## TRANSMITTA Lof OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R 

# SAID# : 1041 3 Date : 

# 7/ya' ? lSo 9 S I S 3 h Address : 

### RemedKitioi i Contractor : PROFESSIONA LENVKONMENTA LENGDIEER S Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# y
D 

# y y Vide o o f propert y (DVD ) Executiv e Summary Sigjie dAcces s Agreemen t for subjec t propert y Paintin g Agreemen t Settlemen t docimient s (i.e. , fo r damag e o r t o replac e plants , etc. ) Photograph s Satisfactory restoratio n signe db y Propert y Owne r Propert y close-ou t chec k lis t signe db y EP A Propert y informatio n fromDougla s Coimty Assessor' s Ofific e 

# y D



### Ignatur e 

# yi^i^u^J^y: ^

4031834 6 Superfun d

# r PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. "Providin g cost-effectiv e environmenta l solutions " Consultin g • Engineerin g Desig n • Remediafio n • Abatemen t • Emergenc yRespons e 250 5 Nort h 24 % Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fax(402 ) 504-328 1



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t SAID #2047 3 130 9 S 2 5 S t

Date s worlced11/1 8 t o 11/0 9 200 8 Basemen t leakin g o n northsid e o f foundation . Broke n fron t porc hwindows , screen s also . Sidin g damage . Inspecte d12/0 2 N o issues .

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

### Propert y Owne r Close-Ou t For m (Lead-BasedPain t Stabilization EP A Contract EP-R7-08-06 ) 

# ^ o m ^ SAID : Propert y Address : j^^C f S QS ^ £}

­ Owner' s Name : 000.,^ ^ P\(\k(<nf ) 

# y Performanc e Standards/Close-Ou t Criteri a 250 5 Nort 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 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio n ofth e stated , exclude d areas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f 

# y garages . 2 . Wa s all scrapin g an dothe r preparatio n work complete dsatisfactorily ? / 

### 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith 

# y tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 yea r product/quality ? 

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

# J 6 . Di dth 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 an y othe r generate ddebris ? 

# y 7 . I s th e gras s are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? y 8 . Are al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

# y 9 . Istherean y evidenc e ofpropert y damag e that wa s don e b y th e contractor ? Any property damag e need s t o b e complete dprio r t o th e EP A Close-Out . 

# y 10 . Ar e ther e an y propert y item s that were temporaril y re-locate db y th e contractor 

## y tha t nee dt o b e move dback ? 11 . Ar e ther e an y (known ) lingerin g issue s withth e property owner(s ) that hav e bee n lef t unresolved ? y Comments :
1 

## fyJQju j -D , ChvJbyiAJrrK. Propert y Owhe r

Signatur e Dat e 

## /y-7yo< y In^ o Professiona l Ertvuronmenta l Engineers Representative Dat e

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

# ENVIRONMENTA L ENGINEERS , INC
. Omaha , N E 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 AClose-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) 

## SAID : ^C)H~ I ^ Property Address : 

# i?-^o ^ S

- y)< r s i Owner' s Name : 

# ( \yyxu . Af^a^rsc)r ? Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwit hth e exceptio n ofth e stated , exclude d areas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f 

# y garages . 2 . Wa s al l scrapin g an dothe r preparatio nwor k complete dsatisfactorily ? 

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

# y 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 yea r product/quality ? 

## y 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y vacuumed / cleaned ? y 6 . Di dth 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 an y 

## y othe r generate ddebris ? 7 . I s th e gras s are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? y 8 . Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r 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 propert y damag e need s t o b e complete dprio r t o th e EP A Close-Out . ly 10 .Ar e ther e an y propert y item s tha t wer e temporaril y re-locate db y th e contracto r y tha t nee dt o b e move dback ? 11 . Ar e ther e an y (known ) lingerin g issue s wit hth e propert y owner(s ) tha t hav e bee n lef t unresolved ? 

