% 

### TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R 

# SAI D # : 2.PiSi? ) Date : IZM^ . Address : -23Z \ V^tY^C^Y l t ^ 

### Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : 2DtO
- PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Videoo f property (DVD ) 

# r V Executiv e Summar y Signe dAcces s Agreemen t fo r subjec t property Pre-Renovatio n For msigne dby Property Owner 

## 6 Pre-Renovatio n For mfo r Occupant/Tenant , i f applicabl e Paintin g Agreemen t Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) Renovatio n Recordkeepin g Checklis t signe db y Certifie dRenovato r Photograph s Satisfactory close-ou t chec k lis t signe db y Propert y Owne r / 

### Property close-ou t chec k lis t signe db y EPA Property informatio n fromDougla s County Assessor' s Offic e Hazar danalysis , i f prepare d 

### Q Safet y Audi t Othe r (describe) :

Date ^
I ^ Dat e 

### (afte r file folde r review ) 4037756 1 Superfun d250 5 Nort h 24• ^

Suit e 21 9 Omatia , N E 6811 0 (402 ) 504-468 8 Fax(402 ) 504-328 1 

# PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. "Providin g cost-effectiv e environmenta l solutions " Consultin g • Engineerin g Desig n • Rennediatio n • Abatemen t • Emergenc yRespons e



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 201 1 SAID #2538 5 282 1 Hamilto n S t

•Date s worked : 7/3 0 t o 7/3 0 201 1 • Pr e propert y condition : Hous e ha s mostl y viny l sidin g wit h painte dwoo dtrims , porc h an dfoundatio n areas . Pain t wa s flaking of f

i n areas . •Problem s encountered : None . •Owne r request/concerns : N/ A
•Inspection/closeou t dates . Owne r 8/1/1 1 EP A 10/4/1 1

### 201 1 

# PROFESSIONA L 250 5 Nort h 24 ^ Suit e 21 9 

# ENVIRONMENTA L ENGINEERS , INC
. Omaha , NE 6811 0 (402 ) 504-468 8 

### "Providin g cost-effectiv e environmenta l solutions " Fa x(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

### EP A Close-Ou t For m (Lead-Base dPain t Stabilizatio n EPA Contrac t EP-R7-08-06 ) SAID : 

# 2sr3a ^ t'ropen Aoaress Prt y Address : ^.?A / J~rC ( Jr n fiXI I ^ Owner' s Name : \\f\\\Vf<A . VQQ A 

### Performanc e Standards/Close-Ou t Criteri a YE S NO 1. Wa s th e entir e structure(s ) painte dwit h th e exceptio n ofth e stated , exclude dareas ? Thi s woul dinclud e paintin g of othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s of garages . 2. Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? 3. Wer e al l require darea s ofth e structure(s ) prime das neede dan dpainte dwit h tw o to p coats ? 

## T: / v i 

### 4. Wa s th e pain t product s utilize dequivalen t to a 25 year product/quality ? 

## T: ^ 5. Ar e al l ofth e area s where contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / cleaned ? 6. Di dth e contractor collect/vacuu mal l fallin g an dscrape dpain t chip s on th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e any othe r generate ddebris ? ^ • ­ 

### 1. Is th e gras s are athat surround s th e structure(s ) in reasonabl y goo dcondition ? " ^ 

### 8. Ar e al l item s suc h as polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 9. Is ther e an y evidenc e ofpropert y damag e tha t wa s don e by th e contractor ? Any property damag e need s tobe complete dprio r to th e EP A Close-Out . 10 . Ha s th e property owne r signe dth e completio n form ? 11 . Ar e ther e an y property item s that wer e temporaril y re-locate d by th e contracto r tha t nee dto be move dback ? 12 . Ar e ther e an y (known ) lingerin g issue s wit h th e property owner(s ) tha t hav e bee n lef t unresolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

tha t is Required :

EPA CO RSignatur e Dat e

### 201 1 # 

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. 'Providin g cost-effectiv e environmenta l solutions ' Consultin g • Erigineei'in g Desig n • RtrneUiniio n - Ao;i;-jrri^i-,;
. • Ei-ief-jenc yReiijOn-^ e 

### Propeit y Owne r Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : (?c b PO ^ 1 Propert y Address : ^^1 / /•/d/y?/'/ ^ ( ^ Owner' s Name : ^ t ) dlv^-g- a|<^-Pre, n Performanc e Standards/Close-Ou t Criteri a 1 . Wa s th e entir e structure(s ) painte dwit h th e exceptio n ofth e stated , exclude dareas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , 

# X porches , bo x beams , columns , rails , an dexterio r surface s o f garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? 

