TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 38775 Date: 12/26/2008 

Address: 2440 CROWN POINT 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

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 Video of property (DVD) 

 Executive Summary 

 Signed Access Agreement for subject property 

 Painting Agreement 

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

 Photographs 

 Satisfactory restoration signed by Property Owner 

 Property close-out check list signed by EPA 

 Property information from Douglas County Assessor's Office 

Signature /• Date 

40309852 IlilUiil 

Superfund 
PROPERTY SUMMARY 

1 Date: 12/23/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December | 

1 Property Address: 2440 CROWN POINT SAID: 38775 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

A.4 Other Relevant Information: None 

Access Date: 11/12/08 

Work Began: 11/13/08 

Closeout Date: 11/14/08 

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 

TECHNOLOGIES. INC. 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, mc . SiXnCES 

Property Status Form 

Phone: ^ j - ;?^^ ^ BVID: 5g)77 5 

Plant & Permanent Landscaping Tn Remain In Place 

Itesn# 

Description and Location 

OnM ^ 

Pre-Existing Condition of Structures 

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

Item# Description & Location 

On Map 

Property Owner Prudent Emplo; 

Signature: Signature: <inM^ 

2605 N. 24*^ Street, Suite S08 4242 Medical Drive, SuKa 4260 8080 Ward Pariamy. i»iit» 40B Omaha, Nebraska 68110 San Antonio, TX 78229 KansMCny, MO 84114 Phnn«> /MmBMjWB D 
3fe77^ 

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

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a number of prop^e s 

located in Omaha, Nebraska, including the property located at o?M^ 0 0 rfN\bT\p>r>Yr\V Ai/ f 

The EPA requests your permission to allow Prudent to perform LBP Stabilization at thra prc^erty. By 

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

Stabilization mcluding scnq>ing paint and painting ofthe referenced property. Further, the owner/tenant 

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

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

Administrative Clerk for the Lead Based Paint Stabilization, Mrs. Deborah Akerele^ohnson. 

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

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

office). 

(Please Print Name) 

Propeity Owner Signature; 

(Signature) (Date) 

PROPERTY INFORMATION . (To be con^ettd by raldcat aad/orpropcrty owner - pleaie print) 

RESOENTNAME: W^dtyJ if ^ /l/l^^^^^ 

RESIDENT ADDRESS: 

IF RENTAL. PROPERTY OWNED BY: 

OWNERfS MAIUNG ADDRESS; 

OWNERTS TELEPHONE NUMBER-HOME: / >^^> TS/ ' "^^^"^^yNanKi l \ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ^ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: / 

NUMBER OF CHILDREN UNDER 7 YEARS OLD \WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: ( ^ 

COMMENTS OR SPECIAL INSTRUCTIONS: (LE. DOGS, ENTRY GATES, ETC.) 

AiniroiOTY FOR ENVntONMBOTAL RESPONSE ACTlOWSiTteactiviCei to be implemented by EPA nndertMaagreei^ 

ofCERCLA.42U.S.C.9604. EPA's right ofaccess to the property Upiovidedfor in Section 104(e) ofCERCLA. 42 U^.C960S(e), which provides entry 

fiv "determining the need fbr response, or cboosing ortaking any lespooK action under tins title, or otfwiwise enibiciiig te 

«80«tai 4 Parkway. Sidta 408 2506 N. 24"* Straet, Suite 308 4242 Medical Drive, Sulta 4250 

'.ansas CHy. MO 64114 Omaha, Nebraaka 68110 San Antonio, TX 78229 •hone: WIS) 3834703 »*• ""• " 
Current Sample Pre-f^novation Form 

Effective until April 2010. 

Confirmatkm of Receipt of Lead Pamphlet 

Q \}:metecei!^e6 a ccp^cAii\ep3rn(i\\et. Renovate Rl^t: Important Lead Haza^ 

InfmmSon for Families, CNId Care Providers and Schools informing me of 

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

performed in my dwrailing unit. Ireceivedthis pamphlet beforett)ewor^ laegan. 

Printe

intd name of rBci|!>ienl Date 

SignatutB of recipient 

Seif-CertiflcatiQn Option (for tanant'Occupied dwellings only) — 

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

you may check the appropriate box below. 

Q Refusal to sign —I certify that I have made a good Mh effort to deliver the 

pamphlet,flSnovateFVgjhit: Important Lead Hazard Infonnation for FamSes, Cihiky Care fVoMcfars and Sc/xx>l^, tottierental dvvel 

date andtimeindicated and that the occupant refused to sign the confirmation 

of tec^. Ifurther certify that I have left a copy of the pamjrfilet at the unit vflth 

ttie occuisant. 