# y Othe r Considerations/Propert y Owne r Discussions/Additiona l Wor k tha ti s Required : /^^-// D /SS//e S 

# lyli i 'o g iP A CO RSignatur e Date

## J C Paintin g Propert yAddres s \'io q g . a^F ^

S i 

### Dat e ( / - / 8 - O q Star t Dat e \ i - 1 ft, - o A Complet e Dat e / /

- / 9

-^ o fi 

### Amoun t O f Prim e An d Pain t Use d Prim e (Gallons ) c ^ Pol y(Boxes ) Pain t (Color ) 5 u J (QS'I S Amoun t (Gallons ) j Q Pain t (Color ) 3-< J Q, o \2 ^ Amoun t (Gallons ) 3 Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons )• Jd 

## CONSEN T OF RACCES S TO ' H TaU'lF'ERT Y ^ ^ , 

### OMAHA LEA D STT EREMEDIA LACTION-LEAD-BASE D PAIN T STABILIZATIO N T 

## •% y Y^oYYMTiJsi-.yypy' y 3 PROPERT Y ADDRESS : /^^P ^ OWNERNAME : DAYTIMEPHONE :



## - Otf'^-oyy^ ^ CELLPHONE : E-MAEL : OWNER' S ADDRES S EFDIFFERENT : TENANT' S NAM E IFAPPLICABLE : DAYTIM EPHONE :

• CEL LPHONE : E-MAIL : Professiona l Environmental Engineers , In c (PE ) is unde r contrac t (#EP-R7-08-06 ) wit hth e U.S . Environmental Protectio n Agency (EPA ) to stabiliz e leadbase dpain t (LBP )on residential structure s at anumbe r of propertie s locaite d

inOmaha , Nebraska . Th e pain t stabilizatio n work is bein g don e to protec t th e soi l cleanup s tha t wer e performe d by EP A contractors . Pain t stabilizatio n activitie s will include : scrapin g of cracke d or flakin g LB Pfro mstructures , appUcatio n of aprim e coa t an d tw o (2 ) coat s of pain t Moving part s of window s an ddoor s ar e no t include dan dwill no t be addressed . Your cooperatio n is requeste d in givin g permissio nto thi s EPA contracto r (PE ) to ente r an dhav e acces s to thi s propert y for th e purpos e of stabilizin g lead-base dpain t as outline d on th e propert y identifie dabove . By signin g thi s document I agre e to allo w an EP A contracto rto conduc t asoi l cleanu p at my propert y following completio n of lead-base dpain t stabilization . I understan dtha t th e stabilizatio ncontracto r can no t provid e assurance s tha t th e soil cleanu p contracto r wi U

be boun dto . I furthe r understan dtha t th e soi l cleanu p contracto r wil l make al l reasonabl e effort s to addres s concern s tha t I, as th e propert y owner , ma y hav e regardin g soi l cleanu p at my property . I full y understan dtha t by signin g thi s Consent for Access , (1 ) thi s acces s wi U remai n in effect unti l th e wor k

ha s been satisfiactoril y completed , (2 ) tha t th e Propert y Owner or Tenant ,if applicable , willbe given th e Housin g an dUrban Developmen t (HUD ) an dEPA pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio n for Families , Da y Car e Providers , an dSchools" , (3 ) th e Propert y Owneror tenan t wil l remov e al l obstruction s fromsurface s tobe pamted , (4 ) will abid e by healt han dsafet y guidanc e provide d by EPA , (5 ) wil l allo w photograph y ofpropert y before an dafter th e pain t stabilizatio n work , (6 ) will be contacte d by a PErepresentativ e approximatel y48 hour sinadvanc e of startin g work , (7 ) agre e no t to obstruc tor tampe r wit han y ofth e LB Pstabilizatio nactions , an d(8 ) will participat e infma l propert y inspectio nan d signth e Completio n Agreement an dPropert y Owne r Satisfactio n Survey . Shoul dyou hav e any question s abou t th e plane dLeadBased-Pain t stabilizatio n activitie s for yon r property , pleas e contac t Professiona l Environmental Engmeers , In c Projec t Manager , Willi e ClayAt 402-504-4688 . Genera l question s abou t th e Omah aLeadSit e cleanup canbe directe dto Paulett aFrance-Isetts , EPA Remedial Projec t Manage r 402-731-2454 , or th e EP A Publi c Informatio n Center s at 402-991-958 3 (Nort hOmah aoffice) or 402-731-304 5 (Sout hOmah aoflice) . D Yes , I gian t acces s to mypropert yan d w u give n th e pamphle t D No , I do no t gran t acces s to mypropert yan d I wa s "Renovat e Right , Importan t Lea d biforaiatk m fo rFamUies , Chik l give n (h e pamphle t "Renovat e Right , importan t Lea d Car e Provkiers , an d Schools. " Infonnatk m for Families , ChiM e Car e ProvMers , an d Schools. ' 