# y ^ 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwit h tw o to p 

## 0 coats ? 4 . Wa s th e pain t product s utilize dequivalen t t

o a2 5 yea r product/quality ? 

# y 5 . Are al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / cleaned ? 

# X 6 . Didth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e any othe r generate d 

# Y debris ? 7 . I s th e gras s are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? % 

### 8 . Are al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrier tape , etc . properl y removed ? 

# y 9 . I s ther e an y evidenc e ofpropert y damag e tha t wa s don e b y th e contractor ? An y property damag e need s to b e complete dprio r t

o th e EP A Close-Out . 10 . Ar e yo u satisfie dwith th e wor k

performed ? 

# V 11 . Are ther e an y property item s tha t were temporaril y re-locate dby th e contracto r tha t nee dt o b e move dback ? 12 . Ar e ther e any (known ) lingerin g issue s wit h th e propert y ovvner(s ) tha t hav e been lef t unresolved ? # 

### Othe r Considerations/Property Owner Discussions/Additiona l Wor k

tha t i s Required : 250 5 Non h 24" , Suit e 21 9 Omaha
. N E 6811 0 (402 ) 504-468 8 Fa

x(402 ) 504-328 1



### YE S N O

^ 

# y



# X y .
ALI{!U, ^ /T » ^.^-<S!( . 

### Property-Owner Signature /
- / ­ ' /


### Dat e Professional Envitonmenta l Engineer s Signature Date* '-, '
. -Xf * «

Professiona l Environmenta l Engineers : EP A Pain t Stabilizatio n 201 1 SAID # ^^S^g) ^ Propert yAddres s '2P P \ V-bTri \ VV-)\ n S"V ^ Stories / Sidin g typ e I ' I' P Transit e Vtoo d Viny l Meta l Stucc o Garage ? Ye s Painted ? Ye s N o 

### V Where ? Sidin g 

## r Y /n n h i Tri m Dat e acces s signe d f IL. I I { \ Pre-vide o ^l2S>'\\ \ Pos t vide o Contracto rAssigne d 

# fc 

# mm" ^
Oat e starte d 7 ' 3r>/ / D..eende d '7-1>0-/ / Weathe rCondition s 

# M l

Pain t use d Prim e use d Pol yuse d Problems/Issue s(effectiv e Apri l 2010 )


### RENOVATIO N RECORDKEEPIN G CHECKLIS T
Nam e o f Firm : 

# : V?o-/ / ^^^ / HaiAAiif m Dat e an dLocatio n o f Renovatio n Brief Descriptio n o f Renovation : Name o f Assigne dRenovator : / i . Name(s ) o f Traine dWorkers : (/(yr/6lO l / fd/ft/ l Name o f Dus t Samplin g Technician , Inspector , and/o r Ris k Assessor , i f used : AJ//\
­ D^Copie s o f renovato r an ddus t samplin g technician qualification s (trainin g certificates , certifications ) o n file. [Z

l Certifie drenovato r provide dtrainin g t o worker s o n (chec k all tha t apply) : Z

l Postin g warnin g sign s D/Settin g up plasti c containmen t barrier s ^Maintainin g containmen t r/Avoidin g sprea do f dus t to adjacent area s p Waste handlin g j^Post-renovatio n cleanin g U Tes t kit s use db y certifie drenovato r t

o determin e whethe r lea dwa s presen t on component s affectedby renovatio n (identif y kit s use danddescrib e samplin g location s an dresults : A,/// ^

Zl Warnin g sign s poste da t entranc e t o wor k

area . Wor k

are acontaine dt o preven t sprea do f dus t an ddebris . Ck'Window s i n an dwithi n 2 0 fee t ofth e wor k

are aar e close d C

f Door s i n an dwithi n 2 0 fee t ofth e wor k

area s ar e close dan dseale d pnDoor s tha t mus t b e use di n th e wor k

are aare covere dt o allo w passag e but preven t spreado f dust . 0 Groun dcovere db y plasti c sheetin g extendin g 1 0 fee t fro mwor k

are a- plasti c anchore dto the buildin g andweighte ddow n b y heav y objects . ^ Ifnecessary , vertical containmen t installe dt o preven t migratio n o f dus t an ddebri s t o adjacen t • '^property . 

# D ^ Wast e containe don-sit e an dwhil e bein g transporte doff-site .(effectiv e Apri l 2010 )



### L

aWor k

site properl y cleane dafte r renovation . c aAll chip s an ddebri s picke dup , protectiv e sheetin g misted , foldeddirt y sid e inward , an dtape dfo r Removal . D Wor k

are aMEP A vacuume dto get pain t chip s fro mgroun dsurface , ifnecessary . D Certifie drenovato r performe dpost-renovatio n cleanin g verificatio n (describ e results) :
f I certif y unde r penalt y c i la w tha t th e above infonnatio n is true an dcomplete . 