Q Unavailable fbr sigrtatura —I certify that! have made a good Mh effort to 

deRver the pamphlet,flienovaf©FVght- Important Lead Hazard infonnation for 

FamSes, (M i Care prcwders mid Schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. 

I further certify that I ha^retefta copy erf the paiTvphtet at the unit tv slkSng it 

underthedoor^^ ^^^^ ^ //^^^ ^ 

Rinted name of person certifying 

Attempted delivery 

dateandtime 

lead pamphlet delivefy 

Signature of person certilying leadranphietdeRver^ . 

i^/ndha. /U>£-

Unit Address 

Nota Regaiding Mailing Option —As an altemative to delivety in person, you 

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

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

post office). 
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Douglas County, Nebraska Property Record - R0600870000 

Print Report ! Information is valid as of 2008-9-4 NEW Feature - Parcel Dimensions available _ scale 0-50 n west of 90th St - View On Map I 

Treasurer's Tax Report 

New Feature -*-*- > Auto Sales Searrh 

Owner 

(WIOORE WESLEY A 

2440 CROWN POINT AVE 

OMAHANE 68111-0000 

Property Informatio n 

Key Number: 0087 0000 06 

Account Type: Residential 

Parcel Number: 0600870000 

Parcel Address: 2440 CROWN POINT AV 

OIVIAHANE 68111-0000 

Legal Description: BELLE ISLE LOT 20 BLOCK 1 45 X 136 

Value Informatio n 

Land Improvement Total 

2008 

2007 

2006 

2005 

2004 

2003 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$62,700.00 

$55,100.00 

$55,100.00 

$55,100.00 

$31,600.00 

$31,600.00 

$65,200.00 

$57,600.00 

$57,600.00 

$57,600.00 

$34,100.00 

$34,100.00 

Land Informatio n 

Acres SF Unita Depth Width Vacant 

0.14 6120.0 1.0 136.0 45.0 No 

Improvemen t Informatio n 

Building 1 

11/6/2008 11:24 AM 
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28.Q-, 2*ff 

r 

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U/6/2008 11:24AIVI 2 of 3 
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Square Footage: 

Perimeter 

UnitType: 

Built As: 

HVAC: 

Exterior: 

Interior: 

Roof Cover: 

Roof Type: 

Floorcover: 

YearBuilt 

1923 

Detail Type 

Appliance 

Appliance 

Basement 

Fixture 

Fixture 

Fixture 

Garage 

Porch 

1350.0 

0.0 

1 1/2 Story Fin 

Central Air to Air 

f>flasonry Common Bricl< 

Drywall 

Composition Shingle 

Gable 

Allowance 

Year Percent 

Remodeled Remodeled 

0 0% 

Detail Description 

Allowance 

Fireplace Masonry 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

Bath Half 

Detached 

End Screen 

Percent Complete: 

Quality. 

Condition: 

Condo Square Footage: 

Rooms: 

Units: 

Baths: 

Bedrooms: 

Stories: 

Foundation: 

Sprinkler Square Footage: 

Adjusted Year 

100.0% 

Average 

Fair 

0.0 

7.0 

1.0 

1.5 

5.0 

1.5 

Blocl< 

0.0 

Physical Age Built 

1923 86 

Unita 

1.0 

1.0 

840.0 

1.0 

1.0 

1.0 

240.0 

261.0 

11/6/2008 11:24 AM 5 of 3 
1

Pruder^t Property Ciose-Out Form (lead-Based Paint Stabilization) 

SAID: S-?nl ^ 

Property Add».«. :^446(MJ^ ) ^t.f t M ­

Owner's Name: /.d6$ fa/ flM £ 

Performance Standards/close-Out Criteria 

NO 

 Was the entire structure{s) painted with the exception of the stated, excluded areas? This wouid 

indude painting of other associated features including fascia, eaves, siding, al! trim, porches, box 

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

2. Was alt scraping and other preparattion work completed satisfactorily? 

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

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

Are ali ofthe areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? _______ ^ 

Did the contractor collect/vacuum all failing and scraped paint chips on the entire property, 

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

Is the grass area that surrounds the structure(s) in reasonably good condition? a 8.

 Are ail items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape etc. 

properly removed? 

9. 

Is there any evidence of property damage that was done by the contractor? Any property damage t needs to be completed prior to the EPA Close-Out. 

10. 

Are there any property items that vrere temporatily re-located by the contractor 

that need to be moved back? 

11. 

Are there any (Icnown) lingering issues with the property owner(s) that have been left unresolved? 

3thertonsiderations?property Owner Discussions?Addttional Woric that is Required 

Ctutdi ^ ^ 

esentative 

Date i(''^6'd'i