## ^J3'0< i i l {2)u0.1A(<l \ ^ ^ 

# yy^i^y Signatur e I Dat e li Slgnabii e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

# ysc^y " j^^s - syZI P COD E ^^/(Z y PROPERT YADDRESS
. PROPERTYADDRES S O F OWNE R I F DIFFEREN TTHA N PROPERT YBEIN G PAINTED : PROPERTYADDRES S ^ZI P COD E I liav e receive d a cop yo f th e pamphlet , Renovat e R/g/if : Importan t Lea d Hazar d Informatio n Fo rFamilies , Chil d Car e Provider s An d School s informin g m e o f th e potentia l risk o f th e lea d hazar d exposur e fro m renovatio n activit yt o b e performe d o n dwellin g uni t I receive d thi s pamphlet befor e th e wor k began
.

PRINTE D NAM E O F RECIPIEN TDATE 

### )JlciM 4 (ylynyy.y^.(ri\ / SIGNATURE OPRECIPIEN T Self-Certificatio n Optio n (Fo rTenant-Occupie d Dwelling s Only ) I f th e lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u ma ychec k th e appropriat e bo x below : yRefusa l T o Sig n - 1 certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , renovat e right importan t lea d hazar d informatkH t fo rfemilies, chil d car e provider s an d schools ; t o th e renta l dwellin g uni t liste d abov e a t th e dat e an d tim e indicate d an d tha t th e occupan t refuse d t o sig n th e confirmatio n o f receip t I furthercertif ytha t I hav e lef t a cop yo f th e pamphle t a t th e uni t wit h occupant . 

# D Unavailabl e Fo rSignatur e - 1 certif ytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphle t renovat e right; importan t lea d hazar d infonnatto n fo rfamilies , chil d car e provkler s an d schools , t o th e renta l dwellin g uni t liste d belo wan d tha t th e occupan t wa s unavailabl e t o sig n th e confinnatio n o f receip t I furthe rcertif ytha t I hav e lef t a cop yo f th e pamphle t a t th e uni t b yslidin g i t unde rth e doo ro rsomewher e o n th e premises
. 

# y/^/LyyZy-?^: ^ y-y^--<:y y PRINTE D NAM E O F PERSO N CERTIFYIN G ATTEMPTE D DEUVER YDAT E AN D TIM E LEA D PAMPHLE TDEUVER Y |^>«
. 

### ^ac SIGNATUR E O F PERSO N CERTIFYIN G LEA D PAMPHLE TDELIVERY :
Not e Regardin g Mailin g Optio n - a s a n altemativ e t o deliver yi n person , yo u ma ymai l th e lead pamphlet t o th e owne r and/o rtenan t Pamphlet mus t t) e maile d a t least 7 days t)efor e renovation
. (Document with a certificat B o f mailin g fro m th e pos t

CONFIRMATIO N O F RECEIP TO F LEA D PAMPHLE T08/0 8

# PAIN TSTABILIZATIO N PRE-PROPERT YASSESSMEN T
PROPERT YADDRESS : y^OyS , C^ S S ^ DAT E ^^ ~ " ^ ^ ^ ^ 

# BVI D y^yy 3 PLAN T& PERMANEN TLANDSCAPIN G T O B E REMOVE ? N O yv ^ YE S |— 1 IF , YE S WHERE :

PRE- E XISUN G CONDmG ^ O F FOUNDATION/STRUCTURE , Le
. BASEMEN TLEAKING ? N O I 1 YE S L-i ^ IF , YE S WHERE : U i.4 i .V-tv ^