# ^^^^A / /M^A/ _ 

# /'j^y / Nam e an dTitle Dat eDougla s County , Nebrask a Propert yRecor d - R214180000 0 « Prin t Repor t Vie w Interactiv e GI S Ma p Informatio n i s \eli d a s o f 2011-7-1 5 Treasurer' s Ta xRepor t Ne w Featur e ->•-•- > Subdivisio n Sale s Searc h Owne r REE D MILDRE D 282 1 HAMILTO N S T OMAH A N E 68131-000 0 

# VD:2^^l-/nO ^ 

# Bi4 = Propert yInformatio n Ke yNumber : 418 0 000 0 2 1 Accoun t Type : Residentia l Parce l Number : 214180000 0 Parce l Address : 282 1 HAMILTO N S T OMAH A N E 68131-000 0 

# /VO O A j Lega l Description : S T CLAR E AD D LO T 6 BLOC K0 5 0 X 127. 5 Valu e Informatio n Lan d Improvemen t Tota l 201 1 $2,600.0 0 $56,500.0 0 $59,100.0 0 201 0 $2,600.0 0 $56,500.0 0 $59,100.0 0 200 9 $2,600.0 0 $56,500.0 0 $59,100.0 0 200 8 $2,600.0 0 $56,500.0 0 $59,100.0 0 200 7 $2,600.0 0 $56,500.0 0 $59,100.0 0 200 6 $2,600.0 0 $56,500.0 0 $59,100.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widti i Vacan t 0.1 4 6350. 0 1. 0 127. 0 50. 0 No Improvemen t Informatio n Buildin g 12a!1HAMlLT0»iS T .t* i 'A^*J<,•.*; > ivn t

.•• \

t l « STO« Y Uf* W CLIC KT O ENLARG E IMAG E Squar e Footage : 1168. 0 Percen t Complete : 100.0 % Perimete r0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : : Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : ! Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 191 2 0 % 191 2 9 6 Z^ta/ 7 Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti c W/floo r 1204. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k8 ft 1168. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 308. 0 Porc h En d Scree n 208. 0 Porc h Sla b Roo f Ceilin g 36. 0

## CONSEN T FO RACCES S T O PROPERT Y OMAH A LEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT V ID 

# •2522 r PROPERT V ADDRESS:2g\!2 l \br^itiO n .SV DAYTIM E PHONE : CELLPHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM E I FAPPLICABLE : DAYTIM E PHONE : CELLPHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc
. (PE ) i s unde rcontrac t (^EP-R7-08-06 ) wit h th e U.S
. Environmenta l Protectio n Agenc y(EPA ) t o stabiliz e lea d base d pain t (LBP ) o n residentia l structure s a t a numbe ro f propertie s locate d i n Omaha , Nebraska
. Th e pain t stabilizatio n wor k i s bein g don e t o protec t th e soi l cleanup s tha t ar e bein g performe d b yEP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g o f cracke d o rflakin g LB P fro m structures , applicatio n o f a prim e coa t an d tw o (2 ) coat s o f paint
. Movin g part s o f window s an d door s ar e no t include d an d wil l no t b e addressed
. You rcooperatio n i s requeste d i n givin g permissio n t o thi s EP A contracto r(PE ) t o ente ran d hav e acces s t o thi s propert yfo rth e purpos e o f stabilizin g lea d -base d pain t a s outline d o n th e propert yidentifie d above
. B ysignin g thi s documen t I agre e t o allo w a n EP A contracto rt o conduc t a soi l cleanu p a t m ypropert yfollowin g completio n o f lead-base d pain t stabilization , i f th e soi l cleanu p ha s no t alread ybee n performed
. I understan d tha t th e stabilizatio n contracto r ca n no t provid e assurance s tha t th e soi l cleanu p contracto rwil l b e boun d to . I furthe runderstan d tha t th e soi l cleanu p contracto rwil l mak e al l reasonabl e effort s t o addres s concern s tha t I , a s th e propert yowner , ma yhav e regardin g soi l cleanu p a t m yproperty . D Yes , I hav e re ^ an d understai) ^ th e pa^grap^ above
. ^ 

