid;^ ^ 'ividi.tw&'tcfp c<cm3^ / 

4. Wii'tte i»iiiit products utiliziefd e(tiiivalent to a.30'year prddiiiiift/qusilit;^? ./ 

5. An&nofthe'sreat} wh ^ cootsminated nMoriaiihave b^spill^<thorough

6. DidtbeoooaractOTOoUixtMKwmaU Min g Old s^ ^

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7. bfhegrmareailintsoifiDmubtiiestfo^^ rccnaditioh? 

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8. Aniflitemsmidiaspolyethylaeshdedog,ladders^paintbrosbiftficdn^.b'arria'tape,etc.propeirty 

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9. Is diere 819 evidence of property daniage that VVKS done by the cl»ntra:ctor7 Any prop<nftydamage 

Beedttbbe.oroiplrtedprior.totoEPA.ClfMfr'Out.. , _.,. ....•:... ,,^., 

10.. AnidKJeany prtiiiefty'ltemis tiiat were ten^Mnrily re^ldcBted by.&is cbiitreigidir diat n^eod to tie 

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OtteCocteidferad<ms/Prt)p€*ty Owne r DiScussions/Additibniil Wor k tteit:is Required 

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Prudent Property Close-Out Forir^ (Lead-Based Paint StabUlzation) 

Owner's Name: ^^Q-^ ^ Ctt/^j'/i-^ 

Performance Standards/close-Out Criteria 

YES 

1. Was the entire strjcture{s} painted with the exception of the stated, excluded arees? This would 

iridude painting of other essociated features induding fascie, eaves, siding, a!i trim, porches, box 

beams, columns, rails, and exterior surfaces of garages. 1 

2. Was all scraping and other preparattion work completed satisfactonly? 

3. Were all required areas of the structur6(s} primed as needed and painted with two top coats? 5 

4 W ^ the paint products utilized equivaient to a 30 year product,^ai!Bl!ty? i£-_J 

Are ai! of the areas where conteminated materials have been spilled 

thoroughly vacuumed/ deaned? t 

Did tiie contractor collect/vacuum ai! fsUing and scraped paint chips on the entire property, 

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

)L 

is the grass area that surrounds the structure(s) in reasonably good condition? ii 

Are all stems such as poiyethylsne sheeting, ladders, paint brushes, cones, barrier tape etc. 

properly removed? 

1 

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

ne4ds to be completed prior to the EPA Close-Out. XI 

10. Are.there any property ite.Ts that were tenr.poratily re-iocated by the contrector 

that need to be moved back? 

X 

11. Are there any (known) lingering Issues with the property ovif?>er(s) that have been left unresolved? 

Other Considerations?property Ov/ner Discussiop=s?.AddJtIon5J Wsri< that is .Requii-sd 

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