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EXISTIN G PAIN TO N WINDOWS , DOORS , FOUNDATION , SIDEWALK, ( I.E.) ? tiOrzy ^ YE S n m IF , YE S WHERE : 

## \rr^^i(^/ i JVA^ ^ pn. hUJiy67 / ^Ifl/yi S nls b

VISUA L DESCRIPTIO N O F PROPERTY/STRUCTURE/GARAGE , (I.E.) : (USE BAC KSID E I F NECESSARY )

PROPEm YOWNE R SIGNATUR E L-TV i

## PAIN TSmeiLEATHOIV ! F^E-PROPERT Y P7A B 

## ASSESSMEN T
PROPBi n ADDRESS:
. 

# y^fi^ P 

# S^^<y ' y yDAT E 

# yy - ^ ^

—BVI D - AREA(S ) TO B E PAINTED : HOUS E PROPER : U< ^ v ' 

### COLO R /lUu-o/ , €\f.i$nyy
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HOUS E TRI M

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### COLO R 

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I AGRE E T O TH E COLOR S LISTE D ABOVE
. ONC E PAINTIN G BEGINS , X UNDERSTAN D I CA N HO I CHANG E TH E ABOV E SELECTE D COLORS :

PROPERT YOWNE RSIGNATURE : 

## fl i

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PAIN TMATC H FOR M 08/0 8

### ^ Dougla s County Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R221950000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t of 9Cth S t - VIe W O D Ma p Informatio n i s vali d a s of 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -•-•- * Aut o Sale s Searc h Owne r ANDERSO N MARYD 130 9 S 2 5 S T 

### SMZ-/C>7 ^ 

## SQS'%1^' ^ OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 195 0 000 0 2 2 Accoun t Type : \ Residentia l Parce l Number : I 221950000 0 Parce l Address : 130 9 S 2 5 S T OMAH AN E 68105-000 0 Lega l Description : i SHULL S 2N D AD D LOT2 0 BLOC K1 2 N 1/ 2 2 5 X 12 6 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $3,600.0 0 $33,500.0 0 $37,100.0 0 200 7 $3,600.0 0 $33,500.0 0 $37,100.0 0 200 6 $3,600.0 0 $33,000.0 0 $36,600.0 0 200 5 $3,600.0 0 $33,000.0 0 $36,600.0 0 200 4 $3,600.0 0 $33,000.0 0 $36,600.0 0 200 3 $3,600.0 0 $33,000.0 0 $36,600.0 0 Sale s Informatio n Sale s Date : 2002-05-2 9 Dee d Type : Q C Book : i 200 4 Page : 00898 2 Price : $0.0 0 Grantor : Lawrenc e S Anderso n Grantee : Mar yD Anderso n Valid/Invalid : Invali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 7 3150. 0 1. 0 126. 0 25. 0 N o Improvemen t Informatio n 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22. . . 11/5/200 8

### V Dougla s County Accoun t Informatio n Pag e 2 o f 2
Buildin g 1 

## y&tr '

Xt> ' 'TM1IT~ " MS - FfUfM r seson o «f f 2R

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( ft CLIC KlOENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : ; 832. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : I Plaste r Baths : 1. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r YearBuil t Physica l Ag e Remodele d Remodele d Buil t 189 0 0 % 189 0 11 8 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 560. 0 Basemen t Minima l Finis h 200. 0 Fixtur e Additiona l Fixture s 1. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Fixtur e Bat h Hal f 1. 0 Garag e Detache d 240. 0 Porc h En d Soli d Wal l 240. 0 Porc h Sla b Roo f Cei l 160. 0 Porc h Sla b Roo f Cei l 160. 0 Use r Atti cFul l Finis h 272. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22. . . 11/5/200 8