# • 7-^' r Signatur e of Propert y( Dat e I full yunderstan d tha t b ysignin g thi s Consen t fo rAccess , (I ) thi s acces s wil l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted , (2 ) tha t th e Propert yOwne ro rTenant , i f applicable , wil l b e give n th e Housin g an d Urba n Developmen t (HUD ) an d EP A pamphlet , "Renovat e Right , Importan t Lea d Hazar d informatio n fo rFamilies , Da yCar e Providers , an d Schools" , (3 ) th e Propert yOwne ro rtenan t wil l remov e al l obstruction s fro m surface s t o b e painted , (4 ) wil l abid e b yhealt h an d safet yguidanc e provide d b yEPA , (5 ) wil l allo w photograph yofpropert ybefor e an d afte rth e pain t stabilizatio n work , (6 ) wil l b e contacte d b ya P E representativ e approximatel y4 8 hour s i n advanc e o f startin g work , (7 ) agre e no t t o obstruc t o rtampe rwit h an yofth e LB P stabilizatio n actions , an d (8 ) wil l participat e i n fina l propert yinspectio n an d sig n th e Completio n Agreemen t an d Propert yOwne rSatisfactio n Survey
. Shoul d yo u hav e an yquestion s abou t th e plane d Lea d Based-Pain t stabilizatio n activitie s fo ryou rproperty , pleas e contac t Professiona l Environmenta l Engineers , Inc
. Projec t Manager , Willi e Cla yo rKelle ySander s A t 402-504-4688
. Genera l question s abou t th e Omah a Lea d Sit e cleanu p ca n b e directe d t o Pauiett a France-Isetts , EP A Remedia l Projec t Manage r402-731-2454 , o r th e EP A Publi c Informatio n Center s a t 402-991-958 3 (Nort h Omah a office ) o r402-731-304 5 (Sout h Omah a office)
. D Yes , I gran t access t o m ypropert yan d wra s give n th e pamphle t D No
. 1 d o no t gran t acces s t o m ypropert yan d I wa s "Renovat e Righ t Importan t Lea d Informatio n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d CJar e Providers , an d Schools. " Informatio n fo rFamilies , Child e Car e Providers , an d Schools. "
naf o

## PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERT Y ADDRESS : 

# : M l 

# \km\ M ' ^ DATE : BVID : ^

AREA{S ) T O B E PAINTED : HOUS E PROPER : COLOR : 

# Al l 

# I k b 'd$
. T

l 

# l\Ey T HOUS E TRIM : COLO R
GARAGE : COLOR : ^
GARAG E TRIM : COLOR : %
PORCH : COLOR : 

# ^y ^ cJ%J4c
- COLOR : 

# ^yrkpeo V ^ra y PORC H TRIM : (COMPET E AL L SECTION , YES , NO , O R NON-APPLICABLE )



### I AGRE E T O TH E COLOR S LISTE D ABOVE
. ONG E TH E PAINTING BEGINS , I UNDERSTAN D I CA N NO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE : P E ACCESO R SIGNATURE :

## PRE-RENOVATIO N FOR M - OWNE R Thi s for mi s t o b e use db y th e firm s contracte dby th e Environmental Protectio n Agency-Regio n 7 t o perfor mLead-Base d Paint stabilizatio n activitie s at th e Omah aLeadSite , Omaha , Nebraska . Owne r Conflnnatio n Pamphle t Receip t ,,/^TJ I hav e receive dacop y ofth e lea dhazardinfonnatio n pamphlet . Renovat e Right : Importan t Lea dHazar dInformatio n fo r Families , Chil dCar e Provider s an dSchools , informin g me ofth e potential ris k ofth e leadhazar dexposur e fro mrenovatio n activity t o b e performe din/o n m y dwellin g unit . I receive dthi s pamphle t before th e wor k

began . Qwne r Acknowledgmen t 

# X (A ) I confin n tha t I ow n an dliv e i n thi s property , that n o chil dunder th e ag e o f 6 reside s here , tha t n o pregnan t woman reside s here , an dtha t thi s property i s no t achild-occupie dfacility . Note : A chil dreside s i n th e primary residenc e o f his/he r custodial parents , lega l guardians , foster parents , o r informa l caretake r if th e chil dlive s an dsleep s mos t o f tim e at th e caretaker' s residence . Note : A child-occupie dfacilit y i s apre-197 8 buildin g visite dregularl y by th e sam e child , unde r 6 year s o f age , o n a t leas t tw o different day s withi n an y week , for at leas t 3 hour s eac h day , provide dthat th e visit s total at leas t 6 0 hour s annually . (B ) I understan dthat th e renovatio n firm , contracte dby th e Environmental Protectio n Agenc y (EPA) , wil l b e usin g lead
af

e wor k

practice s require db y EPA' s Renovation , Repai r an dPaintin g Rule .

Printe dNam e o f Owner-Occupan t

Signatur e o f Owner-Occupan t Dat e